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1.
Int J Behav Nutr Phys Act ; 16(1): 115, 2019 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775773

RESUMO

BACKGROUND: Excessive screen time has been associated with metabolic syndrome (MetS) among adolescents; however, snack intake in front of screens may play a role in this association. Therefore, our objective was to investigate the association between screen-based sedentary time with MetS and whether this association is modified by unhealthy snack intake in front of screens. METHODS: This study was a nationwide, cross-sectional, school-based survey in Brazil including adolescents aged 12 to 17 years. The frequency of snack consumption in front of screen and screen-based sedentary time (TV view, computers and videogames use) were self-reported. Thereafter, screen time was categorized (≤2, 3-5 and ≥ 6 h/day); snack consumption in front of screens was dichotomized. Metabolic syndrome diagnosis was defined based on the International Diabetes Federation criteria. Associations between screen time and MetS were investigated using logistic regression in overall sample and after stratification by snack intake in front of screens. RESULTS: A total of 33,900 adolescents were included in the analysis. The final adjusted model, which included sociodemographic data, physical activity, and energy intake, showed that adolescents who spent ≥6 h/day in front of screens had an increased odds ratio for MetS (OR = 1.68, 95%CI: 1.03-2.74). However, after stratifying the sample according to reported snack intake, the association between higher screen-based sedentary time and MetS remained significant only for adolescents who reported consumption of snacks in front of screens. CONCLUSION: Longer screen-based sedentary times were directly associated with MetS. However, this association seems to be modified by reported snack intake in front of screens.

2.
J. pediatr. (Rio J.) ; 95(4): 385-400, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1040336

RESUMO

Abstract Objectives: This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents. Data source: A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed. Summary of data: A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term. Conclusion: The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.


Resumo Objetivos: Este estudo teve como objetivo avaliar a qualidade das revisões sistemáticas sobre prevenção e tratamento não farmacológico do sobrepeso e da obesidade em crianças e adolescentes. Fontes de dados: Foi realizada uma busca em bases de dados eletrônicas (Medline via Pubmed, Web of Science, Scopus, LILACS, The Cochrane Library e Ensaios Clínicos), incluindo apenas revisões sistemáticas com meta-análise. As revisões foram selecionadas por dois pesquisadores e um terceiro resolveu as divergências. A lista de recomendações do PRISMA foi seguida. Síntese dos dados: Foram identificados 4.574 publicações, e 24 foram incluídas após seleção. Seis publicações eram sobre prevenção da obesidade, 17 sobre tratamento da obesidade e 1 sobre intervenções mistas para prevenção e tratamento da obesidade. As intervenções eram muito heterogêneas e mostraram pouco ou nenhum efeito sobre o peso ou índice de massa corporal. Intervenções mistas que incluíam dieta, exercícios, ações para reduzir o comportamento sedentário e programas que envolviam a escola ou as famílias mostraram alguns efeitos positivos de curto prazo. Revisões que analisaram fatores de risco cardiovascular demonstraram melhoras significativas em curto prazo. Conclusão: As revisões sistemáticas de intervenções para prevenir ou reduzir a obesidade em crianças e adolescentes geralmente mostraram pouco ou nenhum efeito sobre o peso ou índice de massa corporal, embora o perfil cardiovascular possa ter melhorado. Intervenções mistas demonstraram melhores efeitos, mas o impacto em longo prazo dos tratamentos da obesidade de crianças e adolescentes ainda não está claro.

3.
Biol Sport ; 36(2): 141-148, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31223191

RESUMO

The aim of this study was to evaluate the acute effect of aerobic (AER) and eccentric (ECC) exercise on glucose variability, correlating it with circulating markers of inflammation and oxidative stress in healthy subjects. Sixteen healthy subjects (32 ± 12 years old) wore a continuous glucose monitoring system for three days. Participants randomly performed single AER and ECC exercise sessions. Glucose variability was evaluated by glucose variance (VAR), glucose coefficient of variation (CV%) and glucose standard deviation (SD). Blood samples were collected to evaluate inflammatory and oxidative stress markers. When compared with the pre-exercise period of 0-6 h, all the indices of glucose variability presented comparable reductions 12-18 h after both exercises (∆AER: VAR= 151.5, ∆CV% = 0.55 and ∆SD = 3.1 and ECC: ∆VAR = 221.2 , ∆CV% = 3.7 and ∆SD = 6.5). Increased interleukin-6 (IL-6) levels after AER (68.5%) and ECC (30.8%) (P<0.001) were observed, with no differences between sessions (P = 0.459). Uric acid levels were increased after exercise sessions (3% in AER and 4% in ECC, P = 0.001). In conclusion, both AER and ECC exercise sessions reduced glucose variability in healthy individuals. Inflammatory cytokines, such as IL-6, and stress oxidative markers might play a role in underlying mechanisms modulating the glucose variability responses to exercise (clinicalTrials.gov NCT02262208).

