Efetividade de programas de intervenção para obesidade com base em orientações para escolares adolescentes: revisão sistemática / Effectiveness of obesity intervention programs based on guidelines for adolescent students: systematic review

RESUMO Objetivo: Verificar a efetividade de intervenções educacionais baseadas na orientação sobre atividade física e nutrição em escolares. Fonte de dados: Foi realizada busca sistemática em quatro bancos e bases de dados eletrônicos, com artigos publicados entre outubro de 2007 e janeiro de 2017 que abordaram a realização de intervenções educacionais com ênfase em educação nutricional e atividade física ou exercício físico em escolares com idades entre 10 e 19 anos. Síntese dos dados: Foram selecionados 12 artigos para esta revisão. Desses estudos, quatro incluíram a intervenção educacional; quatro associaram intervenções educacionais à inclusão de alimentos saudáveis e atividade física; dois estudos relacionaram as orientações e a atividade física; e, por fim, dois ligaram as orientações com o consumo de alimentos saudáveis. Conclusões: As intervenções baseadas na orientação de atividade física e/ou nutrição foram eficientes, com resultados superiores nos estudos que associaram a prática de atividade física à orientação. Entretanto, observou-se a necessidade da realização de novos estudos que abordem as intervenções educacionais em escolares.

ABSTRACT Objective: To verify the effectiveness of educational interventions based on guidance on physical activity and nutrition in schoolchildren. Data sources: A systematic search was carried out in four electronic databases containing articles published between October 2007 and January 2017 and addressing educational interventions with emphasis on both nutritional education and physical activity in schoolchildren and adolescents aged 10 to 19 years. Data synthesis: Twelve articles were selected for this review, of which four included only educational interventions; four made and association between educational interventions, inclusion of healthy foods and physical activity; two made a relation between guidelines and physical activity; and finally, two associated guidelines with consumption of healthy foods. Conclusions: Interventions based on physical activity and/or nutrition counseling were efficient and showed superior results in studies that associated the practice of physical activity with counseling. However, the need for new studies on educational interventions among schoolchildren and adolescents was made evident.

EFFECTIVENESS OF OBESITY INTERVENTION PROGRAMS BASED ON GUIDELINES FOR ADOLESCENT STUDENTS: SYSTEMATIC REVIEW. / EFETIVIDADE DE PROGRAMAS DE INTERVENÇÃO PARA OBESIDADE COM BASE EM ORIENTAÇÕES PARA ESCOLARES ADOLESCENTES: REVISÃO SISTEMÁTICA.

OBJECTIVE: To verify the effectiveness of educational interventions based on guidance on physical activity and nutrition in schoolchildren. DATA SOURCES: A systematic search was carried out in four electronic databases containing articles published between October 2007 and January 2017 and addressing educational interventions with emphasis on both nutritional education and physical activity in schoolchildren and adolescents aged 10 to 19 years. DATA SYNTHESIS: Twelve articles were selected for this review, of which four included only educational interventions; four made and association between educational interventions, inclusion of healthy foods and physical activity; two made a relation between guidelines and physical activity; and finally, two associated guidelines with consumption of healthy foods. CONCLUSIONS: Interventions based on physical activity and/or nutrition counseling were efficient and showed superior results in studies that associated the practice of physical activity with counseling. However, the need for new studies on educational interventions among schoolchildren and adolescents was made evident.

OBJETIVO: Verificar a efetividade de intervenções educacionais baseadas na orientação sobre atividade física e nutrição em escolares. FONTE DE DADOS: Foi realizada busca sistemática em quatro bancos e bases de dados eletrônicos, com artigos publicados entre outubro de 2007 e janeiro de 2017 que abordaram a realização de intervenções educacionais com ênfase em educação nutricional e atividade física ou exercício físico em escolares com idades entre 10 e 19 anos. SÍNTESE DOS DADOS: Foram selecionados 12 artigos para esta revisão. Desses estudos, quatro incluíram a intervenção educacional; quatro associaram intervenções educacionais à inclusão de alimentos saudáveis e atividade física; dois estudos relacionaram as orientações e a atividade física; e, por fim, dois ligaram as orientações com o consumo de alimentos saudáveis. CONCLUSÕES: As intervenções baseadas na orientação de atividade física e/ou nutrição foram eficientes, com resultados superiores nos estudos que associaram a prática de atividade física à orientação. Entretanto, observou-se a necessidade da realização de novos estudos que abordem as intervenções educacionais em escolares.

