Replacing screen time, with physical activity and sleep time: influence on cardiovascular indicators and inflammatory markers in Brazilian children

Abstract Objective: To examine if the substitution of different screen time intervals with light physical activity (LPA), moderate to vigorous physical activity (MVPA) and sleep is associated with cardiovascular indicators and inflammatory markers in children. Methods: This is a cross-sectional study developed with 186 children aged between six and 11 years old from public schools in southern Brazil. CRF was measured with the 6-minute running and walking test, following the Brazil Sports Project procedures. The percentage of fat was evaluated through DXA. LPA and MVPA were measured using accelerometers. Sleep and screen time were assessed by questionnaires answered by parents. Leptin and C-reactive protein were measured by fasting blood collection. Systolic and diastolic blood pressure were determined through a digital sphygmomanometer. Isotemporal substitution models were used for statistical analysis. Results: Replacing 1 h of screen time with MVPA was associated with lower BMI, systolic and diastolic blood pressure, fat percentage, leptin, and C-reactive protein. When screen time was substituted for sleep time, lower waist circumference was observed. Regarding the substitution of 1 h of screen time with LPA, significant values were found only for leptin. Conclusion: The replacement of screen time with physical activities of different intensities and sleep time was associated with benefits in cardiovascular indicators and inflammatory markers in childhood.

Replacing screen time, with physical activity and sleep time: influence on cardiovascular indicators and inflammatory markers in Brazilian children.

OBJECTIVE: To examine if the substitution of different screen time intervals with light physical activity (LPA), moderate to vigorous physical activity (MVPA) and sleep is associated with cardiovascular indicators and inflammatory markers in children. METHODS: This is a cross-sectional study developed with 186 children aged between six and 11 years old from public schools in southern Brazil. CRF was measured with the 6-minute running and walking test, following the Brazil Sports Project procedures. The percentage of fat was evaluated through DXA. LPA and MVPA were measured using accelerometers. Sleep and screen time were assessed by questionnaires answered by parents. Leptin and C-reactive protein were measured by fasting blood collection. Systolic and diastolic blood pressure were determined through a digital sphygmomanometer. Isotemporal substitution models were used for statistical analysis. RESULTS: Replacing 1 h of screen time with MVPA was associated with lower BMI, systolic and diastolic blood pressure, fat percentage, leptin, and C-reactive protein. When screen time was substituted for sleep time, lower waist circumference was observed. Regarding the substitution of 1 h of screen time with LPA, significant values were found only for leptin. CONCLUSION: The replacement of screen time with physical activities of different intensities and sleep time was associated with benefits in cardiovascular indicators and inflammatory markers in childhood.

Cardiometabolic Risk in Children and Adolescents: The Paradox between Body Mass Index and Cardiorespiratory Fitness. / Risco Cardiometabólico em Crianças e Adolescentes: O Paradoxo entre Índice de Massa Corporal e Aptidão Cardiorrespiratória.

BACKGROUND: Cardiometabolic risk has been shown to be inversely associated with cardiorespiratory fitness (CRF) and positively associated with body mass index (BMI). OBJECTIVE: Our objective was to analyze the association of cardiometabolic risk factors with combined BMI and CRF in schoolchildren from a city in southern Brazil. METHODS: Cross-sectional study with a sample of 1252 schoolchildren aged seven to 17 years. Total cholesterol (TC), HDL-c, LDL-c, triglycerides (TG), systolic (SBP) and diastolic blood pressure (DBP) were evaluated. CRF and BMI were grouped into one variable and the schoolchildren were classified as eutrophic/fit, eutrophic/unfit, overweight-obese/fit, and overweight-obese/unfit. Crude and adjusted analyzes were performed using Poisson Regression and an alpha of 0.05 was adopted. RESULTS: Overweight-obese and fit schoolchildren showed a prevalence ratio (PR) of 1.50 (1.04 - 2.16) for altered TG, 3.05 (2.05 - 4.54) for elevated SBP, and 2.70 (1.87 - 3.88) for elevated DBP. Overweight-obese and unfit schoolchildren showed a PR for high TC of 1.24 (1.11 - 1.39) and 1.51(1.11 - 2.04) for low HDL levels. In addition, they had a risk of 2.07 (1.60 - 2.69) for altered TG, 3.36 (2.31 - 4.60) for elevated SBP and 2.42 (1.76 - 3.32) for altered DBP. CONCLUSION: BMI played a central role in the association with risk and CRF was shown to attenuate the association between risk factors and obesity. Overweight-obese children and adolescents had a higher cardiometabolic risk, but the effect size was larger among the unfit.

FUNDAMENTO: Foi demonstrado que o risco cardiometabólico está inversamente associado à aptidão cardiorrespiratória (APCR) e positivamente associado ao índice de massa corporal (IMC). OBJETIVO: Analisar a associação de fatores de risco cardiometabólicos com IMC e APCR combinados em escolares de um município do sul do Brasil. MÉTODOS: Estudo transversal com uma amostra de 1252 escolares de sete a 17 anos. Foram avaliados colesterol total (CT), HDL-c, LDL-c, triglicerídeos (TG), pressão arterial sistólica (PAS) e diastólica (PAD). APCR e IMC foram agrupados em uma variável e os escolares classificados como eutróficos/aptos, eutróficos/inaptos, excesso de peso/aptos e excesso de peso/inaptos. Análises foram realizadas por meio de Regressão de Poisson e uma alfa de 0,05 foi adotado. RESULTADOS: Escolares classificados com excesso de peso/aptos demonstraram uma razão de prevalência (RP) de 1,50 (1,04 ­ 2,16) para TG alterado, 3,05 (2,05 ­ 4,54) para PAS e 2,70 (1,87 ­ 3,88) para PAD elevada. Escolares com excesso de peso/ inaptos apresentaram RP para CT alto de 1,24 (1,11 ­ 1,39) e 1,51 (1,11 ­ 2,04) para baixos níveis de HDL. Além disso, apresentaram um risco de 2,07 (1,60 ­ 2,69) para TG alterado, 3,26 (2,31 ­ 4,60) para PAS e 2,42 (1,76 ­ 3,32) para PAD elevada. CONCLUSÃO: O IMC apresentou um papel central na associação com o risco e a APCR demonstrou atenuar a associação entre fatores de risco e excesso de peso. Escolares com excesso de peso apresentaram um risco cardiometabólico mais elevado, mas o tamanho do efeito foi maior entre os inaptos.

