Optimization of Care for Adult Outpatients With Type 2 Diabetes Through the Diabetes Self-Management Multidisciplinary Program: A Randomized Clinical Trial.

OBJECTIVES: Our aim in this study was to evaluate the efficacy of a Self-Management Multidisciplinary Program (MP) on glycemic management, quality of life and diabetes self-care activities. METHODS: People with type 2 diabetes and glycated hemoglobin (A1C) of >7.5% were randomized to participate in the MP or to usual care (UC). The MP consisted of face-to-face meetings with each health-care provider (nurse, pharmacist, dietitian, physical educator and social worker) to approach diabetes self-management issues. MP topics were tailored toward local habits and culture. Three different modules were offered over 12 weeks. The primary outcome was change in A1C from baseline to 12 months. Diabetes Quality of Life and Summary of Diabetes Self-Care Activities questionnaires were assessed at baseline and at 6 and 12 months. RESULTS: Ninety-six participants were included (mean 59 years of age, 60% women, diabetes duration 16±10 years, 62% of lower middle/low socioeconomic status). Change in A1C at 12 months (UC: 0.52% [95% confidence interval, -1.07 to 0.04]; MP: -0.30% [95% confidence interval, -1.05 to 0.44]; p=0.33) was not different between the groups. There was an increase in satisfaction and a reduction in worry about future effects of diabetes in the MP group, which was not found in the UC group. CONCLUSIONS: A short-term self-management multidisciplinary program improved diabetes-related quality of life but failed to reduce A1C in individuals with longstanding type 2 diabetes and a low socioeconomic status.

Severity of obesity is associated with worse cardiometabolic risk profile in adolescents: Findings from a Brazilian national study (ERICA).

OBJECTIVE: The prevalence of obesity and severe obesity among adolescents has increased dramatically in developing countries. However, the distribution of cardiometabolic risk factors through the severity of obesity continuum is relatively unknown among youth. The aim of this study was to evaluate the association of weight categories with cardiometabolic risk factors among Brazilian adolescents. METHODS: ERICA (The Study of Cardiovascular Risk in Adolescents) was a multicenter, school-based, cross-sectional study composed of Brazilian adolescents (12-17 y of age). Severity of obesity was classified according to the International Obesity Task Force reference values for body mass index (BMI) and several cardiometabolic risk factors were measured after clinical and biochemical exams and categorized using standard definitions of abnormal values. RESULTS: Among the 37 892 adolescents enrolled, 8708 had excess weight, being classified with overweight (17.2%), obesity (5.6%), and severe obesity (1.3%). Increasing severity of obesity was associated with a worse cardiometabolic profile in the overall sample. Multivariable models that controlled for age, sex, skin color, socioeconomic status, physical activity, and total energy intake, showed that individuals in higher categories of severity of obesity tended to have higher prevalence ratios of most cardiometabolic risk factors compared with the other weight groups, except for high fasting blood glucose among boys. CONCLUSIONS: Progressive degrees of excess weight are positively associated with cardiometabolic risk factors in youth from a middle-income country, indicating the importance in classifying the severity of weight excess among adolescents and considering this to plan prevention programs against early development of obesity-related diseases.

Validation to Brazilian Portuguese of the Self-Care Inventory-revised for adults with type 2 diabetes.

Objective The aim of this study was to cross-culturally adapt and validate the Brazilian Portuguese version of SCI-R to adults with type 2 diabetes. Materials and methods The SCI-R is a 15-question survey that reflects how well patients with diabetes have adhered to treatment recommendations. A pretest (n = 40) was first performed to improve comprehension of the survey items. A final version was then self-administered in another 75 adults with type 2 diabetes to determine the survey's reliability and validity according to its association with HbA1c. Finally, we conducted a test-retest reliability analysis over three weeks to stabilize the sample and determine intra-observer variability. Results After the pretest phase, the final sample's (N = 75) mean age was 59.9 ± 7.5 years and mean HbA1c level was 8.6 ± 1.5% (70 ± 16.4 mmol/mol). The initial Cronbach's alpha was 0.61; however, further analysis showed that four items had low item correlation and were excluded from the final version, which increased the Cronbach's alpha to 0.63. In predictive validity analysis, HbA1c levels correlated significantly with total survey scores (r = -0.38, P = 0.001). The intra-class correlation coefficient between baseline and three-week scores was 0.93, which indicates high reproducibility. Conclusions The Brazilian Portuguese version of the SCI-R is a valid tool for measuring treatment adherence in adults with type 2 diabetes.

