Establishing international optimal cut-offs of waist-to-height ratio for predicting cardiometabolic risk in children and adolescents aged 6-18 years.

BACKGROUND: Waist-to-height ratio (WHtR) has been proposed as a simple and effective screening tool for assessing central obesity and cardiometabolic risk in both adult and pediatric populations. However, evidence suggests that the use of a uniform WHtR cut-off of 0.50 may not be universally optimal for pediatric populations globally. We aimed to determine the optimal cut-offs of WHtR in children and adolescents with increased cardiometabolic risk across different countries worldwide. METHODS: We used ten population-based cross-sectional data on 24,605 children and adolescents aged 6-18 years from Brazil, China, Greece, Iran, Italy, Korea, South Africa, Spain, the UK, and the USA for establishing optimal WHtR cut-offs. We performed an external independent test (9,619 children and adolescents aged 6-18 years who came from other six countries) to validate the optimal WHtR cut-offs based on the predicting performance for at least two or three cardiometabolic risk factors. RESULTS: Based on receiver operator characteristic curve analyses of various WHtR cut-offs to discriminate those with ≥ 2 cardiometabolic risk factors, the relatively optimal percentile cut-offs of WHtR in the normal weight subsample population in each country did not always coincide with a single fixed percentile, but varied from the 75th to 95th percentiles across the ten countries. However, these relatively optimal percentile values tended to cluster irrespective of sex, metabolic syndrome (MetS) criteria used, and WC measurement position. In general, using ≥ 2 cardiometabolic risk factors as the predictive outcome, the relatively optimal WHtR cut-off was around 0.50 in European and the US youths but was lower, around 0.46, in Asian, African, and South American youths. Secondary analyses that directly tested WHtR values ranging from 0.42 to 0.56 at 0.01 increments largely confirmed the results of the main analyses. In addition, the proposed cut-offs of 0.50 and 0.46 for two specific pediatric populations, respectively, showed a good performance in predicting ≥ 2 or ≥ 3 cardiometabolic risk factors in external independent test populations from six countries (Brazil, China, Germany, Italy, Korea, and the USA). CONCLUSIONS: The proposed international WHtR cut-offs are easy and useful to identify central obesity and cardiometabolic risk in children and adolescents globally, thus allowing international comparison across populations.

Effects of exergaming on the microcirculation of adolescents with overweight or obesity-a clinical trial efficacy.

To assess the effect of exergaming on the microcirculation function of adolescents with overweight or obesity, this non-randomized clinical trial efficacy was conducted with 61 adolescents aged between 10 and 16 years. The intervention group (n = 31) performed exergaming three times per week for 8 weeks. Both groups received guidelines for a healthy diet and staying physically active. Microcirculation was assessed using a laser Doppler flowmetry (LDF) at baseline and after intervention. Primary outcomes derived from LDF assessment included resting flow, maximum flow, maximum/resting flow ratio, area under hyperemia, and post-occlusive reactive hyperemia (PORH). Secondary outcomes were body mass index and systemic blood pressure. Unpaired Student's t test compared intergroup analyses, and paired Student's t test compared intragroup analyses. The significance was set at 5%. Statistical analysis intergroup and intragroup was done by fitting a two-way mixed effects model. Microcirculation was similar between groups. Maximum flow (109.0 ± 38.3 versus 124.6 ± 43.0, P = 0.022), area under hyperemia (1614 ± 472 versus. 1755 ± 461, P = 0.023), and PORH (2.18 ± 0.49 versus 2.01 ± 0.52, P = 0.031) were statistically different after intervention. Body mass index decreased in intervention (24.5 ± 3.8-24.1 ± 4.0 kg/m2, P = 0.002) and control (25.2 ± 3.2-25.1 ± 3.3 kg/m2, P = 0.031) groups. Systolic blood pressure decreased significantly in the intervention group (110 ± 10-106 ± 9 mm Hg; P = 0.041) but not diastolic blood pressure (66.0 ± 7-68.8 ± 8 mm Hg; P = 0.089). Exergaming for 8 weeks led to improvements in the microcirculation function in adolescents with overweighed or obesity. Clinical trials: NTC03532659.

Relação das práticas parentais com sobrepeso e obesidade em adolescentes escolares: estudo de caso-controle / Relación de las prácticas parentales sobrepeso y obesidad en adolescentes escolares: estudio de casos y controles / Relation of parental practices overweight and obesity in school adolescents: case-control study

Objetivo: avaliar as práticas parentais educativas relativas à alimentação e sua relação com sobrepeso/obesidade em adolescentes escolares. Método: estudo de caso-controle com adolescentes de escolas públicas, mediante investigação das dimensões restritivas em relação ao consumo de doces e alimentos calóricos, pressão para comer, comer de acordo com a determinação e monitoramento-controle sobre consumo de doces e alimentos calóricos. Aplicou-se teste qui-quadrado com intervalo de confiança de 95%. Resultados: participaram 148 adolescentes (80 casos-sobrepeso/obesidade e 68 controles-eutróficos). Houve associação entre estado nutricional do cuidador e do adolescente (OR=5,688; p<0,01), maior percentual de sobrepeso/obesidade entre adolescentes submetidos a práticas restritivas de consumo de doces; em pressão para comer, proporção maior de adolescentes com sobrepeso/obesidade entre os cuidadores que discordaram; maior percentual de adolescentes com sobrepeso/obesidade entre as mães/cuidadores que relataram monitorar o consumo de alimentos calóricos na maior parte do tempo. Conclusão: as práticas parentais educativas relacionaram-se com o sobrepeso/obesidade em adolescentes escolares.