Association between cardiorespiratory fitness and body fat in girls / Relação entre aptidão cardiorrespiratória e adiposidade corporal em meninas

Abstract Objective: To estimate the prevalence of low cardiorespiratory fitness and its association with excess body fat, considering the sexual maturation and economic level in female adolescents. Methods: Cross-sectional, epidemiological study of 1223 adolescents (10-17 years) from the public school system of Cascavel, PR, Brazil, in 2006. We analyzed the self-assessed sexual maturation level (prepubertal, pubertal and post-pubertal), the economic level (high and low) through a questionnaire and body fat (normal and high) through triceps and subscapular skinfolds. The 20-meter back-and-forth test was applied to estimate maximum oxygen consumption. Cardiorespiratory fitness was assessed according to reference criteria and considered low when the minimum health criterion for age and sex was not met. Chi-square test and logistic regression were applied, with a significance level of 5%. Results: The prevalence of low cardiorespiratory fitness was 51.3%, being associated with all study variables (p<0.001). At the crude analysis, adolescents with high body fat were associated with low cardiorespiratory fitness, when compared to those with normal body fat (OR=2.76; 95%CI: 2.17-3.52). After adjustment by sexual maturation, this association remained valid and showed an effect that was 1.8-fold higher (95%CI: 1.39-2.46) and after adjusting by economic level, the effect was 1.9-fold higher (95%CI: 1.45-2.61). Conclusions: Approximately half of the assessed girls showed unsatisfactory levels of cardiorespiratory fitness for health, which was associated with high body fat, regardless of sexual maturation level and economic level. Effective public health measures are needed, with particular attention to high-risk groups.

Resumo Objetivo: Estimar a prevalência de aptidão cardiorrespiratória baixa e sua associação com excesso de adiposidade corporal, considerando a maturação sexual e o nível econômico, em adolescentes do sexo feminino. Métodos: Estudo epidemiológico transversal com 1.223 adolescentes (10-17 anos) da rede pública de ensino de Cascavel, PR, Brasil, em 2006. Analisou-se a maturação sexual (pré-púbere, púbere e pós-púbere) autoavaliada, o nível econômico (NE) (alto e baixo) por questionário e a adiposidade corporal (normal e elevada) por dobras cutâneas do tríceps e subescapular. Aplicou-se o teste de vaivém de 20 metros para estimar o consumo máximo de oxigênio. A aptidão cardiorrespiratória foi avaliada por critérios referenciados e considerada baixa quando não atingido o critério mínimo para a saúde segundo idade e sexo. Foram aplicados o teste de qui-quadrado e a regressão logística, com nível de significância de 5%. Resultados: A prevalência de aptidão cardiorrespiratória baixa foi de 51,3% que se associou a todas as variáveis do estudo (p<0,001). Na análise bruta, as adolescentes com adiposidade corporal elevada associaram-se à aptidão cardiorrespiratória baixa, quando comparada com aquelas com adiposidade normal (RC=2,76; IC95% 2,17-3,52). Após ajuste pela maturação sexual, essa associação se manteve e mostrou efeito 1,8 vez maior (IC95% 1,39-2,46) e, após ajuste pelo NE, o efeito foi 1,9 vezes maior (IC95% 1,45-2,61). Conclusões: Aproximadamente metade dos avaliados apresentou níveis insatisfatórios de aptidão cardiorrespiratória para a saúde, o que se associou à adiposidade corporal elevada, independentemente da maturação sexual e NE. Medidas efetivas de saúde pública são necessárias, com especial atenção para grupos de maior risco.

Association between cardiorespiratory fitness and body fat in girls. / Relação entre aptidão cardiorrespiratória e adiposidade corporal em meninas.

OBJECTIVE: To estimate the prevalence of low cardiorespiratory fitness and its association with excess body fat, considering the sexual maturation and economic level in female adolescents. METHODS: Cross-sectional, epidemiological study of 1,223 adolescents (10-17 years) from the public school system of Cascavel, PR, Brazil, in 2006. We analyzed the self-assessed sexual maturation level (prepubertal, pubertal and post-pubertal), the Economic Level (EL) (high and low) through a questionnaire and body fat (normal and high) through triceps and subscapular skinfolds. The 20-meter back-and-forth test was applied to estimate maximum oxygen consumption. Cardiorespiratory fitness was assessed according to reference criteria and considered low when the minimum health criterion for age and sex was not met. Chi-square test and logistic regression were applied, with a significance level of 5%. RESULTS: The prevalence of low cardiorespiratory fitness was 51.3%, being associated with all study variables (p<0.001). At the crude analysis, adolescents with high body fat were associated with low cardiorespiratory fitness, when compared to those with normal body fat (OR=2.76; 95%CI: 2.17-3.52). After adjustment by sexual maturation, this association remained valid and showed an effect that was 1.8-fold higher (95%CI: 1.39-2.46) and after adjusting by EL, the effect was 1.9-fold higher (95%CI: 1.45-2.61). CONCLUSIONS: Approximately half of the assessed girls showed unsatisfactory levels of cardiorespiratory fitness for health, which was associated with high body fat, regardless of sexual maturation level and EL. Effective public health measures are needed, with particular attention to high-risk groups.

Brazilian pediatric reference data for quantitative ultrasound of phalanges according to gender, age, height and weight.

