Community violence in neighborhoods and common mental disorders among Brazilian adolescents.

BACKGROUND: This study aims to explore the association between exposure to neighborhood violence and the presence of common mental disorders (CMDs) among Brazilian adolescents aged 12 to 17 years. Additionally, we aim to analyze whether sex, age and race are modifiers of the effect of this association. METHODS: The study comprised 1,686 adolescents residing in the municipality of Rio de Janeiro, situated in the Southeast region of Brazil. To measure exposure to community violence, we constructed three crime indicators using data from Civil Police of the State of Rio de Janeiro: crimes against property, nonlethal crimes, and lethal crimes. Employing geospatial analysis based on the adolescents' residence location, logistic regression modeling was performed to measure the association between violence and CMDs. RESULTS: Adolescents living in regions with higher rates of the three types of violence studied herein were more likely to have CMDs, with odds ratios (ORs) ranging from 2.33 to 2.99. When stratified by sex, age and race, girls, older adolescents and blacks have a greater magnitude of effect on the measure of association, indicating a heightened risk for CMDs. CONCLUSION: This study provides important contributions to the public health field, as it reveals new information on the influence of community violence on the mental health of adolescents. Given the elevated rates of violence globally, knowing the effects of such violence on adolescents becomes crucial for the prevention and treatment of CMDs within this population.

Registration with Primary Health Care and COVID-19 mortality: cohort of diabetics from five administrative health regions in the city of Rio de Janeiro, Brazil, 2020-2021. / Cadastro na Atenção Primária e mortalidade por COVID-19: coorte de diabéticos de cinco regiões administrativas de saúde do município do Rio de Janeiro, 2020­2021.

OBJECTIVE: The present study carried out an analysis of survival according to the status of registration with Primary Health Care (PHC) and of factors associated with death from COVID-19, in cases residing in Programmatic Area 3.1 (PA3.1) with a diagnosis of diabetes (in the notification form or in the electronic medical record), of the Municipality of Rio de Janeiro (RJ), Brazil, in 2020-2021. METHODS: A probabilistic linkage of databases was performed based on information on cases notified as COVID-19 and data from the electronic medical records of people living with diabetes. A survival analysis was carried out, using the Cox regression model stratified by age group and adjusted for confounding variables. RESULTS: Individuals registered with the PHC of PA3.1 had almost twice the risk of death from COVID-19 (adjusted hazard ratio [HRadj]=1.91) when compared to those unregistered. This association was stronger in individuals aged 18 to 59 years registered with the PHC (HRadj=2.82) than in individuals aged 60 years or over (HRadj=1.56). CONCLUSION: Surveillance strategies for identifying and adequately monitoring higher-risk groups, among individuals living with diabetes, within the scope of Primary Health Care, can contribute to reducing mortality from COVID-19.

OBJETIVO: O presente estudo realizou uma análise de sobrevivência segundo situação de cadastro na Atenção Primária à Saúde (APS) e de fatores associados ao óbito por COVID-19, nos casos residentes da Área Programática 3.1 (AP3.1) com diagnóstico de diabetes (na ficha de notificação ou no prontuário eletrônico) do município do Rio de Janeiro, em 2020­2021. MÉTODOS: Foi realizado relacionamento probabilístico de bases de dados com base nas informações dos casos notificados por COVID-19 e dos dados de prontuário eletrônico de pessoas que vivem com diabetes. Conduziu-se uma análise de sobrevivência, utilizando-se o modelo de regressão de Cox estratificado por faixa etária e ajustando-se por variáveis confundidoras. RESULTADOS: Verificou-se que indivíduos cadastrados na APS da AP3.1 possuíam risco quase duas vezes maior de óbito por COVID-19 (hazard ratio ajustada ­ HRaj=1,91) quando comparados aos não cadastrados na APS da AP3.1. Essa associação foi mais forte naqueles com 18 a 59 anos, cadastrados na APS (HRaj=2,82), do que nos de 60 anos ou mais (HRaj=1,56). CONCLUSÃO: Estratégias de vigilância para a identificação e acompanhamento adequado de grupos de maior risco de mortalidade, dentre indivíduos que vivem com DM, no âmbito da APS podem contribuir para a redução da mortalidade em decorrência da COVID-19.

Asma em adolescentes: o que o estudo ERICA nos mostrou? / Asthma in adolescents: what did ERICA study show us?

