Association of dietary patterns and body phenotypes in Brazilian adolescents / Associação entre padrões alimentares e fenótipos corporais em adolescentes brasileiros

Abstract Objectives: to investigate the association between dietary patterns, physical activity, and body phenotypes in adolescents. Methods: this school-based cross-sectional study involved 1,022 adolescents aged ten to 19 years. Dietary patterns and body phenotypes were defined using a principal component analysis. Body phenotype was defined using anthropometry, body composition, biochemistry, sexual maturation, and dietary patterns from 19 food groups, using a food frequency questionnaire. The association between the dietary patterns and body phenotypes was assessed using a linear regression model. Results: five body phenotypes (BP1adiposity, BP2puberty, BP3biochemical, BP4muscular, BP5lipids_biochemical) and five dietary patterns (DP1ultraprocessed_foods, DP2fresh_foods, DP3bread_rice_beans, DP4culinary_preparations, DP5cakes_rice_beans) were identified. There were higher BP_adiposity scores for obese adolescents, but energy expenditure was similar for obese and non-obese adolescents. Physical activity was positively associated with BMI, BP_adiposity, and BP_puberty. We observed a negative association between DP_ultraprocessed_foods and BMI, and a positive association between DP_fresh_food. DP_fresh_foods was positively associated with BP_adiposity; DP_ultraprocessed_foods and DP_culinary_preparations were negatively associated with this phenotype. BP_biochemical was negatively associated with DP_fresh_foods. Conclusion: we identified a negative association between a dietary pattern composed mainly of ultra-processed foods, fresh foods, and BP_adiposity. These associations need to be better explored, especially in adolescents, as both dietary patterns and phenotypes were defined using multivariate analysis.

Resumo Objetivos: investigar associação entre padrão alimentar (PA), atividade física (AF) e fenótipos corporais (FC) em adolescentes. Métodos: estudo transversal de base escolar com 1.022 adolescentes de dez a 19 anos. Padrão alimentar e fenótipo corporal foram definidos por meio da análise de componentes principais. O fenótipo corporal foi definido usando antropometria, composição corporal, bioquímica e maturação sexual, e padrão alimentar a partir de 19 grupos de alimentos de um questionário de frequência alimentar. A associação entre padrão alimentar e fenótipo corporal foi avaliada por modelo de regressão linear. Resultados: foram identificados cinco fenótipos corporais (FC1adiposidade, FC2puberdade, FC3bioquímico, FC4muscular, FC5lipídios_bioquímico) e cinco padrões alimentares (PA1alimentos_ultraprocessados, PA2alimentos_frescos, PA3pão_arroz_feijão, PA4preparações_culinárias, PA5bolos_arroz_feijão). Há maiores escores de FC_adiposidade para adolescentes com obesidade, mas o gasto energético foi semelhante para adolescentes com e sem diagnóstico de obesidade. Atividade física associou-se positivamente com IMC, FC_adiposidade e FC_puberdade. Observamos associação negativa entre PA_ultraprocessados e IMC, e positiva entre PA_alimentos_frescos. PA_alimentos_frescos associou-se positivamente com FC_adiposidade; PA_ultraprocessados e PA_preparações_culinárias se associaram negativamente a este fenótipo. FC_bioquímico associou-se negativamente com PA_alimentos_frescos. Conclusão: identificamos associação negativa entre padrão alimentar composto principalmente por alimentos ultraprocessados e alimentos in natura e FC_adiposidade. Essas associações devem ser exploradas com o mesmo público em estudos futuros, principalmente em adolescentes, pois tanto o padrão alimentar quanto o fenótipo foram definidos por meio de análise multivariada.

Lifestyle behaviors and associated factors among individuals with diabetes in Brazil: a latent class analysis approach.

The purpose of the cross-sectional study was to identify patterns of modifiable lifestyle behaviors and examine the relationship between sociodemographic characteristics and distinct lifestyle behaviors. The data were gathered from the National Health Survey 2019, a study that included adults with diabetes. Four domains of lifestyle behaviors were used to define these behaviors: smoking, alcohol consumption, physical activity, and diet. The association between patterns of lifestyle behaviors and variables of interest was assessed using multinomial regression analysis. The three lifestyle patterns identified were: Class 1, referred to as "unhealthy diet," comprised 17.0% of the sample and was characterized by unhealthy eating habits; Class 2 (less active and insufficient fruit and vegetable intake) represented 71.2% of the sample; Class 3 referred to as "low risk" (11.8%) is characterized by a lower probability of engaging in most risky behaviors. A person over 45 years of age with little or no education and no health care coverage was less likely to be a member of Class 1. Male individuals who do not attend a doctor regularly exhibited more chances of belonging to Class 2. Mixed-race individuals aged 45 years or more with a low level of education have a lower chance of belonging to this class.