Objetivo: avaliar as práticas parentais educativas relativas à alimentação e sua relação com sobrepeso/obesidade em adolescentes escolares. Método: estudo de caso-controle com adolescentes de escolas públicas, mediante investigação das dimensões restritivas em relação ao consumo de doces e alimentos calóricos, pressão para comer, comer de acordo com a determinação e monitoramento-controle sobre consumo de doces e alimentos calóricos. Aplicou-se teste qui-quadrado com intervalo de confiança de 95%. Resultados: participaram 148 adolescentes (80 casos-sobrepeso/obesidade e 68 controles-eutróficos). Houve associação entre estado nutricional do cuidador e do adolescente (OR=5,688; p<0,01), maior percentual de sobrepeso/obesidade entre adolescentes submetidos a práticas restritivas de consumo de doces; em pressão para comer, proporção maior de adolescentes com sobrepeso/obesidade entre os cuidadores que discordaram; maior percentual de adolescentes com sobrepeso/obesidade entre as mães/cuidadores que relataram monitorar o consumo de alimentos calóricos na maior parte do tempo. Conclusão: as práticas parentais educativas relacionaram-se com o sobrepeso/obesidade em adolescentes escolares. Considerações finais: revelaram-se atendimentos influenciados por estereótipos de gênero e sexualidade, o que reduz o acesso a uma Atenção Primária à Saúde de qualidade, promotora do cuidado para com a saúde de mulheres lésbicas.

Objective: to evaluate the educational parental practices related to food and its relationship with overweight/obesity in school adolescents. Method: case-control study with adolescents from public schools, through investigation of the restrictive dimensions-in relation to the consumption of sweets and caloric foods, pressure to eat, eating according to determination and monitoring-control on consumption of sweets and caloric foods. Chi-square test was applied with a 95% confidence interval. Results: the participants were 148 adolescents (80 cases-overweight/obesity and 68 controls-eutrophic). There was an association between nutritional status of the caregiver and adolescents (OR=5.688; p<0.01), a higher percentage of overweight/obesity among adolescents submitted to restrictive practices of sweet consumption; pressure to eat, a higher proportion of overweight/obese adolescents among caregivers who disagreed; higher percentage of overweight/obese adolescents among mothers/caregivers who reported monitoring caloric food consumption most of the time. Conclusion: educational parenting practices were related to overweight/obesity in school adolescents.

Association between breakfast omission and abdominal adiposity in low-income adolescents / Associação entre a omissão do desjejum e a adiposidade abdominal em adolescentes de baixa renda

ABSTRACT Objective To assess the association between breakfast omission, overweight/obesity, abdominal adiposity, and unhealthy lifestyle of low-income adolescents. Methods A cross-sectional population study involving 571 public school students aged between 15 and 19 years old. The habit of having breakfast was assessed using a form, checking the weekly frequency of a given meal and considered as breakfast omission when these adolescents did not have breakfast for at least 5 days in the past week. Sociodemographic and lifestyle variables (sedentarism, physical activity level, and sleep duration) were also assessed. Overweight/obesity was defined as a body mass index above a Z-score of +1, and the presence of abdominal adiposity was determined by a waist circumference/height ratio greater than 0.5. The association between breakfast omission and lifestyle variables was assessed using the chi-square test and a multivariate logistic regression of the anthropometric indicators. Results The omission of breakfast was found in 31% of the adolescents and was associated with physical inactivity (p<0.001). Regarding anthropometric indicators, breakfast omission was an independent factor for determining abdominal adiposity, with a 1.8 times greater chance of having this condition among those who omitted breakfast (p=0.037). Conclusions Omitting breakfast was frequent among the students assessed, and was associated with abdominal adiposity, a cardiometabolic risk factor. Investigation and early intervention are fundamental to change this behavior.

RESUMO Objetivo O estudo objetivou avaliar a associação entre omissão do desjejum, sobrepeso/obesidade, adiposidade abdominal e estilo de vida não saudável em adolescentes de baixa renda. Methods Este foi um estudo populacional com delineamento transversal, envolvendo 571 adolescentes de escolas públicas, entre 15 e 19 anos. O hábito do desjejum foi avaliado através de formulário que verificou a frequência semanal da realização dessa refeição, sendo considerado omissão do desjejum quando os adolescentes não o realizaram por pelo menos cinco dias na última semana. Variáveis sociodemográficas e de estilo de vida (sedentarismo, nível de atividade física e horas de sono) também foram analisadas. A classificação em sobrepeso/obesidade contemplou o índice de massa corporal acima do +1 escore-z, e definiu-se adiposidade abdominal quando a relação circunferência abdominal/estatura foi maior que 0,5. A associação entre a omissão do desjejum e as variáveis de estilo de vida foi avaliada através do teste do qui-quadrado e com os indicadores antropométricos por regressão logística multivariada Results O hábito de omitir o desjejum esteve presente em 31% dos adolescentes e apresentou associação com a inatividade física (p<0,001). Em relação aos indicadores antropométricos, a omissão do desjejum foi um fator independente para determinação da adiposidade abdominal, verificando-se uma chance 1,8 vezes maior de presença dessa condição entre os que omitiam o desjejum (p=0,037). Conclusions A omissão do desjejum foi frequente entre os estudantes avaliados e esteve associada à adiposidade abdominal, um fator de risco cardiometabólico, sendo fundamental a investigação e a intervenção precoce para a mudança desse comportamento.

Metabolically Healthy Obesity and High Carotid Intima-Media Thickness in Children and Adolescents: International Childhood Vascular Structure Evaluation Consortium.