AIMS: To establish normative data for phalangeal quantitative ultrasound (QUS) measures in Brazilian students. METHODS: The sample was composed of 6870 students (3688 females and 3182 males), aged 6 to 17 years. The bone status parameter, Amplitude Dependent Speed of Sound (AD-SoS) was assessed by QUS of the phalanges using DBM Sonic BP (IGEA, Carpi, Italy) equipment. Skin color was obtained by self-evaluation. The LMS method was used to derive smoothed percentiles reference charts for AD-SoS according to sex, age, height and weight and to generate the L, M, and S parameters. RESULTS: Girls showed higher AD-SoS values than boys in the age groups 7-16 (p<0.001). There were no differences on AD-SoS Z-scores according to skin color. In both sexes, the obese group showed lower values of AD-SoS Z-scores compared with subjects classified as thin or normal weight. Age (r2 = 0.48) and height (r2 = 0.35) were independent predictors of AD-SoS in females and males, respectively. CONCLUSION: AD-SoS values in Brazilian children and adolescents were influenced by sex, age and weight status, but not by skin color. Our normative data could be used for monitoring AD-SoS in children or adolescents aged 6-17 years.

Comparação do estado nutricional de meninas de acordo com diferentes referências para índice de massa corporal / A comparison of the nutritional status of girls according to different body mass index references

Comparar o estado nutricional de meninas de nove a 17 anos na cidade de Cascavel (PR) segundo três referências para índice de massa corporal (IMC). Métodos: estudo transversal com 2759 meninas. Verificou-se o peso e a estatura obtendo-se o IMC além da avaliação da maturidade sexual e do nível socioeconômico. O estado nutricional foi classificado pelos pontos de corte do IMC propostos por Conde e Monteiro, WHO, e CDC. Resultados: as frequências dos estados nutricionais não diferiram significativamente na mesma referência para IMC por faixa etária, por nível socioeconômico e por tipo de escola. Por nível de maturidade sexual, apenas a referência da WHO apresentou valores de obesidade e sobrepeso maiores para o estadio de mamas grau 5. No entanto, quando comparadas as três referências entre si, o CDC apresentou frequências significativamente menores de sobrepeso e obesidade por faixa etária, por nível de maturidade sexual, por nível socioeconômico e por tipo de escola. Apesar das três referências apresentarem concordância entre si, esta foi maior entre os de Conde e Monteiro, e da WHO. Conclusões: a referência do CDC identificou menor percentual de meninas com sobrepeso e obesidade. As referências propostas por Conde e Monteiro e WHO apresentaram resultados semelhantes...

To compare the nutritional status of girls aged between nine and seventeen years in the city of Cascavel (in the Brazilian State of Paraná) according to three body mass index (BMI) references. Methods: a cross-sectional study was conducted with 2759 girls. Weight and height were measured to obtain the BMI and the sexual maturity and socioeconomic status of the girls evaluated. Nutritional status was classified using the BMI cut-off points proposed by Conde & Monteiro, the WHO, and the CDC. Results: the frequencies for different nutritional states did not differ significantly when the same BMI reference was used according to age, socioeconomic status or type of school attended. In terms of sexual maturity, only the WHO reference WHO produced higher levels of obesity and overweight for girls with Stage 5 breasts. However, when the three references were compared with one another, the CDC produced significantly lower frequencies for overweight and obesity by age group, level of sexual maturity, socioeconomic status and type of school. All three references were in agreement, this was greater between Conde & Monteiro, and the WHO. Conclusions: the CDC reference identified a smaller percentage of overweight and obese girls. The references proposed by Conde & Monteiro and the WHO produced similar results...

A associacao entre a adiposidade corporal e a aptidao musculoesqueletica em meninos e mediada pelo nivel economico? / Does socioeconomic status mediate the association between adiposity and musculoskeletal fitness in boys?

Objetivou-se estimar a prevalência de adiposidade corporal elevada e sua associação com a aptidão musculoesquelética, por nível econômico, em crianças e adolescentes do sexo masculino. Estudo epidemiológico transversal realizado em 1.531 escolares (6-17 anos) da rede de ensino pública do município de Cascavel, PR, Brasil. A adiposidade corporal foi estimada pela técnica de dobras cutâneas. Foram coletadas informações referentes à idade, nível econômico e estágio maturacional, bem como ao desempenho nos testes de sentar e alcançar, abdominal em 1 minuto, impulsão horizontal e Shuttle run. As análises (teste t de student não pareado e regressão de Poisson) foram realizadas por nível econômico alto e baixo (baixo+médio), com nível de significância de 5%. A prevalência de adiposidade corporal elevada foi de 30,4%, sendo maior (p<0,05) naqueles de nível econômico alto (33,3% vs 28,3%). Após ajuste para todas as variáveis, no nível econômico baixo, a adiposidade corporal elevada se associou a baixa resistência abdominal (RP=1,44; IC95%=1,05-1,99) e potência de membros inferiores (RP=2,09; IC95%=1,46-1,98). No nível econômico alto, o desfecho foi associado à baixa resistência abdominal (RP=1,72; IC95%=1,17-2,51) e, à média (RP=2,83; IC95%=1,76-4,55) e baixa (RP=3,90; IC95%=2,38-6,38) potência de membros inferiores. Em ambos os estratos sociais, o menor desempenho muscular (resistência abdominal e potência de membros inferiores) conferiu maior probabilidade de ter adiposidade corporal elevada. Porém, a magnitude das valências musculares associadas à adiposidade corporal elevada parece diferir de acordo com o nível econômico.