Risco Cardiometabólico em Crianças e Adolescentes: O Paradoxo entre Índice de Massa Corporal e Aptidão Cardiorrespiratória / Cardiometabolic Risk in Children and Adolescents: The Paradox between Body Mass Index and Cardiorespiratory Fitness

Resumo Fundamento Foi demonstrado que o risco cardiometabólico está inversamente associado à aptidão cardiorrespiratória (APCR) e positivamente associado ao índice de massa corporal (IMC). Objetivo Analisar a associação de fatores de risco cardiometabólicos com IMC e APCR combinados em escolares de um município do sul do Brasil. Métodos Estudo transversal com uma amostra de 1252 escolares de sete a 17 anos. Foram avaliados colesterol total (CT), HDL-c, LDL-c, triglicerídeos (TG), pressão arterial sistólica (PAS) e diastólica (PAD). APCR e IMC foram agrupados em uma variável e os escolares classificados como eutróficos/aptos, eutróficos/inaptos, excesso de peso/aptos e excesso de peso/inaptos. Análises foram realizadas por meio de Regressão de Poisson e uma alfa de 0,05 foi adotado. Resultados Escolares classificados com excesso de peso/aptos demonstraram uma razão de prevalência (RP) de 1,50 (1,04 - 2,16) para TG alterado, 3,05 (2,05 - 4,54) para PAS e 2,70 (1,87 - 3,88) para PAD elevada. Escolares com excesso de peso/ inaptos apresentaram RP para CT alto de 1,24 (1,11 - 1,39) e 1,51 (1,11 - 2,04) para baixos níveis de HDL. Além disso, apresentaram um risco de 2,07 (1,60 - 2,69) para TG alterado, 3,26 (2,31 - 4,60) para PAS e 2,42 (1,76 - 3,32) para PAD elevada. Conclusão O IMC apresentou um papel central na associação com o risco e a APCR demonstrou atenuar a associação entre fatores de risco e excesso de peso. Escolares com excesso de peso apresentaram um risco cardiometabólico mais elevado, mas o tamanho do efeito foi maior entre os inaptos.

Abstract Background Cardiometabolic risk has been shown to be inversely associated with cardiorespiratory fitness (CRF) and positively associated with body mass index (BMI). Objective Our objective was to analyze the association of cardiometabolic risk factors with combined BMI and CRF in schoolchildren from a city in southern Brazil. Methods Cross-sectional study with a sample of 1252 schoolchildren aged seven to 17 years. Total cholesterol (TC), HDL-c, LDL-c, triglycerides (TG), systolic (SBP) and diastolic blood pressure (DBP) were evaluated. CRF and BMI were grouped into one variable and the schoolchildren were classified as eutrophic/fit, eutrophic/unfit, overweight-obese/fit, and overweight-obese/unfit. Crude and adjusted analyzes were performed using Poisson Regression and an alpha of 0.05 was adopted. Results Overweight-obese and fit schoolchildren showed a prevalence ratio (PR) of 1.50 (1.04 - 2.16) for altered TG, 3.05 (2.05 - 4.54) for elevated SBP, and 2.70 (1.87 - 3.88) for elevated DBP. Overweight-obese and unfit schoolchildren showed a PR for high TC of 1.24 (1.11 - 1.39) and 1.51(1.11 - 2.04) for low HDL levels. In addition, they had a risk of 2.07 (1.60 - 2.69) for altered TG, 3.36 (2.31 - 4.60) for elevated SBP and 2.42 (1.76 - 3.32) for altered DBP. Conclusion BMI played a central role in the association with risk and CRF was shown to attenuate the association between risk factors and obesity. Overweight-obese children and adolescents had a higher cardiometabolic risk, but the effect size was larger among the unfit.

Moderating Role of Physical Fitness in the Association Between TV Time and Adiposity Parameters in Adolescents.

PURPOSE: To identify whether physical fitness (PF) components play a moderating role in the relationship between TV time and adiposity levels. DESIGN: Cross-sectional study. SETTING: Few studies have examined if different PF levels modify the association between TV time and adiposity in adolescents. Studies often focus on the isolated relationships between obesity and TV time, or obesity and PF levels. SUBJECTS: 1071 adolescents (617 girls), aged 12 to 17 years. MEASURES: Cardiorespiratory fitness (CRF), abdominal muscular endurance, and lower limb strength were evaluated using the protocols of the Projeto Esporte Brasil fitness testing battery. TV time was obtained using a self-reported questionnaire. Body mass index (BMI) and waist circumference (WC) were also assessed. Moderation analyses were conducted through multiple linear regression models with the following associations tested in different models: PF components, TV time, and interaction (PF component x TV time) with adiposity parameters (BMI and WC). RESULTS: A significant interaction term was found for CRF and TV time in the association with both WC (ß: -.005; 95% CI: -.009; -.001; P = .012) and BMI (ß: -.002; 95% CI: -.004; -.001; P = .009). CONCLUSION: CRF moderates the relationship between TV time and adiposity measures in this cross-sectional analysis. These data support strategies looking at increasing physical activity levels to improve CRF and avoid the development of excess abdominal obesity and excess weight.