OBJECTIVE: It has been argued that metabolically healthy obesity (MHO) does not increase cardiovascular disease (CVD) risk. This study examines the association of MHO with carotid intima-media thickness (cIMT), a proxy of CVD risk, in children and adolescents. RESEARCH DESIGN AND METHODS: Data were available for 3,497 children and adolescents aged 6-17 years from five population-based cross-sectional studies in Brazil, China, Greece, Italy, and Spain. Weight status categories (normal, overweight, and obese) were defined using BMI cutoffs from the International Obesity Task Force. Metabolic status (defined as "healthy" [no risk factors] or "unhealthy" [one or more risk factors]) was based on four CVD risk factors: elevated blood pressure, elevated triglyceride levels, reduced HDL cholesterol, and elevated fasting glucose. High cIMT was defined as cIMT ≥90th percentile for sex, age, and study population. Logistic regression model was used to examine the association of weight and metabolic status with high cIMT, with adjustment for sex, age, race/ethnicity, and study center. RESULTS: In comparison with metabolically healthy normal weight, odds ratios (ORs) for high cIMT were 2.29 (95% CI 1.58-3.32) for metabolically healthy overweight and 3.91 (2.46-6.21) for MHO. ORs for high cIMT were 1.44 (1.03-2.02) for unhealthy normal weight, 3.49 (2.51-4.85) for unhealthy overweight, and 6.96 (5.05-9.61) for unhealthy obesity. CONCLUSIONS: Among children and adolescents, cIMT was higher for both MHO and metabolically healthy overweight compared with metabolically healthy normal weight. Our findings reinforce the need for weight control in children and adolescents irrespective of their metabolic status.

Nursing care of overweight children: A concept analysis.

AIM: To report an analysis of the concept nursing care of overweight children. BACKGROUND: Patient care is the essence of nursing practice. Nursing professionals must define how to serve specific population groups, including overweight children, presenting real solutions to their problem. A clear conceptual analysis is necessary to unify nursing language and to contribute to nursing practice. DESIGN: Concept analysis. DATA SOURCES: The following databases were searched: COCHRANE, SCOPUS, LILACS, CINAHL, MEDLINE/PubMed, and CAPES Theses Library of Brazil. REVIEW METHODS: Walker and Avant's concept analysis methodology was adopted in this study. Twenty-two articles were analyzed, and the uses, attributes, antecedents, and outcomes of the concept were identified. The nursing care assumptions proposed by Virginia Henderson comprised the theoretical referential. RESULTS: The attributes of nursing care for overweight children included investigation, guidance, and monitoring of dietary, clinical, academic, and social aspects, along with evaluation of lifestyle and anthropometric data related to the affected children and their families. CONCLUSION: This study enabled the construction of a defined concept for nursing care of overweight children that may be useful in the construction of a medium-range theory. Further research is recommended to verify the usefulness of the nursing approach.

Persistent metabolic syndrome and risk of cardiovascular disease in children and adolescents.

OBJECTIVE: to verify persistence of metabolic syndrome (MetS) and components in overweight children and adolescents, as well as its relation to socioeconomic and demographic characteristics and to the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score. METHOD: a two-point longitudinal study: at enrollment and after a 24-month interval, with 133 individuals ages from two to 18 years. The demographic anthropomorphic and blood variables were evaluated. Analysis was carried out by simple and paired association tests, as well as multiple logistic regression. RESULTS: persistent MetS was observed in 38.3% of the sample, associated cardiovascular risk (ACR) in 79.7%, reduction in arterial pressure and do HDL-c. After adjusting for age and sex, excess weight (ExpB: 0.182; CI: 0.059-0.561), low HDL-c (ExpB: 9.247; CI: 1.157-73.930) and high LDL-c (ExpB:1.915; CI: 0.921-3.979) were associated with persistent MetS. CONCLUSION: persistent MetS was associated with obesity, HDL-c and LDL-c, but not with the PDAY score.

Persistent metabolic syndrome and risk of cardiovascular disease in children and adolescents / Síndrome metabólico infantojuvenil persistente y relación con el riesgo de enfermedad cardiovascular / Síndrome metabólica infanto-juvenil persistente e relação com o risco de doença cardiovascular

ABSTRACT Objective: to verify persistence of metabolic syndrome (MetS) and components in overweight children and adolescents, as well as its relation to socioeconomic and demographic characteristics and to the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score. Method: a two-point longitudinal study: at enrollment and after a 24-month interval, with 133 individuals ages from two to 18 years. The demographic anthropomorphic and blood variables were evaluated. Analysis was carried out by simple and paired association tests, as well as multiple logistic regression. Results: persistent MetS was observed in 38.3% of the sample, associated cardiovascular risk (ACR) in 79.7%, reduction in arterial pressure and do HDL-c. After adjusting for age and sex, excess weight (ExpB: 0.182; CI: 0.059-0.561), low HDL-c (ExpB: 9.247; CI: 1.157-73.930) and high LDL-c (ExpB:1.915; CI: 0.921-3.979) were associated with persistent MetS. Conclusion: persistent MetS was associated with obesity, HDL-c and LDL-c, but not with the PDAY score.

RESUMEN Objetivo: Verificar persistencia del síndrome metabólico (SM) y componentes en niños y adolescentes con exceso de peso, además de su relación con características socioeconómicas, demográficas y con el puntaje de Pathobiological Determinants of Atherosclerosis in Youth (PDAY). Método: Estudio longitudinal con dos ítems: reclutamiento y 24 meses con 133 individuos de entre 2 y 18 años. Evaluadas variables socioeconómicas, demográficas, antropométricas y sanguíneas. Realizado análisis mediante tests de asociación simple y pareada, además de regresión logística múltiple. Resultados: Se verificó persistencia de SM en 38,3% de muestra, riesgo cardiovascular asociado (RCV) en 79,7%, reducción de presión arterial y HDL-c. Ajustados por edad y sexo, el exceso de peso (ExpB: 0,182; IC: 0,059-0,561), el bajo HDL-c (ExpB:9,247; IC:1,157-73,930) y el elevado LDL-c (ExpB:1,915; IC: 0,921-3,979) se mostraron asociados a la SM persistente. Conclusión: El SM persistente estuvo asociado al exceso de peso, HDL-c y LDL-c, pero no con el puntaje PDAY.