We aimed to estimate the prevalence of high body adiposity and its association with musculoskeletal fitness in male children and adolescents according to socioeconomic status. A cross-sectional epidemiological study was carried out with 1,531 school children (6-17 years old) attending public schools in Cascavel, state of Paraná, Brazil. Body adiposity was estimated based on skinfold thickness. Information was also collected on chronological age, socioeconomic status, sexual maturation, performance in physical tests such as sit and reach, 1-minute sit-up, stationary long jump and Shuttle run. Statistical analyses were performed (Student's unpaired t test and Poisson regression) taking into consideration socioeconomic status (high and low+middle), with p<0.05. High body adiposity was observed in 30.4% of the sample, and was greater (p<0.05) among those of high socioeconomic status (33.3% vs 28.3%). After adjustment for all variables, high body adiposity was associated with low abdominal resistance (PR=1.44; CI95%=1.05-1.99) and lower limb power (PR=2.09; CI95%=1.46-1.98) in the low socioeconomic status group. In the high socioeconomic status group, the outcome was associated with low abdominal resistance (PR=1.72; CI95%=1.17-2.51) and with intermediate (PR=2.83; CI95%=1.76-4.55) and low (PR=3.90; CI95%=2.38-6.38) lower limb power. In both socioeconomic levels, lower musculoskeletal fitness (abdominal resistance and lower limb power) was associated with high body adiposity. However, the magnitude of the association between muscular capacity and high body adiposity seems to differ according to socioeconomic status.

Aerobic fitness and biological and sociodemographic indicators in female school children / Aptidão aeróbia, indicadores sociodemográficos e biológicos em escolares do sexo feminino

Aerobic fitness is an important health-related fitness component. The objective of this study was to analyze the influence of age, growth, body composition, sexual maturation and socioeconomic status on the aerobic fitness of female school children attending public schools in Cascavel, Paraná, Brazil. A cross-sectional epidemiological study was conducted in 2006 on 1,317 school children aged 8 to 17 years. Body mass, height and triceps and medial calf skinfold thickness were measured and relative body fat (%BF) was calculated. Sexual maturation was self-assessed using a breast development scale (M1 to M5). The questionnaire proposed by the Brazilian Association of Research Companies was used to assess socioeconomic status. Aerobic fitness was estimated by the 20-m shuttle run test. The results were analyzed using two-way ANOVA, Tukey post hoc test, Spearman and Pearson correlation coefficients, and multiple linear regression with 95% confidence intervals. Three variables (age, %BF and socioeconomic status) showed an interaction (p<0.05) in the prediction of VO2peak rel (R²=0.73). All independent variables (body mass, height, age, %BF, socioeconomic status, and sexual maturation) were significant predictors (p<0.05) of VO2pico abs (R²=0.88). In conclusion, chronological age and sexual maturation were the best predictors of VO2peak abs (positive) and VO2peak rel (negative).

A aptidão aeróbia é considerada um dos mais importantes componentes da aptidão física relacionada à saúde. O objetivo deste estudo foi analisar a influência da idade, das variáveis de crescimento, composição corporal, maturação sexual e do nível econômico (NE) sobre aptidão aeróbia em escolares do sexo feminino de escolas públicas da cidade de Cascavel, PR, Brasil. Estudo epidemiológico transversal realizado com 1.317 escolares de oito a 17 anos de idade no ano de 2006. Foram coletadas as variáveis de massa corporal, estatura, dobras cutâneas do tríceps e panturrilha medial e calculado o percentual de gordura corporal (%GC). A maturação sexual foi autoavaliada por meio da prancha de desenvolvimento de mamas (M1 a M5). O NE foi obtido por um questionário proposto pela Associação Brasileira das Empresas de Pesquisa. O teste de vai-vem de 20 metros foi utilizado para mensurar a aptidão aeróbia. Foram aplicados a Anova two-way, teste post hoc de Tukey, as correlações de Pearson e Spearman e a análise de regressão linear múltipla, com nível de confiança de 95%. Três variáveis (idade, %GC e NE) apresentaram interação (p<0,05) na predição do VO2pico rel (R²=0,73) e todas as variáveis independentes (massa corporal, idade, estatura, %G, NE e maturação sexual) foram significativas para predizer o VO2pico abs (R²=0,88). Conclui-se que a idade cronológica e a maturação sexual foram as variáveis que melhor predizem positivamente os valores de VO2pico abs e negativamente os de VO2pico rel.

Prevalência de obesidade abdominal e fatores associados em crianças e adolescentes de Cascavel-PR, Brasil / Abdominal obesity prevalence and associated factors in children and adolescents in Cascavel-PR State, Brazil

O objetivo deste estudo foi verificar a prevalência de obesidade abdominal e a sua associação com indicadores sociodemográficos, estado nutricional e maturação sexual em escolares de oito a 17 anos, do sexo feminino. Trata-se de um estudo transversal realizado com 2.595 escolares do sexo feminino de escolas públicas e privadas da cidade de Cascavel-PR, Brasil. Foram coletadas informações sociodemográficas, antropométricas e de maturação sexual. Para a análise dos dados aplicou-se o teste qui-quadrado e a regressão logística binária. A prevalência de obesidade abdominal foi de 8,2%. As escolares do Ensino Médio apresentaram menores chances de ter obesidade abdominal, quando comparadas as meninas do Ensino Fundamental (OR=0,36; IC95%=0,15-0,85) e aquelas com excesso de peso apresentaram maiores chances de ter o desfecho (OR=181,36; IC95%=84,43-389,58). São necessárias intervenções educacionais visando à prevenção e redução da obesidade abdominal, principalmente entre as escolares do Ensino Fundamental e com excesso de peso.