A asma é uma doença heterogênea caracterizada pela história de sintomas respiratórios que variam de intensidade e ao longo do tempo. Devido à sua alta prevalência, constitui um problema mundial de saúde pública, atingindo todas as faixas etárias, em especial crianças e adolescentes. O objetivo deste artigo foi analisar as produções científicas sobre asma baseadas no Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). Trata-se de uma revisão narrativa incluindo os artigos originais sobre asma baseados nos dados do ERICA, publicados em periódicos indexados em inglês e português. O ERICA foi um estudo multicêntrico nacional realizado em 2013 e 2014, que investigou a prevalência de asma e fatores de risco cardiovascular, incluindo obesidade, diabetes mellitus, hipertensão arterial sistêmica, dislipidemia, tabagismo, sedentarismo, hábitos alimentares inadequados, e a associação entre esses fatores, em adolescentes de 12 a 17 anos, estudantes de escolas públicas e privadas de municípios brasileiros com mais de 100.000 habitantes. Nos cinco estudos selecionados, foi possível demonstrar que a prevalência de asma foi significativamente maior entre adolescentes do sexo feminino em todas as capitais e macrorregiões do Brasil, com predomínio da doença na região Sudeste do nosso país. Além disso, a asma esteve fortemente associada ao tabagismo (passivo e ativo) e foi associada à duração curta do sono. Por outro lado, não esteve associada com os níveis séricos de vitamina D. Em relação aos parâmetros metabólicos, foi observado que a síndrome metabólica e alguns de seus componentes, como a circunferência abdominal, estiveram significativamente associados à asma grave em adolescentes brasileiros.

Asthma is a heterogeneous disease characterized by a history of respiratory symptoms that vary in intensity and over time. Due to its high prevalence, asthma is considered a global public health problem affecting all age groups, especially children and adolescents. This study aimed to analyze scientific papers on asthma based on the Study of Cardiovascular Risks in Adolescents (ERICA). We provide a narrative review of original articles on asthma based on ERICA data published in indexed journals in English and Portuguese. ERICA was a national multicenter study conducted in 2013 and 2014 that investigated the prevalence of asthma and cardiovascular risk factors, including obesity, diabetes mellitus, systemic arterial hypertension, dyslipidemia, smoking, sedentary lifestyle, and inadequate eating habits, and the association between these factors in adolescents aged 12 to 17 years, students from public and private schools in Brazilian cities of more than 100,000 population. In the 5 selected studies, the prevalence of asthma was significantly higher in female adolescents in all capitals and macro-regions of Brazil, occurring predominantly in the southeast region of the country. In addition, asthma was strongly associated with smoking (passive and active) as well as with short sleep duration, but not with serum vitamin D levels. Regarding metabolic parameters, metabolic syndrome and some of its components, such as waist circumference, were significantly associated with severe asthma in Brazilian adolescents.

Association between polyunsaturated fatty acids intake and insulin resistance in Brazilian adolescents (ERICA Study).

OBJECTIVE: Some studies have proposed a beneficial effect of polyunsaturated fatty acid (PUFA) intake with regard to insulin sensitivity. The aim of this study was to estimate the energy percentage and the daily PUFA intake to investigate the association between PUFAs and insulin resistance in a large sample of Brazilian adolescents. METHODS: We evaluated 37 023 adolescents ages 12 to 17 y, who were participants in ERICA (Study of Cardiovascular Risk in Adolescents). Energy percentage and PUFA daily intake were extracted from a 24-h dietary recall. The mean daily intake of total fat, median, and the respective 95% confidence intervals (95% CI) of daily intake of linoleic acid (LA), α-linolenic acid (ALA) and the ratio of LA to ALA were estimated according to sociodemographic variables. Associations of PUFA and markers of glucose homeostasis were analyzed by Poisson regression model. RESULTS: Mean total fat intake was 30.1% of energy (95% CI, 29.9-30.4). Most participants met the current recommended values of PUFA and LA/ALA ratio ranging from 5:1 to 10:1 (80.9%, 95% CI, 79.8-81.8). ALA intake was inversely associated with higher waist circumference (prevalence ratio [PR], 0.996; 95% CI, 0.994-0.998). LA/ALA ratio ≥9:1 was significantly associated with higher levels of homeostasis model assessment of insulin resistance (HOMA-IR; PR, 1.01; 95% CI, 1.006-1.02), and ratio >10:1 also showed significant association with higher levels of HOMA-IR (PR, 1.02; 95% CI, 1.01-1.03) and glycated hemoglobin (PR, 1.14; 95% CI, 1.04-1.26). These associations remained significant after adjustment. CONCLUSION: Promotion of ALA intake and balanced LA/ALA ratio should be considered as a possible health strategy aimed at contributing to better control of glucose homeostasis and insulin resistance in adolescents.

Cadastro na Atenção Primária e mortalidade por COVID-19: coorte de diabéticos de cinco regiões administrativas de saúde do município do Rio de Janeiro, 2020-2021 / Registration with Primary Health Care and COVID-19 mortality: cohort of diabetics from five administrative health regions in the city of Rio de Janeiro, Brazil, 2020-2021

RESUMO Objetivo: O presente estudo realizou uma análise de sobrevivência segundo situação de cadastro na Atenção Primária à Saúde (APS) e de fatores associados ao óbito por COVID-19, nos casos residentes da Área Programática 3.1 (AP3.1) com diagnóstico de diabetes (na ficha de notificação ou no prontuário eletrônico) do município do Rio de Janeiro, em 2020-2021. Métodos: Foi realizado relacionamento probabilístico de bases de dados com base nas informações dos casos notificados por COVID-19 e dos dados de prontuário eletrônico de pessoas que vivem com diabetes. Conduziu-se uma análise de sobrevivência, utilizando-se o modelo de regressão de Cox estratificado por faixa etária e ajustando-se por variáveis confundidoras. Resultados: Verificou-se que indivíduos cadastrados na APS da AP3.1 possuíam risco quase duas vezes maior de óbito por COVID-19 (hazard ratio ajustada — HRaj=1,91) quando comparados aos não cadastrados na APS da AP3.1. Essa associação foi mais forte naqueles com 18 a 59 anos, cadastrados na APS (HRaj=2,82), do que nos de 60 anos ou mais (HRaj=1,56). Conclusão: Estratégias de vigilância para a identificação e acompanhamento adequado de grupos de maior risco de mortalidade, dentre indivíduos que vivem com DM, no âmbito da APS podem contribuir para a redução da mortalidade em decorrência da COVID-19.

