Distribuição da gordura corporal em escolares: um estudo usando o método LMS / Body fat distribution in schoolchildren: a study using the LMS method

INTRODUÇÃO: A avaliação do sobrepeso e obesidade em populações ainda tem sido baseada predominantemente no índice de massa corporal, o qual tem sido considerado o indicador universal da adiposidade. OBJETIVO: Analisar a distribuição da gordura corporal de escolares de sete a 10 anos, por meio da construção de referenciais percentílicos das dobras cutâneas, utilizando os parâmetros LMS. MÉTODO: Os dados são relativos a uma amostra representativa de escolares de sete a 10 anos frequentando escolas públicas e privadas, que participaram de pesquisa mais ampla de prevalência do sobrepeso e obesidade, realizada em 2002, em Florianópolis (Santa Catarina, Brasil), e composta por 2.918 crianças. Para este estudo utilizaram-se os dados antropométricos de estatura, dobras cutâneas subescapular, suprailíaca, tricipital e panturrilha medial. O método LMS, que visa normalizar os dados que apresentam assimetria em sua distribuição, foi utilizado para analisar e comparar a distribuição das dobras por faixa etária e sexo. RESULTADOS: Ambos os sexos apresentaram valores maiores de gordura subcutânea na região do tríceps e da panturrilha, porém, no sexo masculino estes foram inferiores aos das meninas e com pouco incremento ao longo da faixa etária investigada. A dobra que apresentou maior incremento nos valores medianos foi a suprailíaca, para o sexo feminino, a qual alcançou valores próximos aos da dobra tricipital aos 10 anos de idade. CONCLUSÕES: O método LMS propicia a análise da distribuição dos valores das dobras cutâneas, as quais são importantes para avaliar a evolução da gordura corporal e o estado nutricional de crianças.

INTRODUCTION: Assessment of overweight and obesity in populations is has still been based on the body mass index, that is considered the universal indicator of adiposity. OBJECTIVE: To analyze 7-10 year-old schoolchildren body fat distribution, by building percentiles referentials of skinfold thickness, using LMS parameters. METHOD: Data were taken from a representative sample of 7-10-year-old schoolchildren attending public and private schools that participated in a comprehensive research study conducted in 2002, in the city of Florianopolis (Santa Catarina, Brazil), and composed of 2,918 children. In this study, the anthropometric data used were height, subscapular, suprailiac, triciptal and medial calf skinfolds. The LMS method, which propitiates normalizing data with asymmetric distribution, was used to analyze and compare skinfold thickness patterns by sex and age group. RESULTS: Both sexes presented higher values of subcutaneous fat in the triceps and calf regions; nevertheless, in male subjects theses values were lower than in females and with low increment along the age group investigated. The skinfold with the highest increment in median values was the suprailiac for females, which reached values close to those of the triciptal skinfold at 10 yr old. CONCLUSIONS: The LMS method propitiates analysis of the skinfolds thickness, which are important to perform analyses of the evolution of the body fat and the nutritional status of children.

Weight and height of people living with HIV/AIDS attended by the Brazilian National Health System / Peso e altura de pessoas vivendo com HIV/aids em atendimento no Sistema Unico de Saude

The nutritional status of people living with HIV/AIDS (PLWHA) is related to morbidity and mortality and its monitoring is important in the maintenance of the health status. This is a cross-sectional study carried out in Brazilian National Health System in the Municipality of São Paulo. It describes anthropometrical characteristics: weight and height; indices of weight for height (W/H), height for age (H/A), body mass index for age (BMI/A) and Z score for height and weight. The study includes 772 participants from all ages: children, adolescents, adults and elderly. The graphical analysis shows that in under-5s and in the 5 to 19 years old group, the W/H, the H/A and the BMI/A curves are similar to the reference population with an exception in the H/A for 5 to 19 years old group which is left-shifted (mean Z = -0.66). In the case of adults, graphics for the study population show median weight apparently lower than in the reference population for most age groups in the case of men, and when age is greater in women. The proportion of people over 20 years old with AIDS on anti-retroviral therapy is lower when coinfection is present (p < 0.001). The findings of the study showed that, for children and adolescents with HIV/AIDS, the average weight and height are lower than the values for non infected population. For adults and elderly, the weight average is lower than the reference population with a worsening among coinfected patients. This underscores the need to direct more effort in nutritional actions thus helping enhance the health status of this group.