The aim of this study was to determine the abdominal obesity prevalence and its association with socio-demographic indicators, nutritional status and sexual maturity in female students aged 8 to 17 years. This is a cross-sectional study with 2,595 female students from public and private schools of the city of Cascavel, Paraná State, Brazil. Socio-demographic, anthropometric and sexual maturity data were collected. Data analysis was carried out by a chi-square test and binary logistic regression. The obesity prevalence was 8.2%. High-school students were less likely to have abdominal obesity when compared with girls at basic education (OR = 0.36, 95%CI=0.15-0.85) and those with overweight were more likely to have the outcome (OR = 181.36, 95%CI=84.43-389.58). Educational interventions aimed at preventing and reducing abdominal obesity should be implemented, especially among overweight schoolchildren.

Dados sociodemográficos, estado nutricional e maturação sexual de escolares do sexo masculino: exposição à insatisfação com a imagem corporal / Sociodemographic data, nutritional status and sexual maturation of male students: exposure to dissatisfaction with body image

O objetivo do presente estudo foi verificar a prevalência da percepção com a imagem corporal (IC) e identificar a associação com fatores sociodemográficos, estado nutricional e maturação sexual em escolares do sexo masculino (7 a 17 anos) do município de Cascavel, PR, Brasil. Foram avaliados 1.521 escolares e analisadas as variáveis idade, série, nível econômico, IMC, maturação sexual e a percepção da imagem corporal. Utilizou-se o teste qui-quadrado e a regressão logística multinomial. A prevalência de insatisfação com a IC foi de 74,7%, e os escolares que desejam diminuir a silhueta possuem de sete a 13 anos (RC=2,81; IC95%=1,48-5,31) e apresentam estado nutricional normal (RC=0,14; IC95%=0,10-0,20). Aqueles que desejam ter uma silhueta maior têm entre sete e dez anos (RC=1,86; IC95%=1,15-3,02), cursam o Ensino Fundamental (RC=0,50; IC95%=0,30-0,85) e possuem estado nutricional normal (RC=2,17; IC95%=1,45-3,27). Conclui-se que a insatisfação com a imagem corporal associou-se com a idade, série e estado nutricional.

The aim of this study was to determine the prevalence of body image perception (BI) and its association with sociodemographic factors, nutritional status and sexual maturation in male students (7 to 17 years of age) from Cascavel, Paraná State, Brazil. The study evaluated 1521 students, and analyzed age, school grade, socioeconomic status, BMI, sexual maturation and body image perception. Chi-square test and multinomial logistic regression were used. The prevalence of BI dissatisfaction was 74.7%, and students who wanted to reduce their silhouette aged 7 to 13 years (OR = 2.81, CI 95% 1.48 to 5.31) and showed a normal nutritional status (OR = 0.14, CI 95% = 0.10 to 0.20). Those who wanted to have a larger silhouette aged between 7 and 10 years (OR = 1.86, CI 95% 1.15 to 3.02), were at high school (OR = 0.50, CI 95% = 0.30 - 0.85) and showed a normal nutritional status (OR = 2.17, CI 95% 1.45 to 3.27). BI dissatisfaction was associated with age, grade and nutritional status.

[Preliminary comparison between phalangeal quantitative ultrassonography and bone densitometry for bone mass evaluation in adolescents]. / Comparação preliminar entre ultrassonografia quantitativa de falanges e densitometria óssea na avaliação da massa óssea em adolescentes.

OBJECTIVE: To evaluate the association between quantitative ultrasonography at hand phalanges (QUS) and dual energy X-ray absorptiometry (DXA), and between these methods with food intake and history of bone fractures. SUBJECTS AND METHODS: After two years of follow up of 270 schoolchildren, 10 of them, who showed bone mass below - 2 SD in QUS, were included in the present study. Laboratory results and DXA data were analyzed. RESULTS: Bone mass evaluated by DXA at L1-L4 ranged from -2.8 to -1.1 SDS, and whole body bone mass, from -2.9 to -1.2 SDS. Three children had history of non-pathological bone fractures. Dietary assessment showed low intake of calcium in 10 cases, of phosphorus in 6, and of vitamin D in 8 cases. There were no differences among the cases of bone mass below-2 SD in any of the three used methods. There was no association between history of bone fractures and food intake, and between these evaluations and bone mass. CONCLUSION: In this small group of schoolchildren there was an association between the methods QUS and DXA. However, there was no association between bone mass and the history of bone fractures, or calcium, phosphorus and vitamin D intake.