Lifestyle behaviors and associated factors among individuals with diabetes in Brazil: a latent class analysis approach / Comportamentos de estilo de vida e fatores associados entre indivíduos portadores de diabetes no Brasil: uma abordagem com análise de classes latentes

Abstract The purpose of the cross-sectional study was to identify patterns of modifiable lifestyle behaviors and examine the relationship between sociodemographic characteristics and distinct lifestyle behaviors. The data were gathered from the National Health Survey 2019, a study that included adults with diabetes. Four domains of lifestyle behaviors were used to define these behaviors: smoking, alcohol consumption, physical activity, and diet. The association between patterns of lifestyle behaviors and variables of interest was assessed using multinomial regression analysis. The three lifestyle patterns identified were: Class 1, referred to as "unhealthy diet," comprised 17.0% of the sample and was characterized by unhealthy eating habits; Class 2 (less active and insufficient fruit and vegetable intake) represented 71.2% of the sample; Class 3 referred to as "low risk" (11.8%) is characterized by a lower probability of engaging in most risky behaviors. A person over 45 years of age with little or no education and no health care coverage was less likely to be a member of Class 1. Male individuals who do not attend a doctor regularly exhibited more chances of belonging to Class 2. Mixed-race individuals aged 45 years or more with a low level of education have a lower chance of belonging to this class.

Resumo Neste estudo de caráter transversal objetivou-se identificar os padrões de comportamento de estilo de vida e sua associação com características sociodemográficas. Utilizou-se como base de dados a Pesquisa Nacional de Saúde de 2019, com adultos (≥ 18 anos) diabéticos. Os padrões de saúde foram definidos pela Análise de Classes Latentes em quatro domínios: tabagismo, consumo de bebidas alcoólicas, atividade física e alimentação. Foi aplicada análise de regressão multinominal para identificar a associação entre os padrões de comportamento e as variáveis sociodemográficas de interesse. Identificou-se três padrões de comportamento: a Classe 1 corresponde a 17% da amostra e compreende indivíduos com maior probabilidade de comportamentos de risco ligados à alimentação; a Classe 2 (baixos nível de atividade física e consumo de frutas e hortaliças) compreende 71,2% da amostra; e a Classe 3 (11,8% da população) reúne os indivíduos com menor chance de desenvolver comportamentos de risco. Indivíduos com 45 anos ou mais, com baixa escolaridade e sem plano de saúde têm menos chances de pertencer à Classe 1. Homens, que não fazem visitas regulares ao médico têm maiores chances de pertencer à Classe 2, bem como aqueles com 45 anos ou mais, com baixa escolaridade.

Association of health predictors with quality of life in children and adolescents.

OBJECTIVES: To evaluate the association of health-related quality of life (HRQOL) with physical activity, food consumption, sleep duration and screen time in children and adolescents. METHODS: Cross-sectional study with 268 students aged 10-17 years from a public school in Brazil. The outcome variable was HRQOL score, evaluated by the Pediatric Quality of Life Inventory™ (PedsQL™). Exposure variables were habitual physical activity, food consumption, sleep duration, and screen time. A general linear model was used to estimate age-adjusted means and 95 % confidence interval (95 % CI) of HRQOL scores, and a multivariable analysis of variance to identify factors associated with lower/higher HRQOL scores. The study was approved by the Human Research Ethics Committee of the Pontifical Catholic University of Campinas. RESULTS: Overall HRQOL score was 70.3 (95 % CI: 68.0-72.6). Multivariable analyses showed lower HRQOL scores for those adolescents who: 1-were physically inactive (67.3; p=0.014); 2-sleep less than 6 h per night (66.8; p=0.003); 3-eat fruits and vegetables less than five days/week (68.9; p=0.027); and 4-eat fast food twice/week or more (68.6; p=0.036) when compared to their opposite groups. Screen time was not statistically significantly associated with total HRQOL. CONCLUSIONS: The joint association found in our study suggests that at least three habits must change to improve the HRQOL of children and adolescents (physical activity, food consumption, and sleep duration). Therefore, interventions in schools to promote a healthy lifestyle to achieve a better HRQOL should include a multidisciplinary team to properly guide children and adolescents about these habits simultaneously.

The Potential Impact of Different Taxation Scenarios towards Sugar-Sweetened Beverages on Overweight and Obesity in Brazil: A Modeling Study.

The adoption of fiscal policies based on the specific taxation of sugar-sweetened beverages (SSBs) has been recommended by international health agencies, as they are measures that potentially reduce consumption. This study is an ex ante risk comparison that estimates the impact of three tax scenarios (20, 25, and 30%) with a 100% pass-on rate to SSBs on the prevalence of high weight and obesity in the Brazilian population. Data on the consumption habits, weight, and height of 46,164 adults aged 20 years or over from Brazilian recent national surveys were used. The shift in consumption after taxation was estimated based on the price elasticity of the demand. The percentage changes in overweight for 20, 25, and 30% taxation were 1.84% (95%CI: 1.82; 1.86), 1.89% (95%CI: 1.87; 1.90), and 2.25% (95%CI: 2.24; 2.27), respectively. The change in the prevalence of obesity was 1.93% (95%CI: 1.87; 2.00), 2.90% (95%CI: 2.80; 3.02), and 4.16% (95%CI: 4.01; 4.32), respectively. Taxes on SSBs may have a more favorable result among the heaviest consumers, who are young adults (20-29 years), especially men, thereby promoting a greater reduction in the prevalence of high weight and obesity.