RESUMO Objetivo: verificar a persistência da síndrome metabólica (SM) e componentes em crianças e adolescentes com excesso de peso, além de sua relação com características socioeconômicas, demográficas e com o escore Pathobiological Determinants of Atherosclerosis in Youth (PDAY). Método: estudo longitudinal com dois pontos: recrutamento e 24 meses com 133 indivíduos entre dois e 18 anos. Foram avaliadas variáveis socioeconômicas, demográficas, antropométricas e sanguíneas. Realizou-se análise através de testes de associação simples e pareado, além de regressão logística múltipla. Resultados: verificou-se persistência de SM em 38,3% da amostra, risco cardiovascular associado (RCV) em 79,7%, redução da pressão arterial e do HDL-c. Ajustados por idade e sexo, o excesso de peso (ExpB: 0,182; IC: 0,059-0,561), o baixo HDL-c (ExpB: 9,247; IC: 1,157-73,930) e o elevado LDL-c (ExpB:1,915; IC: 0,921-3,979) mostraram-se associados à SM persistente. Conclusão: a SM persistente teve associação com o excesso de peso, HDL-c e LDL-c, mas não com o escore PDAY.

Serial album validation for promotion of infant body weight control.

OBJECTIVE: to validate the content and appearance of a serial album for children aged from 7 to 10 years addressing the topic of prevention and control of body weight. METHOD: methodological study with descriptive nature. The validation process was attended by 33 specialists in educational technologies and/or in excess of infantile weight. The agreement index of 80% was the minimum considered to guarantee the validation of the material. RESULTS: most of the specialists had a doctoral degree and a graduate degree in nursing. Regarding content, illustrations, layout and relevance, all items were validated and 69.7% of the experts considered the album as great. The overall agreement validation index for the educational technology was 0.88. Only the script-sheet 3 did not reach the cutoff point of the content validation index. Changes were made to the material, such as title change, inclusion of the school context and insertion of nutritionist and physical educator in the story narrated in the album. CONCLUSION: the proposed serial album was considered valid by experts regarding content and appearance, suggesting that this technology has the potential to contribute in health education by promoting healthy weight in the age group of 7 to 10 years.

Serial album validation for promotion of infant body weight control / Validação de álbum seriado para a promoção do controle de peso corporal infantil / Validez de álbum seriado para la promoción del control de peso corporal infantil

ABSTRACT Objective: to validate the content and appearance of a serial album for children aged from 7 to 10 years addressing the topic of prevention and control of body weight. Method: methodological study with descriptive nature. The validation process was attended by 33 specialists in educational technologies and/or in excess of infantile weight. The agreement index of 80% was the minimum considered to guarantee the validation of the material. Results: most of the specialists had a doctoral degree and a graduate degree in nursing. Regarding content, illustrations, layout and relevance, all items were validated and 69.7% of the experts considered the album as great. The overall agreement validation index for the educational technology was 0.88. Only the script-sheet 3 did not reach the cutoff point of the content validation index. Changes were made to the material, such as title change, inclusion of the school context and insertion of nutritionist and physical educator in the story narrated in the album. Conclusion: the proposed serial album was considered valid by experts regarding content and appearance, suggesting that this technology has the potential to contribute in health education by promoting healthy weight in the age group of 7 to 10 years.

RESUMO Objetivo: validar o conteúdo e a aparência de álbum seriado para crianças de 7 a 10 anos abordando o tema prevenção e controle do peso corporal. Método: estudo metodológico, de natureza descritiva. O processo de validação teve participação de 33 especialistas em tecnologias educativas e/ou em excesso de peso infantil. Foi considerado o índice de concordância de no mínimo 80% para se garantir a validação do material. Resultados: a maioria dos especialistas tinha doutorado e era graduada em enfermagem. Quanto ao conteúdo, ilustrações, layout e relevância, todos os itens foram validados e 69,7% dos especialistas consideraram o álbum como ótimo. O índice de validação de concordância global da tecnologia educativa foi 0,88. Apenas a ficha-roteiro 3 não atingiu o ponto de corte do índice de validação do conteúdo. Foram realizadas alterações no material, tais como mudança do título, inclusão do contexto escolar e inserção de nutricionista e educador físico na estória narrada no álbum. Conclusão: o álbum seriado proposto foi considerado válido por especialistas quanto ao conteúdo e aparência, sugerindo que esta tecnologia tem potencial para contribuir na educação em saúde sobre promoção do peso saudável na faixa etária de 7 a 10 anos.

RESUMEN Objetivo: validar el contenido y la apariencia del álbum seriado para niños de 7 a 10 años, abordando el tema prevención y control del peso corporal. Método: estudio metodológico, de naturaleza descriptiva. El proceso de validez tuvo la participación de 33 especialistas en tecnologías educativas y/o en exceso de peso infantil. Fue considerado el índice de concordancia de lo mínimo 80% para garantizar la validez del material. Resultados: la mayoría de los especialistas tenía doctorado y era graduado en enfermería. Sobre al contenido, ilustraciones, layout y relevancia, todos los ítems fueron validados y 69,7% de los especialistas consideraron el álbum como óptimo. El índice de validez de concordancia global de la tecnología educativa fue 0,88. Apenas la ficha-guía 3 no consiguió el punto de cohorte del índice de validez del contenido. Fueron realizadas alteraciones en el material, tales como: cambio del título, inclusión del contexto escolar e inserción de nutricionista y educador físico en la historia narrada en el álbum. Conclusión: el álbum seriado propuesto fue considerado válido por especialistas sobre el contenido y apariencia, sugiriendo que esta tecnología tiene potencial para contribuir en la educación en salud sobre promoción del peso sano en el grupo de edad de 7 a 10 años.

