Changes in meal frequency among adolescents living in a socially vulnerable area of the Rio de Janeiro metropolitan region, Brazil. / Mudanças na frequência do consumo de refeições em adolescentes residentes em área de vulnerabilidade social da região metropolitana do Rio de Janeiro, Brasil.

This study described changes in meal frequency over a 5-year period among adolescents living in the Rio de Janeiro metropolitan region. The data used were from two cross-sectional, population-based studies conducted by home visits. In 2005 the final sample was 1089 households with 511 adolescents (aged 12 to 18 years) and in 2010, 1121 households with 314 adolescents. Meal frequency was obtained through self-administered questionnaire and the adolescents were assessed for appropriate weight by BMI cut-off points, by sex and age group. Increasingly, traditional daily lunch was replaced by snacks (from 3.7% to 13.7%) and traditional dinner was eaten (62.9% to 72.0%). Overweight adolescents ate breakfast less often than those not overweight (in 2005, 68.3% and 79.3%, p=0.02 and, in 2010, 59.5% and 77.4%, p=0.03). Traditional daily lunch was increasingly replaced by snacks and consumption of traditional dinner increased over the 5-year period. Also, eating breakfast every day was associated with BMI classification at both study times: those who were overweight consumed breakfast less frequently.

O objetivo deste estudo foi descrever as mudanças na frequência do consumo de refeições de adolescentes residentes na região metropolitana do Rio de Janeiro, em período de 5 anos. Utilizaram-se dados de dois estudos transversais, de base populacional, que foram realizados por meio de visitas domiciliares. Em 2005, a amostra final foi de 1089 domicílios com 511 adolescentes (de 12 a 18 anos), e em 2010 de 1121 domicílios com 314 adolescentes. A frequência do consumo de refeições foi obtida por meio de questionário autopreenchido e a avaliação da adequação de peso dos adolescentes foi realizada com base nos pontos de corte do IMC por sexo e faixa etária. Houve aumento da substituição diária do almoço tradicional por lanche (3,7% para 13,7%) e no consumo do jantar tradicional (62,9% para 72,0%). Os adolescentes com sobrepeso consumiram o desjejum com menor frequência do que aqueles sem sobrepeso (2005: 68,3% vs 79,3% p=0,02, 2010: 59,5% vs 77,4% p=0,03). Conclui-se que houve aumento da substituição diária do almoço tradicional por lanche e no consumo do jantar tradicional no período de 5 anos. Ademais, a prática do desjejum diário se associou com a classificação de IMC nos dois momentos do estudo, de modo que aqueles com sobrepeso consomem o desjejum com menor frequência.

Mudanças na frequência do consumo de refeições em adolescentes residentes em área de vulnerabilidade social da região metropolitana do Rio de Janeiro, Brasil / Changes in meal frequency among adolescents living in a socially vulnerable area of the Rio de Janeiro metropolitan region, Brazil

Resumo O objetivo deste estudo foi descrever as mudanças na frequência do consumo de refeições de adolescentes residentes na região metropolitana do Rio de Janeiro, em período de 5 anos. Utilizaram-se dados de dois estudos transversais, de base populacional, que foram realizados por meio de visitas domiciliares. Em 2005, a amostra final foi de 1089 domicílios com 511 adolescentes (de 12 a 18 anos), e em 2010 de 1121 domicílios com 314 adolescentes. A frequência do consumo de refeições foi obtida por meio de questionário autopreenchido e a avaliação da adequação de peso dos adolescentes foi realizada com base nos pontos de corte do IMC por sexo e faixa etária. Houve aumento da substituição diária do almoço tradicional por lanche (3,7% para 13,7%) e no consumo do jantar tradicional (62,9% para 72,0%). Os adolescentes com sobrepeso consumiram o desjejum com menor frequência do que aqueles sem sobrepeso (2005: 68,3% vs 79,3% p=0,02, 2010: 59,5% vs 77,4% p=0,03). Conclui-se que houve aumento da substituição diária do almoço tradicional por lanche e no consumo do jantar tradicional no período de 5 anos. Ademais, a prática do desjejum diário se associou com a classificação de IMC nos dois momentos do estudo, de modo que aqueles com sobrepeso consomem o desjejum com menor frequência.

Abstract This study described changes in meal frequency over a 5-year period among adolescents living in the Rio de Janeiro metropolitan region. The data used were from two cross-sectional, population-based studies conducted by home visits. In 2005 the final sample was 1089 households with 511 adolescents (aged 12 to 18 years) and in 2010, 1121 households with 314 adolescents. Meal frequency was obtained through self-administered questionnaire and the adolescents were assessed for appropriate weight by BMI cut-off points, by sex and age group. Increasingly, traditional daily lunch was replaced by snacks (from 3.7% to 13.7%) and traditional dinner was eaten (62.9% to 72.0%). Overweight adolescents ate breakfast less often than those not overweight (in 2005, 68.3% and 79.3%, p=0.02 and, in 2010, 59.5% and 77.4%, p=0.03). Traditional daily lunch was increasingly replaced by snacks and consumption of traditional dinner increased over the 5-year period. Also, eating breakfast every day was associated with BMI classification at both study times: those who were overweight consumed breakfast less frequently.

Changes in prevalence of overweight in adolescents living in areas highly vulnerable to food insecurity. / Mudanças na prevalência de excesso de peso em adolescentes residentes em área de alta vulnerabilidade a insegurança alimentar.