Impact of a reduction in sugar-sweetened beverage consumption on the burden of type 2 diabetes in Brazil: A modeling study.

AIM: To model the impact of a 20 % tax on sugar-sweetened beverages (SSBs) on the disease burden of T2DM among Brazilian adults. METHODS: This is an ex-ante risk comparative study. The model applied a 20 % tax on SSB and projected the incidence, prevalence, and mortality of T2DM over a 20-year period (2019 to 2039). Using recent national data on consumption, previously published cross- and own-price elasticities of SSBs and diabetes relative risk we estimated changes on T2DM burden. RESULTS: With a 20 % tax on SSBs, after 10 years, we estimated a reduction of 37,303 new cases of T2DM for men and 56,757 for women; 184,129 prevalent cases for men and 219,236 for women; and 5,386 and 6,075 deaths for men and women, respectively. After 20 years, 8.6 % and 12.4 % new cases of T2DM will have been prevented, 4.0 % and 5.5 % prevalent cases, and 13.7 % and 12.7 % deaths among men and women, respectively. CONCLUSIONS: SSB taxes have the potential to reduce the burden of and deaths attributable to T2DM. Our results show that a fiscal policy may significantly impact strategic plans to tackle noncommunicable diseases.

Taxing sugar-sweetened beverages as a policy to reduce overweight and obesity in countries of different income classifications: a systematic review.

OBJECTIVE: To evaluate the potential impact of sugar-sweetened beverage (SSB) taxes on overweight and obesity prevalence in countries of different income classifications. DESIGN: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020161612). Five databases (Cochrane Library, Embase, LILACS (via Virtual Health Library) and MEDLINE (via PubMed), and Web of Science were searched, from January 2009 to December 2019. Articles that reported changes in purchases, sales, intake, body weight, BMI, overweight and/or obesity prevalence due to a tax on or price change in SSB were included. SETTING: Studies conducted in countries of different income classifications. PARTICIPANTS: The search yielded 8349 articles of which 21 met inclusion criteria. RESULTS: Among the sixteen studies selected, only two did not show that consumption, sales and purchase decreased as the price of SSB increased. In eight of the thirteen studies selected, a positive effect of an SSB tax on decreasing overweight and obesity prevalence was expected. It is estimated that a 20 % taxation on SSB would result in a greater decrease in the prevalence of overweight and obesity compared to a 10 % rate. Studies with no significant effect of taxing on sales, purchases, consumption and prevalence of obesity were from high-income countries, while significant effects of taxing on reducing purchase, consumption and/or obesity prevalence were found in studies from upper-middle- and middle-income countries. CONCLUSION: A high SSB tax might be an effective fiscal policy to decrease purchase and consumption of SSB and reduce overweight/obesity prevalence, especially if the tax were specific for beverage volume.

Self-perceived body image and body satisfaction of adolescents / Imagem corporal autopercebida e satisfação corporal de adolescentes

Abstract Objectives: to evaluate self-perceived body image and body satisfaction of adolescents and their associated factors. Methods: across-sectional study carried out with 200 adolescents from a non-govern-mental organization of Campinas-SP. Self-perceived body image was assessed using a scale of silhouettes and body satisfaction by body areas. Association between sociodemographic and anthropometric data and body image and satisfaction were assessed by logistic regres-sion. Results: seventy percent of normal weight boys and 88% of girls wrongly perceived their nutritional status according to the objective standards. The prevalence of body dissatisfac-tion was 76.5%. Twenty-two percent of adolescents reported dissatisfaction with their body shape. Self-perceived body image was associated with nutritional status (OR= 0.25; CI95%=0.09-0.73), abdominal obesity (Waist/Height ratio- WHR) (OR=26.57; CI95%=3.98-177.18), and gender (OR=2.65; CI95%=1.16-6.05). Conclusions: we identified an important distortion and dissatisfaction with body shape. Girls, overweight/obese adolescents and those with abdominal obesity have more chance to this condition. These findings can subsidize actions that deal with the issue of acceptance of self-image, preventing more serious disorders that may directly affect the health of young-sters.

Resumo Objetivos: avaliar a imagem corporal autopercebida e a satisfação corporal de adoles-centes e seus fatores associados. Métodos: estudo transversal realizado com 200 adolescentes de uma organização não governamental de Campinas-SP. A imagem corporal autopercebida foi avaliada por meio de escala de silhuetas e a satisfação corporal por áreas do corpo. A associação entre dados sociodemográficos e antropométricos e imagem e satisfação corporal foi avaliada por regressão logística. Resultados: setenta por cento dos meninos com peso normal e 88% das meninas perce-beram erroneamente seu estado nutricional de acordo com os parâmetros objetivos. A prevalência de insatisfação corporal foi de 76,5%. Vinte e dois por cento dos adolescentes relataram insatisfação com a forma corporal. A autopercepção da imagem corporal foi asso-ciada ao estado nutricional (OR= 0,25; IC95%=0,09-0,73), obesidade abdominal (Relação cintura estatura- RCE) (OR=26,57; IC95%=3,98-177,18) e sexo (OR=2,65; IC95%=1,16-6,05). Conclusões: identificou-se uma importante distorção e insatisfação com a forma corporal. Meninas, adolescentes com sobrepeso / obesidade e aqueles com obesidade abdo-minal têm mais chances de apresentar dessa condição. Esses achados podem subsidiar ações que tratam da questão da aceitação da autoimagem, prevenindo distúrbios mais graves que podem afetar diretamente a saúde dos jovens.