O estado nutricional de pessoas que vivem com HIV/aids (PVHA) está relacionado a morbidade e mortalidade e seu monitoramento auxilia na manutenção do estado de saúde. Este é um estudo de corte transversal realizado no Sistema Único de Saúde no Município de São Paulo. O presente estudo descreve características antropométricas: peso e altura; índices de peso para estatura (P/E), estatura para idade (E/I), índice de massa corporal para idade (IMC/I) e escore Z para peso e estatura. Inclui 772 participantes entre crianças, adolescentes, adultos e idosos. A análise gráfica mostra que, em crianças menores de 5 anos e no grupo de 5 a 19 anos, o P/E, a E/I e as curvas de IMC/I são semelhantes às da população de referência, com uma exceção onde a curva de E/I para o grupo de 5 a 19 anos é deslocada para a esquerda (média Z = -0,66). No caso dos adultos, observou-se mediana de peso aparentemente menor do que a população de referência para a maioria dos grupos de idade entre os homens e para as mulheres em idade mais avançada. A proporção de pessoas maiores de 20 anos com aids usando terapia antirretroviral é menor na presença de coinfecção (p < 0,001). As conclusões do estudo mostraram que crianças e adolescentes com HIV/aids apresentam estatura e peso médio inferior à população não infectada. Entre os adultos e idosos, o peso médio é menor que o da população de referência, principalmente na presença de coinfecção. Enfatiza-se a necessidade de reforçar ações nutricionais, contribuindo, assim, para melhoria do estado de saúde desse grupo.

Nutritional strategies of physically active subjects with muscle dysmorphia.

BACKGROUND: The aim of this study was to identify dietary strategies for physically active individuals with muscle dysmorphia based on a systematic literature review. METHOD: References were included if the study population consisted of adults over 18 years old who were physically active in fitness centers. We identified reports through an electronic search ofScielo, Lilacs and Medline using the following keywords: muscle dysmorphia, vigorexia, distorted body image, and exercise. We found eight articles in Scielo, 17 in Medline and 12 in Lilacs. Among the total number of 37 articles, only 17 were eligible for inclusion in this review. RESULTS: The results indicated that the feeding strategies used by physically active individuals with muscle dysmorphia did not include planning or the supervision of a nutritionist. Diet included high protein and low fat foods and the ingestion of dietary and ergogenic supplements to reduce weight. CONCLUSION: Physically active subjects with muscle dysmorphia could benefit from the help of nutritional professionals to evaluate energy estimation, guide the diet and its distribution in macronutrient and consider the principle of nutrition to functional recovery of the digestive process, promote liver detoxification, balance and guide to organic adequate intake of supplemental nutrients and other substances.

Weight and height of people living with HIV/AIDS attended by the Brazilian National Health System.

The nutritional status of people living with HIV/AIDS (PLWHA) is related to morbidity and mortality and its monitoring is important in the maintenance of the health status. This is a cross-sectional study carried out in Brazilian National Health System in the Municipality of São Paulo. It describes anthropometrical characteristics: weight and height; indices of weight for height (W/H), height for age (H/A), body mass index for age (BMI/A) and Z score for height and weight. The study includes 772 participants from all ages: children, adolescents, adults and elderly. The graphical analysis shows that in under-5s and in the 5 to 19 years old group, the W/H, the H/A and the BMI/A curves are similar to the reference population with an exception in the H/A for 5 to 19 years old group which is left-shifted (mean Z = -0.66). In the case of adults, graphics for the study population show median weight apparently lower than in the reference population for most age groups in the case of men, and when age is greater in women. The proportion of people over 20 years old with AIDS on anti-retroviral therapy is lower when coinfection is present (p < 0.001). The findings of the study showed that, for children and adolescents with HIV/AIDS, the average weight and height are lower than the values for non infected population. For adults and elderly, the weight average is lower than the reference population with a worsening among coinfected patients. This underscores the need to direct more effort in nutritional actions thus helping enhance the health status of this group.