4.
Diabetol Metab Syndr ; 11: 40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31149031

RESUMO

Objective: To evaluate the association between adiponectin concentrations and metabolic syndrome (MetS) risk and to investigate if this association is independent of weight status in adolescents. Methods: Adiponectin concentrations and MetS risk were assessed in 4546 Brazilian adolescents (12-17 years old) enrolled in The Study of Cardiovascular Risks in Adolescents ("ERICA"), a cross-sectional multicenter study in Brazil. For analyses, adiponectin was categorized in sex and age-specific quartiles and MetS risk was expressed as a continuous score, calculated as the average of the standardized values (z-score) of the five MetS components. Multiple linear regression models were used to investigate the association between the quartiles of adiponectin and MetS risk. Results: Adiponectin was inversely associated with waist circumference and log-transformed triglycerides, and positively associated with HDL-c. We also observed an inverse association between adiponectin concentrations and MetS risk. After adjustment for sociodemographic variables, physical activity, skipping breakfast and body mass index (BMI), higher quartiles of adiponectin remained inversely associated with waist circumference and MetS risk. A direct association between adiponectin and HDL-c was also observed. In further analysis, the sample was stratified by weight status and an inverse association between quartiles of adiponectin and MetS risk was observed in both normal weight and overweight/obese adolescents. Conclusion: Higher adiponectin concentrations were independently and inverse associated with MetS risk in Brazilian adolescents, even after adjusting for BMI. These results were similar in normal weight and overweight/obese adolescents, suggesting that adiponectin may play a role in early development of MetS.

5.
BMC Public Health ; 19(1): 657, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31142294

RESUMO

BACKGROUND: Hypertension is a clinical condition highly prevalent in the elderly, imposing great risks to cardiovascular diseases and loss of quality of life. Current guidelines emphasize the importance of nonpharmacological strategies as a first-line approach to lower blood pressure. Exercise is an efficient lifestyle tool that can benefit a myriad of health-related outcomes, including blood pressure control, in older adults. We herein report the protocol of the HAEL Study, which aims to evaluate the efficacy of a pragmatic combined exercise training compared with a health education program on ambulatory blood pressure and other health-related outcomes in older individuals. METHODS: Randomized, single-blinded, multicenter, two-arm, parallel, superiority trial. A total of 184 subjects (92/center), ≥60 years of age, with no recent history of cardiovascular events, will be randomized on a 1:1 ratio to 12-week interventions consisting either of a combined exercise (aerobic and strength) training, three times per week, or an active-control group receiving health education intervention, once a week. Ambulatory (primary outcome) and office blood pressures, cardiorespiratory fitness and endothelial function, together with quality of life, functional fitness and autonomic control will be measured in before and after intervention. DISCUSSION: Our conceptual hypothesis is that combined training intervention will reduce ambulatory blood pressure in comparison with health education group. Using a superiority framework, analysis plan prespecifies an intention-to-treat approach, per protocol criteria, subgroups analysis, and handling of missing data. The trial is recruiting since September 2017. Finally, this study was designed to adhere to data sharing practices. TRIAL REGISTRATION: NCT03264443 . Registered on 29 August, 2017.


Assuntos
Promoção da Saúde/métodos , Hipertensão/prevenção & controle , Estilo de Vida , Idoso , Protocolos Clínicos , Humanos , Pessoa de Meia-Idade
6.
Diabetol Metab Syndr ; 11: 34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31073334

RESUMO

Background: This study was developed to evaluate quality indicators in type 2 diabetes patient care at the Unified Public Health System's primary and tertiary health care centers within a local population. Methods: This was a retrospective cohort of 488 patients with type 2 diabetes (148 in each primary health care unit, ESF and UBS, and 192 at the tertiary health care unit) with a 1-year follow-up to evaluate the following care quality indicators: nephropathy, neuropathy and retinopathy tests, yearly lipid profile and nutritional assessments, and an inquiry about tobacco use. The presence of > 50% of the quality of care assessment measures was considered acceptable. Indicators were also evaluated in relation to patients without proper diabetes control (HbA1c > 8.5%). Results: In the results, a high percentage of patients were excluded specifically for not presenting the two HbA1c tests within a year (n = 208, 58.1% at ESF; n = 225, 58.4% at UBS; and n = 39, 16.9% at the tertiary health care unit). From the included patients, only 7 (4.7%) at ESF, 7 (4.7%) at UBS, and 52 (27.0%) at the tertiary health care unit showed > 50% of the quality criteria covered. When only patients without proper diabetes control were evaluated, none of them at any of the health care units showed all the quality criteria covered. Conclusions: Our results show a low percentage of care assessment measures at each evaluated health care unit, pointing out the need to improve the protocols and care lines of diabetic patients.