Validation of smartphone addiction scale - Short version (SAS-SV) in Brazilian adolescents.

The objectives of this study were to analyze the psychometric properties of the Smartphone Addiction Scale - Short Version (SAS-SV) as follows: (i) the factor structure of the SAS-SV using different statistical methods; (ii) the evidence of convergence; (iii) the temporal stability of the SAS-SV; and (iv) predictive SAS-SV validity. A total of 451 adolescents participated in this study (age M = 13.1; SD = 1.22) by completing a sociodemographic questionnaire (including items evaluating the perception of smartphone use), the Internet Addiction Test (IAT), and the SAS-SV. It was found that 53.2% demonstrated problematic smartphone use. The SAS-SV showed good reliability (α = 0.81; ω = 0.78), and all of its items were kept. The network analysis indicated that the items evaluating the withdrawal and preoccupation symptoms had the greatest influence on the network. The intraclass correlation coefficient was 0.846 and indicated good temporal stability of the SAS-SV 20-30 days after the first application. The receiver operating characteristic (ROC) curve analysis indicated 33 points as the best cutoff for the SAS-SV (AUC = 0.739; sensitivity = 65.37%; specificity = 72.26). The instrument also showed a moderate correlation with the variables related to smartphone use (time spent on smartphones, number of messages sent and received, and number of times the smartphone is checked). These data indicate that the SAS-SV may be a reliable instrument for use with Brazilian adolescents.

Ultra-processed food consumption and obesity in adolescents / Consumo de alimentos ultraprocessados e obesidade em adolescentes

ABSTRACT Objective To evaluate the relationship between ultra-processed food consumption and obesity indicators in adolescents. Methods Cross-sectional study with a convenience sample of 200 10- to 18-year-old adolescents from Campinas, São Paulo (SP). Usual dietary intake was determined through a semiquantitative food frequency questionnaire. Daily intake of each food was obtained from the intake frequency. Subsequently, foods were classified as raw and minimally processed, cooking ingredients or ultra-processed foods, and their caloric contribution to the total energy value was calculated. Sociodemographic and anthropometric variables were also investigated. Overweight was defined as Z-score>+1 and obesity was defined as Z-score>+2 according to the Body Mass Index per age group. The associations were tested by chi-square test and linear trend. Results The frequency of obesity was 47.0%, and 21.5% presented increased waist circumference. The average energy intake was 4,176kcal/day, of which 50.6% was derived from ultra-processed foods. The categories with the highest caloric contributions among ultra-processed foods were industrial loaves/cakes (16.2%), sweets and candy (6.2%), pastas (6.0%) and sweetened drinks (5.1%). No association was found between ultra-processed food consumption and anthropometric indicators. Conclusion The significant contribution of ultra-processed foods to daily calories is evidence of a poor diet of this population of young people, although this has not been shown as a factor associated with excess weight. Therefore, there is an urgent need for public policies that discourage the consumption of these products and encourage the return to a traditional diet.

RESUMO Objetivo Avaliar a relação entre o consumo de alimentos ultraprocessados e indicadores de obesidade em adolescentes. Métodos Estudo transversal com amostra de conveniência de 200 adolescentes de 10 a 18 anos, de Campinas (SP). O consumo alimentar habitual foi obtido por meio de um questionário de frequência alimentar semiquantitativo. A partir da frequência de consumo foi obtido o consumo diário de cada alimento. Posteriormente os alimentos foram classificados em in natura e minimamente processados, ingredientes culinários e alimentos ultraprocessados e calculada sua contribuição calórica no valor energético total. Variáveis sociodemográficas e antropométricas também foram investigadas. O sobrepeso foi definido por meio do escore Z>1 e a obesidade escore Z>2 segundo o Índice de Massa Corporal para idade. As associações foram testadas pelo teste qui-quadrado e de tendência linear. Resultados A frequência de obesidade foi de 47,0% e 21,5% apresentaram circunferência da cintura aumentada. O consumo médio de energia foi de 4.176kcal/dia, sendo 50,6% provenientes de ultraprocessados. As categorias com as maiores contribuições calóricas entre os ultraprocessados foram os pães/bolos industrializados (16,2%), doces e guloseimas (6,2%), massas (6,0%) e bebidas adoçadas (5,1%). Não observou-se associação entre o consumo de ultraprocessados e indicadores antropométricos. Conclusão A expressiva contribuição dos ultraprocessados nas calorias diárias evidencia a qualidade ruim da alimentação dos jovens, embora não tenha se mostrado como fator associado ao excesso de peso. Ressalta-se a necessidade urgente de políticas públicas que desestimulem o consumo destes produtos e incentivem o resgate da alimentação tradicional.

[Association between excess weight and serum lipid alterations in adolescents]. / Associação entre excesso de peso e alterações lipídicas em adolescentes.