Comparação preliminar entre ultrassonografia quantitativa de falanges e densitometria óssea na avaliação da massa óssea em adolescentes / Preliminary comparision between phalangeal quantitative ultrassonography and bone densitometry for bone mass evaluation in adolescents

OBJETIVO: Avaliar associação entre ultrassonografia quantitativa de falanges da mão (QUS) e a densitometria por absorção de raio-X de dupla energia (DXA) e desses com os históricos alimentar e de fraturas. SUJEITOS E MÉTODOS: Após dois anos de acompanhamento de 270 escolares, 10 com massa óssea por QUS abaixo de -2 DP foram incluídos no estudo e avaliados com DXA. RESULTADOS: A massa óssea por DXA de L1-L4 variou de -2,8 a -1,1 DP e de corpo inteiro -2,9 e -1,2. Três estudantes apresentaram fraturas. Baixa ingestão de cálcio foi observada nos 10 casos, de fósforo em 6 e de vitamina D em 8. Não houve diferença entre os casos com massa abaixo de -2 DP nos três métodos de avaliação. Não foi observada associação entre as fraturas e o histórico alimentar, nem com os valores de massa óssea. CONCLUSÃO: Neste pequeno grupo de adolescentes houve associação entre QUS e DXA, porém sem associação entre essas avaliações e as fraturas e a ingestão de cálcio, fósforo e vitamina D.

OBJECTIVE: To evaluate the association between quantitative ultrasonography at hand phalanges (QUS) and dual energy X-ray absorptiometry (DXA), and between these methods with food intake and history of bone fractures. SUBJECTS AND METHODS:After two years of follow up of 270 schoolchildren, 10 of them, who showed bone mass below - 2 SD in QUS, were included in the present study. Laboratory results and DXA data were analyzed. RESULTS: Bone mass evaluated by DXA at L1-L4 ranged from -2.8 to -1.1 SDS, and whole body bone mass, from -2.9 to -1.2 SDS. Three children had history of non-pathological bone fractures. Dietary assessment showed low intake of calcium in 10 cases, of phosphorus in 6, and of vitamin D in 8 cases. There were no differences among the cases of bone mass below-2 SD in any of the three used methods. There was no association between history of bone fractures and food intake, and between these evaluations and bone mass. CONCLUSION: In this small group of schoolchildren there was an association between the methods QUS and DXA. However, there was no association between bone mass and the history of bone fractures, or calcium, phosphorus and vitamin D intake.

Influência da composição corporal sobre a massa óssea em crianças e adolescentes / Influence of body composition on bone mass in children and adolescents

OBJETIVO: Avaliar a influência da composição corporal sobre a massa óssea em crianças e adolescentes. MÉTODOS: Estudo transversal com 267 estudantes saudáveis de ambos os sexos (141 meninos e 126 meninas) com idades entre 8 e 18 anos. Peso, altura, índice de massa corporal, massa magra, massa gorda, índice de massa gorda, percentual de gordura corporal, circunferência da cintura e do quadril e relação cintura-quadril foram avaliados. A massa óssea foi avaliada por ultrassonografia das falanges da mão (DBM Sonic BPI GEA, Carpi, Italy). RESULTADOS: As meninas apresentaram maior massa óssea em relação aos meninos, com o avanço da idade e estádio puberal. Em ambos os sexos, a massa óssea apresentou correlações significativas e positivas com idade, peso, altura, índice de massa corporal, massa magra, e circunferências da cintura e do quadril; e negativa com a relação cintura-quadril. Nas meninas, houve também correlação positiva com massa gorda, índice de massa gorda e percentual de gordura corporal. A idade e a massa magra foram preditoras para a massa óssea nos meninos e a idade, o estádio púbere e o índice de massa gorda preditores nas meninas. CONCLUSÃO: A correlação entre massa óssea e composição corporal ocorreu em ambos os sexos, sendo a massa magra preditora da quantidade óssea nos meninos e o índice de massa gorda nas meninas.

OBJECTIVE: To evaluate the influence of body composition on bone mass in children and adolescents. METHODS: A cross-sectional study with 267 healthy students of both sexes (141 males and 126 females) aged 8 to 18 years. Weight, height, body mass index, lean mass, fat mass, fat mass index, body fat percentage, waist and hip circumferences, and waist-to-hip ratio were evaluated. Bone mass was assessed using ultrasound of hand phalanges (DBM Sonic BP IGEA, Carpi, Italy). RESULTS: Females showed greater bone mass in relation to males with ad vances in age and pubertal stage. In both sexes, the bone mass showed significant and positive correlations with age, weight, height, body mass index, lean mass, waist and hip circumfer ences; and negative correlations with waist-to-hip ratio. In females, there was also a positive correlation with fat mass, fat mass index, and body fat percentage. Age and lean mass were predictors for bone mass in males, and age, pubertal stage and fat mass index were predictors in females. CONCLUSION: The correlation between bone mass and body composition occurred in both sexes, with lean mass and fat mass index being the predictor of bone mass in males and females, respectively.

Influence of body composition on bone mass in children and adolescents.