Adolescentes: comportamento e risco cardiovascular / Adolescents: behavior and cardiovascular risk

Contexto: Os benefícios para a saúde decorrentes da prática regular de atividade física estão bem documentados. Entretanto, são raros os estudos associando essa prática ao comportamento sedentário e ao risco cardiovascular em adolescentes. Objetivos: Pretende-se avaliar a prática de atividade física, o comportamento sedentário e a associação com o risco cardiovascular mensurado pelo escore Pathobiological Determinants of Atherosclerosis in Youth (PDAY). Métodos: Estudo transversal desenvolvido nas escolas públicas estaduais de Campina Grande, PB, Brasil, com 576 adolescentes de 15 a 19 anos, incluindo variáveis socioeconômicas, demográficas, de estilo de vida e clínicas. Os dados foram coletados através de formulário validado, antropometria, aferição da pressão arterial e exames laboratoriais. Foram utilizadas medidas descritivas, teste do qui-quadrado de Pearson e regressão logística binomial. Trabalhou-se com o SPSS 22.0 se adotou intervalo de confiança de 95%. Resultados: A idade média foi de 16,8 anos. A maioria dos adolescentes era do sexo feminino (66,8%), não branco (78.7%) e pertencente às classes C, D e (69,1%). Quanto ao sedentarismo e à insuficiência de atividade física, as prevalências foram de 78,1% e 60,2%, respectivamente. De acordo com o escore PDAY, 10,4% dos adolescentes apresentaram alto risco cardiovascular; 31,8% risco intermediário; e 57,8%, risco baixo. Verificou-se que PDAY esteve associado ao sexo e à adiposidade abdominal. Conclusões: Ficou comprovado que adiposidade abdominal e sexo masculino representam importantes fatores de risco cardiovascular em adolescentes. Considerando-se a presença de um fator de risco modificável, medidas preventivas voltadas ao estilo de vida são essenciais

Background: The health benefits of regular physical activity are well documented. However, there are few studies associating this practice with sedentary behavior and cardiovascular risk in adolescents. Objectives: To evaluate physical activity levels and sedentary behavior and their associations with cardiovascular risk using the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score Methods: A cross-sectional study carried out in state-owned public schools in Campina Grande, PB, Brazil, with 576 adolescents aged 15 to 19 years, investigating socioeconomic; demographic; lifestyle; and clinical variables. Data were collected using a validated form covering anthropometry data; blood pressure measurements; and laboratory tests. Data were analyzed using descriptive statistics, Pearson's chi-square test, and binomial logistic regression using SPSS 22.0 and adopting a 95% confidence interval. Results: Mean age was 16.8 years. The majority of the adolescents were female (66.8%); non-white (78.7%); and belonged to socioeconomic classes C, D and E (69.1%). The prevalence rates of sedentary behavior and physical inactivity were 78.1% and 60.2%, respectively. According to the PDAY score, 10.4% of adolescents were at high cardiovascular risk and 31.8% and 57.8% were at intermediate risk and low risk, respectively. PDAY scores were associated with sex and abdominal adiposity. Conclusions: It was found that abdominal fat and being male were important cardiovascular risk factors in adolescents. Considering that modifiable risk factors were present, preventive measures aimed at lifestyle changes are essential

Vulnerability associated with sexually transmitted infections in physically disabled people. / Vulnerabilidade associada às infecções sexualmente transmissíveis em pessoas com deficiência física.

OBJECTIVE: to analyze the conditions that enhance the dimensions of individual, social and programmatic vulnerability associated with sexually transmitted infections in physically disabled people. METHODS: this transversal study, with a quantitative approach, was conducted in 2015 in conjunction with an association for disabled people in Campina Grande, PB, Brazil. Ninety-eight individuals participated in the study and answered a questionnaire regarding the dimensions of vulnerability in relation to sexually transmitted infections. The chi-square test, Fisher's test, contingency coefficient test and prevalence ratio test were all performed. RESULTS: an association was identified between the occurrence of sexually transmitted infections with the number of partners (p = 0.020); the belief that having few partners was a form of prevention (p = 0.044); the belief that poor hygiene was a risk factor; age (p = 0.007); the type of disability (p = 0.007); and having a consultation with a urologist (p = 0.030). CONCLUSION: physically disabled people have conditions that enhance their vulnerability to sexually transmitted infections, which are linked to individual, social and programmatic dimensions. By characterizing the conditions of vulnerability it is possible to devise specific prevention linked to the reality of the social and health conditions of individuals.

Vulnerabilidade associada às infecções sexualmente transmissíveis em pessoas com deficiência física / Vulnerability associated with sexually transmitted infections in physically disabled people

Resumo O objetivo deste artigo é analisar as condições que potencializam as dimensões de vulnerabilidade individual, social e programática associadas às infecções sexualmente transmissíveis em pessoas com deficiência física. Estudo transversal, com abordagem quantitativa, realizado em 2015, em uma associação para pessoas com deficiência de Campina Grande/PB, Brasil. Participaram 98 sujeitos que responderam um formulário sobre as dimensões de vulnerabilidade para infecções sexualmente transmissíveis. Realizaram-se os testes de Qui-quadrado, Fisher, Coeficiente de contingência e razão de prevalência. Verificou-se associação entre a ocorrência de infecções sexualmente transmissíveis com o número de parceiros (p = 0,020), acreditar em poucos parceiros como prevenção (p = 0,044), acreditar na má higiene como fator de risco, idade (p = 0,007), tipo de deficiência (p = 0,007) e realização de consulta com urologista (p = 0,030). As pessoas com deficiência física possuem condições que potencializam a vulnerabilidade para infecções sexualmente transmissíveis, atrelada às dimensões individual, social e programática. Por meio da caracterização das condições de vulnerabilidade é possível traçar uma prevenção específica atrelada a suas realidades individual, social e de saúde.