Liver and kidney function markers among gym users: the role of dietary supplement usage.

Dietary supplements have been increasingly used by gym users and are often consumed without the guidance of a health professional. Moreover, the indiscriminate supplements use can have adverse health effects, such as changes in liver and kidney function. The aim of this study was to verify the association between dietary supplements intake with alterations in the liver and kidney function among gym users. A cross-sectional study was conducted with 594 gym users (mean age 37 (sd 14) years, 55·2 % women) from a city in southern Brazil. A questionnaire was used to evaluate the use of dietary supplements. The markers of the liver (alanine aminotransferase, aspartate aminotransferase (AST), alkaline phosphatase, γ-glutamyltransferase) and renal (creatinine and urea) function were also evaluated on a subsample of the study population. Data were analysed by binary logistic regression, adjusted for sex, age and education. The prevalence of dietary supplement intake was 36·0 %. Individuals who intake dietary supplements showed a higher prevalence to present slight alterations in the AST enzyme and in the urea after adjustments for potential confounders. In conclusion, the use of dietary supplement was associated with slight alterations in AST enzyme and in the urea among gym users. These findings show the importance of using supplements correctly, especially with guidance from professionals trained to avoid possible risks to health.

Sleep-related problems and eating habits during COVID-19 lockdown in a southern Brazilian youth sample.

The pandemic has affected children's behaviors and this fact has an effect on their healthy habits, such as sleep and diet. The aim of the current study was to determinate the prevalence of sleep-related problems and its relationship with eating habits in children from the south of Brazil during the pandemic. Parents/legal guardians of 3-17 years old participants responded to a online survey distributed using the snowball sampling strategy in Brazil. The survey was conducted in April, 2020. Participants were asked for their sleep duration and sleep-related problems, as well as for their eating habits. Logistic regressions were performed to analyze the relationship between sleep-related problems and eating habits. 495 participants were included in the analysis. 48.8% of participants reported sleep-related problems with 12.3% not meeting the sleep guidelines. Moreover, participants reported eating fruits or vegetables and sweets over four and three per week, respectively. Different associations were found between varibles of sleep and eating habits. Those participants with healthy eating habits showed a lower prevalence of sleep-related problems.

Combination of sleep duration, TV time and body mass index is associated with cardiometabolic risk moderated by age in youth.

OBJECTIVES: The combination of sleep duration, television (TV) time and body mass index (BMI) may be related to the alteration of cardiometabolic risk. However, there are few studies that use these variables grouped, and showing the moderating role of age. This study aimed to verify if the combination of sleep duration, TV time and BMI is associated with cardiometabolic risk and the moderating role of age in this relationship in youth. METHODS: Cross-sectional study conducted with 1411 adolescents (611 male), aged 10-17 years. Sleep duration, TV time and BMI were assessed and grouped into eight categories. Cardiometabolic risk was assessed by a continuous metabolic risk score, including the following variables: low HDL-cholesterol, elevated triglycerides, dysglycemia, high systolic blood pressure, high waist circumference and low cardiorespiratory fitness. Generalized linear models were used to test moderation of age in the relationship between the eight categories of sleep duration/television time/BMI with cardiometabolic risk. RESULTS: Cardiometabolic risk factor showed association with all overweight or obesity independent of sleep time and TV time. Age moderated the relationship between sleep duration/television time/BMI with cardiometabolic risk. This association was stronger in younger adolescents (11 and 13 years), indicating that individuals with inadequate sleep, prolonged TV time and overweight/obesity present higher cardiometabolic risk values when compared to 15-year-old adolescents. CONCLUSION: Overweight/obesity, independently of sleep duration and TV time, is the main risk factor for cardiometabolic disorders in adolescence. When moderated by age, younger adolescents that presented the combination of risk factors had higher cardiometabolic risk.

Tracking of cardiometabolic risk in a Brazilian schoolchildren cohort: a 3-year longitudinal study.

BACKGROUND: Clustering of cardiometabolic risk factors is a sign of detrimental health. Tracking is a term used to describe a variable longitudinal stability across time. High tracking provides the chance to determine which cardiometabolic risk factors should be the target of early treatment and prevention efforts. The present study aims to analyze the tracking of cardiometabolic risk factors and clustered cardiometabolic risk score in children across a 3-year time span, and to verify the odds of staying at risk (measured by the clustered score) from baseline to follow-up. METHODS: Longitudinal study that included 354 (155 boys) children, aged 7-12 years at baseline. A clustered score was calculated by summing the systolic blood pressure, waist circumference, triglycerides, glucose, and the TC/HDL-C ratio Z-scores divided by five. A second clustered score was calculated including cardiorespiratory fitness (CRF). RESULTS: CRF and anthropometric parameters presented high tracking (r≥0.662), whereas the cardiometabolic parameters exhibited low-to-moderate tracking (0.100≤r≤0.571). The clustered scores' tracking was moderate (r≥0.508; r≥0.588 [CRF]). Participants in the higher risk groups at baseline presented 3.81 (95% CI: 2.40; 6.05) and 4.64 (95% CI: 2.85; 7.56), including CRF, times higher chance of remaining at risk three years later. Moreover, participants in the worst profile regarding CRF or anthropometrics at baseline presented at least 4.00 times higher chance of being at risk three years later. CONCLUSIONS: Participants with worst CRF and adiposity had an increased risk of presenting higher clustered risk after three years.