7.
Eur J Nutr ; 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30963230

RESUMO

PURPOSE: This study aimed to assess the dietary patterns of adolescents using a food-based diet quality index and their compliance with a healthy dietary guideline METHODS: Participants included 71,553 Brazilian adolescents (12-17 years old) from the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional school-based multicenter study.. Dietary intake was measured by one 24-h recall. A second recall was collected in a random subsample (~ 10%) to correct within-person variability. The Diet Quality Index for Adolescents adapted for Brazilians (DQIA-BR) was used to measure the overall quality of the dietary intake. The National Cancer Institute method was applied to estimate usual dietary intake. The DQIA-BR and the distribution of its components (quality, diversity, and equilibrium) were analyzed according to sex, geographical area, and type of school RESULTS: The mean (SD) DQIA-BR scores were 14.8% (6.1%) for females and 19.0% (6.3%) for males. All analyzed strata revealed low scores of DQIA-BR and its components. The median usual intake was five to sevenfold below the recommendations for vegetables and fruits and approximately twofold below the recommendations for dairy. The highest DQIA-BR mean scores were found in the northern region [17.0% (6.4%), females; 20.7% (6.3%), males]. Adolescents in both types of schools had relatively similar median intakes of snacks (~ 85 g) and sugared drinks (~ 600 ml) CONCLUSIONS: The overall diet quality of Brazilian adolescents is inadequate based on evaluated parameters in all regions and socioeconomic backgrounds.

8.
J. pediatr. (Rio J.) ; 95(2): 155-165, Mar.-Apr. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1002460

RESUMO

Abstract Purpose: To evaluate the prevalence of excessive screen-based behaviors among Brazilian adolescents through a systematic review with meta-analysis. Data source: Systematic review and meta-analysis were recorded in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO-CRD 2017 CRD42017074432). This review included observational studies (cohort or cross-sectional) that evaluated the prevalence of excessive screen time (i.e. combinations involving different screen-based behaviors) or TV viewing (≥2 h/day or >2 h/day in front of screen) through indirect or direct methods in adolescents aged between 10 and 19 years. The research strategy included the following databases: MEDLINE, LILACS, SciELO and ADOLEC. The search strategy included terms for "screen time", "Brazil", and "prevalence". Random effect models were used to estimate the prevalence of excessive screen time in different categories. Data summary: Twenty-eight out of 775 studies identified in the search met the inclusion criteria. The prevalence of excessive screen time and TV viewing was 70.9% (95% CI: 65.5-76.1) and 58.8% (95% CI: 49.4-68.0), respectively. There was no difference between sexes in both analyses. The majority of studies included showed a low risk of bias. Conclusions: The prevalence of excessive screen time and TV viewing was high among Brazilian adolescents. Intervention are needed to reduce the excessive screen time among adolescents.


Resumo Objetivo: Avaliar a prevalência de tempo excessivo de tela e de TV em adolescentes brasileiros através de revisão sistemática com metanálise. Fontes de dados: A revisão sistemática e a metanálise foram registradas no Registro Prospectivo Internacional da Base de Dados de Análises Sistemáticas (Prospero-CRD 2017 CRD 42017074432). Esta análise incluiu estudos observacionais (coorte ou transversais) que avaliaram a prevalência de tempo excessivo de tela (ou seja, combinações que envolvem diferentes comportamentos baseados em tempo de tela) ou tempo em frente à TV (≥ 2 horas/dia ou > 2 horas/dia em frente à tela) por avaliação direta ou indireta em adolescentes com idades entre 10 a 19 anos. A estratégia de pesquisa incluiu as seguintes bases de dados: MEDLINE, LILACS, SciELO e ADOLEC. A estratégia de busca incluiu termos como "tempo de tela", "Brasil" e "prevalência". Os modelos de efeito aleatório foram utilizados para estimar a prevalência de tempo excessivo de tela em diferentes categorias. Resumo de dados: Dos 775 estudos identificados na busca 28 atenderam aos critérios de inclusão. A prevalência de tempo excessivo de tela e tempo de TV foi 70,9% (IC de 95%: 65,5 a 76,1) e 58,8% (IC de 95%: 49,4 a 68,0), respectivamente. Não houve diferença entre os sexos nas duas análises. A maior parte dos estudos incluídos mostrou baixo risco de viés. Conclusões: A prevalência de tempo excessivo de tela e tempo de TV foi alta entre os adolescentes brasileiros. São necessárias intervenções para reduzir o tempo excessivo de tela entre os adolescentes.