This study ascertained changes, over 5 years, in the prevalence of overweight in adolescents and associations with socio-demographic variables and food insecurity. Two cross-sectional population-based studies were conducted with 511 (2005) and 314 (2010) adolescents resident in Campos Elíseos (Duque de Caxias-RJ). Overweight was evaluated by sex and age specific cut-off points of BMI (weight/height²). The prevalence of food insecurity was investigated using the Brazilian Food Insecurity Scale. Logistic regression was used to determine the association between changes in overweight over time and sex, age, skin colour, and food insecurity. Overweight was found to increase significantly, between 2005 and 2010, in boys who were younger (from 20.1% to 49.5%), black or brown (22.2% to 37.3%), those with per capita income of up to half a minimum wage (13.6% to 32.5%) and those experiencing moderate or severe food insecurity (9.2% to 36.3%). It was concluded that overweight increased significantly in adolescents living in an area of food insecurity, and that younger, black or brown, lower-income adolescents, and those living with moderate and severe food insecurity, were more exposed to that increase.

O objetivo deste estudo foi verificar as mudanças na prevalência do excesso de peso em adolescentes e sua associação com variáveis sociodemográficas e insegurança alimentar em período de 5 anos. Foram realizados dois estudos transversais com 511 (2005) e 314 (2010) adolescentes de 12 a 18,9 anos residentes de Campos Elíseos (Duque de Caxias-RJ). Excesso de peso foi avaliado por meio do IMC (peso/estatura²). A insegurança alimentar foi investigada por meio da Escala Brasileira de Insegurança Alimentar (EBIA). Utilizou-se regressão logística para verificar a associação entre as mudanças temporais de excesso de peso segundo sexo, idade, cor da pele, e insegurança alimentar. Quanto à evolução do excesso de peso pode se notar que nos meninos houve aumento significativo para os mais novos (20,1% para 49,5%), os de cor preta ou parda (22,2% para 37,3%), os que tinham renda per capita de até ½ salário mínimo (13,6% para 32,5%) e os que apresentavam insegurança alimentar moderada e grave (9,2% para 36,3%) entre 2005 e 2010. Conclui-se que o aumento do excesso de peso foi expressivo nos adolescentes residentes em área de insegurança alimentar, e os meninos mais novos, pretos ou pardos, de menor renda e residentes em lares com insegurança alimentar moderada e grave estão mais expostos a este aumento.

Mudanças na prevalência de excesso de peso em adolescentes residentes em área de alta vulnerabilidade a insegurança alimentar / Changes in prevalence of overweight in adolescents living in areas highly vulnerable to food insecurity

Resumo O objetivo deste estudo foi verificar as mudanças na prevalência do excesso de peso em adolescentes e sua associação com variáveis sociodemográficas e insegurança alimentar em período de 5 anos. Foram realizados dois estudos transversais com 511 (2005) e 314 (2010) adolescentes de 12 a 18,9 anos residentes de Campos Elíseos (Duque de Caxias-RJ). Excesso de peso foi avaliado por meio do IMC (peso/estatura²). A insegurança alimentar foi investigada por meio da Escala Brasileira de Insegurança Alimentar (EBIA). Utilizou-se regressão logística para verificar a associação entre as mudanças temporais de excesso de peso segundo sexo, idade, cor da pele, e insegurança alimentar. Quanto à evolução do excesso de peso pode se notar que nos meninos houve aumento significativo para os mais novos (20,1% para 49,5%), os de cor preta ou parda (22,2% para 37,3%), os que tinham renda per capita de até ½ salário mínimo (13,6% para 32,5%) e os que apresentavam insegurança alimentar moderada e grave (9,2% para 36,3%) entre 2005 e 2010. Conclui-se que o aumento do excesso de peso foi expressivo nos adolescentes residentes em área de insegurança alimentar, e os meninos mais novos, pretos ou pardos, de menor renda e residentes em lares com insegurança alimentar moderada e grave estão mais expostos a este aumento.

Abstract This study ascertained changes, over 5 years, in the prevalence of overweight in adolescents and associations with socio-demographic variables and food insecurity. Two cross-sectional population-based studies were conducted with 511 (2005) and 314 (2010) adolescents resident in Campos Elíseos (Duque de Caxias-RJ). Overweight was evaluated by sex and age specific cut-off points of BMI (weight/height²). The prevalence of food insecurity was investigated using the Brazilian Food Insecurity Scale. Logistic regression was used to determine the association between changes in overweight over time and sex, age, skin colour, and food insecurity. Overweight was found to increase significantly, between 2005 and 2010, in boys who were younger (from 20.1% to 49.5%), black or brown (22.2% to 37.3%), those with per capita income of up to half a minimum wage (13.6% to 32.5%) and those experiencing moderate or severe food insecurity (9.2% to 36.3%). It was concluded that overweight increased significantly in adolescents living in an area of food insecurity, and that younger, black or brown, lower-income adolescents, and those living with moderate and severe food insecurity, were more exposed to that increase.

Concurrent validity of the Brazilian Portuguese version of the Questionnaire on Eating and Weight Patterns-5 (QEWP-5) in the general population.

The Questionnaire on Eating and Weight Patterns-5 is a self-report instrument developed for the screening of Binge Eating Disorder (BED) and Bulimia Nervosa (BN) according to DSM-5. The present study aimed to examine the concurrent validity of the Brazilian version of QEWP-5 to assess BED and BN in the general population. The Brazilian version of QEWP-5 was administered to 2297 subjects, aged from 18 to 60 years. All screen-positive and a subset of screen-negative participants were also interviewed by telephone using the eating disorders (ED) module of Structured Clinical Interview for DSM-IV - Patients Version (SCID-I-P) for the assessment of BED, BN, and their subthreshold forms. For the assessment of BED, the sensitivity of QEWP-5 was 0.41 and its specificity was 0.90. The positive and negative predictive values were 0.48 and 0.87, respectively. Regarding the assessment of BN, QEWP-5 showed a sensitivity of 0.56, a specificity of 0.90, a positive predictive value of 0.35, and a negative predictive value of 0.95. For the global screening of ED (BED, BN, and subthreshold forms), QEWP-5 showed a sensitivity of 0.71, a specificity of 0.83, a positive predictive value of 0.64 and a negative predictive value of 0.87. QEWP-5 can be a useful instrument for the initial screening of diagnostic threshold ED psychopathology in general population samples. However, it has less utility in identifying cases of BED and BN independently.