ABSTRACT Objective: The present study carried out an analysis of survival according to the status of registration with Primary Health Care (PHC) and of factors associated with death from COVID-19, in cases residing in Programmatic Area 3.1 (PA3.1) with a diagnosis of diabetes (in the notification form or in the electronic medical record), of the Municipality of Rio de Janeiro (RJ), Brazil, in 2020-2021. Methods: A probabilistic linkage of databases was performed based on information on cases notified as COVID-19 and data from the electronic medical records of people living with diabetes. A survival analysis was carried out, using the Cox regression model stratified by age group and adjusted for confounding variables. Results: Individuals registered with the PHC of PA3.1 had almost twice the risk of death from COVID-19 (adjusted hazard ratio [HRadj]=1.91) when compared to those unregistered. This association was stronger in individuals aged 18 to 59 years registered with the PHC (HRadj=2.82) than in individuals aged 60 years or over (HRadj=1.56). Conclusion: Surveillance strategies for identifying and adequately monitoring higher-risk groups, among individuals living with diabetes, within the scope of Primary Health Care, can contribute to reducing mortality from COVID-19.

Comparison of Quality of Carbohydrate Metrics Related to Fasting Insulin, Glycosylated Hemoglobin and HOMA-IR in Brazilian Adolescents.

Low glycemic index (GI) and glycemic load (GL) diets are effective for glycemic control (GC) associated with a carbohydrate-controlled meal plan. However, whether GI and GL peaks are related to GC is unknown. Objective: To compare the daily GI (DGI)/GL (DGL) and average GI (AvGI)/GL (AvGL) of meals (accounting for peaks) related to GC markers (GCM) in Brazilian adolescents. Methods: A representative national school-based (public/private) sample of students without diabetes, 12−17 years of age, was evaluated. Food intake was based on a 24 h recall. The models for complex cluster sampling were adjusted (sex, sexual maturation, age, and physical activity). Results: Of 35,737 students, 74% were from public schools, 60% girls, 17% overweight, and 8% obese. The minimum DGI and DGL were observed at lunch, with higher values at night. Fasting insulin was 1.5 times higher in overweight/obese (OW) girls, and 1.7 times higher in OW boys than in normal-weight (NW) girls. The same trend was observed for the homeostatic model assessment for insulin resistance (HOMA-IR) (OW = 2.82 vs. NW = 1.84 in girls; OW = 2.66 vs. NW = 1.54 in boys; p < 0.05). The daily and average metrics were greater for NW adolescents. Glycosylated hemoglobin was not associated with these metrics, except for AvGL. Insulin and HOMA-IR were associated with all metrics in NW adolescents, with greater coefficients associated with AvGL. Among overweight/obese adolescents, only GI metrics were associated (ß = 0.23; AvGI and insulin) and appeared to have the best association with GCM. Conclusions: Among NW adolescents, GL is a better measure of carbohydrate quality, but for those with overweight/obesity, carbohydrate consumption is more associated with GC, probably because they eat/report small amounts of carbohydrates.

Reference values for the tri-ponderal mass index and its association with cardiovascular risk factors in Brazilian adolescents aged 12 to 17 years.

OBJECTIVES: The aims of this study was to determine the cutoff values for tri-ponderal mass index (TMI) and investigate the association between overweight/obesity as classified by TMI and cardiometabolic risk factors in Brazilian adolescents aged 12 to 17 y. METHODS: This was a cross-sectional study comprising 37 815 adolescents (40 % boys; 12-17 y) enrolled in the Study of Cardiovascular Risks in Adolescents. TMI was calculated as weight divided by cubed height (kg/m3). Overweight (TMI-for-age ≥85th percentile to <95th percentile) and obesity (TMI-for-age ≥95th percentile) were determined for both sexes. Poisson regression model analyses were used to test associations. RESULTS: TMI was stable across the age span (12-17 y) in both sexes. Boys and girls classified by TMI as obese had higher prevalence ratios (PR) for hypertension (PR, 4.98; 95% confidence interval [CI], 3.26-7.61 for boys; PR, 6.88; 95% CI, 3.70-12.78 for girls), insulin resistance (PR, 19.72; 95% CI, 13.56-28.69 for boys; PR, 10.04; 95% CI, 7.47-13.50 for girls), hypercholesterolemia (PR,5.05; 95% CI, 3.68-6.94 for boys; PR, 1.44; 95% CI, 1.00-2.11 for girls), and hypertriacylglycerolemia (PR,7.36; 95% CI, 5.16-10.50 for boys; PR, 3.37; 95% CI, 2.52-4.51 for girls) when compared with normal weight counterparts. CONCLUSIONS: Obesity, as classified by TMI, was strongly associated with several cardiovascular risk factors. Our data showed that TMI was stable across the age span. Therefore, a fixed cutoff value to determine weight status in Brazilian adolescents seems appropriate.