9.
Pediatr Diabetes ; 20(4): 389-396, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30737879

RESUMO

BACKGROUND: Type 2 diabetes mellitus (T2DM) in adolescents represents a clinical challenge related to lifestyle and obesity; however, only a few data are available in developing countries. Therefore, our aim was to investigate the prevalence of T2DM and prediabetes among Brazilian adolescents, as well as to describe the cardio-metabolic profile according to the diagnosis. METHODS: This is a cross-sectional school-based multicenter study including youth aged 12 to 17 years from cities with more than 100 000 inhabitants in Brazil (n = 37 854 students). Fasting glucose, hemoglobin A1c (HbA1c) and other cardio-metabolic risk factors were measured. Prediabetes was defined by glucose levels 100 to 125 mg/dL or HbA1c 5.7% to 6.4%. T2DM was defined by self-report, glucose ≥126 mg/dL or HbA1c ≥ 6.5%. Multinomial logistic regression was used to estimate the odds ratio (OR) of prediabetes or T2DM according to covariates. RESULTS: Prevalences of prediabetes and T2DM were 22.0% (95% confidence interval [CI] 20.6%-23.4%) and 3.3% (95% CI 2.9%-3.7%), respectively. This estimates represented 213 830 adolescents living with T2DM and 1.46 million adolescents with prediabetes in Brazil. Prevalences of cardio-metabolic risk factors were higher in adolescents with prediabetes and T2DM. In the multinomial logistic model, obesity (OR 1.59, 95% CI 1.20-2.11), high waist circumference (OR 1.51, 95% CI 1.13-2.01), and skipping breakfast (OR 1.48, 95% CI 1.21-1.81) were associated with an increased OR for T2DM, while studying at rural area (OR 0.56, 95% CI 0.41-0.78) was associated with a decreased OR for T2DM. CONCLUSIONS: The prevalence of T2DM and prediabetes was high among Brazilian adolescents, which highlights that this disease became a public health challenge not only among adults in Brazil.

10.
Blood Press Monit ; 24(2): 52-58, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30640739

RESUMO

OBJECTIVE: Increased blood pressure (BP) variability and inflammation are included among the factors recognized as potential predictors of cardiovascular events in type 2 diabetes and hypertension. This study aimed to evaluate whether C-reactive protein (CRP) is associated with increased BP variability in diabetic-hypertensive patients. PATIENTS AND METHODS: We carried out a cross-sectional study with 285 diabetic-hypertensive patients, evaluating laboratory characteristics and 24-h ambulatory BP monitoring. SD, coefficient of variation (CV%), time-rate index of 24-h systolic BP (SBP), and 24-h BP patterns were evaluated. Pearson's χ-test, Student's t-test, and the Mann-Whitney test were used to compare the groups. Groups were defined by CRP of up to 3 mg/l (low) and more than 3 mg/l (high). RESULTS: The age of the patients was 59 (54-62) years; 101 (35%) were men. There was an increase in office SBP [137 (127-148) vs. 145 (130-157) mmHg] and DBP [79 (73-86) vs. 82 (76-91) mmHg] in the high CRP group. Blood pressure variability indexes were not different among groups [SD: 11.2 (9-15) vs. 12.2 (10-15) mmHg; CV%: 8.6 (7-11) vs. 9.4 (7-12); time rate: 0.55±0.12 vs.12.2 (10-15) mmHg/min]. In addition, BMI (29.3±3.8 vs. 30.9±3.6 kg/m), total cholesterol [166 (148-190) vs. 177 (156-210) mg/dl], and HbA1c [7.5% (6.6-8.9) vs.8.3% (7.1-9.9)] were higher in the high CRP group. CONCLUSION: In patients with diabetes and hypertension, higher CRP levels are linked to cardiometabolic derangements, although they are not associated with increased BP variability.