Mudanças na obesidade, comportamento sedentário e inatividade física, entre 2010 e 2017, em adolescentes / Changes in obesity, sedentary behavior and physical inactivity, between 2010 and 2017, in adolescents

RESUMO O estudo investigou mudanças na prevalência de obesidade, comportamento sedentário (CS) e inatividade física (IF) em adolescentes. Analisou-se dois estudos transversais, realizados em 2010 e 2017, com amostras probabilísticas de estudantes (328 e 366, respectivamente) em 12 escolas municipais de Niterói, RJ. A obesidade foi classificada com base em valores de Z escore ≥ +2 do índice de massa corporal (IMC = peso/estatura2), segundo critério da Organização Mundial de Saúde; o CS para aqueles com algum comportamento de tela (televisão, vídeo game) por ≥ 2 horas/dia e IF aqueles que realizaram < 300 min/semana de atividade física moderada a intensa. A comparação entre os estudos foi feita com base no teste qui-quadrado (variáveis categóricas) e no teste t de Student (variáveis contínuas). A prevalência de obesidade aumentou nos meninos (6,2% para 15,6% p< 0,001) e diminuiu nas meninas (8,4% para 6,9% p= 0,035). A frequência de CS diminuiu de (90,7% para 67,7% p < 0,001) nos meninos e de (90,3 para 52,8% p < 0,001) nas meninas e a IF não se alterou nos meninos e aumentou nas meninas (84,6% para 89,9% p< 0,001). As mudanças observadas foram dependentes do sexo, com os meninos mais vulneráveis ao aumento de obesidade, as meninas mais IF e ambos os sexos menos CS no período investigado.

ABSTRACT The study investigated changes in the prevalence of obesity, sedentary behavior (SB) and physical inactivity (PI) in adolescents. Two cross-sectional studies were analyzed, 2010 and 2017, with probabilistic samples from students (328 and 366, respectively) in 12 municipal schools in Niterói, RJ. Obesity was classified based on body mass index (BMI = weight / height2) Z score values ≥ +2, according to the World Health Organization criteria. The weight classification was made with body mass index (BMI = weight/height2), the SB for those with some screen behavior (television, video game) for ≥ 2 hours/day and IF those who performed <300 min / week moderate to intense physical activity. The comparison between the studies was based on the chi-square test (categorical variables) and Student's t test (continuous variables). The prevalence of obesity increased in boys (6.2% to 15.6% p <0.001) and decreased in girls (8.4% to 6.9% p = 0.035). The frequency of SB decreased from (90.7% to 67.7% p <0.001) in boys and from (90.3 to 52.8% p <0.001) in girls and the PI did not change in boys and increased in girls (84.6% to 89.9% p <0.001). The changes observed were sex-dependent, with boys more vulnerable to increased obesity, girls more PI and both sexes less SB in the investigated period.

Body image dissatisfaction and associated factors in adolescents. / Insatisfação com a imagem corporal e fatores associados em adolescentes.

This study aimed to examine the factors associated with body dissatisfaction in adolescents. This is a cross-sectional study with students from two public and four private schools in the metropolitan region of Rio de Janeiro. Body dissatisfaction was evaluated using the Body Silhouette Scale, by the difference between the image they perceive as their current image and the one they would like to have. The association was assessed by hierarchical logistic regression multinomial model, by estimating odds ratios (OR) and 95% confidence intervals (95%CI). Among the 1,019 adolescents evaluated (13-19 years), 75% showed body dissatisfaction, 41.4% wishing for a smaller silhouette and 33.7% wishing for larger silhouettes. The wish for a smaller silhouette was more significant in girls, overweight adolescents, those with an unsatisfactory meal pattern, and with higher waist circumference. Adolescents that had been exposed to teasing due to their body shape increased the probability of wishing for both smaller and larger silhouettes. Strategies are required for a more positive perception of body image, especially for girls and for overweight adolescents, which provide guidance on adequate meal consumption and prevent exposure to peer teasing, valuing coexistence and well-being in the face of existing bodily differences.

O objetivo do estudo foi examinar os fatores associados a insatisfação com a imagem corporal (IIC) em adolescentes. Estudo transversal com estudantes de duas escolas públicas e quatro escolas privadas da região metropolitana do Rio de Janeiro. A IIC foi avaliada pela Escala de Silhuetas Corporais, pela diferença entre a imagem que percebem como a sua atual e a que gostariam de ter. A associação foi investigada por meio de regressão logística multinomial hierarquizada, estimando-se as odds ratios (OR) e intervalos de confiança de 95% (IC95%). Entre os 1.019 adolescentes avaliados (13 a 19 anos), 75,0% apresentaram IIC, 41,4% desejando ter silhueta menor e 33,7% desejando ter silhueta maior do que a auto percebida. O desejo de ter uma silhueta menor foi maior nas meninas, naqueles que tinham padrão de refeição insatisfatório, com excesso de peso e perímetro da cintura elevado. A exposição a provocações por causa do corpo aumentou a chance para desejar silhuetas menores e maiores. Evidencia-se a necessidade de estratégias para uma percepção mais positiva da imagem corporal, principalmente para meninas e jovens com excesso de peso, que orientem sobre consumo adequado de refeições e para prevenção de exposição a provocações pelos pares, valorizando a convivência e o bem estar frente às diferenças corporais existentes.