Validation to Brazilian Portuguese of the Self-Care Inventory-revised for adults with type 2 diabetes

ABSTRACT Objective The aim of this study was to cross-culturally adapt and validate the Brazilian Portuguese version of SCI-R to adults with type 2 diabetes. Materials and methods The SCI-R is a 15-question survey that reflects how well patients with diabetes have adhered to treatment recommendations. A pretest (n = 40) was first performed to improve comprehension of the survey items. A final version was then self-administered in another 75 adults with type 2 diabetes to determine the survey's reliability and validity according to its association with HbA1c. Finally, we conducted a test-retest reliability analysis over three weeks to stabilize the sample and determine intra-observer variability. Results After the pretest phase, the final sample's (N = 75) mean age was 59.9 ± 7.5 years and mean HbA1c level was 8.6 ± 1.5% (70 ± 16.4 mmol/mol). The initial Cronbach's alpha was 0.61; however, further analysis showed that four items had low item correlation and were excluded from the final version, which increased the Cronbach's alpha to 0.63. In predictive validity analysis, HbA1c levels correlated significantly with total survey scores (r = -0.38, P = 0.001). The intra-class correlation coefficient between baseline and three-week scores was 0.93, which indicates high reproducibility. Conclusions The Brazilian Portuguese version of the SCI-R is a valid tool for measuring treatment adherence in adults with type 2 diabetes.

Overview of meta-analysis on prevention and treatment of childhood obesity / Visão geral das meta-análises sobre prevenção e tratamento da obesidade infantil

Abstract Objectives: This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents. Data source: A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed. Summary of data: A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term. Conclusion: The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.

Resumo Objetivos: Este estudo teve como objetivo avaliar a qualidade das revisões sistemáticas sobre prevenção e tratamento não farmacológico do sobrepeso e da obesidade em crianças e adolescentes. Fontes de dados: Foi realizada uma busca em bases de dados eletrônicas (Medline via Pubmed, Web of Science, Scopus, LILACS, The Cochrane Library e Ensaios Clínicos), incluindo apenas revisões sistemáticas com meta-análise. As revisões foram selecionadas por dois pesquisadores e um terceiro resolveu as divergências. A lista de recomendações do PRISMA foi seguida. Síntese dos dados: Foram identificados 4.574 publicações, e 24 foram incluídas após seleção. Seis publicações eram sobre prevenção da obesidade, 17 sobre tratamento da obesidade e 1 sobre intervenções mistas para prevenção e tratamento da obesidade. As intervenções eram muito heterogêneas e mostraram pouco ou nenhum efeito sobre o peso ou índice de massa corporal. Intervenções mistas que incluíam dieta, exercícios, ações para reduzir o comportamento sedentário e programas que envolviam a escola ou as famílias mostraram alguns efeitos positivos de curto prazo. Revisões que analisaram fatores de risco cardiovascular demonstraram melhoras significativas em curto prazo. Conclusão: As revisões sistemáticas de intervenções para prevenir ou reduzir a obesidade em crianças e adolescentes geralmente mostraram pouco ou nenhum efeito sobre o peso ou índice de massa corporal, embora o perfil cardiovascular possa ter melhorado. Intervenções mistas demonstraram melhores efeitos, mas o impacto em longo prazo dos tratamentos da obesidade de crianças e adolescentes ainda não está claro.

Higher adiponectin concentrations are associated with reduced metabolic syndrome risk independently of weight status in Brazilian adolescents.