Abstract Objective to analyze the conditions that enhance the dimensions of individual, social and programmatic vulnerability associated with sexually transmitted infections in physically disabled people. Methods this transversal study, with a quantitative approach, was conducted in 2015 in conjunction with an association for disabled people in Campina Grande, PB, Brazil. Ninety-eight individuals participated in the study and answered a questionnaire regarding the dimensions of vulnerability in relation to sexually transmitted infections. The chi-square test, Fisher’s test, contingency coefficient test and prevalence ratio test were all performed. Results an association was identified between the occurrence of sexually transmitted infections with the number of partners (p = 0.020); the belief that having few partners was a form of prevention (p = 0.044); the belief that poor hygiene was a risk factor; age (p = 0.007); the type of disability (p = 0.007); and having a consultation with a urologist (p = 0.030). Conclusion physically disabled people have conditions that enhance their vulnerability to sexually transmitted infections, which are linked to individual, social and programmatic dimensions. By characterizing the conditions of vulnerability it is possible to devise specific prevention linked to the reality of the social and health conditions of individuals.

Validación de instrumento para la detección de adolescentes con sobrepeso en la escuela / Validação de instrumento para o screening de adolescentes com excesso de peso na escola / Instrument validation for screening of adolescents with overweight at school

El objetivo fue validar el contenido del instrumento de enfermería para la detección de adolescentes con sobrepeso en la escuela. Estudio metodológico llevado a cabo en tres etapas: creación del «Formulario para la detección de adolescentes con sobrepeso en la escuela»; evaluación psicométrica por especialistas; modificación del instrumento de acuerdo con las recomendaciones. Las pruebas estadísticas de Kappa y Chi-Quadrado fueron utilizadas en el análisis. Las frecuencias positivas de los criterios psicométricos fueron ≥80%, con algunas diferencias de concordancia entre los especialistas (p<0,001). Algunos criterios presentaron pobre concordancia (k=0,20-0,39) y otros sin concordancia (k=0). El ítem de evaluación física tuvo valor Kappa 1 em todos los criterios. Después de hacer las alteraciones, todos los criterios tuvieron alta concordancia (K=1), con exención del ítem «Perfil sociodemográfico y datos generales». El instrumento fue considerado de contenido válido y útil para la identificación del diagnóstico de enfermería de sobrepeso y para la implementación del proceso de enfermería en esa población (AU)

Objetivou-se validar o conteúdo de instrumento para uso do enfermeiro no screening de adolescentes com excesso de peso na escola. Estudo metodológico realizado em três etapas: construção do «Formulário para o screening de adolescentes com excesso de peso na escola»; avaliação do Formulário por especialistas, segundo critérios psicométricos; modificação do Formulário conforme os pareceres. Utilizaram-se os testes Kappa e Qui-Quadrado. Os critérios psicométricos atingiram frequências ≥80% de respostas positivas, com diferença entre os especialistas (p<0,001). Alguns critérios apresentaram fraca concordância (k=0,20-0,39) ou nenhuma concordância (k<0). O item sobre avaliação física obteve valor Kappa 1 em todos os critérios. Após as alterações no Formulário, todos os critérios atingiram alta concordância (k=1), exceto o item «Perfil sociodemográfico e dados gerais». O instrumento foi considerado válido quanto ao conteúdo e útil para a identificação do diagnóstico de enfermagem excesso de peso, podendo impactar na implementação do processo de enfermagem nessa população (AU)

The aim was to validate the content of a nursing instrument for the screening of overweight adolescents in schools. Methodological study conducted in three phases: construction of the «Overweight Screening Form for Adolescents in Schools»; psychometric evaluation by specialists; modification of instrument according to specialists’ suggestions. The Kappa and Chi Square tests were used in the analysis. The frequency of positive responses for the psychometric criteria was ≥80%, with some agreement differences among the specialists (p<0,001). Some criteria presented low agreement (k=0,20-0,39) or no agreement (k=0). The physical evaluation item obtained a Kappa 1 in all criteria. After Form alterations were made, all criteria reported high agreement (k=1), except for «Sociodemographic profile and general data». The instrument was considered to have content validity and useful for the identification of nursing diagnosis of overweight adolescents. It can serve as a tool in the implementation of the nursing process with this population (AU)

Sleep quality and metabolic syndrome in overweight or obese children and adolescents / Qualidade do sono e síndrome metabólica em crianças e adolescentes com sobrepeso ou obesidade

ABSTRACT Objective To assess sleep quality and its association with metabolic syndrome and its components. Methods This cross-sectional study was conducted from June 2011 to March 2012 at the Childhood Obesity Center, Campina Grande, Paraíba , Brazil, with 135 overweight or obese children and adolescents. Sleep quality was assessed by the Pittsburgh Sleep Quality Index. Metabolic syndrome diagnosis was based on abdominal circumference, blood pressure, glycemia, high density lipoprotein-cholesterol, and triglycerides. The data were treated by the software Statistical Package for the Social Sciences version 22.0 at a significance level of 5%. Results The prevalence of poor sleep quality or sleep disorder according to the Pittsburgh Sleep Quality Index was 40.7%, and females had higher mean global Pittsburgh Sleep Quality Index score. Metabolic syndrome prevalence was 63.0%. Females also had higher daytime dysfunction. Poor sleep quality was associated with high diastolic blood pressure (OR=2.6; p =0.015) and waist circumference (OR=3.17; p =0.024) after adjusting for sex and age. Conclusion Girls had higher global Pittsburgh Sleep Quality Index score, which was associated with daytime dysfunction. Poor sleep quality was a predictor of high diastolic blood pressure in the study sample.