Insatisfação com a imagem corporal e fatores associados em adolescentes / Body image dissatisfaction and associated factors in adolescents

Resumo O objetivo do estudo foi examinar os fatores associados a insatisfação com a imagem corporal (IIC) em adolescentes. Estudo transversal com estudantes de duas escolas públicas e quatro escolas privadas da região metropolitana do Rio de Janeiro. A IIC foi avaliada pela Escala de Silhuetas Corporais, pela diferença entre a imagem que percebem como a sua atual e a que gostariam de ter. A associação foi investigada por meio de regressão logística multinomial hierarquizada, estimando-se as odds ratios (OR) e intervalos de confiança de 95% (IC95%). Entre os 1.019 adolescentes avaliados (13 a 19 anos), 75,0% apresentaram IIC, 41,4% desejando ter silhueta menor e 33,7% desejando ter silhueta maior do que a auto percebida. O desejo de ter uma silhueta menor foi maior nas meninas, naqueles que tinham padrão de refeição insatisfatório, com excesso de peso e perímetro da cintura elevado. A exposição a provocações por causa do corpo aumentou a chance para desejar silhuetas menores e maiores. Evidencia-se a necessidade de estratégias para uma percepção mais positiva da imagem corporal, principalmente para meninas e jovens com excesso de peso, que orientem sobre consumo adequado de refeições e para prevenção de exposição a provocações pelos pares, valorizando a convivência e o bem estar frente às diferenças corporais existentes.

Abstract This study aimed to examine the factors associated with body dissatisfaction in adolescents. This is a cross-sectional study with students from two public and four private schools in the metropolitan region of Rio de Janeiro. Body dissatisfaction was evaluated using the Body Silhouette Scale, by the difference between the image they perceive as their current image and the one they would like to have. The association was assessed by hierarchical logistic regression multinomial model, by estimating odds ratios (OR) and 95% confidence intervals (95%CI). Among the 1,019 adolescents evaluated (13-19 years), 75% showed body dissatisfaction, 41.4% wishing for a smaller silhouette and 33.7% wishing for larger silhouettes. The wish for a smaller silhouette was more significant in girls, overweight adolescents, those with an unsatisfactory meal pattern, and with higher waist circumference. Adolescents that had been exposed to teasing due to their body shape increased the probability of wishing for both smaller and larger silhouettes. Strategies are required for a more positive perception of body image, especially for girls and for overweight adolescents, which provide guidance on adequate meal consumption and prevent exposure to peer teasing, valuing coexistence and well-being in the face of existing bodily differences.

Association of body image dissatisfaction with body mass index trajectory: the Adolescent Nutritional Assessment Longitudinal Study cohort / Associação da insatisfação com a imagem corporal com a trajetória do índice de massa corporal: Estudo Longitudinal de Avaliação Nutricional de Adolescentes

ABSTRACT Objective To examine the association of body image dissatisfaction (BID) with body mass index (BMI) trajectory among students from a metropolitan area of Rio de Janeiro. Methods Data were analyzed for 809 middle school students followed from 2010 to 2013, and 1131 high school students followed from 2010 to 2012. BID was assessed using a body silhouettes scale. Type of school (public and private) was used as a proxy of socioeconomic status. Results In the middle school cohort, girls from private schools who wanted to have smaller and bigger silhouettes gained fewer BMI units than those who were satisfied with their body image ( p < 0.05). In the high school, girls from private schools who wished to have bigger and smaller silhouettes experienced greater BMI increase than girls who were satisfied with their body image ( p < 0.05). Also, in the high school cohort, boys from public schools who wished to have smaller and bigger silhouettes experienced smaller BMI increase than boys who were satisfied ( p < 0.05). Conclusion BID may be related to the BMI trajectory in girls from private schools and in boys from public schools.

RESUMO Objetivo Examinar a associação da insatisfação com a imagem corporal (IIC) com a trajetória do índice de massa corporal (IMC) entre estudantes de uma região metropolitana do Rio de Janeiro. Métodos Oitocentos e nove alunos do ensino fundamental foram acompanhados entre 2010 e 2013, e 1.131 alunos do ensino médio foram acompanhados de 2010 a 2012. A IIC foi avaliada por meio da escala de silhuetas corporais. O tipo de escola (pública e privada) foi utilizado como proxy do status socioeconômico. Resultados Na coorte do ensino fundamental, as meninas de escolas particulares que desejavam ter silhuetas menores e maiores ganharam menos IMC do que aquelas que estavam satisfeitas com a imagem corporal ( p < 0,05). No ensino médio, as meninas de escolas particulares que desejavam ter silhuetas menores e maiores experimentaram maior aumento do IMC do que as meninas que estavam satisfeitas ( p < 0,05). Além disso, na coorte do ensino médio, meninos de escolas públicas que desejavam ter silhuetas menores e maiores experimentaram menor aumento no IMC do que meninos que estavam satisfeitos ( p < 0,05). Conclusão A IIC pode estar relacionada à trajetória do IMC em meninas de escolas particulares e meninos de escolas públicas.

Cross-cultural adaptation of the Brazilian version of the Questionnaire on Eating and Weight Patterns-5 (QEWP-5).