Assuntos
Pressão Sanguínea , Proteína C-Reativa/metabolismo , Diabetes Mellitus Tipo 2 , Hipertensão , Índice de Massa Corporal , Colesterol/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Hipertensão/sangue , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade
11.
Rev Paul Pediatr ; 37(1): 65-72, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30624535

RESUMO

OBJECTIVE: To evaluate the physical activity level and functional capacity of children and adolescents with congenital heart disease and to describe correlations between functionality, surgical and echocardiographic findings, metabolic and inflammatory profile and differences between acyanotic and cyanotic heart defects. METHODS: A cross-sectional study including children and adolescents with congenital heart disease between six and 18 years old that were evaluated with the 6-minute walk test (6MWT) to assess functional capacity. The short version form of the International Physical Activity Questionnaire (IPAQ) was performed to evaluate physical activity levels. Also, echocardiography and blood collection, to evaluate the metabolic (blood glucose, lipids, insulin) and inflammatory markers (C-reactive protein), were assessed. RESULTS: Twenty-five individuals were evaluated. Of them, 14 had acyanotic heart defects and 11 cyanotic heart defects. Mean age was 12.0±3.7 years, and 20 (80%) were male. IPAQ showed that six (24%) individuals were very active, eight (32%) were active, nine (36%) had irregular physical activity, and two (8%) were sedentary. The mean distance walked in the 6MWT, considering all studied individuals, was 464.7±100.4 m, which was 181.4±42.0 m less than the predicted (p=0.005). There was a positive correlation between Z score 6MWT and the number of surgical procedures (r=-0.455; p=0.022). CONCLUSIONS: Children and adolescents with congenital heart disease have low functional capacity, but they are not completely sedentary.


Assuntos
Tolerância ao Exercício , Exercício , Cardiopatias Congênitas , Desempenho Físico Funcional , Comportamento Sedentário , Adolescente , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/estatística & dados numéricos , Índice de Massa Corporal , Brasil/epidemiologia , Criança , Estudos Transversais , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/psicologia , Frequência Cardíaca , Humanos , Masculino , Teste de Caminhada/métodos , Teste de Caminhada/estatística & dados numéricos
12.
Diabetol Metab Syndr ; 11: 2, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30622653

RESUMO

Introduction: Strict glucose control using multiple doses of insulin is the standard treatment for type 1 diabetes mellitus (T1DM), but increased risk of hypoglycemia is a frequent drawback. Regular insulin in multiple doses is important for achieving strict glycemic control for T1DM, but short-acting insulin analogues may be better in reducing hypoglycemia and postprandial glucose levels. Objective: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose in patients with T1DM. Methods: Searches were run on the electronic databases MEDLINE, Cochrane-CENTRAL, EMBASE, ClinicalTrials.gov, LILACS, and DARE for RCTs published until August 2017. To be included in the study, the RCTs had to cover a minimum period of 4 weeks and had to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose levels in patients with T1DM. Two independent reviewers extracted the data and assessed the quality of the selected studies. The primary outcomes analyzed were hypoglycemia (total episodes, nocturnal hypoglycemia, and severe hypoglycemia) and postprandial glucose (at all times, after breakfast, after lunch, and after dinner). Glycated hemoglobin (HbA1c) levels and quality of life were considered secondary outcomes. The risk of bias of each RCT was assessed using the Cochrane Collaboration Risk of Bias table, while the quality of evidence for each outcome was assessed using the GRADEpro software. The pooled mean difference in the number of hypoglycemic episodes and postprandial glucose between short-acting insulin analogues vs. regular human insulin was calculated using the random-effects model. Results: Of the 2897 articles retrieved, 22 (6235 patients) were included. Short-acting insulin analogues were associated with a decrease in total hypoglycemic episodes (risk rate 0.93, 95% CI 0.87-0.99; 6235 patients; I2 = 81%), nocturnal hypoglycemia (risk rate 0.55, 95% CI 0.40-0.76, 1995 patients, I2 = 84%), and severe hypoglycemia (risk rate 0.68, 95% CI 0.60-0.77; 5945 patients, I2 = 0%); and with lower postprandial glucose levels (mean difference/MD - 19.44 mg/dL; 95% CI - 21.49 to - 17.39; 5031 patients, I2 = 69%) and lower HbA1c (MD - 0,13%; IC 95% - 0.16 to - 0.10; 5204 patients; I2 = 73%) levels. Conclusions: Short-acting insulin analogues are superior to regular human insulin in T1DM patients for the following outcomes: total hypoglycemic episodes, nocturnal hypoglycemia, severe hypoglycemia, postprandial glucose, and HbA1c.