Risk factors in adolescents as predictors of arterial hypertension in adults: Protocol for a systematic review.

This is a protocol of a review paper, and there is no abstract. This review is part of a doctoral project that aims to develop a discrete event simulation model to predict how many adolescents may become hypertensive in adulthood. We will use data from the Brazilian study of cardiovascular risks in adolescents, called ERICA (Portuguese acronym). This study may help promote adherence to disease prevention protocols.

Association between asthma and sleep hours in Brazilian adolescents: ERICA

Abstract Objective To investigate the association between asthma and sleep duration in participants of the Study of Cardiovascular Risks in Adolescents. Materials and methods Cross-sectional, national, school-based study, involving adolescents aged 12-17 years. In the period between 2013−14, data from 59,442 participants were analyzed. Bivariate analysis between current asthma and short sleep duration, defined as < 7 h/night, was performed separately with the other variables analyzed: sex, age group, type of school, weight categories, and common mental disorders. Then, different generalized linear models with Poisson family and logarithmic link functions were used to assess the independence of potential confounding covariates associated with both asthma and short sleep duration in the previous analysis. Crude and adjusted prevalence ratios and respective 95% confidence intervals were calculated, and a value of p < 0.05 was considered significant for all analyses performed. Results Prevalence of current asthma was 13.4%, being significantly higher among students with short sleep duration (PR: 1.17; 95% CI: 1.01-1.35; p = 0.034). This remained significant even after adjusting for the other study covariates. Conclusion There was a positive association between the prevalence of current asthma and short sleep duration among Brazilian adolescents. Considering the high prevalence and morbidity of the disease in this age group, the promotion of sleep hygiene should be considered as a possible health strategy aimed at contributing to better control of asthma in this population.

Association between anthropometric measures and insulin resistance in Brazilian adolescents: data from the national study of cardiovascular risk factors in adolescents - ERICA.

OBJECTIVES: To evaluate anthropometric measures (AM) and insulin resistance (IR) association in adolescents aged 12-17 years and investigates how body mass index (BMI) interrelates with specific indicators of fat distribution in this association. METHODS: This analysis is from the Study of Cardiovascular Risks in Adolescents (ERICA) study, a national, cross-sectional study. AM was categorized by quartiles, and their means and 95% confidence intervals (95% CI) were estimated. The prevalence of IR was estimated for each AM according to the quartiles. The associations between AM and homeostatic model assessment of insulin resistance (HOMA-IR) levels were analyzed using Poisson models. RESULTS: 37,892 adolescents were included. IR prevalence tended to increase as quartiles increased for each AM. The association of BMI with IR persisted with the adjustment for others AM. The greatest reduction in the association's strength was achieved with the adjustment by the waist circumference (WC) and the waist-to-height ratio (WHtR). Most other AM were also associated with IR. CONCLUSION: AM has a positive association with the prevalence of IR, and the joint effect of BMI and central adiposity measures should be considered in cardiometabolic risk evaluation in adolescents.

Association between asthma and sleep hours in Brazilian adolescents: ERICA.

OBJECTIVE: To investigate the association between asthma and sleep duration in participants of the Study of Cardiovascular Risks in Adolescents. MATERIALS AND METHODS: Cross-sectional, national, school-based study, involving adolescents aged 12-17 years. In the period between 2013-14, data from 59,442 participants were analyzed. Bivariate analysis between current asthma and short sleep duration, defined as < 7 h/night, was performed separately with the other variables analyzed: sex, age group, type of school, weight categories, and common mental disorders. Then, different generalized linear models with Poisson family and logarithmic link functions were used to assess the independence of potential confounding covariates associated with both asthma and short sleep duration in the previous analysis. Crude and adjusted prevalence ratios and respective 95% confidence intervals were calculated, and a value of p < 0.05 was considered significant for all analyses performed. RESULTS: Prevalence of current asthma was 13.4%, being significantly higher among students with short sleep duration (PR: 1.17; 95% CI: 1.01-1.35; p = 0.034). This remained significant even after adjusting for the other study covariates. CONCLUSION: There was a positive association between the prevalence of current asthma and short sleep duration among Brazilian adolescents. Considering the high prevalence and morbidity of the disease in this age group, the promotion of sleep hygiene should be considered as a possible health strategy aimed at contributing to better control of asthma in this population.

Neighborhood physical disorder and common mental disorders in adolescence.