OBJECTIVE: To evaluate the association between adiponectin concentrations and metabolic syndrome (MetS) risk and to investigate if this association is independent of weight status in adolescents. METHODS: Adiponectin concentrations and MetS risk were assessed in 4546 Brazilian adolescents (12-17 years old) enrolled in The Study of Cardiovascular Risks in Adolescents ("ERICA"), a cross-sectional multicenter study in Brazil. For analyses, adiponectin was categorized in sex and age-specific quartiles and MetS risk was expressed as a continuous score, calculated as the average of the standardized values (z-score) of the five MetS components. Multiple linear regression models were used to investigate the association between the quartiles of adiponectin and MetS risk. RESULTS: Adiponectin was inversely associated with waist circumference and log-transformed triglycerides, and positively associated with HDL-c. We also observed an inverse association between adiponectin concentrations and MetS risk. After adjustment for sociodemographic variables, physical activity, skipping breakfast and body mass index (BMI), higher quartiles of adiponectin remained inversely associated with waist circumference and MetS risk. A direct association between adiponectin and HDL-c was also observed. In further analysis, the sample was stratified by weight status and an inverse association between quartiles of adiponectin and MetS risk was observed in both normal weight and overweight/obese adolescents. CONCLUSION: Higher adiponectin concentrations were independently and inverse associated with MetS risk in Brazilian adolescents, even after adjusting for BMI. These results were similar in normal weight and overweight/obese adolescents, suggesting that adiponectin may play a role in early development of MetS.

Prevalence of excessive screen time and TV viewing among Brazilian adolescents: a systematic review and meta-analysis / Prevalência de tempo excessivo de tela e tempo de TV em adolescentes brasileiros: revisão sistemática e metanálise

Abstract Purpose: To evaluate the prevalence of excessive screen-based behaviors among Brazilian adolescents through a systematic review with meta-analysis. Data source: Systematic review and meta-analysis were recorded in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO-CRD 2017 CRD42017074432). This review included observational studies (cohort or cross-sectional) that evaluated the prevalence of excessive screen time (i.e. combinations involving different screen-based behaviors) or TV viewing (≥2 h/day or >2 h/day in front of screen) through indirect or direct methods in adolescents aged between 10 and 19 years. The research strategy included the following databases: MEDLINE, LILACS, SciELO and ADOLEC. The search strategy included terms for "screen time", "Brazil", and "prevalence". Random effect models were used to estimate the prevalence of excessive screen time in different categories. Data summary: Twenty-eight out of 775 studies identified in the search met the inclusion criteria. The prevalence of excessive screen time and TV viewing was 70.9% (95% CI: 65.5-76.1) and 58.8% (95% CI: 49.4-68.0), respectively. There was no difference between sexes in both analyses. The majority of studies included showed a low risk of bias. Conclusions: The prevalence of excessive screen time and TV viewing was high among Brazilian adolescents. Intervention are needed to reduce the excessive screen time among adolescents.

Resumo Objetivo: Avaliar a prevalência de tempo excessivo de tela e de TV em adolescentes brasileiros através de revisão sistemática com metanálise. Fontes de dados: A revisão sistemática e a metanálise foram registradas no Registro Prospectivo Internacional da Base de Dados de Análises Sistemáticas (Prospero-CRD 2017 CRD 42017074432). Esta análise incluiu estudos observacionais (coorte ou transversais) que avaliaram a prevalência de tempo excessivo de tela (ou seja, combinações que envolvem diferentes comportamentos baseados em tempo de tela) ou tempo em frente à TV (≥ 2 horas/dia ou > 2 horas/dia em frente à tela) por avaliação direta ou indireta em adolescentes com idades entre 10 a 19 anos. A estratégia de pesquisa incluiu as seguintes bases de dados: MEDLINE, LILACS, SciELO e ADOLEC. A estratégia de busca incluiu termos como "tempo de tela", "Brasil" e "prevalência". Os modelos de efeito aleatório foram utilizados para estimar a prevalência de tempo excessivo de tela em diferentes categorias. Resumo de dados: Dos 775 estudos identificados na busca 28 atenderam aos critérios de inclusão. A prevalência de tempo excessivo de tela e tempo de TV foi 70,9% (IC de 95%: 65,5 a 76,1) e 58,8% (IC de 95%: 49,4 a 68,0), respectivamente. Não houve diferença entre os sexos nas duas análises. A maior parte dos estudos incluídos mostrou baixo risco de viés. Conclusões: A prevalência de tempo excessivo de tela e tempo de TV foi alta entre os adolescentes brasileiros. São necessárias intervenções para reduzir o tempo excessivo de tela entre os adolescentes.

