Fatores associados ao excesso de peso em uma amostra populacional de adolescentes escolares / Factors associated with overweight among school adolescents

INTRODUCTION: Overweight has been reported as a public health problem. Consequently, this suggests epidemiological studies for nutritional surveillance. OBJECTIVE: To analyze the prevalence and factors associated with overweight among high school students in Capital of the Brazilian Western Amazon. METHODS: Cross-sectional study of 2694 adolescents from public and private schools. They collected demographic, socioeconomic and sedentary behavior through self-responded questionnaire. Overweight rating followed the recommendations of the World Health Organization (2007). The prevalence rates were calculated, odds ratio and their confidence intervals were calculated at 95%. They identified the factors associated with excess weight by multiple binary logistic regression. RESULTS: The overall prevalence of overweight was 24.2% and 26.3% for males and 22.4% for females. After adjustment factors associated with overweight were economic class A / B (OR = 1.30, 95% CI 1.02 to 1.45), private school type (OR = 1.21, 95% CI 1,02-1.46) and poor health perception (OR = 1.27, 95% CI 1.03 to 1.58). It was concluded that excess weight showed high prevalence in economy class adolescents and B and private schools in Porto Velho, RO, Brazil. CONCLUSION: Therefore, the practice of physical activity associated with a diet should be encouraged, in addition to reducing sedentary behavior, to prevent the development of overweight and obesity.

INTRODUÇÃO: O excesso de peso tem sido reportado como um problema de saúde pública. Por conseqüência, essa situação sugere a realização de estudos epidemiológicos voltados para a vigilância nutricional. OBJETIVO: Analisar a prevalência e fatores associados ao excesso de peso entre escolares do ensino médio em Capital da Amazônia Ocidental Brasileira. MÉTODO: Estudo descritivo transversal com 2694 adolescentes de escolas públicas e privadas. Foram coletadas informações demográficas, socioeconómica e comportamento sedentário por meio de questionário auto respondido. A classificação de excesso de peso seguiu as recomendações da Organização Mundial da Saúde (2007). Foram calculadas as prevalências, razão de chance e seus respectivos intervalos de confiança em 95%. Identificaram-se os fatores associados ao excesso de peso por regressão logística binaria múltipla. RESULTADOS: A prevalência geral de excesso de peso foi 24,2%, sendo 26,3% para o sexo masculino e 22,4% para o feminino. Após análise ajustada os fatores associados ao excesso de peso foram classe económica A/B (OR = 1,30; IC95%=1,02 - 1,45), tipo de escola privada (OR = 1,21; IC95%=1,02 - 1,46) e percepção de saúde insatisfatória (OR = 1,27; IC95%= 1,03 - 1,58). Concluiu-se que excesso de peso apresentou elevada prevalência em adolescentes de classe econômica A e B e escolas privadas de Porto Velho, RO, Brasil. CONCLUSÃO: Portanto, a prática de atividade física associada uma dieta alimentar deve ser estimulada, além da redução ao comportamento sedentário, para prevenir o desenvolvimento de sobrepeso e obesidade.

ERICA: prevalence of dyslipidemia in Brazilian adolescents.