13.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 65-72, Jan.-Mar. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-985130

RESUMO

ABSTRACT Objective: To evaluate the physical activity level and functional capacity of children and adolescents with congenital heart disease and to describe correlations between functionality, surgical and echocardiographic findings, metabolic and inflammatory profile and differences between acyanotic and cyanotic heart defects. Methods: A cross-sectional study including children and adolescents with congenital heart disease between six and 18 years old that were evaluated with the 6-minute walk test (6MWT) to assess functional capacity. The short version form of the International Physical Activity Questionnaire (IPAQ) was performed to evaluate physical activity levels. Also, echocardiography and blood collection, to evaluate the metabolic (blood glucose, lipids, insulin) and inflammatory markers (C-reactive protein), were assessed. Results: Twenty-five individuals were evaluated. Of them, 14 had acyanotic heart defects and 11 cyanotic heart defects. Mean age was 12.0±3.7 years, and 20 (80%) were male. IPAQ showed that six (24%) individuals were very active, eight (32%) were active, nine (36%) had irregular physical activity, and two (8%) were sedentary. The mean distance walked in the 6MWT, considering all studied individuals, was 464.7±100.4 m, which was 181.4±42.0 m less than the predicted (p=0.005). There was a positive correlation between Z score 6MWT and the number of surgical procedures (r=-0.455; p=0.022). Conclusions: Children and adolescents with congenital heart disease have low functional capacity, but they are not completely sedentary.


RESUMO Objetivo: Avaliar o nível de atividade física e a capacidade funcional de crianças e adolescentes com cardiopatia congênita, além de descrever correlações entre funcionalidade, achados cirúrgicos e ecocardiográficos, perfil metabólico e inflamatório e diferenças entre cardiopatias congênitas acianótica e cianótica. Métodos: Estudo transversal com crianças e adolescentes com cardiopatia congênita entre seis e 18 anos de idade. Foi realizado o teste de caminhada de 6 minutos para avaliar a capacidade funcional, e aplicou-se a versão curta do Questionário Internacional de Atividade Física (IPAQ) para avaliar os níveis de atividade física. Foram feitos também: exame ecocardiográfico, coleta de sangue para avaliação de perfil metabólico e inflamatório (glicemia, triglicerídeos, colesterol total, lipoproteína de alta densidade - HDL-colesterol, lipoproteína de baixa densidade - LDL-colesterol, hemograma completo, proteína C reativa, insulina). Resultados: Foram avaliados 25 indivíduos, dos quais 14 tinham cardiopatia congênita acianótica e 11 cianótica. A média de idade foi de 12,0±3,7 anos, e 20 (80%) eram do sexo masculino. O IPAQ mostrou que seis (24%) indivíduos eram muito ativos, oito (32%) eram ativos, nove (36%) tinham atividade física irregular e dois (8%) eram sedentários. A média de distância percorrida no teste de caminhada dos 6 minutos, considerando todos os indivíduos estudados, foi de 464,7±100,4 m, sendo 181,4±42,0 m menor do que o previsto (p=0,005). Encontrou-se correlação entre o escore Z do teste de caminhada de 6 minutos e o número de procedimentos cirúrgicos realizados (r=-0,455; p=0,022). Conclusões: Crianças e adolescentes com cardiopatia congênita têm baixa capacidade funcional, mas não são completamente sedentários.

14.
J Pediatr (Rio J) ; 95(2): 155-165, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29859903

RESUMO

PURPOSE: To evaluate the prevalence of excessive screen-based behaviors among Brazilian adolescents through a systematic review with meta-analysis. DATA SOURCE: Systematic review and meta-analysis were recorded in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO-CRD 2017 CRD42017074432). This review included observational studies (cohort or cross-sectional) that evaluated the prevalence of excessive screen time (i.e. combinations involving different screen-based behaviors) or TV viewing (≥2h/day or >2h/day in front of screen) through indirect or direct methods in adolescents aged between 10 and 19 years. The research strategy included the following databases: MEDLINE, LILACS, SciELO and ADOLEC. The search strategy included terms for "screen time", "Brazil", and "prevalence". Random effect models were used to estimate the prevalence of excessive screen time in different categories. DATA SUMMARY: Twenty-eight out of 775 studies identified in the search met the inclusion criteria. The prevalence of excessive screen time and TV viewing was 70.9% (95% CI: 65.5-76.1) and 58.8% (95% CI: 49.4-68.0), respectively. There was no difference between sexes in both analyses. The majority of studies included showed a low risk of bias. CONCLUSIONS: The prevalence of excessive screen time and TV viewing was high among Brazilian adolescents. Intervention are needed to reduce the excessive screen time among adolescents.