INTRODUCTION: The Questionnaire on Eating and Weight Patterns-5 (QEWP-5) is a self-report instrument developed to screen individuals for binge eating disorder (BED), as defined by the DSM-5. However, this version of the instrument had not been adapted for the Brazilian population. OBJECTIVE: To describe translation and cross-cultural adaptation of the QEWP-5 into Brazilian Portuguese. METHODS: Translation and cross-cultural adaptation of the QEWP-5 included the following steps: forward translation, comparison of translations and a synthesis version, blind back-translations, comparison of the back translations with the original version, and a comprehensibility test. The comprehensibility test was conducted with a sample of 10 participants with BED or bulimia nervosa and 10 eating disorders experts. Additionally, a Content Validity Index (CVI-I) was calculated for each item and then averaged to produce an index for the entire scale (CVI-Ave), to assess content equivalence. RESULTS: Some inconsistencies emerged during the process of translation and adaptation. However, the expert committee solved them by consensus. The participants of the comprehensibility test understood the Brazilian version of QEWP-5 well. Only 2 patients (20%) had doubts about items related to subjective binge eating episodes. Content equivalence analysis rated all items relevant, with CVI-I ranging from 0.8 to 1.0 and an overall CVI-Ave of 0.94. In view of the good overall assessment of the pre-final version of the instrument, additional changes were not made to the final version. CONCLUSION: The Brazilian version of the QEWP-5 was cross-culturally adapted and was well understood by the target population. Further studies are required to assess its psychometric properties.

The intertwined effect of lack of emotional warmth and child abuse and neglect on common mental disorders in adolescence.

Adolescence is a vulnerable period for mental health problems. Although child abuse and neglect (CAN) are known risk factors for some of them, it is not clear if the negative consequences on mental health also occur in families where CAN and a warm parent-child relationship coexist. The aim of this study is to explore this gap and investigate the effects of different types of CAN according to levels of warmth in the parent-child relationship on common mental disorders (CMD) in adolescence. This is a cross-sectional study encompassing 487 adolescents attending the ninth grade at 2 public and 4 private schools in Rio de Janeiro, Brazil. CAN was measured by the Child Trauma Questionnaire (CTQ), CMD by the General Health Questionnaire (GHQ-12) and the level of warmth in the parent-child relationship were recalled using short Egna Minnen Betraffände Uppfostran (s-EMBU-23). The adjusted separate effects of different types of CAN and a low level of warmth in the parent-child relationship, and both in tandem, were estimated using multivariate linear regression models. Results indicated that emotional abuse and neglect, physical abuse and neglect, and a low level of warmth in the parent-child relationship are important risk factors for CMD in adolescence. Nevertheless, in families where CAN coexist with a warm and affectionate parent-child relationship, the negative effects of CAN on mental health are attenuated. Evidence indicates that actions to prevent or interrupt CAN and improving parental practices could be effective strategies to reduce CMD in adolescence.

Meal habits and anthropometric indicators in adolescents from public and private schools of the metropolitan region of Rio de Janeiro / Consumo de refeições e indicadores antropométricos em adolescentes de escolas públicas e privadas da região metropolitana do Rio de Janeiro

ABSTRACT Objective To describe meal consumption habits and assess their associations with anthropometric indicators. Methods A cross-sectional study was performed on 1,749 elementary and high school students from public and private schools in the city of Rio de Janeiro, Brazil (mean age=15.3 years), who were selected for the baseline of the Longitudinal Study for Nutritional Assessment of Adolescents. Meal habits and meals consumed in the company of parents were assessed using a self-administered questionnaire. The consumption of the main meals was categorized as regular (daily) or irregular (≤6 times a week). The meal consumption profile was considered either satisfactory (breakfast, lunch, and dinner consumed on a daily basis) or unsatisfactory. Body Mass Index, waist-to-height ratio, and body fat percentage were calculated. The association between meal consumption habits and anthropometric indicators was estimated using multivariate logistic regression models, adjusted for age and sex and stratified according to the type of school. Results Regular lunch consumption was more frequent among private schools students, who also had higher frequency of eating dinner irregularly. Among students from private schools, the unsatisfactory meal consumption profile and irregular meal habits were associated with being overweight, having a high waist-to-height ratio, and increased body fat percentage. Among students from public schools, it was observed association between being overweight with irregular breakfast habits. Conclusion In adolescents, the association between meal habits and weight status may be modulated by socioeconomic condition.

RESUMO Objetivo Este artigo tem como objetivo descrever os hábitos de consumo de refeições e avaliar sua associação com indicadores antropométricos. Métodos Trata-se de estudo de desenho transversal em que foram analisados 1.749 estudantes do ensino fundamental e médio, de escolas públicas e privadas, selecionadas no município do Rio de Janeiro (idade média=15,3 anos), investigados no estudo de base do Estudo Longitudinal de Avaliação Nutricional de Adolescentes. Os hábitos de consumo de refeições e a realização de refeições na presença dos pais foram avaliados por meio de questionário autoaplicado, sendo categorizadas em regular (diariamente) e irregular (≤6 vezes/semana). O perfil de consumo de refeições foi considerado satisfatório (quando desjejum, almoço e jantar eram realizados diariamente) ou insatisfatório. Foram calculados o Índice de Massa Corporal, a razão cintura/estatura e o percentual de gordura corporal. A associação entre hábitos de consumo de refeição e indicadores antropométricos foi estimada por meio de modelos de regressão logística multivariados, ajustados por idade e sexo e estratificados segundo o tipo de escola. Resultados O consumo regular do almoço mostrou-se mais comum entre alunos de escolas privadas, os quais também apresentaram frequência mais elevada de realização irregular do jantar. Entre alunos de escolas privadas, o perfil insatisfatório e o consumo irregular de refeições se associaram com o excesso de peso, a razão cintura/estatura elevada e percentual de gordura corporal aumentado. Por outro lado, entre alunos de escolas públicas, a associação com excesso de peso foi encontrada para o consumo irregular do desjejum. Conclusão Em adolescentes, a associação entre hábitos de refeições e condição de peso é, possivelmente, modulada pela condição socioeconômica.

Diet quality among adolescents has deteriorated: a panel study in Niterói, Rio de Janeiro State, Brazil, 2003-2008.