Impact of intervention on nutritional status, consumption of processed foods, and quality of life of adolescents with excess weight / Impacto da intervenção no estado nutricional, consumo de processados e qualidade de vida de adolescentes com excesso de peso

Abstract Objective: To evaluate the impact of a nutritional intervention on nutritional status, ultra-processed food consumption, and quality of life of adolescents with excess weight. Methods: Experimental study with adolescent students with excess weight, divided into two groups, an intervention group and a control group. The nutritional intervention lasted six months, with an educational and motivational approach. Nutritional status (waist circumference and body mass index), quality of life, and ultra-processed food consumption were evaluated before and after the period. Results: Sixty-two adolescents with overweight or obesity participated in the study, 37 in the intervention group and 25 in the control group, aged 13.2 ± 1.5 years in intervention group, and 13.0 ± 1.8 years in control group, both of which had a higher female participation. There were changes in the body mass index (intervention group Δ: −0.81 ± 2.28, control group Δ: −0.64 ± 1.28) and in the waist circumference for intervention group (Δ:−3.31 ± 5.47). For the pre- and post-ultra-processed food consumption, there was a significant reduction in the consumption of soft drinks in the intervention group (Δ: −0.07 [−0.27 to 0.00]), instant noodles (Δ: −0.03 [−0.07 to 0.00]), and sandwich cookies (Δ: −0.06 [−0.26 to 0.00]). The quality of life increased in the intervention group and decreased in the control group, with no intra- (p = 0.162) or intergroup statistical relevance in the pre- (p = 0.426) and post- (0.249) intervention period, with a reduction in the emotional domain score, with a significant variation in the intervention group (pre and post; Δ: −19.0 ± 40.6). Conclusion: There was a decrease in body mass index and waist circumference (central obesity being more often related to insulin resistance), reduction of ultra-processed food consumption (soft drinks, sandwich cookies, and instant noodles), and a tendency toward quality of life improvement (however, there was a decrease in the domains of emotional and school quality of life).

Resumo Objetivo: Avaliar o impacto de uma intervenção nutricional no estado nutricional, no consumo de alimentos ultraprocessados e na qualidade de vida de adolescentes com excesso de peso. Métodos: Estudo experimental, realizado com escolares com excesso de peso, que foram divididos em dois grupos, intervenção e controle. A intervenção nutricional durou seis meses, com abordagem educativa e motivacional. Foram avaliados, antes e após o período, estado nutricional (circunferência da cintura e índice de massa corporal), qualidade de vida e consumo de alimentos ultraprocessados. Resultados: Participaram 62 adolescentes com sobrepeso ou obesidade, 37 do grupo intervenção e 25 do grupo controle, 13,2 ± 1,5 anos no grupo intervenção e 13,0 ± 1,8 anos no grupo controle, ambos com maior participação do sexo feminino. No índice de massa corporal houve mudanças [grupo intervenção (variação de −0,81 ± 2,28); grupo controle (variação de −0,64 ± 1,28)] e circunferência da cintura para os grupos intervenção (variação de −3,31 ± 5,47). No consumo de alimentos ultraprocessados pré e pós, houve redução significativa no grupo intervenção do consumo de refrigerante [variação de −0,07 (−0,27 a 0,00)], macarrão instantâneo [variação de −0,03 (−0,07 a 0,00)] e bolacha recheada [variação de −0,06 (−0,26 a 0,00)]. A qualidade de vida aumentou no grupo intervenção e reduziu no grupo controle, sem relevância estatística intra (p = 0,162) ou entre grupos pré (p = 0,426) e pós (0,249), reduziu a pontuação do domínio emocional, com variação significativa no grupo intervenção (pré e pós) (Δ−19,0 ± 40,6). Conclusão: Obteve-se uma diminuição do índice de massa corporal e circunferência da cintura (obesidade central mais relacionada com resistência insulínica), diminuição de alimentos ultraprocessados (refrigerante, biscoito recheado e macarrão instantâneo), tendência de melhoria da qualidade de vida (contudo, diminuição dos domínios da qualidade de vida emocional e escolar).

Physical fitness as a moderator in the relationship between adiposity and cardiometabolic risk factors in children and adolescents.

BACKGROUND: The aim of this study was to verify the moderator role of physical fitness in the relationship between adiposity and cardiometabolic risk factors in normal weight and overweight/obese children and adolescents. METHODS: Cross-sectional study comprising 2482 children and adolescents, aged 7-17 years. Physical fitness was evaluated according the procedures of Projeto Esporte Brazil, and waist circumference (WC) with an inelastic tape. Cardiometabolic risk score was defined by the z-score sum of glucose, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. Moderation analysis was done through linear regression models. RESULTS: Significant interaction term for cardiorespiratory fitness (CRF)×WC with cardiometabolic risk factors (P<0.001), as well as for lower limbs strength (LLS)×WC (P<0.001) and agility × WC (P=0.01) in normal weight girls. For normal weight boys it was found a significant interaction term for CRF×WC with cardiometabolic risk factor (P=0.007), and also for agility × WC (P=0.003), while overweight/obese boys showed a significant interaction term only for agility × WC with cardiometabolic risk factor (P=0.001). CONCLUSIONS: CRF, LLS and agility are moderators in the relationship between WC and cardiometabolic risk factors in normal weight girls, while CRF and agility were moderators for normal weight boys and only agility for overweight/obese boys.

Influence of FTO (Fat mass and obesity) gene and parental obesity on Brazilian children and adolescents adiposity.