Assuntos
Comportamento do Adolescente , Tempo de Tela , Televisão/estatística & dados numéricos , Adolescente , Brasil/epidemiologia , Criança , Humanos , Prevalência , Comportamento Sedentário , Fatores Socioeconômicos , Adulto Jovem
15.
Eur J Clin Nutr ; 73(3): 432-440, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29789711

RESUMO

BACKGROUND/OBJECTIVES: The association between active lifestyle components and vitamin D status in adolescents remains relatively unexplored. We aimed to investigate independent and joint associations of moderate-to-vigorous physical activity (MVPA) and screen time with serum 25-hydroxyvitamin D [25(OH)D] concentrations in adolescents. METHODS: This multicenter cross-sectional study involved 1152 Brazilian adolescents (age 12-17 years). Serum 25(OH)D was measured in a single laboratory and categorized as ≤20, 21-29, or ≥30 ng/mL. Demographic and lifestyle characteristics were assessed by self-reports. Ordered logistic regression was used to investigate potential associations of being physically active (MVPA ≥ 300 min/week) and excessive screen time (>2 h/day) with serum 25(OH)D concentrations. RESULTS: The prevalence of higher serum 25(OH)D concentrations (≥30 ng/mL) was 36.4%. In adjusted models, being physically active was associated with higher serum 25(OH)D concentrations only in boys [proportional odds ratio (POR) = 2.04, 95% CI 1.42-2.93], while excessive screen time was not associated with serum 25(OH)D. Adolescents who were physically active and limited their screen time had higher odds of a higher serum 25(OH)D concentration, but the association was significant only for boys (POR = 2.11, 95% CI 1.19-3.74). CONCLUSIONS: MVPA may play an important role in increasing serum 25(OH)D concentrations in adolescence, especially for boys, regardless of screen time.

16.
J Pediatr (Rio J) ; 95(4): 385-400, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30121174

RESUMO

OBJECTIVES: This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents. DATA SOURCE: A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed. SUMMARY OF DATA: A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term. CONCLUSION: The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.

17.
Endocrine ; 63(2): 252-258, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30132262

RESUMO

OBJECTIVE: Part of the beneficial effects of metformin on the prevention of cardiovascular events in diabetes can be attributed to pleiotropic effects, including a blood pressure (BP)-lowering effect. In a double-blind parallel clinical trial (NCT02072382), the effect of metformin on BP evaluated by ambulatory blood pressure monitoring (ABPM) was measured. METHODS: Ninety-seven patients with hypertension, but without diabetes mellitus, were randomized to receive 850-1700 mg of metformin (n = 48) or placebo (n = 49). Clinical, laboratory, and ABPM data were collected at the baseline and after 8 weeks of follow-up. RESULTS: The sample consisted mainly of White overweight women. There was no difference in BP reduction measured by ABPM between both groups. There was no effect in BP measured in the different periods of ABP monitoring and office BP. Additionally, fasting plasma glucose, lipids, and C-reactive protein remained unchanged during the trial. There was a significant reduction in waist circumference with metformin (95.1 ± 10.4 to 89.3 ± 27.4 cm; p = 0.02). CONCLUSION: In the present trial, metformin did not reduce BP, measured by ABP monitoring, in hypertensive patients without diabetes.

18.
Artigo em Português | LILACS | ID: biblio-998685

RESUMO

As doenças cardiovasculares são a principal causa de morte no Brasil. Os fatores de risco modificáveis dessas doenças podem ser observados desde a infância e sua persistência está associada ao diagnóstico precoce de morbidades. Neste contexto, a adolescência é considerada um período chave para estratégias de prevenção. Com objetivo de avaliar a prevalência de fatores de risco cardiovascular e seus fatores as-sociados foi planejado o Estudo de riscos cardiovasculares em adolescentes (ERICA), um inquérito multicêntrico de base escolar com abrangência nacional que envolveu mais de 70 mil adolescentes, entre 12 e 17 anos, de cidades brasileiras com mais de 100 mil habitantes. Os principais resultados do estudo apontaram prevalências preo-cupantes de sobrepeso/obesidade (25,5%, IC 95%: 24,4%-26,6%), pressão arterial elevada (9,6%, IC 95%: 8,9%-10,3%) e HDL-c baixo (47,3%, IC 95%: 45,2%-49,3%). A prevalência de síndrome metabólica foi de 2,6% (IC 95%: 2,3%-2,9%). Além disso, mais da metade dos adolescentes reportaram um estilo de vida sedentário. As estimativas regionais apontaram a região sul como a que tem maiores prevalências de fatores de risco. O ERICA foi um estudo pioneiro no Brasil e os adolescentes que participaram do estudo no Rio de Janeiro, Porto Alegre, Brasília e Fortaleza serão acompanhados em uma nova etapa. Os primeiros resultados do ERICA podem servir de referência para futuras pesquisas sobre riscos cardiovasculares entre adolescentes brasileiros, bem como subsidiar políticas públicas de saúde.