OBJECTIVE: The aim of this study is to estimate the association between observed indicators of neighborhood physical disorder and common mental disorders in adolescents. METHODS: The study population included 2506 adolescents from three Brazilian state capitals (Rio de Janeiro, Porto Alegre, and Fortaleza) who participated in the Cardiovascular Risk Study in Adolescents (ERICA), a cross-sectional school-based study conducted in 2013-2014. Common mental disorders were assessed using the 12-item General Health Questionnaire. Measures of neighborhood physical disorder were based on the 2010 Brazilian census data and were derived using principal component analysis. RESULTS: Although associations were found between some exposure components and CMD, there were no clear or consistent trends across exposure quartiles. CONCLUSION: Overall, there was no evidence of an association between observed indicators of neighborhood physical disorder and common mental disorders. Future studies should explore alternative tools for measuring neighborhood physical disorder to minimize the likelihood of exposure misclassification.

[Association between sharing meals with parents or guardians and obesity in Brazilian adolescents]. / Associação entre realização de refeições com os pais ou responsáveis e obesidade em adolescentes brasileiros.

The study aimed to analyze the association between sharing lunch or supper with parents/guardians and obesity in Brazilian adolescents participating in the Study of Cardiovascular Risk Factors in Adolescents (ERICA in Portuguese). This was a cross-sectional, school-based study with adolescents 12 to 17 years of age. Obesity was classified by body mass index based on World Health Organization criteria, according to age and sex. The association between obesity and sharing lunch and supper with parents/guardians (never, sometimes, almost every day, and every day) was analyzed according to crude and sex- and age-adjusted prevalence ratios. A total of 71,740 adolescents were assessed. Of these, 48% and 60% of girls and 56% and 65% of boys, respectively, shared lunch and supper every day or nearly every day. Boys who shared lunch and supper with their parents/guardians nearly every day and every day showed lower prevalence of obesity. Stratified by age bracket, only younger boys that ate lunch with their parents/guardians sometimes (PR = 0.64; 95%CI: 0.46-0.89), nearly every day (PR = 0.50; 95%CI: 0.37-0.69), and every day (PR = 0.65; 95%CI: 0.49-0.85) and supper with their parents/guardians every day (PR = 0.61; 95%CI: 0.43-0.87) showed lower prevalence of obesity. The findings highlight the importance of promoting healthy eating behaviors in the family setting as part of strategies to prevent obesity in adolescents.

Association Between Abdominal Waist Circumference and Blood Pressure In Brazilian Adolescents With Normal Body Mass Index: Waist circumference and blood pressure in Adolescents.

Obesity is the most common chronic disease in adolescents. In adults, waist circumference (WC) is associated with the presence of cardiovascular risk factors and is also a better predictor of cardiovascular (CV) risk than body mass index (BMI). The association between WC and CV risk factors in adolescents has been poorly explored so far, mainly in those within the normal BMI range. Objective: To evaluate the association between WC and elevated blood pressure (BP) in adolescents with a normal BMI. Methods: Cross-sectional analysis of 73,399 scholars between 12 and 17 years old from the ERICA study, a school-based, national representative study with Brazilian adolescents. Only those within the normal range of BMI were included. The WC was categorized into quartiles for sex and age (Q1 to Q4). For the analysis, BP values ≥ 90th percentile were considered to indicate elevated BP, what includes hypertension and pre-hypertension. The Poisson Regression model was used and the prevalence ratio was estimated. Results: A total of 53,308 adolescents with normal BMI were included. Prevalence of elevated BP in the overall group was 18.0%. In female adolescents with WC in the lowest quartile for their age, the prevalence of elevated BP was 7.3% (12-14 years) and 6.9% (15-17 years), increasing in the upper quartile to 15.2% and 19.5% respectively, with a prevalence ratio (PR) indicating chance at least two times higher for elevated BP in Q4 (p < 0.001). Similarly, this was observed in boys, with a prevalence of elevated BP of 10.0% and 18.9% in Q1, increasing to 21.4% and 49.6% in Q4 (p < 0.001). Conclusion: In adolescents, there is a strong association of increased WC with BP elevation, even when the BMI is adequate.

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

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

Blood pressure reference values for Brazilian adolescents: data from the Study of Cardiovascular Risk in Adolescents (ERICA Study) / Valores de referência para pressão arterial em adolescentes brasileiros: dados do Estudo dos Riscos Cardiovasculares em Adolescentes (Estudo ERICA)

Abstract Objective: Blood pressure (BP) references for Brazilian adolescents are lacking in the literature. This study aims to investigate the normal range of office BP in a healthy, non-overweight Brazilian population of adolescents. Method: The Brazilian Study of Cardiovascular Risks in Adolescents (Portuguese acronym "ERICA") is a national school-based study that included adolescents (aged 12 through 17 years), enrolled in public and private schools, in cities with over 100,000 inhabitants, from all five Brazilian macro-regions. Adolescents' height and body mass index (BMI) were classified in percentiles according to age and gender, and reference curves from the World Health Organization were adopted. Three consecutive office BP measurements were taken with a validated oscillometric device using the appropriate cuff size. The mean values of the last two readings were used for analysis. Polynomial regression models relating BP, age, and height were applied. Results: Among 73,999 adolescents, non-overweight individuals represented 74.5% (95% CI: 73.3-75.6) of the total, with similar distribution across ages. The majority of the non-overweight sample was from public schools 84.2% (95% CI: 79.9-87.7) and sedentary 54.8% (95% CI: 53.7-55.8). Adolescents reporting their skin color as brown (48.8% [95% CI: 47.4-50.1]) or white (37.8% [95% CI: 36.1-39.5]) were most frequently represented. BP increased by both age and height percentile. Systolic BP growth patterns were more marked in males when compared to females, along all height percentiles. The same pattern was not observed for diastolic BP. Conclusions: Blood pressure references by sex, age, and height percentiles for Brazilian adolescents are provided.