The study estimated the prevalence of serum lipid alterations among adolescents and investigated its association with excess weight and abdominal obesity. It involved a cross-sectional study with 525 adolescents from Piracicaba (São Paulo state). Anthropometric (body mass index, waist circumference and waist-height ratio) and biochemical information were obtained (total cholesterol and fractions, triglycerides). The relationship between the anthropometric indicators and alterations in lipid profile was tested by logistic regression. The prevalence of dyslipidemia was in the order of 81%. An association was verified between high WHeR and serum lipid alterations in total cholesterol (OR = 2.00; CI 95% = 1.09-3.64) and triglycerides (OR = 4.48; CI 95% = 2.03-9.89) after adjustment for age and sex. No significant associations of alterations in lipid profile were found with excess weight and CC. The high prevalence of dyslipidemia and its association with abdominal obesity indicates that preventive measures should begin in childhood in order to reduce the occurrence of cardiovascular diseases.

O estudo estimou a prevalência de alterações lipídicas entre adolescentes e investigou sua associação com o excesso de peso e com a obesidade abdominal. Foi um estudo transversal realizado com 525 adolescentes de Piracicaba (SP). Foram obtidas informações antropométricas (índice de massa corporal, circunferência da cintura e relação cintura estatura) e bioquímicas (colesterol total e frações, triglicerídeos). A associação entre alterações no perfil lipídico e indicadores antropométricos foi testada pela regressão logística. Aproximadamente 81% dos adolescentes apresentaram alteração em pelo menos uma fração lipídica. Verificou-se que houve associação entre RCEst aumentada e alteração do perfil lipídico para colesterol total (OR = 2,00; IC 95% = 1,09-3,64) e para triglicerídeo (OR = 4,48; IC 95% = 2,03-9,89) após ajuste por sexo e idade. Não foram verificadas associações significativas das alterações no perfil lipídico com o excesso de peso e a CC. A elevada prevalência de alterações lipídicas e sua associação com a obesidade abdominal indicam que medidas de prevenção devem ser iniciadas na infância e na adolescência com o intuito de reduzir a ocorrência de doenças cardiovasculares.

Associação entre excesso de peso e alterações lipídicas em adolescentes / Association between excess weight and serum lipid alterations in adolescents

Resumo O estudo estimou a prevalência de alterações lipídicas entre adolescentes e investigou sua associação com o excesso de peso e com a obesidade abdominal. Foi um estudo transversal realizado com 525 adolescentes de Piracicaba (SP). Foram obtidas informações antropométricas (índice de massa corporal, circunferência da cintura e relação cintura estatura) e bioquímicas (colesterol total e frações, triglicerídeos). A associação entre alterações no perfil lipídico e indicadores antropométricos foi testada pela regressão logística. Aproximadamente 81% dos adolescentes apresentaram alteração em pelo menos uma fração lipídica. Verificou-se que houve associação entre RCEst aumentada e alteração do perfil lipídico para colesterol total (OR = 2,00; IC 95% = 1,09-3,64) e para triglicerídeo (OR = 4,48; IC 95% = 2,03-9,89) após ajuste por sexo e idade. Não foram verificadas associações significativas das alterações no perfil lipídico com o excesso de peso e a CC. A elevada prevalência de alterações lipídicas e sua associação com a obesidade abdominal indicam que medidas de prevenção devem ser iniciadas na infância e na adolescência com o intuito de reduzir a ocorrência de doenças cardiovasculares.

Abstract The study estimated the prevalence of serum lipid alterations among adolescents and investigated its association with excess weight and abdominal obesity. It involved a cross-sectional study with 525 adolescents from Piracicaba (São Paulo state). Anthropometric (body mass index, waist circumference and waist-height ratio) and biochemical information were obtained (total cholesterol and fractions, triglycerides). The relationship between the anthropometric indicators and alterations in lipid profile was tested by logistic regression. The prevalence of dyslipidemia was in the order of 81%. An association was verified between high WHeR and serum lipid alterations in total cholesterol (OR = 2.00; CI 95% = 1.09-3.64) and triglycerides (OR = 4.48; CI 95% = 2.03-9.89) after adjustment for age and sex. No significant associations of alterations in lipid profile were found with excess weight and CC. The high prevalence of dyslipidemia and its association with abdominal obesity indicates that preventive measures should begin in childhood in order to reduce the occurrence of cardiovascular diseases.

Identifying Overweight and Obesity in Brazilian Schoolchildren, 2014.