Fatores associados à inatividade física em adolescentes de 10-14 anos de idade, matriculados na rede pública de ensino do município de Salvador, BA / Factors associated with physical inactivity in adolescents aged 10-14 years, enrolled in the public school network of the city of Salvador, Brazil

OBJETIVO: Investigar os fatores associados à inatividade física em adolescentes de Salvador, BA. MÉTODOS: Trata-se de um estudo transversal, realizado com 803 jovens de 10 a 14 anos, matriculados na rede pública de ensino da cidade de Salvador, BA. Foram coletados dados referentes ao nível de atividade física (variável dependente), hábitos sedentários, dados demográficos, socioeconômicos, maternos e antropométricos (variáveis independentes). Optou-se pela análise de Poisson multivariada para as análises estatísticas de interesse. RESULTADOS: A prevalência da inatividade física foi de 49,6% (IC 95% 46,14 - 53,06); sendo maior entre as moças (feminino: 59,9%; masculino: 39%, p < 0,001). Em análise multivariada, verificou-se a associação inversa e estatisticamente significante entre inatividade física e condição econômica das famílias classificadas em Classe D/E Piores condições econômicas, tanto para os participantes do sexo masculino (RP = 0,73 IC 95% 0,54 - 0,046) quanto para os do sexo feminino (RP = 0,79 IC95% 0,66 - 0,96) . Em análise complementar por desmembramento dos domínios verificou-se tendência significativamente decrescente da inatividade física, representado pelo deslocamento, com o declínio das condições financeiras dos adolescentes em ambos os sexos (Rapazes - Classes B1/B2/C1 = 20,6,%, C2 = 11,0%, D/E = 6,0%, p=0,001; Moças - Classes B1/B2/C1 = 26,7%, C2 = 12,5%, D/E = 10,8%, p = 0,003). CONCLUÕES A prevalência de inatividade física é alta entre os adolescentes investigados. Jovens de baixo nível econômico são mais ativos em comparação com seus pares de melhor nível econômico. Contudo, a direção da associação entre atividade física e nível econômico é dependente dos domínios da atividade física avaliados.

OBJECTIVE: To investigate the factors associated to the physical inactivity among teenagers in Salvador, BA. METHODOLOGY: A cross-sectional study was made with 803 teenagers from 10 to 14 years old, enrolled in public high schools in Salvador, BA. Information concerning physical activity levels (dependent variable), sedentary behavior, demographic, anthropometric, socioeconomic and maternal characteristics (independent variables) were collected. The Poisson multivariate analysis was chosen to analyze the statistical data. RESULTS: The prevalence of physical inactivity was 49,6% (CI 95% 46,14 - 53,06); with higher standards between females (girls: 59,9%; boys: 39%, p < 0,001). With the multivariate analyses, it was verified a inverse association between physical inactivity and family economical condition that was classified in D/E worse economical levels either among males (PR = 0,73, CI 95%, 0,54 - 0,046), as among females (PR = 0,79; CI 95%; 0,66 - 0,96). In complementary analysis according to domains of physical activity, It was observed a significant decrease of physical inactivity in displacement domain between teenagers of lower economical levels (Boys - Classes B1/B2/C1 = 20,6%, C2 = 11%, D/E = 6%, p = 0,001; Girls - Classes B1/B2/C1 = 26,7%, C2 = 12,5%, D/E = 10,8%, p = 0,003). CONCLUSIONS: The prevalence of physical inactivity is high among the studied teenagers. Youths with lower economical levels are more active comparing with those with higher economical standards. Moreover, the association between physical activity and economical condition is influenced by physical activity domain that was investigated.

Factors associated with physical inactivity in adolescents aged 10-14 years, enrolled in the public school network of the city of Salvador, Brazil.

OBJECTIVE: To investigate the factors associated to the physical inactivity among teenagers in Salvador, BA. METHODOLOGY: A cross-sectional study was made with 803 teenagers from 10 to 14 years old, enrolled in public high schools in Salvador, BA. Information concerning physical activity levels (dependent variable), sedentary behavior, demographic, anthropometric, socioeconomic and maternal characteristics (independent variables) were collected. The Poisson multivariate analysis was chosen to analyze the statistical data. RESULTS: The prevalence of physical inactivity was 49,6% (CI 95% 46,14 - 53,06); with higher standards between females (girls: 59,9%; boys: 39%, p < 0,001). With the multivariate analyses, it was verified a inverse association between physical inactivity and family economical condition that was classified in D/E worse economical levels either among males (PR = 0,73, CI 95%, 0,54 - 0,046), as among females (PR = 0,79; CI 95%; 0,66 - 0,96). In complementary analysis according to domains of physical activity, It was observed a significant decrease of physical inactivity in displacement domain between teenagers of lower economical levels (Boys - Classes B1/B2/C1 = 20,6%, C2 = 11%, D/E = 6%, p = 0,001; Girls - Classes B1/B2/C1 = 26,7%, C2 = 12,5%, D/E = 10,8%, p = 0,003). CONCLUSIONS: The prevalence of physical inactivity is high among the studied teenagers. Youths with lower economical levels are more active comparing with those with higher economical standards. Moreover, the association between physical activity and economical condition is influenced by physical activity domain that was investigated.