Resumo Objetivo Referências de pressão arterial (PA) para adolescentes brasileiros estão ausentes na literatura. Este estudo tem como objetivo investigar a variação normal da pressão arterial no consultório em uma população brasileira saudável de adolescentes sem sobrepeso. Método O Estudo dos Riscos Cardiovasculares em Adolescentes (ERICA) é um estudo brasileiro, de âmbito nacional e de base escolar, que incluiu adolescentes (12 a 17 anos) matriculados em escolas públicas e privadas, em cidades com mais de 100.000 habitantes, de todas as cinco macrorregiões brasileiras. A altura e o índice de massa corporal (IMC) dos adolescentes foram classificados em percentis de acordo com a idade e o sexo, sendo adotadas as curvas de referência da Organização Mundial de Saúde. Foram realizadas três medidas consecutivas de PA no consultório com um dispositivo oscilométrico validado, utilizando o manguito de tamanho apropriado. Os valores médios das duas últimas leituras foram utilizados nas análises. Modelos de regressão polinomial relacionando PA, idade e estatura foram aplicados. Resultados Entre os 73.999 adolescentes, os indivíduos sem sobrepeso representaram 74,5% (IC95%: 73,3-75,6) do total, com distribuição similar entre as idades. A maior parte da amostra sem sobrepeso originava-se das escolas públicas, com 84,2% (IC95%: 79,9-87,7), e os sedentários 54,8% (IC95%: 53,7-55,8). Os adolescentes que relataram sua cor de pele como parda (48,8% [IC95%: 47,4-50,1]) e branca (37,8%: [IC 95% 36,1-39,5]) foram os mais representados. A PA aumentou tanto com a idade, quanto com o percentil de altura. Os padrões de aumento sistólico da PA foram mais acentuados no sexo masculino quando comparados ao sexo feminino, em todos os percentis de altura. O mesmo padrão não foi observado para a PA diastólica. Conclusões São fornecidas referências de pressão arterial por sexo, idade e percentil de altura para adolescentes brasileiros.

Prevalence and factors associated with hypovitaminosis D in adolescents from a sunny country: Findings from the ERICA survey.

Vitamin D plays a role in bone and metabolic health in life long, however hypovitaminosis D is common in different settings. The aim of this study was to describe vitamin D status among adolescents from a large sunny country and analyze associated factors. This was a multicenter, cross-sectional, school-based study. A total of 1152 adolescents age 12-17 from four Brazilian cities, Rio de Janeiro, Fortaleza, Brasília, and Porto Alegre, were included. Anthropometric variables, diet, type of school, race and season of data collection were evaluated. Serum concentrations of 25-hydroxyvitamin D [25(OH)D] were measured and categorized into three levels: ≤ 20 ng/mL, 21-29 ng/mL and ≥ 30 ng/mL. Ordered logistic regression models were used to explore the factors associated with hypovitaminosis D. The prevalence of vitamin D levels below 20 ng/mL, between 21 and 29 ng/mL and above 30 ng/mL was 21 % (95 %CI: 19 %-24 %), 42 % (95 %CI: 39 %-46 %) and 37 % (95 %CI: 33 %-40 %), respectively. In the final adjusted model, hypovitaminosis D was positively associated with gender, center (latitudes), data collected in winter or spring, non-whites, and private school students. A higher proportional odds ratio (POR) for hypovitaminosis D was found among obese boys (POR = 2.2, 95 %CI: 1.1-4.5), but not girls. Adequate dietary intake of vitamin D was a protective factor (POR = 0.4, 95 %CI: 0.2-0.6) against hypovitaminosis D. In conclusion, there is a high prevalence of Brazilian adolescents at risk of hypovitaminosis D, independent of region. Due to their potential benefits, lifestyle changes should be stimulated, including healthier food choices and spending more time outdoors (with sun protection).

Blood pressure reference values for Brazilian adolescents: data from the Study of Cardiovascular Risk in Adolescents (ERICA Study).

OBJECTIVE: Blood pressure (BP) references for Brazilian adolescents are lacking in the literature. This study aims to investigate the normal range of office BP in a healthy, non-overweight Brazilian population of adolescents. METHOD: The Brazilian Study of Cardiovascular Risks in Adolescents (Portuguese acronym "ERICA") is a national school-based study that included adolescents (aged 12 through 17 years), enrolled in public and private schools, in cities with over 100,000 inhabitants, from all five Brazilian macro-regions. Adolescents' height and body mass index (BMI) were classified in percentiles according to age and gender, and reference curves from the World Health Organization were adopted. Three consecutive office BP measurements were taken with a validated oscillometric device using the appropriate cuff size. The mean values of the last two readings were used for analysis. Polynomial regression models relating BP, age, and height were applied. RESULTS: Among 73,999 adolescents, non-overweight individuals represented 74.5% (95% CI: 73.3-75.6) of the total, with similar distribution across ages. The majority of the non-overweight sample was from public schools 84.2% (95% CI: 79.9-87.7) and sedentary 54.8% (95% CI: 53.7-55.8). Adolescents reporting their skin color as brown (48.8% [95% CI: 47.4-50.1]) or white (37.8% [95% CI: 36.1-39.5]) were most frequently represented. BP increased by both age and height percentile. Systolic BP growth patterns were more marked in males when compared to females, along all height percentiles. The same pattern was not observed for diastolic BP. CONCLUSIONS: Blood pressure references by sex, age, and height percentiles for Brazilian adolescents are provided.