This study aimed to analyze changes in the diet quality of adolescents from public schools in Niterói, Rio de Janeiro State, Brazil, over a five-year period. Data on the food consumption of adolescents (12-19 years) were obtained by means of two sets of 3-day food records in two school-based, cross-sectional studies conducted in 2003 and 2008. The Brazilian Revised Healthy Eating Index (BHEI-R) was used to estimate dietary quality. From 2003 to 2008 there was an overall decrease in the scores attributed to "total vegetables", "dark green and orange vegetables", and "meat, eggs, and legumes", but there was an increase in the score for "milk and dairy" (4.0 vs. 5.2; p < 0.01). Among female adolescents, the BHEI-R decreased (64.1 vs. 62.4; p = 0.04), as did the scores attributed to "total vegetables", "dark green and orange vegetables", "meat, eggs, and legumes", and "solid fat, alcohol, and added sugar". In contrast, among males, only the "whole grains" score decreased (0.2 vs. 0.1; p = 0.04). From 2003 to 2008, the diet quality of female public school students declined in Niterói.

[Trends in energy and nutrient intake by adolescents in public schools in Niterói, Rio de Janeiro State, Brazil, 2003-2008]. / Evolução da ingestão de energia e nutrientes de adolescentes de escolas públicas de Niterói, Rio de Janeiro, Brasil, 2003-2008.

The study analyzed variations in energy and nutrient intake by adolescents enrolled in public schools, examined in two school-based cross-sectional surveys, in 2003 and 2008. Food consumption was assessed with three food records. Weight was classified according to World Health Organization criteria. A total of 433 adolescents were studied in 2003 and 510 in 2008. Prevalence of excess weight was 17% in 2003 and 22% in 2008 (p > 0.05). There was a reduction in the intake of saturated fats and vitamin A in boys. Girls showed an increase in the intake of energy, carbohydrates, and calcium and a reduction in protein and iron. Both boys and girls reduced their intake of vitamin E and lipids and increased their sodium. Adolescents with excess weight showed an increase in calcium intake and a decrease in saturated fat and vitamin A. The nutritional quality of the adolescents' diet declined over the course of the five years.

Changes in beverage consumption among adolescents from public schools in the first decade of the century XXI. / Modificações no consumo de bebidas de adolescentes de escolas públicas na primeira década do século XXI.

OBJECTIVE: To evaluate the changes in beverage consumption among adolescents between 2003 and 2008. METHODS: Two school-based cross-sectional studies were carried out with public school students (12 to 19 years-old) from Niterói, Rio de Janeiro, Brazil. Data from three food records were used to estimate daily, weekdays and weekend average consumption (volume and percent contribution for total daily energy intake) of milk and milk-based beverages, sugar sweetened beverages, fresh squeezed fruit juices, caffeinated and alcoholic beverages. Beverage consumption age-adjusted means for weekdays and weekends were compared using linear regression (Generalized Linear Models - GLM). RESULTS: A total of 433 adolescents were examined in 2003, and 510 in 2008. The prevalence of overweight was 17% in 2003 and 22% in 2008 (p > 0.05). Milk was the most consumed beverage, being reported by 89% of adolescents, followed by sodas (75%). In general, in the five-year period, there was an increase in the prevalence of consumption of alcoholic drinks, guarana syrup refreshment, and processed fruit drinks, especially on weekdays. The soft drink was the largest contributor to the total energy consumption, corresponding on average to 4% of daily energy intake. CONCLUSION: The main changes in the beverage consumption among adolescents from Niterói, in the first decade of the XXI century, were the tendency to reduce the consumption of milk and the increase in the consumption of processed and alcoholic beverages.

Software to record 24-hour food recall: application in the Study of Cardiovascular Risks in Adolescents. / Programa para registro de recordatório alimentar de 24 horas: aplicação no Estudo de Riscos Cardiovasculares em Adolescentes.

INTRODUCTION: The Study of Cardiovascular Risk in Adolescents (ERICA) is a national multicenter study whose purpose is to describe the cardiovascular risk profile, including obesity, changes in lipid and glucose metabolism, and blood pressure, of about 75,000 Brazilian adolescents. OBJECTIVE: To describe the development of a tool for data collection of 24-hour food recall (REC24h) in ERICA and to report its performance in the pilot study. METHODS: The Multiple Pass Method was used for the development of the computer program that guides REC24h interview. REC24h-ERICA uses a database composed of 1,626 food items including preparation methods and units of predefined portion sizes. Food consumption data are obtained through interviews and entered directly into REC24h-ERICA, avoiding the use of paper. RESULTS: The pilot study included 1,367 adolescents, of which 1,047 (77%) responded to REC24h. The researchers did not report difficulties in program use, the average duration of interviews was 20 minutes and the interviewers inserted 50 new food items. CONCLUSION: The program developed was proven suitable for use in large-population studies, even in a country like Brazil, where there is great diversity in eating habits.

Modificações no consumo de bebidas de adolescentes de escolas públicas na primeira década do século XXI / Changes in beverage consumption among adolescents from public schools in the first decade of the century XXI

RESUMO: Objetivo: Avaliar mudanças no consumo de bebidas em adolescentes entre 2003 e 2008. Métodos: Foram realizados dois estudos transversais de base escolar com estudantes de 12 a 19 anos de idade de escolas públicas de Niterói, Rio de Janeiro. Dados de três registros alimentares foram utilizados para estimar o consumo médio diário, de dias de semana e de final de semana (volume e a contribuição para a ingestão diária de energia) de leite, bebidas à base de leite, bebidas com adição de açúcar, suco de frutas frescas, bebidas cafeinadas e bebidas alcoólicas. Foram utilizados Modelos Lineares Generalizados (GLM) para estimar médias ajustadas por idade e as diferenças nos estimadores segundo os dias de semana. Resultados: Foram investigados 433 adolescentes em 2003 e 510 foram investigados em 2008. A prevalência de excesso de peso foi de 17% em 2003 e de 22% em 2008 (p > 0,05). O leite foi a bebida mais consumida, sendo relatada por 89% dos adolescentes, seguido dos refrigerantes (75%). De maneira geral, no período de cinco anos, verificou-se aumento da prevalência de consumo de bebidas alcoólicas, bebidas à base de xarope de guaraná e sucos processados, especialmente nos dias de semana. O refrigerante foi a bebida que mais contribuiu para o consumo energético total, correspondendo, em média, a 4% da ingestão energética diária. Conclusão: As principais mudanças no perfil de consumo de bebidas entre os adolescentes de Niterói na primeira década do século XXI foram a tendência para redução do consumo de leite e o aumento no consumo das bebidas processadas e das bebidas alcoólicas.