Objectives Evaluate the influence of the genetic variant rs9939609 of the FTO gene on anthropometric characteristics and whether parental obesity is related to children and adolescents being overweight. Methods A total of 2,364 children and adolescents between 6 and 17 years old were genotyped and the lipid profile, plasma glucose level, and anthropometric characteristics were measured to assess adiposity. Results The AA genotype (risk) was associated with higher body mass index (BMI Z-score; p = 0.006), waist circumference (WC; p = 0.001), and triglycerides (p = 0.033). The association of the participants' adiposity characteristics with the parents' BMI and FTO genotypes showed an association of the BMI Z-score when either the mother or father was overweight or obese (p = 0.028 and p = 0.029). In the overweight or obese father/eutrophic mother, we also observe an association of FTO rs9939609 with WC (p = 0.039). The effect of these variables on the risk of obesity was also tested: overweight or obese mother (OR = 1.82, p = 0.041), overweight and obese parents (OR = 3.09, p < 0.0001), and FTO rs9939609 AA genotype (OR = 2.08, p = 0.0004) were associated. With regard to altered WC and high body fat percentage (BF%), either overweight or obese parents (OR = 2.39, p < 0.0001; OR = 1.92, p < 0.002) showed an association. The FTO rs9939609 AA genotype (OR = 1.99, p = 0.0002) was associated with altered WC. Conclusions The results show that parental weight also contributes to obesity and may interact with the FTO genetic make-up.

Relação entre indicadores antropométricos, aptidão cardiorrespiratória e perfil hematológico de adolescentes no sul do Brasil / Relationship between anthropometric indicators, cardiorespiratory fitness and hematological profile of adolescents

A obesidade pode influenciar no baixo desempenho da aptidão cardiorrespiratória (APCR), bem como colaborar com alterações nos níveis de indicadores hematológicos. Objetivo: Verificar se existe associação entre indicadores antropométricos, APCR e perfil hematológico de adolescentes no sul do Brasil. Método: Estudo transversal, em que foram avaliados 1 6 98 ado lescentes (742 do sexo masculino) com idade entre 10 e 17 anos, de escolas da rede pública e particular de Santa Cruz do Sul-RS. A avaliação antropométrica foi realizada, utilizando-se os seguintes parâmetros: IMC e circunferência da cintura (CC). Para o teste de APCR, foi utilizado o test e de co rrida/cam inha do s 6 minutos. Para reconhecimento do perfil hematológico, foram avaliados os seguintes parâmetros: leucócitos (WBC), eritrócitos (RBC), hemoglobina (HBC), hematócrito (HCT) e amplitude de distribuição dos glóbulos vermelhos (RDW). A associação entre as variáveis contínuas foi testada por meio da correlação de Pearson. Foram considerados significativos os valores de p<0,05. Resultados: Nos meninos, identificou-se relação fraca entre IMC com RBC (r=0,293; p<0,001) e com HCT (r=0,271; p <0,001 ). A CC também demonstrou associação fraca com estas duas variáveis hematológicas (RBC: r=0,311; p<0,001; HCT: r=0,291; p<0,001). Os níveis de APCR estiveram associados, também de fo rma fraca e direta, com HBC (r=0,224; p<0,001) e HCT (r=0,258; p<0,001). Para o sexo feminino, os níveis de W BC associaram-se, de forma fraca, com IMC (r=0,208; p<0,001) e com CC (r=0,185; <0,001). Conclusão: Os resultados obtidos no presente estudo evidenciam correlação positiva, porém fraca, entre o perfil hematológico dos adolescentes com as variáveis antropométricas e APCR...(AU)

Obesity might cause cardiorespiratory fitness (CRF) to underperform, as well as collaborate with changes in hematological parameters. Aim: To investigate the asso ciation between anthropometric indicators, CRF, and the hematological profiles of adolescents in Southern Brazil. Method: A cross-sectional study of 1,698 adolescents (742 boys, 956 girls), aged between 10 and 17 from p ublic and private schools of Santa Cruz do Sul, State of Rio Grande do Sul, was conducted. Furt h ermore, an anthropometric evaluation of the following parameters was performed: body mass index (BMI) and waist circumference (WC). CRF was evaluated using the 6-minute run/walk test. Hematolo gical p rofile was evaluated based on the following parameters: leucocytes (WBC), erythrocytes (RBC), hemoglobin (HGB), hematocrit (HCT), and red cell distribution width (RDW). The association of continuo us v ariables was tested through Pearson's correlation; p values lower than 0.05 were considered significant. Result s: The boys' BMI presented a weak correlation with RBC (r = 0.293; p < 0.001) and HCT (r = 0.271; p < 0.001). Their WC also presented a weak correlation with both hematological variables (RBC: r = 0.311; p < 0.001; HCT: r = 0.291; p < 0.001). Their CRF levels exhibited a direct but weak asso ciatio n wit h HGB (r = 0.224; p < 0.001) and HCT (r = 0.258; p < 0.001). The WBC levels of girls were fo un d t o be weak ly associated with BMI (r = 0.208; p < 0.001) and WC (r = 0.185; p < 0 .0 01 ). Co nclusio n: Th e result s highlight a positively weak correlation of the hematological profile of adolescents with an throp ometric variables and CRF...(AU)

Efeitos de um programa de intervenção interdisciplinar sobre o agrupamento de variáveis cardiometabólicas em adolescentes com excesso de peso / Effects of an interdisciplinary intervention program on the grouping of cardiometabolic variables in adolescents with excessive weight