Associação entre realização de refeições com os pais ou responsáveis e obesidade em adolescentes brasileiros / Association between sharing meals with parents or guardians and obesity in Brazilian adolescents / Asociación entre realización de comidas con los padres o tutores y obesidad en adolescentes brasileños

Resumo: O objetivo do trabalho foi analisar a associação da frequência de almoçar e jantar com os pais/responsáveis e obesidade em adolescentes brasileiros participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). Estudo seccional, de base escolar, com adolescentes de 12 a 17 anos. A obesidade foi classificada pelo índice de massa corporal baseado nos critérios da Organização Mundial da Saúde, segundo idade e sexo. A associação entre obesidade e almoço e jantar com os pais/responsáveis (nunca, às vezes, quase todos os dias e todos os dias) foi investigada pela razão de prevalência bruta e ajustada para estratos de sexo e faixa etária. Foram avaliados 71.740 adolescentes. Desses, almoçavam e jantavam com os pais/responsáveis todos os dias ou quase todos os dias, respectivamente, cerca de 48% e 60% das meninas e 56% e 65% dos meninos. Os meninos que almoçavam e jantavam com os pais/responsáveis quase todos os dias e todos os dias apresentaram menor prevalência de obesidade. Na estratificação por faixa etária, apenas os meninos mais novos que afirmaram almoçar com os pais/responsáveis às vezes (RP = 0,64; IC95%: 0,46-0,89), quase todos os dias (RP = 0,50; IC95%: 0,37-0,69) e todos os dias (RP = 0,65; IC95%: 0,49-0,85) e jantar com os pais/responsáveis todos os dias (RP = 0,61; IC95%: 0,43-0,87) apresentaram menor prevalência de obesidade. Os achados reforçam a importância da promoção de comportamentos alimentares saudáveis no ambiente familiar como parte das estratégias de prevenção da obesidade em adolescentes.

Abstract: The study aimed to analyze the association between sharing lunch or supper with parents/guardians and obesity in Brazilian adolescents participating in the Study of Cardiovascular Risk Factors in Adolescents (ERICA in Portuguese). This was a cross-sectional, school-based study with adolescents 12 to 17 years of age. Obesity was classified by body mass index based on World Health Organization criteria, according to age and sex. The association between obesity and sharing lunch and supper with parents/guardians (never, sometimes, almost every day, and every day) was analyzed according to crude and sex- and age-adjusted prevalence ratios. A total of 71,740 adolescents were assessed. Of these, 48% and 60% of girls and 56% and 65% of boys, respectively, shared lunch and supper every day or nearly every day. Boys who shared lunch and supper with their parents/guardians nearly every day and every day showed lower prevalence of obesity. Stratified by age bracket, only younger boys that ate lunch with their parents/guardians sometimes (PR = 0.64; 95%CI: 0.46-0.89), nearly every day (PR = 0.50; 95%CI: 0.37-0.69), and every day (PR = 0.65; 95%CI: 0.49-0.85) and supper with their parents/guardians every day (PR = 0.61; 95%CI: 0.43-0.87) showed lower prevalence of obesity. The findings highlight the importance of promoting healthy eating behaviors in the family setting as part of strategies to prevent obesity in adolescents.

Resumen: El objetivo del estudio fue analizar la asociación de la frecuencia de comer y cenar con los padres/tutores y la obesidad en adolescentes brasileños participantes del Estudio de Riesgos Cardiovasculares en Adolescentes (ERICA). Se trata de un estudio seccional, con base escolar, en adolescentes de 12 a 17 años. La obesidad fue clasificada por el índice de masa corporal, basado en los criterios de la Organización Mundial de la Salud, según edad y sexo. La asociación entre obesidad, comida y cena con los padres/tutores (nunca, a veces, casi todos los días y todos los días) se investigó por la razón de prevalencia bruta y ajustada para estratos de sexo y franja de edad. Se evaluaron a 71.740 adolescentes. De esos, comían y cenaban con los padres/responsables todos los días o casi todos los días, respectivamente, cerca de un 48% y un 60% de las niñas y un 56% y 65% de los niños. Los niños que comían y cenaban con los padres/responsables casi todos los días y todos los días presentaron menor prevalencia de obesidad. En la estratificación por franja de edad, solamente los niños más jóvenes que afirmaron comer con los padres/responsables a veces (RP = 0,64; IC95%: 0,46-0,89), casi todos los días (RP = 0,50; IC95%: 0,37-0,69) y todos los días (RP = 0,65; IC95%: 0,49-0,85) y cenar con los padres/responsables todos los días (RP = 0,61; IC95%: 0,43-0,87) presentaron menor prevalencia de obesidad. Los resultados refuerzan la importancia de la promoción de comportamientos alimentarios saludables en el ambiente familiar como parte de las estrategias de prevención de la obesidad en adolescentes.