OBJECTIVE: To evaluate the influence of body composition on bone mass in children and adolescents. METHODS: A cross-sectional study with 267 healthy students of both sexes (141 males and 126 females) aged 8 to 18 years. Weight, height, body mass index, lean mass, fat mass, fat mass index, body fat percentage, waist and hip circumferences, and waist-to-hip ratio were evaluated. Bone mass was assessed using ultrasound of hand phalanges (DBM Sonic BP IGEA, Carpi, Italy). RESULTS: Females showed greater bone mass in relation to males with advances in age and pubertal stage. In both sexes, the bone mass showed significant and positive correlations with age, weight, height, body mass index, lean mass, waist and hip circumferences; and negative correlations with waist-to-hip ratio. In females, there was also a positive correlation with fat mass, fat mass index, and body fat percentage. Age and lean mass were predictors for bone mass in males, and age, pubertal stage and fat mass index were predictors in females. CONCLUSION: The correlation between bone mass and body composition occurred in both sexes, with lean mass and fat mass index being the predictor of bone mass in males and females, respectively.

Estado nutricional de escolares segundo a localização geográfica das escolas em Sorocaba, São Paulo / Nutritional status of schoolchildren according to school geographical localization in the city of Sorocaba, São Paulo, Brazil

OBJETIVO: Verificar as prevalências de baixo peso, sobrepeso e obesidade em escolares, segundo a localização geográfica das escolas públicas na cidade de Sorocaba (SP), Brasil. MÉTODOS: Foi avaliado o maior número possível de escolares de sete a dez anos de idade, num total de 11.290 indivíduos pertencentes à rede pública municipal de escolas. Para a determinação de baixo peso, sobrepeso e obesidade foram utilizados, respectivamente, os percentis <5, >85 e >95 do índice de massa corpórea por idade para sexo e idade propostos pelos Centers for Disease Control and Prevention (CDC, 2000). Comparou-se a prevalência de alterações nutricionais de acordo com a localização da escola. RESULTADOS: A prevalência de baixo peso, sobrepeso e obesidade nas crianças avaliadas, segundo a região geográfica de Sorocaba foi, respectivamente: Centro 3,4, 17,2 e 15,1 por cento; Sul 4,2, 15,4 e 11,2 por cento; Leste 3,2, 14,7 e 12,7 por cento; Nordeste 4,3, 11,9 e 10,7 por cento; Norte 5,8, 12 e 9,1 por cento; Noroeste 7,5, 11 e 9,1 por cento; Oeste 6,0, 11 e 9,2 por cento. Os meninos apresentaram 5,3, 12,1 e 11,9 por cento e as meninas 5,9, 12,3 e 8,2 por cento de baixo peso, sobrepeso e obesidade, respectivamente. Houve diferença significativa na prevalência de alterações nutricionais entre as regiões da cidade (p<0,001) CONCLUSÕES: O Centro e o Leste de Sorocaba apresentaram as maiores taxas de escolares com excesso de peso, as regiões Noroeste e Oeste, as maiores taxas de baixo peso. Na análise por sexo, os meninos apresentaram maiores taxas de obesidade. Esses resultados podem ajudar a planejar políticas públicas para a prevenção da obesidade em escolares.

OBJECTIVE: To estimate the prevalence of underweight, overweight and obesity in students of public schools from Sorocaba, São Paulo, Brazil. METHODS: This cross-sectional study enrolled 11,290 children aged seven to ten from public schools in the city of Sorocaba. Underweight, overweight and obesity were defined as, respectively, <5th, >85th and >95th body mass index percentiles for sex and age, according to the Centers for Disease Control and Prevention growth chart (CDC, 2000). The prevalence of nutritional alterations was assessed according to the geographical localization. RESULTS: Rates for underweight, overweight and obesity were respectively: Central area 3.4, 17.2 and 15.1 percent; Southern area, 4.2, 15.4 and 11.2 percent; Eastern area, 3.2, 14.7 and 12.7 percent; Northeast, 4.3, 11.9 and 10.7 percent; North, 5.8, 12 and 9.1 percent; Northwest 7.5, 11 and 9.1 percent; and Western regions 6, 11 and 9.2 percent. The differences between areas were significant (p<0.001). Boys had 5.3, 12.1 and 11.9 percent of underweight, overweight and obesity, while girls presented the rates of 5.9, 12.3 and 8.2 percent. CONCLUSIONS: Central and Eastern regions of the city had the highest rates of children with overweight. The northwest and western regions presented the highest underweight rates. Boys have higher rates of obesity. These results should help to plan Public Health strategies to prevent obesity in schoolchildren.

Body composition of white and black Brazilian schoolchildren.

AIM: To evaluate body composition of black and white schoolchildren in Brazil. METHODS: The study included 1,443 children aged 6-11 years, both genders, black and white skin colors. The measures of weight, height, BMI, brachial perimeter, tricipital and subscapular skinfolds, lean and fat area of the arm were transformed into standard deviation scores (SDS). RESULTS: As to frequency of variables under -2 SDS, only arm perimeter and lean area of the arm in both white and black schoolchildren showed results over 7%, but tricipital and subscapular skinfolds, fat area of the arm, sum of skinfolds and fat percentage, in both skin colors, presented results close to zero. As to frequency of variables over +2 SDS, only fat percentage presented results over 5% in both skin colors. CONCLUSION: The present study did not find important differences in body composition between black and white schoolchildren in this group of the Brazilian population.