CONTEXT: For any intervention in a population, we need to understand population characteristics and needs. The School Health Program (PSE) is a Brazilian national proposal for the improvement of schoolchildren's quality of life by integrating health and education areas to address vulnerabilities that affect the development of students from public schools. OBJECTIVE: To describe the prevalence of overweight and obesity in school-aged children and adolescents and to expound methods to evaluate the nutritional status deviation. DESIGN: Cross-sectional study. SETTING: Schools in Itatiba, Sao Paulo, Brazil, participating in PSE. PARTICIPANTS: A total of 6829 schoolchildren aged 6 month to 15 years. MAIN OUTCOME MEASURES: Nutritional status and standard percentile curves for body mass index (BMI) for gender. RESULTS: In children younger than 5 years, the prevalence of being overweight was 13.9%; for those between 5 years or older and younger than 10 years, it was 33.9%; and for those 10 years or older, it was 34.0%. In males, obesity and severe obesity were more present (10.7% and 3.7%, respectively) than in girls (9.5% and 1.9%, respectively). Regarding location, it was found that the region with the highest income showed a higher prevalence of overweight children. Compared with the World Health Organization reference BMI curves, our reference percentile curve showed a higher standard for the cutoff points between normal range and overweight. CONCLUSION: From our results, we found that age and measures of weight and height in schoolchildren could contribute, in a cheap and simple way, to the assessment of nutritional status in a region. This is helpful in providing health monitoring and assisting in making public health decisions, as well as serving in comparison with other scientific studies. Partnership between education and health systems can facilitate and improve the quality of health management among schoolchildren.

Tempo excessivo diante da televisão e sua influência sobre o consumo alimentar de adolescentes / Excessive television-viewing time and its influence on adolescent food intake

RESUMO Objetivo Investigar a associação entre o tempo diante da televisão e o consumo alimentar de adolescentes. Métodos Trata-se de estudo transversal com 815 adolescentes de ambos os sexos, de escolas públicas de Piracicaba, São Paulo. Foram obtidos dados sociodemográficos e antropométricos, bem como sobre o tempo despendido em frente à televisão e o consumo alimentar habitual. Este último foi obtido mediante aplicação do Questionário de Frequência Alimentar, avaliando-se a adequação do consumo (porções/dia) de sete grupos alimentares conforme recomendação do Guia Alimentar Brasileiro. O tempo de televisão foi obtido a partir do total de horas diárias dedicadas a assistir à televisão, sendo classificadas duas categorias: <2 horas/dia e >2 horas/dia. Utilizou-se o teste t de Student para avaliar a diferença de médias entre as variáveis contínuas. A relação entre variáveis independentes e tempo de televisão foi testada pela regressão de Poisson. Resultados Os adolescentes que permanecem mais tempo em frente à televisão consumiram mais leite e derivados (p=0,03), açúcares e doces (p=0,01) e refrigerante (p=0,02). Observou-se que o baixo consumo de frutas, assim como o consumo excessivo de doces, açúcares e refrigerantes e a menor idade, estavam associados ao maior tempo de televisão. Na análise multivariável, hábitos alimentares não saudáveis, como a baixa ingestão de frutas (p=0,014) e o consumo elevado de doces e açúcares (p=0,041), permaneceram independentemente associados ao tempo de televisão. Conclusão O tempo excessivo em frente à televisão se associou a hábitos alimentares inadequados. Os adolescentes que permanecem tempo excessivo em frente à televisão devem ser incentivados a adotar uma prática alimentar mais saudável, já que a alimentação inadequada e o sedentarismo, sobretudo em associação, aumentam o risco de doenças crônicas ainda na adolescência.

ABSTRACT Objective To investigate the association between television-viewing time and adolescent food intake. Methods This cross-sectional study included 815 male and female adolescents from public schools in Piracicaba, São Paulo. The following data were collected: sociodemographic and anthropometric data, television-viewing time, and habitual food intake. The latter was obtained by a food frequency questionnaire to assess the intake adequacy (servings/day) of seven food groups according to the Brazilian Food Guide. Television-viewing time regarded the total number of hours per day dedicated to watching television, which was then classified into two categories: £2 hours/day and >2 hours/day. The Student's t test measured the difference between the means of the continuous variables. The relationship between the independent variables and television-viewing time was tested by Poisson regression. Results Adolescents with higher television-viewing time consumed more milk and dairy products (p=0.03), sugars and sweets (p=0.01), and soda (p=0.02). Low fruit intake, high sweet, sugar, and soda intakes, and lower age were associated with higher television-viewing time. In multivariate analysis unhealthy food habits, such as low fruit intake (p=0.014) and high sugar and sweet intakes (p=0.041), remained independently associated with television-viewing time. Conclusion High television-viewing time was associated with poor eating habits. Adolescents with high television-viewing time should be encouraged to make healthier food choices, since poor eating habits and physical inactivity increase the risk of chronic diseases already during adolescence, especially when combined.

Is the secular trend in height delaying overweight rise among adolescents? The Brazilian case.

OBJECTIVE: To explore if the secular trend in height is contributing to delay overweight rise among Brazilian adolescents. DESIGN: Changes in BMI mean over time were fitted using linear regression including as independent variables survey year, height, survey-specific income quintiles, age and an interaction term of height × survey year. Overweight was defined as BMI≥25·0 kg/m2. Changes in overweight prevalence over time were fitted using Poisson regression. SETTING: Four national household surveys: 1974/5, 1989, 2002/3 and 2008/9. SUBJECTS: Brazilian adolescents. RESULTS: Mean values of height and BMI increased over the period, for both sexes and in all age ranges, except for girls aged 14-19 years from 1989 to 2002/3. The highest average increment and mean rate of height were between 1989 and 2002/3 and in 10-15-year-olds. The annual increment of height decreased from 2002/3 to 2008/9 in parallel with the increment in BMI rate. After fitting the regression model, the height × survey year interaction and per capita income were strong vectors to increase BMI mean. Changes in increment rate of height played a protective role against overweight in the last two periods for both sexes, mainly for girls. The period from 1989 to 2002/3 was the strongest vector associated with overweight in boys and the association decreased to the next period, from 2002/3 to 2008/9. CONCLUSIONS: BMI and height of adolescents have increased in a wavering and alternate way throughout four decades in Brazil. The rate of height increment has played a protective role against overweight in adolescents.