OBJECTIVE To determine the distribution of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides in Brazilian adolescents, as well as the prevalence of altered levels of such parameters. METHODS Data from the Study of Cardiovascular Risks in Adolescents (ERICA) were used. This is a country-wide, school-based cross-sectional study that evaluated 12 to 17-year old adolescents living in cities with over 100,000 inhabitants. The average and distribution of plasma levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were evaluated. Dyslipidemia was determined by levels of total cholesterol ≥ 170 mg/dl, LDL cholesterol ≥ 130 mg/dl, HDL cholesterol < 45 mg/dL, or triglycerides ≥ 130 mg/dl. The data were analyzed by gender, age, and regions in Brazil. RESULTS We evaluated 38,069 adolescents - 59.9% of females, and 54.2% between 15 and 17 years. The average values found were: total cholesterol = 148.1 mg/dl (95%CI 147.1-149.1), HDL cholesterol = 47.3 mg/dl (95%CI 46.7-47.9), LDL cholesterol = 85.3 mg/dl (95%CI 84.5-86.1), and triglycerides = 77.8 mg/dl (95%CI 76.5-79.2). The female adolescents had higher average levels of total cholesterol, LDL cholesterol, and HDL cholesterol, without differences in the levels of triglycerides. We did not observe any significant differences between the average values among 12 to 14 and 15- to 17-year old adolescents. The most prevalent lipid alterations were low HDL cholesterol (46.8% [95%CI 44.8-48.9]), hypercholesterolemia (20.1% [95%CI 19.0-21.3]), and hypertriglyceridemia (7.8% [95%CI 7.1-8.6]). High LDL cholesterol was found in 3.5% (95%CI 3.2-4.0) of the adolescents. Prevalence of low HDL cholesterol was higher in Brazil's North and Northeast regions. CONCLUSIONS A significant proportion of Brazilian adolescents has alterations in their plasma lipids. The high prevalence of low HDL cholesterol and hypertriglyceridemia, especially in Brazil's North and Northeast regions, must be analyzed in future studies, to support the creation of strategies for efficient interventions.

ERICA: prevalence of metabolic syndrome in Brazilian adolescents.

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.

ERICA: prevalences of hypertension and obesity in Brazilian adolescents.

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.

ERICA: prevalence of dyslipidemia in Brazilian adolescents / ERICA: prevalência de dislipidemia em adolescentes brasileiros

ABSTRACT OBJECTIVE To determine the distribution of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides in Brazilian adolescents, as well as the prevalence of altered levels of such parameters. METHODS Data from the Study of Cardiovascular Risks in Adolescents (ERICA) were used. This is a country-wide, school-based cross-sectional study that evaluated 12 to 17-year old adolescents living in cities with over 100,000 inhabitants. The average and distribution of plasma levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were evaluated. Dyslipidemia was determined by levels of total cholesterol ≥ 170 mg/dl, LDL cholesterol ≥ 130 mg/dl, HDL cholesterol < 45 mg/dL, or triglycerides ≥ 130 mg/dl. The data were analyzed by gender, age, and regions in Brazil. RESULTS We evaluated 38,069 adolescents – 59.9% of females, and 54.2% between 15 and 17 years. The average values found were: total cholesterol = 148.1 mg/dl (95%CI 147.1-149.1), HDL cholesterol = 47.3 mg/dl (95%CI 46.7-47.9), LDL cholesterol = 85.3 mg/dl (95%CI 84.5-86.1), and triglycerides = 77.8 mg/dl (95%CI 76.5-79.2). The female adolescents had higher average levels of total cholesterol, LDL cholesterol, and HDL cholesterol, without differences in the levels of triglycerides. We did not observe any significant differences between the average values among 12 to 14 and 15- to 17-year old adolescents. The most prevalent lipid alterations were low HDL cholesterol (46.8% [95%CI 44.8-48.9]), hypercholesterolemia (20.1% [95%CI 19.0-21.3]), and hypertriglyceridemia (7.8% [95%CI 7.1-8.6]). High LDL cholesterol was found in 3.5% (95%CI 3.2-4.0) of the adolescents. Prevalence of low HDL cholesterol was higher in Brazil’s North and Northeast regions. CONCLUSIONS A significant proportion of Brazilian adolescents has alterations in their plasma lipids. The high prevalence of low HDL cholesterol and hypertriglyceridemia, especially in Brazil’s North and Northeast regions, must be analyzed in future studies, to support the creation of strategies for efficient interventions.