[Antropometry, sexual maturation and menarcheal age according to socioeconomic status of schoolgirls from Cascavel (PR)]. / Antropometria, maturação sexual e idade da menarca de acordo com o nível socioeconômico de meninas escolares de Cascavel (PR).

OBJECTIVE: To evaluate age of menarche and anthropometric data of schoolgirls of different socioeconomic levels in Cascavel, state of Parana, in Southern Brazil. METHODS: A cross-sectional study was carried out in 2006 with 2,761 girls evaluated in 27 private and public schools. Age at menarche was obtained by the status quo method. Sexual maturity was assessed by self evaluation, according to Tanner's criteria. Socioeconomic level was obtained through the ABEP (2003) questionnaire. Data of weight, stature and Body Mass Index (BMI) were obtained. Data were analyzed by descriptive statistics and Mann-Whitney test at 5% significance. RESULTS: Age at menarche was 12.2+/-1.2 years in the whole sample, and was 12.1+/-1.1; 12.3+/-1.2 and 12.4+/-1.2 in girls from high, medium and low socioeconomic levels, respectively. Post-menarche girls aged 10-17 years had higher values of stature and weight and girls aged 11-14 years had higher BMI. CONCLUSIONS: Age at menarche was lesser in girls from a higher socioeconomic level. Although these differences had been found in distinct socioeconomic levels, they were considered biologically small.

[Nutritional status of white and black schoolchildren in the south of Brazil]. / Estado nutricional de escolares brancos e negros do sul do Brasil.

OBJECTIVE: To evaluate the nutritional status of pupils from public schools of two cities in the western part of the state of Parana according to socioeconomic status and race. METHODS: 1,443 children (aged 6 - 11 years) of both genders, classified as white or black and with different socioeconomic status were evaluated by weight, height and body mass index, transformed into the z score. A descriptive analysis of the data was performed, and the chi-square test, Fisher's exact test, variance analysis and linear regression with significance of 5% were used. RESULTS: In the low socioeconomic status black pupils were predominant. Black boys presented lower values in weight and height in relation to white boys. When values of the z score lower than -2 were considered, white girls predominated in weight and height and black boys in height. No significant difference was found in values above +2. Low interaction of socioeconomic status and age was observed to predict weight, as well as for socioeconomic status, age and color of the skin, for height. CONCLUSION: Despite socioeconomic and racial differences found, there was no important variation of the nutritional status in the group of schoolchildren evaluated.

Bone quantity and quality in Brazilian female schoolchildren and adolescents.

The aim of the present study was to evaluate quantitative ultrasound parameters of the finger phalanges bones (AD-SoS, amplitude-dependent speed of sound, and BTT, bone transmission time) of schoolchildren, using a DBM Sonic device (IGEA, Carpi, Italy), to obtain normative values for the Brazilian population. The sample consisted of 1,775 healthy schoolchildren, all females, aged 8-17 years. We observed a progressive increase for the variables of weight, height, body mass index (BMI), AD-SoS, and BTT with advancing age. Results for AD-SoS showed increasing and significant variation from 8 to 17 years old (1,938-2,103 m/s, an increase of 8.52%, P < 0.0001), and also for BTT (0.84-1.45 micros, an increase of 72.6%, P < 0.0001). A gradual increase in the values of AD-SoS and BTT was observed with advances in pubertal stages. There was an interaction between the variables of age, height, and pubertal stages, predicting AD-SoS (R (2) = 0.49) and BTT (R (2) = 0.53). The study showed that AD-SoS and BTT, evaluated by means of bone ultrasonometry of the phalanges in females, increase gradually with age, being more evident during puberty, probably as a reflex of the structural organization of bone growth and development, or changes in the content of the bone tissue.

Bone mass in schoolchildren in Brazil: the effect of racial miscegenation, pubertal stage, and socioeconomic differences.

The purpose of this study was to evaluate bone mass by phalanges ultrasound in healthy white and black schoolchildren in relationship to socioeconomic level, pubertal stage, and body composition. Included were 1,356 healthy schoolchildren aged from 6 to 11 years from different socioeconomic levels and both genders; all were placed into white and black groups. Weight, height, body mass index, fat percentage, fat mass, and lean mass were evaluated by anthropometric methods, and AD-SoS bone quantity and UBPI bone quality were evaluated using a third-generation IGEA phalanges DBM Sonic BP ultrasound. Data were compared using the Mann-Whitney, chi-squared, correlation coefficient, and analyses of multiple linear regression statistical tests with 5% significance. Black schoolchildren predominated in the low socioeconomic levels. Higher values of weight and height for black boys and girls were observed in the lean mass in relation to white children of the same gender and age. An increasing variation in the bone quantity mean was observed from 6 to 11 years of age and with pubertal stage for both genders and skin color. The white schoolchildren presented higher values of bone quantity and quality in relation to the black children. The anthropometric, gender, and socioeconomic level variables explained only 16 and 11% of the variability of bone quantity and quality, respectively. As such, the present study, carried out with healthy black and white Brazilian schoolchildren, demonstrated higher bone mass, as evaluated by ultrasound, in white than in black schoolchildren.