ABSTRACT: Objective: To evaluate the changes in beverage consumption among adolescents between 2003 and 2008. Methods: Two school-based cross-sectional studies were carried out with public school students (12 to 19 years-old) from Niterói, Rio de Janeiro, Brazil. Data from three food records were used to estimate daily, weekdays and weekend average consumption (volume and percent contribution for total daily energy intake) of milk and milk-based beverages, sugar sweetened beverages, fresh squeezed fruit juices, caffeinated and alcoholic beverages. Beverage consumption age-adjusted means for weekdays and weekends were compared using linear regression (Generalized Linear Models - GLM). Results: A total of 433 adolescents were examined in 2003, and 510 in 2008. The prevalence of overweight was 17% in 2003 and 22% in 2008 (p > 0.05). Milk was the most consumed beverage, being reported by 89% of adolescents, followed by sodas (75%). In general, in the five-year period, there was an increase in the prevalence of consumption of alcoholic drinks, guarana syrup refreshment, and processed fruit drinks, especially on weekdays. The soft drink was the largest contributor to the total energy consumption, corresponding on average to 4% of daily energy intake. Conclusion: The main changes in the beverage consumption among adolescents from Niterói, in the first decade of the XXI century, were the tendency to reduce the consumption of milk and the increase in the consumption of processed and alcoholic beverages.

ERICA: prevalence of metabolic syndrome in Brazilian adolescents / ERICA: prevalência de síndrome metabólica em adolescentes brasileiros

ABSTRACT OBJECTIVE To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents. METHODS We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status. RESULTS Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95%CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95%CI 2.4-3.2]), when compared with private schools (1.9% [95%CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides. CONCLUSIONS ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome.

RESUMO OBJETIVO Determinar a prevalência de síndrome metabólica e de seus componentes em adolescentes brasileiros. MÉTODOS Foram avaliados 37.504 adolescentes, participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA), estudo transversal de âmbito nacional e de base escolar. Os adolescentes, de 12 a 17 anos de idade, residiam em municípios com mais de 100 mil habitantes. A amostra foi estratificada e conglomerada em escolas e turmas. Os critérios daInternational Diabetes Federation foram utilizados para definir síndrome metabólica. Prevalências de síndrome metabólica foram estimadas segundo sexo, faixa etária, tipo de escola e estado nutricional. RESULTADOS Dos 37.504 adolescentes, 50,2% eram do sexo feminino; 54,3% tinham de 15 a 17 anos e 73,3% estudavam em escolas públicas. A prevalência nacional de síndrome metabólica foi 2,6% (IC95% 2,3-2,9), discretamente maior no sexo masculino e naqueles de 15 a 17 anos na maioria das macrorregiões. A prevalência foi a maior nos residentes na macrorregião Sul, nas adolescentes mais jovens e nos adolescentes mais velhos. A prevalência foi maior nas escolas públicas (2,8% [IC95% 2,4-3,2]) que nas escolas privadas (1,9% [IC95% 1,4-2,4]) e nos adolescentes obesos em comparação aos não obesos. As combinações de componentes mais frequentes, respondendo por 3/4 das combinações, foram: circunferência de cintura elevada, HDL-colesterol baixo e pressão arterial elevada, seguida de circunferência da cintura elevada, lipoproteína de alta densidade (HDL-c) baixo e triglicerídeos elevados, e wpor circunferência da cintura elevada, HDL baixa e triacilgliceróis e pressão arterial elevados. A HDL baixa foi o segundo componente mais frequente, mas a maior prevalência de síndrome metabólica (26,8%) foi observada na presença de triglicerídeos elevado. CONCLUSÕES O ERICA é o primeiro estudo nacional a apresentar prevalências de síndrome metabólica e descrever a participação dos seus componentes. Apesar de a prevalência da síndrome metabólica ter sido baixa, as altas prevalências de alguns componentes e de participação de outros na composição da síndrome torna importante o diagnóstico precoce de tais alterações, mesmo que não agrupadas na síndrome metabólica.

ERICA: prevalences of hypertension and obesity in Brazilian adolescents / ERICA: prevalências de hipertensão arterial e obesidade em adolescentes brasileiros

ABSTRACT OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.