Cardiovascular disease is the leading cause of mortality in Brazil. Modifiable risk factors for this group of diseases can be observed since childhood, and their persisten-ce is associated with the early diagnosis of morbidities. In this context, adolescence is considered a key period for prevention strategies. In order to evaluate the prevalence of cardiovascular risk factors and their associated factors, the Study of Cardiovascular Risks in Adolescents ("ERICA") was planned. This is a multicenter school-based nationwide survey involving more than 70,000 adolescents aged between 12 and 17 years from Brazilian cities with more than 100 thousand inhabitants. The main results of the study indicated concerning prevalence of overweight/obesity (25.5%, 95% CI: 24.4%-26.6%), high blood pressure (9.6%, 95% CI: 8.9%-10.3%) and low HDL-c (47.3%, 95% CI: 45.2%-49.3%). The prevalence of metabolic syndrome was 2.6% (95% CI: 2.3%-2.9%). In addition, more than half of adolescents reported a sedentary lifestyle. Regional estimates pointed to the south as the region with the highest prevalence of risk factors. ERICA was a pioneering study in Brazil and the adolescents who participated in the study in Rio de Janeiro, Porto Alegre, Brasília and Fortaleza will be followed in a new stage. The first results of ERICA can both serve as a reference for future research on cardiovascular risks among Brazilian adolescents and support public health policies.


Assuntos
Humanos , Adolescente , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/patologia , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/genética , Comportamento Sedentário/história
19.
Nutrients ; 10(11)2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30445703

RESUMO

Stress increases inflammation but whether adherence to Mediterranean diet counteracts this association and how early can these effects be observed is not well known. We tested whether (1) cortisol is associated to inflammation, (2) cortisol is associated to the adolescent Mediterranean diet score (aMDS), (3) aMDS lessens inflammation, (4) aMDS associates with cortisol levels and inflammation. Two hundred and forty-two adolescents (137 females; 12.5⁻17.5 years old) provided salivary cortisol, blood and 2-day 24-h dietary recall from which aMDS was derived. Cortisol levels were associated with increased tumor necrosis factor (TNF-α B = 11.887, p = 0.001) when adjusted for age, gender, parental education and body mass index (BMI). Moreover, cortisol levels were inversely associated to adherence to the Mediterranean Diet (B = -1.023, p = 0.002). Adolescents with higher adherence to aMDS had lower levels of interleukins (IL) IL-1, IL-2, IL-6 and TNF-α, compared to those who did not adhere. The association between cortisol and TNF-α was no longer significant when aMDS was included in the model (B = 6.118, p = 0.139). In addition, comparing lower and higher aMDS groups, the association between cortisol and TNF-α was only observed in those with lower aMDS adherence. Our study suggests that adherence to the Mediterranean Diet may counteract the effect of stress on inflammatory biomarkers which may contribute to decreasing the risk of future mental health.


Assuntos
Dieta Mediterrânea , Hidrocortisona/metabolismo , Mediadores da Inflamação/metabolismo , Estresse Fisiológico/fisiologia , Estresse Psicológico/fisiopatologia , Adolescente , Biomarcadores/metabolismo , Criança , Registros de Dieta , Europa (Continente) , Feminino , Humanos , Inflamação , Masculino , Fatores de Proteção , Saliva/metabolismo , Fator de Necrose Tumoral alfa/sangue
20.
J Pediatr (Rio J) ; 2018 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-30098939

RESUMO

OBJECTIVES: The purpose of this study was to evaluate the agreement and risk factors for underestimation and overestimation between nutritional status and self-perceived body image and to assess the prevalence and associated factors for dissatisfaction with body weight among Brazilian adolescents. METHODS: Students aged 12-17 years participating in the Study of Cardiovascular Risk in Adolescents ("ERICA"), a multicenter, cross-sectional, school-based country-wide study, were included (n=71,740). Variables assessed as covariates were sex, age, skin color, socioeconomic status, and common mental disorders (screened by the General Health Questionnaire, GHQ-12). Multinomial logistic regression was used to explore the association between covariates and combinations between self-perceived body image and body mass index (agreement, underestimation and overestimation). The associations between dissatisfaction with body weight and exposure variables were investigated using multivariable Poisson regression models. RESULTS: Approximately 66% students rightly matched their body mass index with self-perceived weight (kappa coefficient was 0.38 for boys and 0.35 for girls). Agreement was higher among younger students and adolescents from low income households. Male sex, older age, and GHQ-12 score ≥3 were associated with weight overestimation. Prevalence of dissatisfaction with body weight was 45.0% (95% CI: 44.0-46.0), and higher among girls, older adolescents, those with underweight or overweight/obesity, as well as those who were physically inactive and with GHQ-12 ≥3. CONCLUSIONS: Most of the sample rightly self-perceived their body image according to body mass index. Students with body image misperception and those dissatisfied with their weight were more likely to present a positive screening for common mental disorders.

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