RESUMO OBJETIVO Determinar a distribuição de colesterol total, LDL-colesterol, HDL-colesterol e triglicerídeos em adolescentes brasileiros, bem como a prevalência de níveis alterados de tais parâmetros. MÉTODOS Foram utilizados dados do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA), estudo transversal, de âmbito nacional e base escolar que avaliou adolescentes de 12 a 17 anos, residentes em municípios com mais de 100 mil habitantes. Foi avaliada a média e distribuição dos níveis plasmáticos de colesterol total, LDL-colesterol, HDL-colesterol e triglicerídeos. Dislipidemia foi determinada por níveis de colesterol total ≥ 170 mg/dl, LDL-colesterol ≥ 130 mg/dl, HDL-colesterol < 45 mg/dL ou triglicerídeos ≥ 130 mg/dl. Os dados foram analisados por sexo, idade e regiões do Brasil. RESULTADOS Foram avaliados 38.069 adolescentes, 59,9% do sexo feminino; 54,2% com idade entre 15 a 17 anos. Os valores médios encontrados foram: colesterol total 148,1 mg/dl (IC95% 147,1-149,1), HDL-colesterol 47,3 mg/dl (IC95% 46,7-47,9), LDL-colesterol 85,3 mg/dl (IC95% 84,5-86,1), e triglicerídeos 77,8 mg/dl (IC95% 76,5-79,2). Adolescentes do sexo feminino apresentaram níveis médios de colesterol total, LDL-colesterol e HDL-colesterol mais elevados, mas sem diferença nos níveis de triglicerídeos. Não houve diferença significativa de valores médios entre adolescentes de 12 a 14 e de 15 a 17 anos. As alterações com maior prevalência foram HDL-colesterol baixo (46,8% [IC95% 44,8-48,9]), hipercolesterolemia (20,1% [IC95% 19,0-21,3]) e hipertrigliceridemia (7,8% [IC95% 7,1-8,6]). O LDL-colesterol elevado foi observado em 3,5% (IC95% 3,2-4,0) dos adolescentes. As prevalências de HDL-colesterol baixo foram mais elevadas nas regiões Norte e Nordeste do País. CONCLUSÕES Uma parcela significativa dos adolescentes brasileiros apresenta alterações dos lípides plasmáticos. A alta prevalência de HDL-colesterol baixo e a hipertrigliceridemia, sobretudo nas regiões Norte e Nordeste do Brasil, devem ser analisadas em futuros estudos para subsidiar formulações de estratégias de intervenções eficazes.

The Study of Cardiovascular Risk in Adolescents--ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents.

BACKGROUND: The Study of Cardiovascular Risk in Adolescents (Portuguese acronym, "ERICA") is a multicenter, school-based country-wide cross-sectional study funded by the Brazilian Ministry of Health, which aims at estimating the prevalence of cardiovascular risk factors, including those included in the definition of the metabolic syndrome, in a random sample of adolescents aged 12 to 17 years in Brazilian cities with more than 100,000 inhabitants. Approximately 85,000 students were assessed in public and private schools. Brazil is a continental country with a heterogeneous population of 190 million living in its five main geographic regions (North, Northeast, Midwest, South and Southeast). ERICA is a pioneering study that will assess the prevalence rates of cardiovascular risk factors in Brazilian adolescents using a sample with national and regional representativeness. This paper describes the rationale, design and procedures of ERICA. METHODS/DESIGN: Participants answered a self-administered questionnaire using an electronic device, in order to obtain information on demographic and lifestyle characteristics, including physical activity, smoking, alcohol intake, sleeping hours, common mental disorders and reproductive and oral health. Dietary intake was assessed using a 24-hour dietary recall. Anthropometric measures (weight, height and waist circumference) and blood pressure were also be measured. Blood was collected from a subsample of approximately 44,000 adolescents for measurements of fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin and fasting insulin. DISCUSSION: The study findings will be instrumental to the development of public policies aiming at the prevention of obesity, atherosclerotic diseases and diabetes in an adolescent population.