O estudo tem por objetivo investigar alterações nas características de agrupamento de variáveis cardiometabólicas relacionados a resistência à insulina em resposta à um programa de intervenção interdisciplinar em adolescentes com excesso de peso. Estudo realizado em adolescentes co m excesso de peso, composto por grupo controle (n=19) e grupo intervenção (n=20), o qual p articipou de programa interdisciplinar de seis meses. Foi avaliado o índice de massa corporal, a circun ferência da cintura, pressão arterial sistólica e diastólica; realizada coleta sanguínea para avaliação da glicose, insulina e ácido úrico e calculado o índice HOMA-IR, antes e após o programa. Foi realizada análise fatorial exploratória por meio de análise de componentes principais, tendo sido consideradas cargas fatoriais associadas os valores ≥ 0,50. No período pré intervenção, três componentes fatoriais explicavam a variabilidade das variáveis em ambos os grupos, sendo a composição dos componentes igual entre estes, em que variáveis antropométricas e de pressão arterial compunham o fator 1; o segundo componente dizia respeito as variáveis relacionadas à resistência à insulina, insulina e HOMA-IR; e o terceiro comp onente era composto da glicemia e ácido úrico. Pós intervenção, dois componentes explicavam em ambos grupos e a composição era distinta, sendo que no grupo intervenção insulina e HOMA-IR passaram a fazer p arte do fator 1; já no grupo controle, a glicemia correlacionou-se negativamente com os indicadores antropométricos e de pressão arterial no componente 1; e glicemia, insulina, HOMA -IR e ácido úrico associaram-se no fator 2. Conclui-se que o programa de intervenção promoveu modificação no agrupamento das variáveis cardiometabólicas de adolescentes obesos, em que as variáveis insulina e HOMA-IR passaram a pertencer ao fator 1. Não foi encontrado nenhum fator central que ex p licasse o agrupamento das variáveis em nenhuma das análises, confirmando assim, a complexa relação en tre as variáveis analisadas...(AU)

The aim of the study was to investigate changes in the characteristics of grouping of cardiometabolic variables related to insulin resistance in response to an interdisciplin ary in tervention program in overweight adolescents. This study was performed in overweight adolescents, composed o f a control group (n = 19) and an intervention group (n = 20), who participated in a six month interdisciplinary program. Body mass index, waist circumference, systolic and diastolic blo o d p ressure were evaluated; blood collection for glucose, insulin and uric acid assessment and HOMA-IR index, before and after the program. An exploratory factorial analysis was performed through analy sis o f m ain components, and factorial loads associated with values ≥ 0.50 were considered. In the p re -interv en tion period, three factorial components explained the variability of the variables in bo th gro ups, an d t he composition of the components was equal, where anthropometric and blood pressure variables comprised factor 1; the second component related to the variables related to insulin resistance, insulin an d HOMAIR; and the third component was composed of glycemia and uric acid. Post-intervention, two components explained in both groups and the composition was distinct, and in the interventio n gro up , in sulin an d HOMA-IR became part of factor 1; in the control group, glycemia was negatively co rrelated wit h t he anthropometric and blood pressure indicators in component 1; and glycemia, insulin, HOMA-IR and uric acid were associated with factor 2. It was concluded that the intervention program promoted modification in the grouping of the cardiometabolic variables of obese adolescents, in which the insulin and HOMA-IR variables belonged to the factor 1. No central factor was found to explain the grouping of variables in an y of the analyzes, thus confirming the complex relationship between the analyzed variables...(AU)

Metabolic risk associated with liver enzymes, uric acid, and hemoglobin in adolescents.

BACKGROUND: The associations of renal, hepatic, and hematologic markers with metabolic risk (MR) have already been shown in adolescents. However, it is still controversial which marker best predicts metabolic changes in youth. The aim of this study was to verify the association of MR with alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid, and hemoglobin (Hb) in adolescents. METHODS: We evaluated 1713 Brazilian adolescents aged 10 to 17 years. MR was calculated using a continuous metabolic risk score, including the sum of Z-scores of waist circumference, systolic blood pressure, fasting glucose, high-density lipoproteins, triglycerides, and cardiorespiratory fitness. Cutoff points were set for MR prediction for five metabolic components (ALT, AST, AST/ALT ratio, uric acid, and Hb). RESULTS: MR was strongly associated with increased uric acid (odds ratio [OR]: 2.50; 95% confidence interval [CI]: 1.74-3.59), ALT (OR: 2.64; 95% CI: 1.63-4.27), and AST levels (OR: 2.53; 95% CI: 1.24-5.18). Uric acid was shown to be the best predictor for MR (sensitivity: 55.79%; specificity: 61.35%; area under the curve: 0.616). CONCLUSION: Elevated hepatic, renal, and hematological markers were associated with MR in adolescents, especially ALT, AST, and uric acid levels. IMPACT: Elevated hepatic, renal, and hematological markers were associated with metabolic risk in adolescents, especially ALT, AST, and uric acid levels. It is still controversial which marker best predicts metabolic changes in adolescents. In addition, association of Hb with metabolic risk is under-studied in this population. It is important to further investigate the relationship between elevated Hb and hepatic markers, since there are key aspects not addressed yet. Our results highlight the importance of creating public health policies aimed to child and adolescent population, to prevention of metabolic disorders from an early age.