RESUMO Objetivo Avaliar a qualidade do sono e sua associação com a síndrome metabólica e seus componentes. Métodos Estudo transversal, realizado entre junho de 2011 e março de 2012 no Centro de Obesidade Infantil, Campina Grande, Paraíba. Foram incluídas 135 crianças e adolescentes com sobrepeso ou obesidade. A qualidade do sono foi avaliada pelo Pittsburgh Sleep Quality Index. Para o diagnóstico de síndrome metabólica, consideraram--se circunferência abdominal, pressão arterial, glicemia, lipoproteínas de alta densidade e triglicerídeos. Os dados foram analisados pelo Statistical Package for the Social Sciences versão 22.0, sendo adotado um nível de significância de 5%. Resultados A prevalência de má qualidade ou distúrbio do sono avaliado pelo Pittsburgh Sleep Quality Index foi 40.7%, e a média do escore global Pittsburgh Sleep Quality Index foi significativamente maior no sexo feminino. A prevalência de síndrome metabólica foi 63.0%. A disfunção diurna foi significativamente maior no sexo feminino. A má qualidade do sono esteve associada à pressão arterial diastólica elevada (OR=2,6; p=0,015) e à circunferência abdominal elevada (OR=3,17; p=0,024), após ajuste para sexo e idade. Conclusão As meninas apresentaram um maior escore global do Pittsburgh Sleep Quality Index e associação com a disfunção diurna. A má qualidade do sono mostrou-se fator preditor de pressão arterial diastólica elevada na amostra estudada.

Fibrinogen: cardiometabolic risk marker in obese or overweight children and adolescents / Fibrinogênio: marcador de risco cardiometabólico em crianças e adolescentes obesos ou com sobrepeso

ABSTRACT OBJECTIVES: To determine the prevalence of increased serum fibrinogen levels and its association with cardiometabolic risk factors in overweight or obese children and adolescents. METHODS: Cross-sectional study with 138 children and adolescents (overweight or obese) followed at a reference outpatient clinic of the public health care network. Fibrinogen concentration was divided into quartiles, and values above or equal to the third quartile were considered high. The association between high fibrinogen values and cardiometabolic risk factors was assessed using Pearson's chi-squared test or Fisher's exact test, as necessary. Logistic regression was used to adjust variables predictive of fibrinogen levels. Analyses were performed using SPSS version 22.0 and SAS software, considering a confidence interval of 95%. RESULTS: Serum fibrinogen levels were elevated in 28.3% of individuals, showing association with the presence of high CRP (p = 0.003, PR: 2.41, 95% CI: 1.30-4.46) and the presence of four or more risk factors (p = 0.042; PR: 1.78, 95% CI: 1.00-3.17). After a logistic regression, only elevated CRP remained associated with altered fibrinogen levels (p = 0.024; PR: 1.32; 95% CI: 1.09-5.25). CONCLUSIONS: Increased fibrinogen was prevalent in the study population and was associated with ultrasensitive C-reactive protein and the presence of four or more cardiovascular risk factors; it should be included in the assessment of individuals at risk.

RESUMO OBJETIVOS: Verificar a prevalência de níveis séricos elevados de fibrinogênio e sua associação com os fatores de risco cardiometabólicos em crianças e adolescentes com sobrepeso ou obesidade. MÉTODOS: Estudo transversal com 138 crianças e adolescentes (obesos ou com sobrepeso) acompanhados em um ambulatório de referência da rede pública. A concentração do fibrinogênio foi distribuída em quartis e considerada elevada quando os valores eram iguais ou superiores ao terceiro quartil. A associação entre o valor elevado do fibrinogênio com os fatores de risco cardiometabólicos foi verificada com o teste qui-quadrado de Pearson ou o teste exato de Fisher, quando necessário. A regressão logística foi usada para ajuste das variáveis preditoras do nível do fibrinogênio. As análises foram feitas no SPSS 22.0 e SAS e considerou-se o intervalo de confiança de 95%. RESULTADOS: Os níveis séricos de fibrinogênio estiveram elevados em 28,3% dos indivíduos e apresentaram associação com a PCR elevada (RP: 2,41; IC95%: 1,30-4,46, p = 0,003) e com a presença de quatro ou mais fatores de risco (RP: 1,78; IC95%: 1,00-3,17; p = 0,042). Após a regressão logística, apenas o PCR elevado continuou associado ao fibrinogênio alterado (RP: 1,32; IC95% 1,09-5,25; p = 0,024). CONCLUSÕES: O aumento do fibrinogênio foi prevalente na população estudada, esteve associado à proteína C reativa ultrassensível e ao número igual ou superior a quatro de fatores de risco cardiovasculares e deve ser incluído na avaliação de indivíduos sob risco.

Fibrinogen: cardiometabolic risk marker in obese or overweight children and adolescents.