[Aggregation of cardiovascular risk factors: alcohol, smoking, excess weight, and short sleep duration in adolescents in the ERICA study]. / Agregação dos fatores de risco cardiovascular: álcool, fumo, excesso de peso e sono de curta duração em adolescentes do estudo ERICA.

This study aimed to analyze the aggregation of alcohol consumption, smoking, excess weight, and short sleep in Brazilian adolescents. This was a cross-sectional multicenter study conducted with teens participating in the Study of Cardiovascular Risk Factors in Adolescents (ERICA in Portuguese). The sample consisted of adolescents that answered the complete questionnaires on sleep, tobacco, and alcoholic beverages, in addition to having their weight and height measured. Aggregation was analyzed by comparing the observed and expected prevalence of risk factors in all possible groupings, with the respective 95% confidence intervals. Analyses were performed in Stata 14 using the svy (survey) command for complex sample data. The sample included 73,624 adolescents, of whom 25.5% had excess weight and 24.2% consumed alcoholic beverages. Aggregation of the four risk factors was O/E = 5.6. Aggregation of three factors was more prevalent in those 15 to 17 years of age (P = 4.8). In the POR (prevalence odds ratio) analysis of the combination of two risk factors, those that smoked showed 11.80 higher odds of also consuming alcohol, compared to those that did not smoke, and vice versa, in private schools. In relation to age, adolescents 12 to 14 years of age that smoked showed 15.46 times higher odds of also drinking, and vice and versa. Adolescents in the sample presented the aggregate presence of four risk factors, and there was a significant relationship between tobacco and alcohol consumption.

O objetivo foi analisar a agregação do consumo de álcool, tabaco, excesso de peso e sono curto em adolescentes brasileiros. Trata-se de estudo transversal, multicêntrico realizado com base em adolescentes participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). A amostra foi composta por adolescentes que responderam completamente aos questionários sobre sono, tabaco e uso de bebidas alcoólicas, além de terem realizado antropometria com medidas de peso e estatura aferidas. A agregação foi analisada comparando a prevalência observada com a esperada dos fatores de risco em todas as possibilidades de agrupamento, e seus intervalos de 95% de confiança. As análises foram realizadas no programa estatístico Stata 14, mediante uso do comando svy (survey) para dados de amostra complexa. São 73.624 adolescentes, 25,5% dos estudantes apresentam excesso de peso e 24,2% fazem uso de bebida alcoólica. A agregação dos quatro fatores de risco foi de O/E = 5,6. A prevalência de agregação dos três fatores foi maior naqueles com 15 a 17 anos (P = 4,8). Na análise de ORP (odds ratio de prevalência) da combinação de dois fatores de risco, observou-se que os fumantes têm 11,80 vezes mais chances de também beber quando comparados àqueles que não fumam e vice-versa, nas escolas privadas. Em relação à idade, adolescentes com 12 e 14 anos que fumam têm 15,46 vezes mais chances de também beber e vice-versa. Adolescentes estudados apresentam a presença dos quatro fatores de forma agregada e há relação significativa entre o tabaco e o consumo de álcool.

El objetivo fue analizar la agregación del consumo de alcohol, tabaco, exceso de peso y sueño corto en adolescentes brasileños. Se trata de un estudio transversal, multicéntrico, realizado a partir de adolescentes participantes del Estudio de Riesgos Cardiovasculares en Adolescentes (ERICA). La muestra estuvo compuesta por adolescentes que respondieron completamente los cuestionarios sobre sueño, tabaco y uso de bebidas alcohólicas, además de haber realizado antropometría con medidas de peso y estatura medidas. La agregación se analizó comparando la prevalencia observada con la esperada de los factores de riesgo en todas las posibilidades de agrupamiento, y sus intervalos de confianza (95%). Los análisis se realizaron con el programa estadístico Stata 14, mediante el uso del control svy (survey) para datos de muestra compleja. Son 73.624 adolescentes, un 25,5% de los estudiantes presentan exceso de peso y un 24,2% consumen bebidas alcohólicas. La agregación de los cuatro factores de riesgo fue de O/E = 5,6. La prevalencia de agregación de los tres factores fue mayor en aquellos con 15 a 17 años (P = 4,8). En el análisis de ORP (odds ratio de prevalencia) de la combinación de dos factores de riesgo, se observó que aquellos que fuman tienen 11,80 veces más oportunidades de beber también, cuando los comparamos con aquellos que no fuman y viceversa en las escuelas privadas. En relación con la edad, los adolescentes con 12 y 14 años que fuman tienen 15,46 veces más oportunidades de también beber y viceversa. Los adolescentes estudiados presentan la presencia de los cuatro factores de forma agregada y existe una relación significativa entre tabaco y el consumo de alcohol.