Efeitos de um programa de intervenção no perfil de risco cardiometabólico de adolescentes com excesso de peso / Effects of an intervention program on the cardiometabolic risk profile of overweight adolescents

O objetivo do estudo é analisar os efeitos de um programa de intervenção interdisciplinar no perfil de risco cardiometabólico de adolescentes com diagnóstico de sobrepeso/ obesidade. Estudo de intervenção, realizado com adolescentes com excesso de peso, constituído por grupo controle e grupo intervenção, o qual participou de um programa interdisciplinar com duração de seis meses. O grupo experimental final é composto por 23 adolescentes (12 sexo feminino e 11 sexo masculino). No início do programa, quatro adolescentes apresentavam sobrepeso e 19 obesidade. O grupo controle é composto pelo mesmo número de sujeitos, uma vez que este foi composto pelos pares dos escolares do grupo experimental. A intervenção contou com sessões de exercícios físicos, em três dias da semana e orientações nutricionais e psicológicas, uma vez por semana. Uma avaliação foi realizada antes do inicio do programa e logo após seu término. As avaliações consistiram em variáveis antropométricas - índice de massa corporal, circunferência da cintura, razão cintura-estatura e razão cintura -quadril, avaliação da pressão arterial, da aptidão cardiorrespiratória e coleta sanguínea para avaliação do perfil lipídico. Para a comparação das variáveis no período pré e pós-intervenção foi utilizado o teste t para amostras pareadas, para as variáveis de distribuição normal e, para as variáveis não paramétricas, foi aplicado o t este de Wilcoxon, considerando o nível de significância de p<0,05. O programa de intervenção foi eficaz n a redução de todos os indicadores antropométricos, na melhora dos níveis de aptidão cardiorrespiratória e na redução dos níveis de colesterol LDL. Entretanto, não modificou de forma significativa o s níveis de pressão arterial e demais parâmetros do perfil lipídico (colesterol total, HDL e triglicerídeos)...(AU)

: The objective of the study is to analyze the effects of an interdisciplinary in terven tion program on the cardiometabolic risk profile of adolescents diagnosed as overweight / obese. Intervention study with overweight adolescents, consisting of a control group and an intervention group, which participated in an interdisciplinary program lasting six months. The final experimental group co nsists o f 23 adolescents (12 females and 11 males). At the beginning of the program, four adolescents were overweight and 19 were obese. The control group is composed of the number of subject s, sin ce it was composed by the pairs of students in the experimental group. The intervention coun ted o n sessio n s o f physical exercises, in three days of the week and nutritional and psychological orientations, once a week . An evaluation was carried out before the start of the program and soon after its completion. The evaluations consisted of anthropometric variable - body mass index, waist circumference, waist-to-waist ratio, and waist-to-hip ratio, arterial pressure, cardiorespiratory fitness evaluation and blood collection t o evaluate the lipid profile. For the comparison of the variables in the pre- and post-intervention period, t he t-test for paired samples was used for the variables of normal distribution and fo r th e n on-parametric variables the Wilcoxon test was used, considering the level of significance of p < 0.05. The intervention program was effective in reducing all anthropometric indicators, improving cardiorespiratory fitness levels and reducing LDL cholesterol levels. However, it did not significantly modify the blood pressure levels and other parameters of the lipid profile (total cholesterol, HDL and triglycerides)...(AU)

Impact of intervention on nutritional status, consumption of processed foods, and quality of life of adolescents with excess weight.

OBJECTIVE: To evaluate the impact of a nutritional intervention on nutritional status, ultra-processed food consumption, and quality of life of adolescents with excess weight. METHODS: Experimental study with adolescent students with excess weight, divided into two groups, an intervention group and a control group. The nutritional intervention lasted six months, with an educational and motivational approach. Nutritional status (waist circumference and body mass index), quality of life, and ultra-processed food consumption were evaluated before and after the period. RESULTS: Sixty-two adolescents with overweight or obesity participated in the study, 37 in the intervention group and 25 in the control group, aged 13.2±1.5 years in intervention group, and 13.0±1.8 years in control group, both of which had a higher female participation. There were changes in the body mass index (intervention group Δ: -0.81±2.28, control group Δ: -0.64±1.28) and in the waist circumference for intervention group (Δ:-3.31±5.47). For the pre- and post-ultra-processed food consumption, there was a significant reduction in the consumption of soft drinks in the intervention group (Δ: -0.07 [-0.27 to 0.00]), instant noodles (Δ: -0.03 [-0.07 to 0.00]), and sandwich cookies (Δ: -0.06 [-0.26 to 0.00]). The quality of life increased in the intervention group and decreased in the control group, with no intra- (p=0.162) or intergroup statistical relevance in the pre- (p=0.426) and post- (0.249) intervention period, with a reduction in the emotional domain score, with a significant variation in the intervention group (pre and post; Δ: -19.0±40.6). CONCLUSION: There was a decrease in body mass index and waist circumference (central obesity being more often related to insulin resistance), reduction of ultra-processed food consumption (soft drinks, sandwich cookies, and instant noodles), and a tendency toward quality of life improvement (however, there was a decrease in the domains of emotional and school quality of life).

Health-related quality of life in adolescents with excess weight / Qualidade de vida relacionada à saúde em adolescentes com excesso de peso

Abstract Objective: To identify health-related quality of life in adolescents with excess weight and associated factors, such as gender, age, and weight categories. Method: A cross-sectional study with collected and secondary data from 276 adolescents aged between 10 and 19 years with overweight and obesity, and whose parents or guardians authorized their participation. Anthropometric data, pubertal development, and the PedsQL 4.0 questionnaire were collected for the health-related quality of life assessment. Categorical data were described as numbers and percentages. For the description of health-related quality of life subscales, medians and the 25th and 75th percentiles were used, as well as the Mann -Whitney test for comparisons between age group, gender, and weight categories. Results: The median health-related quality of life total score was 78.3 (68.5 -87.4). The lowest scale was the "emotional score", 65 (50 -80). Higher health-related quality of life was found in boys in most of the scores (p < 0.05), except for the "school score" (p = 0.09). Regarding the age group, the median of the "physical scores" (p = 0.03) and "social score" (p = 0.02) were significantly lower in the group younger than 14 years. When separated according to weight categories, it was verified that obese adolescents differed significantly in relation to the "physical score" (p = 0.00), "school score" (p = 0.04), and "total score" (p = 0.02) of the health-related quality of life. However, there was no significant difference between the emotional, social, and psychosocial scores. Conclusions: Adolescents with overweight and obesity show losses in the health-related quality of life and also between the different domains, when separated by age, gender, and weight categories.