OBJECTIVES: To determine the prevalence of increased serum fibrinogen levels and its association with cardiometabolic risk factors in overweight or obese children and adolescents. METHODS: Cross-sectional study with 138 children and adolescents (overweight or obese) followed at a reference outpatient clinic of the public health care network. Fibrinogen concentration was divided into quartiles, and values above or equal to the third quartile were considered high. The association between high fibrinogen values and cardiometabolic risk factors was assessed using Pearson's chi-squared test or Fisher's exact test, as necessary. Logistic regression was used to adjust variables predictive of fibrinogen levels. Analyses were performed using SPSS version 22.0 and SAS software, considering a confidence interval of 95%. RESULTS: Serum fibrinogen levels were elevated in 28.3% of individuals, showing association with the presence of high CRP (p=0.003, PR: 2.41, 95% CI: 1.30-4.46) and the presence of four or more risk factors (p=0.042; PR: 1.78, 95% CI: 1.00-3.17). After a logistic regression, only elevated CRP remained associated with altered fibrinogen levels (p=0.024; PR: 1.32; 95% CI: 1.09-5.25). CONCLUSIONS: Increased fibrinogen was prevalent in the study population and was associated with ultrasensitive C-reactive protein and the presence of four or more cardiovascular risk factors; it should be included in the assessment of individuals at risk.

Fatores de risco cardiometabólicos e espessamento da íntima-média da carótida em adolescentes com sobrepeso ou obesidade / Cardiometabolic risk factors and intima-media thickness of the carotid in adolescent with overweight or obesity

Objetivo: Verificar a associação dos fatores de risco cardiometabólicos com a medida da camada íntima-média da carótida em adolescentes com sobrepeso ou obesidade. Métodos: Estudo transversal envolvendo 32 adolescentes com idade de 10 a 20 anos com sobrepeso ou obesidade. Foram utilizadas variáveis sociais, antropométricas e laboratoriais (glicemia de jejum, insulina, índice de homeostase glicêmica da resistência insulínica, proteína C reativa ultrassenssível, fibrinogênio, colesterol total, lipoproteína de baixa densidade, lipoproteína de alta densidade e triglicerídeos) e a medida da espessura da camada média-intimal da artéria carótida comum (IMT). As variáveis foram descritas através de proporção, médias e desvio padrão. Foi realizada a distribuição das medidas da camada íntima-média da carótida em percentis e comparado os valores médios dos fatores de risco cardiometabólicos através do teste de ANOVA. Todas as análises foram realizadas com a versão 17.0 do programa SPSS, considerado o nível de significância de 5%. Resultados: A maioria dos avaliados apresentava obesidade e em aproximadamente um terço da amostra a medida da íntima-média da carótida se encontrava acima do percentil 75 para a idade e 37,5% apresentavam quatro ou mais fatores de risco cardiometabólico. Conclusões: A presença de espessamento da camada íntima média da carótida, um marcador precoce de aterosclerose subclínica e quatro ou mais fatores de risco cardiometabólicos em adolescentes com sobrepeso ou obesidade sinalizam a necessidade de medidas preventivas que consigam interromper a progressão da doença aterosclerótica.

Hábitos alimentares, de atividade física e estado nutricional de cuidadores de crianças e adolescentes com excesso de peso / Dietary habits, physical exercise and nutritional status of caregivers of overweight children and adolescents / Hábitos alimentares, de actividad física y estado nutricional de cuidadores de niños y adolescentes con exceso de peso

O objetivo deste estudo foi analisar o estado nutricional e hábitos alimentares e de atividade física de cuidadores de crianças e adolescentes com excesso de peso em acompanhamento multidisciplinar. Estudo exploratório, descritivo, transversal e abordagem quantitativa com amostra de 109 cuidadores de crianças e adolescentes em atendimento no Centro de Obesidade Infantil, Campina Grande, Paraíba, Brasil. Aplicou-se questionário estruturado entre fevereiro e abril de 2011. Os resultados evidenciaram 74,3% dos responsáveis com excesso de peso. A prática de atividade física foi considerada, em sua maioria, de forma imprópria e a alimentação classificada como regular. O hábito de comer frituras, biscoito e massas foi considerado ruim. Percebeu-se que os hábitos alimentares e de atividade física foram identificados como inadequados. O estado nutricional e as práticas alimentares e de atividade física podem refletir no estado nutricional das crianças e adolescentes em tratamento, por isso sugere-se que o atendimento de enfermagem envolva cuidadores e familiares.

The objective of this study was to assess the nutritional status and dietary and physical exercise habits of caregivers of overweight children and adolescents in multidisciplinary care. An exploratory, descriptive, cross-sectional and quantitative study with a sample of 109 caregivers of children and adolescents assisted in the Center for Childhood Obesity, Campina Grande, Paraíba, Brazil. A structured questionnaire was applied from February to April 2011. The results showed that 74.3% of caregivers were overweight. The physical activity was considered mostly inappropriately and diet was classified as regular. The habit of eating fried foods, biscuits and pasta was considered bad. It was noted that the dietary and physical activity habits were inappropriate. The nutritional status and dietary and physical exercise practices may reflect in the nutritional status of children and adolescents in treatment, suggesting the inclusion of caregivers and family members in the nursing care.

El objetivo de este estudio fue analizar el estado nutricional y hábitos alimentares y de actividad física de cuidadores de niños y adolescentes con exceso de peso en acompañamiento multidisciplinar. Estudio exploratorio, descriptivo, transversal y de abordaje cuantitativo con muestra de 109 cuidadores de niños e adolescentes en atendimiento en el Centro de Obesidad Infantil, Campina Grande, Paraíba, Brasil. Se aplicó cuestionario estructurado entre febrero y abril de 2011. Los resultados evidenciaron 74,3% de los responsables con exceso de peso. La práctica de actividad física fue considerada, en mayoría, de forma impropia y la alimentación clasificada como regular. El hábito de comer frituras, biscocho y pasta fue considerado malo. Se percibió que los hábitos alimentares y de actividad física fueron identificados como inadecuados. El estado nutricional y las prácticas alimentares y de actividad física puenden reflectar en el estado nutricional de los niños y adolescentes en tratamiento, por eso se sugiere que el atendimiento de enfermería involucre cuidadores y familiares.