RESUMO OBJETIVO Estimar as prevalências de hipertensão arterial e obesidade e a fração atribuível populacional de hipertensão arterial devida à obesidade em adolescentes brasileiros. MÉTODOS Foram avaliados dados dos participantes do Estudo de Riscos Cardiovasculares em Adolescentes, estudo seccional l nacional de base escolar. A amostra foi dividida em 32 estratos geográficos e conglomerados de escolas e turmas, com representatividade nacional, macrorregional e de capitais. Obesidade foi classificada pelo índice de massa corporal segundo idade e sexo. Considerou-se hipertensão arterial a média da pressão arterial sistólica ou diastólica maior ou igual ao percentil 95 da curva de referência. Foram estimadas prevalências e intervalos de confiança de 95% (IC95%) de hipertensão arterial e de obesidade, nacionais e nas macrorregiões do País, por sexo e grupo etário, assim como as frações de hipertensão atribuíveis à obesidade na população. RESULTADOS Foram avaliados 73.399 estudantes, 55,4% do sexo feminino, com média de idade 14,7 anos (DP = 1,6). A prevalência de hipertensão arterial foi 9,6% (IC95% 9,0-10,3); sendo as mais baixas observadas nas regiões Norte, 8,4% (IC95% 7,7-9,2) e Nordeste, 8,4% (IC95% 7,6-9,2) e a mais alta na região Sul, 12,5% (IC95% 11,0-14,2). A prevalência de obesidade foi 8,4% (IC95% 7,9-8,9), mais baixa na região Norte e mais alta na Sul. As prevalências de hipertensão arterial e obesidade foram maiores no sexo masculino. Adolescentes com obesidade tiveram prevalência de hipertensão arterial mais elevada, 28,4% (IC95% 25,5-31,2), do que aqueles com sobrepeso, 15,4% (IC95% 13,8-17,0), ou eutróficos, 6,3% (IC95% 5,6-7,0). A fração de hipertensão arterial atribuível à obesidade foi de 17,8%. CONCLUSÕES O ERICA foi o primeiro estudo brasileiro com representatividade nacional a estimar a prevalência de hipertensão arterial aferida em adolescentes. A fração da prevalência de hipertensão arterial atribuível à obesidade mostrou que cerca de 1/5 dos hipertensos poderiam não ser hipertensos se não fossem obesos.

Diet quality among adolescents has deteriorated: a panel study in Niterói, Rio de Janeiro State, Brazil, 2003-2008 / A queda na qualidade da alimentação dos adolescentes brasileiros: um estudo de painel em Niterói, Estado do Rio de Janeiro, Brasil, 2003-2008 / La caída en la calidad de la alimentación de los adolescentes brasileños: un estudio de panel en Niterói, Estado de Río de Janeiro, Brasil, 2003-2008

This study aimed to analyze changes in the diet quality of adolescents from public schools in Niterói, Rio de Janeiro State, Brazil, over a five-year period. Data on the food consumption of adolescents (12-19 years) were obtained by means of two sets of 3-day food records in two school-based, cross-sectional studies conducted in 2003 and 2008. The Brazilian Revised Healthy Eating Index (BHEI-R) was used to estimate dietary quality. From 2003 to 2008 there was an overall decrease in the scores attributed to "total vegetables", "dark green and orange vegetables", and "meat, eggs, and legumes", but there was an increase in the score for "milk and dairy" (4.0 vs. 5.2; p < 0.01). Among female adolescents, the BHEI-R decreased (64.1 vs. 62.4; p = 0.04), as did the scores attributed to "total vegetables", "dark green and orange vegetables", "meat, eggs, and legumes", and "solid fat, alcohol, and added sugar". In contrast, among males, only the "whole grains" score decreased (0.2 vs. 0.1; p = 0.04). From 2003 to 2008, the diet quality of female public school students declined in Niterói.

O estudo teve como objetivo analisar as mudanças na qualidade da dieta de adolescentes matriculados em escolas públicas em Niterói, Estado do Rio de Janeiro, Brasil, ao longo de cinco anos. Os dados sobre consumo alimentar dos adolescentes (12-19 anos de idade) foram obtidos através de dois conjuntos de registros alimentares de três dias em dois estudos transversais de base escolar, em 2003 e 2008. O Índice Brasileiro de Alimentação Saudável (IAS-R) versão revisada, foi utilizado para estimar a qualidade da dieta. Entre 2003 e 2008, houve uma queda geral na pontuação atribuída a "total de verduras e hortaliças", "verduras e hortaliças de cor laranja" e "carne, ovos e legumes", mas houve um aumento no consumo de "leite e laticínios" (4,0 vs. 5,2; p < 0,01). Entre adolescentes femininas, houve uma queda do IAS-R (64,1 vs. 62,4; p = 0,04), assim como, do consumo de "total de verduras e hortaliças", "verduras e hortaliças de cor laranja", "carne, ovos e legumes" e "gordura sólida, álcool e açúcar". Por outro lado, entre adolescentes masculinos, houve uma queda apenas no consumo de "cereais integrais" (0,2 vs. 0,1; p = 0,04). Entre 2003 e 2008, a qualidade da dieta de adolescentes femininas deteriorou em Niterói.

El estudio tuvo como objetivo analizar los cambios en la calidad de la dieta de adolescentes matriculados en escuelas públicas en Niterói, Estado de Río de Janeiro, Brasil, a lo largo de cinco años. Los datos sobre consumo alimentario de los adolescentes (12-19 años de edad) fueron obtenidos a través de dos conjuntos de registros alimentarios de tres días, en dos estudios transversales de base escolar, en 2003 y 2008. El Índice Brasileño de Alimentación Saludable (IAS-R), versión revisada, se utilizó para estimar la calidad de la dieta. Entre 2003 y 2008, hubo una caída general en la puntuación atribuida al "total de verduras y hortalizas", "verduras y hortalizas de color naranja" y "carne, huevos y legumbres", pero hubo un aumento en el consumo de "leche y lácteos" (4,0 vs. 5,2; p < 0,01). Entre adolescentes femeninas hubo una caída del IAS-R (64,1 vs. 62,4; p = 0,04), así como, del consumo de "total de verduras y hortalizas", "verduras y hortalizas de color naranja", "carne, huevos y legumbres" y "grasa sólida, alcohol y azúcar". Por otro lado, entre adolescentes masculinos, hubo una caída sólo en el consumo de "cereales integrales" (0,2 vs. 0,1; p = 0,04). Entre 2003 y 2008, la calidad de la dieta de adolescentes femeninas se deterioró en Niterói.