Dietary intake of adolescents compared with the Brazilian Food Guide and their differences according to anthropometric data and physical activity / A ingestão dietética de adolescentes em comparação com o Guia Alimentar Brasileiro e suas diferenças de acordo com dados antropométricos e atividade física

ABSTRACT: Objective: To assess the dietary intake of adolescents compared with the Brazilian Food Guide and to explore their differences according to anthropometric data and physical activity. Methods: A total of 476 adolescents from public schools of Piracicaba, SP, Brazil participated in this study. A semi-quantitative food frequency questionnaire was used to estimate food group intake of adolescents. Height, weight and waist circumference of all participants were measured. Physical activity pattern was determined by questioning about participation in regular sport activities. Results: The prevalence of overweight was 36.1% and 60% were not physically active. 7.8, 7.1, 6.3, and 0.2% of adolescents consumed vegetables, fruits, milk and derivatives, and cereals, respectively, according to recommendations. About 55 and 79% of adolescents consumed excessively oils/fats and sugar/sweets, respectively. Physically active adolescents consumed more cereals, fruits, vegetables, milk and derivatives, and meats and eggs. Conclusion: Most adolescents did not follow the food group recommendations and those who were physically active have healthier food habits.

RESUMO: Objetivo: Avaliar o consumo alimentar de adolescentes em comparação com o Guia Alimentar Brasileiro e explorar suas diferenças segundo dados antropométricos e atividade física. Métodos: Foram entrevistados 476 adolescentes de escolas públicas de Piracicaba, SP, Brasil. O consumo alimentar foi avaliado por questionário de freqüência alimentar. Altura, peso e circunferência da cintura foram medidos. O padrão de atividade física foi determinado pelo questionamento sobre a participação em atividades físicas regulares. Resultados: A prevalência de sobrepeso foi de 36,1% e 60% não eram fisicamente ativos. 7,8, 7,1, 6,3 e 0,2% dos adolescentes consumiram legumes, frutas, leite e derivados, e cereais, respectivamente, de acordo com as recomendações. Cerca de 55 e 79% consumiram óleos/gorduras e açúcares/doces em excesso, respectivamente. Adolescentes fisicamente ativos consumiram mais cereais, frutas, legumes, leite e derivados, carnes e ovos. Conclusão: A maioria dos adolescentes não atingiu as recomendações dos grupos de alimentos e aqueles fisicamente ativos tinham hábitos alimentares mais saudáveis.

Dietary intake of adolescents compared with the Brazilian Food Guide and their differences according to anthropometric data and physical activity.

OBJECTIVE: To assess the dietary intake of adolescents compared with the Brazilian Food Guide and to explore their differences according to anthropometric data and physical activity. METHODS: A total of 476 adolescents from public schools of Piracicaba, SP, Brazil participated in this study. A semi-quantitative food frequency questionnaire was used to estimate food group intake of adolescents. Height, weight and waist circumference of all participants were measured. Physical activity pattern was determined by questioning about participation in regular sport activities. RESULTS: The prevalence of overweight was 36.1% and 60% were not physically active. 7.8, 7.1, 6.3, and 0.2% of adolescents consumed vegetables, fruits, milk and derivatives, and cereals, respectively, according to recommendations. About 55 and 79% of adolescents consumed excessively oils/fats and sugar/sweets, respectively. Physically active adolescents consumed more cereals, fruits, vegetables, milk and derivatives, and meats and eggs. CONCLUSION: Most adolescents did not follow the food group recommendations and those who were physically active have healthier food habits.

[Population coverage of the food and nutrition surveillance system in the state of São Paulo, Brazil]. / Cobertura populacional do Sistema de Vigilância Alimentar e Nutricional no Estado de São Paulo, Brasil.

This article sets out to estimate the population coverage of the Food and Nutrition Surveillance System (SISVAN) at different phases of life and to evaluate its operation in the state of Sao Paulo. The study included 65 cities divided in 14 state regions. The coverage of SISVAN was estimated using data from nutritional status monitoring available in public reports and on government websites, as well as the number of users attended by the public health services. Total users of public health services were obtained by the difference between the total number of inhabitants of 65 cities and the number of beneficiaries of private health plans. Most regions presented reduced population coverage (< 10%). Approximately 57% revealed population coverage of between 5 and 10%. There was a preponderance of records of the nutritional status of children for all regions of the state. A startling statistic was the low coverage for the elderly population, which was zero or near zero in most regions. Despite the efforts by the government to expand and enhance SISVAN, nutritional monitoring in Sao Paulo is still insufficient. This condition hinders the use of SISVAN to produce effective changes in food and nutrition policies.