Overview of meta-analysis on prevention and treatment of childhood obesity.

OBJECTIVES: This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents. DATA SOURCE: A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed. SUMMARY OF DATA: A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term. CONCLUSION: The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.

Prevalence of excessive screen time and TV viewing among Brazilian adolescents: a systematic review and meta-analysis.

PURPOSE: To evaluate the prevalence of excessive screen-based behaviors among Brazilian adolescents through a systematic review with meta-analysis. DATA SOURCE: Systematic review and meta-analysis were recorded in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO-CRD 2017 CRD42017074432). This review included observational studies (cohort or cross-sectional) that evaluated the prevalence of excessive screen time (i.e. combinations involving different screen-based behaviors) or TV viewing (≥2h/day or >2h/day in front of screen) through indirect or direct methods in adolescents aged between 10 and 19 years. The research strategy included the following databases: MEDLINE, LILACS, SciELO and ADOLEC. The search strategy included terms for "screen time", "Brazil", and "prevalence". Random effect models were used to estimate the prevalence of excessive screen time in different categories. DATA SUMMARY: Twenty-eight out of 775 studies identified in the search met the inclusion criteria. The prevalence of excessive screen time and TV viewing was 70.9% (95% CI: 65.5-76.1) and 58.8% (95% CI: 49.4-68.0), respectively. There was no difference between sexes in both analyses. The majority of studies included showed a low risk of bias. CONCLUSIONS: The prevalence of excessive screen time and TV viewing was high among Brazilian adolescents. Intervention are needed to reduce the excessive screen time among adolescents.

Adiponectin levels in Brazilian adolescents: Distribution and associated factors in ERICA survey.

BACKGROUND: The aim of this study was to evaluate the distribution of adiponectin and associated factors with low adiponectin levels in a large sample of adolescents from different Brazilian regions. METHODS: This is a national, school-based, cross-sectional multicenter study of cardiovascular risk factors in Brazilian adolescents aged 12 to 17 years. Serum adiponectin levels (µg/ml) were measured by enzyme-linked immunosorbent assay kit. Given the lack of reference values, sex-and age-specific median was adopted as the cutoff point, with the values below the median representing a higher-risk profile. Associated factors with low levels of adiponectin were investigated using Poisson regression. RESULTS: The sample consisted of 4546 adolescents, the majority female (61.2%). The prevalence of overweight/obesity and abdominal obesity was 30% and 13.4%, respectively. The medians of adiponectin were 13.4 µg/ml (95%CI: 12.8-14.0) in males and 14.2 µg/ml (95%CI: 13.3-15.0) in females. Lower adiponectin levels were associated with both overweight (Prevalence Ratios (PR) = 1.17; 95%CI 1.01-1.36) and obesity (PR = 1.36; 95%CI 1.16-1.56) in males, while, in females, adiponectin levels were associated only with obesity (PR = 1.45; 95% CI 1.26-1.66). Increased waist circumference in both males and females was inversely associated with adiponectin level. CONCLUSIONS: Adiponectin levels were lower among adolescents with weight excess and abdominal obesity. Male adolescents who live in rural areas and study at private schools also showed lower adiponectin concentrations.