Prevalência e fatores associados ao excesso de peso em adolescentes de Salvador, Bahia, Brasil / Prevalence and associated factors of surplus weight in adolescents from Salvador, Bahia, Brazil

OBJETIVO: Estimar a prevalência e identificar fatores associados ao excesso de peso em adolescentes. MÉTODOS: Trata-se de um estudo transversal. Foram selecionados 426 adolescentes de 10 a 18 anos, da cidade de Salvador, região Nordeste do Brasil, por um processo de amostragem por conglomerados, aleatória em três estágios. Os dados sobre a frequência de consumo alimentar e atividade física, maturação sexual, medidas antropométricas e covariáveis foram coletados. O estado nutricional foi classificado por meio dos pontos de corte baseados no índice de massa corporal de crianças e adolescentes brasileiros. As características sexuais secundárias foram autorreferidas pelos avaliados. Os adolescentes que realizaram mais de 300 minutos de atividade física moderada por semana, foram considerados fisicamente ativos. A etnia foi classificada pela cor da pele e atributos físicos. RESULTADOS: A prevalência de excesso de peso para ambos os sexos foi de 14,3 por cento. Estimou-se que a maturação sexual precoce (Razão de Prevalência ajustada = 2,12, IC95 por cento = 1,10-4,05) e insuficientes níveis de atividade física (RP ajustada = 1,85, IC95 por cento = 1,01-3,41), ajustados pela idade (RP ajustada = 1,77, IC95 por cento = 0,97-3,24), são associados, de forma independente, ao excesso de peso em adolescentes de Salvador. CONCLUSÕES: O excesso de peso pode ser considerado elevado entre os adolescentes da cidade de Salvador. Consideram-se necessárias a adoção de políticas públicas de prevenção e combate precoce ao excesso de peso corporal que melhorem o estimulo, disponibilidade e acesso à prática continuada e sistemática da atividade física em nível populacional.

OBJECTIVE: To estimate the prevalence and identify associated factors of surplus weight in adolescents. METHODS: a cross-sectional study design was employed. 426 adolescents, 10 to 18 years old, from the city of Salvador, northeast region of Brazil were selected in a three stage stratified random sampling scheme. Data on the frequency of food consumption and physical activity, sexual maturation, anthropometric measurements and covariates were collected. The nutritional status was classified with cutoff points based on body mass index mean values from Brazilian children and adolescents, while the secondary sexual characteristics were self-reported. The adolescents who performed more than 300 minutes of moderate physical activity per week were considered physically active. Ethnicity was classified by skin color and physical attributes. RESULTS: Total prevalence of surplus weight was of 14.3 percent. Early sexual maturation (Prevalence Rate - /PR/_adjusted =2.12, /CI95 percent/=1.10-4.05) and physical inactivity (/PR/_adjusted =1.85, /CI95 percent/=1.01-3.41), adjusted for age (PR/ adjusted =1.77, /CI0.97 percent/=3.24) were independently associated with surplus weight in adolescents from Salvador, Bahia. CONCLUSIONS: Surplus weight was high among adolescents in Salvador. Public prevention policies should be adopted in order to early prevent surplus weight through improved encouragement to continuous and systematic practice of physical activity at population level.

[Standardization and reliability of anthropometric measurements for population surveys]. / Padronização e confiabilidade das medidas antropométricas para pesquisa populacional.

In this paper we describe the standardization and reliability of anthropometric measurements carried out by five population survey anthropometrists. For the standardization of anthropometric measurement techniques, one expert anthropometrist conducted two theoretical and practical workshops, in September 2006 and March 2007, where the intra- and interobserver technical errors of measurement (TEMs) were assessed, respectively. For the intraobserver assessment of anthropometric measurements, we studied 121 schoolchildren on two different days. For interobserver assessment, we studied 22 schoolchildren that were measured, during the same period, once by each of the five anthropometrists and by an expert anthropometrist. For skinfold thickness, intraobserver TEMs in general were smaller than 1 mm; for circumferences, TEMs in general were smaller than 1 cm. For the subscapular, suprailiac and calf skinfolds, the intraobserver relative TEMs were greater than the acceptable limit for beginner anthropometrists. Intraobserver reliability for skinfold thickness was greater than 0.95 and for circumferences was greater than 0.99 in almost all cases. The results of interobserver TEMs and reliability were similar to intraobserver assessment. The anthropometrists performed better in the intraobserver relative TEMs because their values were smaller than the acceptable limit. We conclude that the anthropometrists showed a better performance after two assessments of the error of measurement. This suggests that the standardization process of anthropometric measurements was carried out with success.