Cobertura populacional do Sistema de Vigilância Alimentar e Nutricional no Estado de São Paulo, Brasil / Population coverage of the food and nutrition surveillance system in the state of São Paulo, Brazil

O objetivo deste artigo é estimar a cobertura populacional do Sistema de Vigilância Alimentar e Nutricional (SISVAN) nos diferentes estágios de vida e avaliar seu funcionamento no estado de São Paulo. O estudo incluiu 65 municípios divididos em 14 regiões do estado. A cobertura do SISVAN foi estimada a partir de dados de monitoramento do estado nutricional disponíveis nos relatórios públicos, e do número de usuários que frequentam os serviços públicos de saúde. O total de usuários foi obtido pela diferença entre o total de habitantes e o número de beneficiários de planos de saúde privados. A maioria das regiões apresentou uma cobertura reduzida (<10%). Cerca de 57% revelaram cobertura entre 5 e 10%. Constatou-se uma preponderância de registros do estado nutricional de crianças para todas as regiões do Estado. Chama a atenção a reduzida cobertura entre os idosos, que é inexistente ou próxima de zero na maioria das regiões. Apesar dos esforços empreendidos pelo governo visando à ampliação e à qualificação do SISVAN, o monitoramento nutricional no estado de São Paulo ainda é insuficiente. Esta condição compromete sua utilização na elaboração de políticas efetivas na área de alimentação e nutrição.

This article sets out to estimate the population coverage of the Food and Nutrition Surveillance System (SISVAN) at different phases of life and to evaluate its operation in the state of Sao Paulo. The study included 65 cities divided in 14 state regions. The coverage of SISVAN was estimated using data from nutritional status monitoring available in public reports and on government websites, as well as the number of users attended by the public health services. Total users of public health services were obtained by the difference between the total number of inhabitants of 65 cities and the number of beneficiaries of private health plans. Most regions presented reduced population coverage (< 10%). Approximately 57% revealed population coverage of between 5 and 10%. There was a preponderance of records of the nutritional status of children for all regions of the state. A startling statistic was the low coverage for the elderly population, which was zero or near zero in most regions. Despite the efforts by the government to expand and enhance SISVAN, nutritional monitoring in Sao Paulo is still insufficient. This condition hinders the use of SISVAN to produce effective changes in food and nutrition policies.

Influência do consumo alimentar sobre o estado nutricional de adolescentes de Sorocaba-SP / Influence of food intake on nutritional status of adolescents from Sorocaba-SP

Descrever as práticas alimentares e avaliar a associação entre o consumo alimentar e a ocorrência de obesidade em adolescentes de escolas públicas de Sorocaba-SP. Métodos - Estudo observacional transversal realizado com adolescentes matriculados no 5º ano de escolas públicas de Sorocaba-SP, com idade mínima de 10 anos. Foram obtidas informações demográficas (sexo e idade), antropométricas (peso e estatura) para avaliação do estado nutricional e de consumo alimentar, utilizando-se um questionário de frequência alimentar semiquantitativo.Para se avaliar o efeito do perfil alimentar sobre o estado nutricional dos escolares utilizou-se o teste t de Student. Resultados - Foram avaliados 154 adolescentes, sendo 61,7% do sexo feminino. Verificou-se que 38,3% dos participantes apresentaram excesso de peso e 3,2% baixo peso. Observou-se que apenas a ingestão de lipídios apresentou diferença estatisticamente significativa (p=0,02) entre eutróficos e com excesso de peso. Embora não tenha sido observada diferença significativa para as demais variáveis dietéticas, os adolescentes com excesso de peso relataram um consumo inferior de alimentos considerados não saudáveis como refrigerantes, doces e alimentos gordurosos, enquanto os eutróficos relataram maior consumo de leite e derivados e de calorias. Conclusão - Não foi encontrada associação entre o consumo alimentar e o estado nutricional na amostra estudada, conforme hipótese inicial. No entanto, deve-se levar em consideração a possibilidade de superestimação de consumo entre os eutróficos e subestimação entre aqueles com excesso de peso...

To describe the dietary patterns and assess the association between dietary intake and prevalence of obesity among adolescents in public schools of Sorocaba-SP. Methods - This was a cross-sectional observational study conducted with adolescents enrolled in 5th grade in public schools of Sorocaba-SP, aged 10 years. We obtained demographic information (sex and age), anthropometric (weight and height) for nutritional status assessment and dietary intake using a semiquantitative food frequency questionnaire. We did use Student t test to evaluate the effect of dietary intake profile on the nutritional status of school children. Results - We evaluated 154 adolescents, 61.7% were female. It was found that 38.3% of participants were overweight and 3.2% underweight. We did observe that only the fat intake showed a statistically significant difference (p = 0.02) between normal and overweight. Although we did not observe no significant difference for other dietary variables, adolescents who are overweight reported a lower consumption of foods considered unhealthy as soft drinks, sweets and fatty foods, while normal weight adolescents reported higher consumption of dairy products and calories. Conclusion - No association was found between dietary intake and nutritional status in the sample as the initial hypothesis. However, should take into account the possibility of overestimation of consumption among normal adolescents and underestimation among those with overweight...