Consumo de alimentos ultraprocessados entre crianças de uma Unidade Básica de Saúde / Ultra-processed food consumption in children from a Basic Health Unit

Resumo Objetivos Avaliar a contribuição dos alimentos ultraprocessados no consumo alimentar de crianças pertencentes à área de abrangência de uma unidade básica de saúde e os fatores associados. Método Estudo transversal com amostra de conveniência de 204 crianças, entre dois a 10 anos, no Sul do Brasil. O consumo alimentar das crianças foi obtido por meio do Recordatório Alimentar de 24 horas e, posteriormente, os alimentos foram classificados em minimamente processados, processados para culinária e ultraprocessados. Um questionário semiestruturado foi aplicado para a coleta das variáveis sociodemográficas e antropométricas. O excesso de peso das crianças foi definido por meio do escore Z > 2 para menores de cinco anos e Z > +1 para entre cinco e 10 anos segundo o Índice de Massa Corporal para idade. Resultados A frequência de excesso de peso foi de 34% (IC95%: 28% a 41%). O consumo médio de energia foi de 1.672,3 kcal/dia, 47% (IC95%: 45% a 49%) provenientes dos ultraprocessados. No modelo de regressão linear múltipla, a escolaridade materna (r = 0,23; p = 0,001) e a idade da criança (r = 0,40; p < 0,001) foram associados à maior contribuição percentual dos ultraprocessados na alimentação (R = 0,42; p < 0,001). Adicionalmente foi observada uma tendência linear significativa para maior consumo de ultraprocessados quando os dados foram estratificados pela idade da criança e nível de escolaridade materna (p < 0,001). Conclusões A contribuição dos ultraprocessados é expressiva na alimentação infantil e a idade da criança mostrou-se como fator associado mais importante para o consumo desses produtos.

Abstract Objectives To evaluate the contribution of ultra-processed food (UPF) on the dietary consumption of children treated at a Basic Health Unit and the associated factors. Methodology Cross-sectional study carried out with a convenience sample of 204 children, aged 2-10 years old, in Southern Brazil. Children's food intake was assessed using a 24-h recall questionnaire. Food items were classified as minimally processed, processed for culinary use, and ultra-processed. A semi-structured questionnaire was applied to collect socio-demographic and anthropometric variables. Overweight in children was classified using a Z score >2 for children younger than 5 and Z score >+1 for those aged between 5 and 10 years, using the body mass index for age. Results Overweight frequency was 34% (95% CI: 28-41%). Mean energy consumption was 1672.3 kcal/day, with 47% (95% CI: 45-49%) coming from ultra-processed food. In the multiple linear regression model, maternal education (r = 0.23; p = 0.001) and child age (r = 0.40; p < 0.001) were factors associated with a greater percentage of UPF in the diet (r = 0.42; p < 0.001). Additionally, a statistically significant trend for higher UPF consumption was observed when data were stratified by child age and maternal educational level (p < 0.001). Conclusions The contribution of UPF is significant in children's diets and age appears to be an important factor for the consumption of such products.

Ultra-processed food consumption in children from a Basic Health Unit.

OBJECTIVES: To evaluate the contribution of ultra-processed food (UPF) on the dietary consumption of children treated at a Basic Health Unit and the associated factors. METHODOLOGY: Cross-sectional study carried out with a convenience sample of 204 children, aged 2-10 years old, in Southern Brazil. Children's food intake was assessed using a 24-h recall questionnaire. Food items were classified as minimally processed, processed for culinary use, and ultra-processed. A semi-structured questionnaire was applied to collect socio-demographic and anthropometric variables. Overweight in children was classified using a Z score >2 for children younger than 5 and Z score >+1 for those aged between 5 and 10 years, using the body mass index for age. RESULTS: Overweight frequency was 34% (95% CI: 28-41%). Mean energy consumption was 1672.3 kcal/day, with 47% (95% CI: 45-49%) coming from ultra-processed food. In the multiple linear regression model, maternal education (r=0.23; p=0.001) and child age (r=0.40; p<0.001) were factors associated with a greater percentage of UPF in the diet (r=0.42; p<0.001). Additionally, a statistically significant trend for higher UPF consumption was observed when data were stratified by child age and maternal educational level (p<0.001). CONCLUSIONS: The contribution of UPF is significant in children's diets and age appears to be an important factor for the consumption of such products.