Influência da maturação sexual, idade cronológica e índices de crescimento no limiar de lactato e no desempenho da corrida de 20 minutos / Influence of sexual maturation, chronological age and growth indices in lactate threshold and performance in the 20 minutes running

Crianças e adolescentes apresentam, em uma determinada carga, menores concentrações de lactato [la] do que os adultos; especula-se que essas diferenças são ligadas a aspectos maturacionais. O objetivo deste estudo foi verificar a influência da maturação sexual, idade cronológica (I) e índices de crescimento (IC - massa corporal, estatura e somatório de dobras cutâneas subescapular e tricipital) na velocidade do limiar de lactato na concentração fixa de lactato ([la]) de 2,5mmol.l-1 (V2,5) e na corrida de 20 minutos (V20). Trinta e três meninos participantes de escolas de esportes foram submetidos a: 1) avaliação antropométrica e avaliação da maturação sexual através dos índices de Tanner (maturação sexual de órgãos genitais e maturação sexual de pêlos púbicos); 2) teste progressivo descontínuo de 3 x 800m (pista de atletismo) para determinar V2,5; e 3) corrida de 20 minutos para determinar a V20 e a [la] final. Não foi encontrada associação entre maturação sexual, idade cronológica e indicadores de crescimento com V2,5. Somente a estatura se mostrou associada com V20. Assim, outras variáveis de desempenho, fisiológicas ou biomecânicas, podem influenciar mais no limiar de lactato e na corrida de 20 minutos, do que as variáveis de crescimento durante a adolescência.

Children and adolescents present less blood lactate concentrations ([la]) than adults under certain loads. It is suggested that these differences are related to maturational aspects. The aim of this study was to verify the influence of sexual maturation, chronological age and growth indices (body weight, height and sum of two skinfolds - subscapular and triceps) over the lactate threshold velocity, in the fixed lactate concentration of 2.5 mmol.l-1 (V2,5) and in the 20 minutes running (V20). Thirty-three boys, aged 13-15 years, who practice different sports were submitted to: 1) anthropometrical and sexual maturation evaluations through the Tanner index (sexual maturation of genitals and pubic hair); 2) progressive discontinuous test (3 x 800m in running track) to determine V2,5; and 3) 20 minutes running test to determine the V20 and final blood [la]. There were no associations between V2,5 and sexual maturation, neither chronological age nor growth index. As the only association verified was between V20 and height (r = 0,41; p < 0,05), the authors conclude that during adolescence other performance, physiological and/or biomechanical variables may play a greater role in lactate threshold and in the 20 minutes running than the growth variables.

Niños y adolescentes presentan en determinada carga menores concentraciones de lactato [la] que los adultos; se especula que esas diferencias están relacionadas a los aspectos de madurez. El objetivo de este estudio ha sido verificar la influencia de la madurez sexual, edad cronológica (I) e índices de crecimiento (IC - masa corporal, estatura y la suma de dobleces cutáneos subescapular y tricipital) en la velocidad del Límite de Lactato en concentración fija de lactato ([la]) de 2,5 mmol.lÕ (V2,5) y en carreras de 20 minutos (V20). Treinta y tres niños participantes de escuelas de deportes fueron sometidos a: 1) evaluación antropométrica y evaluación de madurez sexual a través de los índices de Tanner (madurez sexual de genitales y madurez sexual del pelo pubiano); 2) test progresivo descontinuo de 3 x 800m (pista de atletismo) para determinar V2,5, y 3) carreras de 20 minutos para determinar V20 y la [la] final. No fue encontrada asociación entre madurez sexual, edad cronológica e indicadores de crecimiento con V2,5. Solamente la estatura se mostró asociada con V20. Así, otras variables de desempeño, fisiológicas o biomecánicas, pueden influenciar más al final de la concentración de lactato y en las carreras de 20 minutos que las variables de crecimiento durante la adolescencia.