Resumo Objetivo: Identificar a qualidade de vida relacionada à saúde entre adolescentes com excesso de peso e fatores associados, como gênero, idade e categorias de peso. Método: Estudo transversal com dados coletados e secundários de 276 adolescentes entre 10 e 19 anos, com sobrepeso e obesidade, cujos responsáveis autorizaram a participação. Foram coletados dados antropométricos, desenvolvimento puberal e questionário PedsQL 4.0 para a avaliação da qualidade de vida relacionada à saúde. Os dados categóricos foram descritos por contagens e percentuais. Para a descrição das subescalas da qualidade de vida relacionada à saúde foram usadas medianas e percentis 25 e 75 e teste de Mann-Whitney para comparações entre grupos de faixa etária, gênero e categorias de peso. Resultados: A mediana do escore total da qualidade de vida relacionada à saúde foi de 78,3 (68,5-87,4). A menor escala foi o "escore emocional" 65 (50-80). Encontramos a qualidade de vida relacionada à saúde maior nos meninos na maioria dos escores (p < 0,05), exceto o "escore escolar" (p = 0,09). Quanto à faixa etária, a mediana dos "escores físico" (p = 0,03) e "escore social" (p = 0,02) foram significativamente menores no grupo menor de 14 anos. Ao separar as categorias de peso, percebe-se que os adolescentes obesos diferem significativamente com relação ao "escore físico" (p = 0,00); "escore escolar" (p = 0,04) e "escore total" (p = 0,02) da qualidade de vida relacionada à saúde. Contudo, não houve diferença significativa entre os escores emocional, social e psicossocial. Conclusões: Adolescentes com sobrepeso e obesidade têm prejuízos na qualidade de vida relacionada à saúde e também entre os diferentes domínios, quando separados por faixa etária, gênero e categorias de peso.

Health-related quality of life in adolescents with excess weight.

OBJECTIVE: To identify health-related quality of life in adolescents with excess weight and associated factors, such as gender, age, and weight categories. METHOD: A cross-sectional study with collected and secondary data from 276 adolescents aged between 10 and 19 years with overweight and obesity, and whose parents or guardians authorized their participation. Anthropometric data, pubertal development, and the PedsQL 4.0 questionnaire were collected for the health-related quality of life assessment. Categorical data were described as numbers and percentages. For the description of health-related quality of life subscales, medians and the 25th and 75th percentiles were used, as well as the Mann-Whitney test for comparisons between age group, gender, and weight categories. RESULTS: The median health-related quality of life total score was 78.3 (68.5-87.4). The lowest scale was the "emotional score", 65 (50-80). Higher health-related quality of life was found in boys in most of the scores (p<0.05), except for the "school score" (p=0.09). Regarding the age group, the median of the "physical scores" (p=0.03) and "social score" (p=0.02) were significantly lower in the group younger than 14 years. When separated according to weight categories, it was verified that obese adolescents differed significantly in relation to the "physical score" (p=0.00), "school score" (p=0.04), and "total score" (p=0.02) of the health-related quality of life. However, there was no significant difference between the emotional, social, and psychosocial scores. CONCLUSIONS: Adolescents with overweight and obesity show losses in the health-related quality of life and also between the different domains, when separated by age, gender, and weight categories.

Genetic risk score based on fat mass and obesity-associated, transmembrane protein 18 and fibronectin type III domain containing 5 polymorphisms is associated with anthropometric characteristics in South Brazilian children and adolescents.

The prevalence of childhood obesity has increased worldwide. Although it is considered a polygenic inheritance disease, little is known about its susceptibility when the additive effect is considered. The aim of this study is to investigate whether the genetic risk score (GRS) based on previously associated obesity polymorphisms (SNP) rs9939609 (fat mass and obesity-associated (FTO)), rs6548238 (transmembrane protein 18 (TMEM18)) and rs16835198 (fibronectin type III domain containing 5 (FNDC5)) could serve as a predictor for anthropometric characteristics in a sample of Brazilian children and adolescents. This is a cross-sectional study with 1471 children and adolescents aged 6-17 years. BMI, waist circumference (WC) and percentage of body fat and metabolic parameters were verified. In all, three SNP were genotyped by TaqMan™ allelic discrimination. The metabolic and anthropometric parameters were compared between the genotypes, and the unweighted and weighted GRS (GRS and wGRS, respectively) were created to test the additive effect of these genetic polymorphisms on anthropometric parameters. The prevalence of overweight plus obesity was 41 %. Significant associations were identified for FTO rs9939609, TMEM18 rs6548238 and FNDC5 rs16835198 and for GRS and wGRS with anthropometric phenotypes. The higher score of wGRS was associated with obesity (OR: 2·65, 95 % CI 1·40, 5·04, P=0·003) and with greater WC (OR: 2·91, 95 % CI 1·57, 5·40, P=0·001). Our results suggest that these genetic variants contribute to obesity susceptibility in children and adolescents and reinforce the idea that the additive effect may be useful to elucidate the genetic component of obesity.