Elevated neck circumference and associated factors in adolescents.

BACKGROUND: Upper body subcutaneous fat, estimated by neck circumference (NC), may present greater metabolic risk than visceral fat. The aim of this study was to determine cutoff values for NC in adolescents that identify overweight and obesity, the prevalence of elevated NC, and its association with associated factors. METHODS: Cross-sectional study with adolescents from public schools in São Paulo. Anthropometric variables, blood pressure and pubertal stage were collected. Cutoff values for NC were determined by Receiver Operating Characteristic curves. A binary logistic regression was used to determine relationships between NC and associated factors. RESULTS: Among 1668 adolescents studied, 54.92% were female. The cutoff values of NC in girls and boys that identified overweight were 31.25 and 34.25 cm, and obesity, 32.65 and 37.95 cm, respectively, and the prevalence of adolescents with high NC was 32.63% in females and 37.63% among males. NC for overweight was observed that there was an association with sex, weight, body mass index, arm, waist and thigh circumferences, pubertal stages and body fat percent (BF%). NC for obesity was found association with gender, weight, arm and thigh circumferences, and BF% (p < 0.001). CONCLUSION: It was concluded that there is high prevalence of elevated NC and higher risks for this outcome considering overweight and obesity, sex, weight, arm and thigh circumferences, BF%, besides being an easy and simple measure for use in clinical practice.

Body fat percentiles of Brazilian adolescents according to age and sexual maturation: a cross-sectional study.

BACKGROUND: The objective of this study was to determine body fat percentiles of adolescents in the city of São Paulo, Brazil, according to gender, age, and sexual maturation. METHODS: This study involved 4,690 adolescents aged 10-15 years across 31 schools in the city of São Paulo. Sexual maturation was assessed in terms of Tanner stage. The body fat percentage was calculated using skinfold thickness. Percentile curves were calculated using the LMS (curve, mean, and coefficient of variation) method. RESULTS: The mean body fat percentages were lower in boys aged 10-12 and 13-15 years than in girls. Body fat percentages decreased progressively with sexual maturation in boys, but increased in girls. The 85th, 95th, and 97th percentiles represent the cutoff points for moderately elevated, elevated, and very elevated body fat percentages, respectively, in pre-pubescent boys (85th, 95th, and 97th percentiles: 32.54, 95 41.04, and 97, respectively) and pubescent boys (31.09, 36.30, and 44.33, respectively). These cutoff points were lower in pre-pubescent girls (29.52, 35.01, and 41.82, respectively) and in the 97th percentile in pubescent girls (31.55, 36.20, and 41.86, respectively). CONCLUSION: To our knowledge, these are the first body fat percentages cutoff points according to sexual maturation for adolescents aged 10-15 years in Brazil. Our results provide a significant contribution to the assessment of body composition in this population.

Bender Visual-Motor Gestalt Test in adolescents: relationship between visual-motor development and the Tanner Stages.

Visual-motor skill is fundamental to human development and is an important component of psychological evaluations. The goal of the present study was to determine whether there is a correlation between visual-motor development, as measured by the Bender Visual-Motor Gestalt Test (Bender test), and sexual maturity in adolescents, based on the Tanner Stages in Adolescents. 134 adolescents from 10 to 15 years of age participated in the study. The Bender test and the Raven's Progressive Matrices Test were employed. The measures were administered individually and information on sexual maturity and the presence of developmental disorders was collected from medical charts. The results of the Bender test were not affected by gender, age, schooling, or changes stemming from puberty, but were significantly affected by having repeated a school year and by developmental disorders. An association was found with Raven's scores. The Bender test proved sensitive to developmental disorders in adolescence. No association was found between visual-motor development and sexual maturity in adolescents.

CUT OFF VALUES FOR WAIST CIRCUMFERENCE TO PREDICT OVERWEIGHT IN BRAZILIAN ADOLESCENTS, ACCORDING TO PUBERTAL STAGING. / PONTOS DE CORTE DE CIRCUNFERÊNCIA DA CINTURA DE ACORDO COM O ESTADIAMENTO PUBERAL PARA IDENTIFICAR SOBREPESO EM ADOLESCENTES.

OBJECTIVE: To establish waist circumference cut off points according to pubertal staging to identify overweight in adolescents. METHODS: Longitudinal study approved by the Ethics Research Committee and conducted with 557 adolescents, aged 10 to 15 years old, selected from public schools. Waist, arm, neck and hip circumferences, body fat percentage, body mass index (BMI), height and blood pressure were measured. Pubertal staging was evaluated by Tanner self assessment scale. The Receiver Operating Characteristic Curve (ROC curve) was used to determine predictive power, sensitivity, specificity and waist circumference cut off points to detect overweight. RESULTS: There was a positive correlation between waist circumference and weight, BMI, upper arm and hip circumferences, waist-to-hip ratio and blood pressure in both sexes. Cut off points for waist circumference according to pubertal stage as related to overweight in adolescents with the best performances in ROC curve were: 71.65 cm for prepubescent girls, 67.90 cm for pubescent girls, 70.25 cm for post pubescent girls, and 66.45 cm for pubescent boys. Age, weight, height, BMI, body fat percentage, arm and hip circumferences were associated to altered waist circumference. CONCLUSIONS: The establishment of cut off points for waist circumference according to pubertal staging was proven a good means to identify overweight. These cut off points can be considered reliable for the Brazilian adolescent population, as the isolated use of chronological age in adolescents may underestimate their nutritional status.

OBJETIVO: Elaborar pontos de corte de circunferência da cintura de acordo com o estadiamento puberal para identificar sobrepeso em adolescentes. MÉTODOS: Trata-se de um estudo longitudinal, aprovado pelo Comitê de Ética em Pesquisa, com 557 adolescentes, de 10 a 15 anos de idade, selecionados em escolas públicas. Aferiram-se as medidas de circunferência de cintura, braço, pescoço e quadril, percentual de gordura, massa corporal, estatura e pressão arterial. Para determinar a maturação sexual, foi utilizada a autoavaliação da escala de Tanner. Aplicou-se a curva ROC (Receiver Operating Characteristic Curve) para determinar: poder preditivo, sensibilidade, especificidade e os pontos de corte de circunferência de cintura para identificação de sobrepeso. RESULTADOS: Observou-se correlação positiva entre circunferência de cintura e massa corporal, índice de massa corporal (IMC), circunferência do braço e quadril, razão cintura/quadril e pressão arterial em ambos os sexos. Os pontos de corte para circunferência de cintura de acordo com o estadiamento puberal para identificação de sobrepeso que apresentaram maior desempenho na curva ROC foram: 71,65 cm para meninas pré-púberes, 67,90 cm para meninas púberes, 70,25 cm para meninas pós-púberes e 66,45 cm para meninos púberes. Faixa etária, massa corporal, estatura, IMC, porcentagem de gordura, circunferência do braço e do quadril foram considerados fatores preditores da circunferência da cintura alterada. CONCLUSÕES: Os pontos de corte de circunferência da cintura de acordo com o estadiamento puberal demonstraram excelente desempenho para a identificação de sobrepeso, podendo ser considerados fidedignos para a população de adolescentes brasileiros, uma vez que utilizar apenas a idade cronológica na adolescência pode subestimar o estado nutricional.

Body trunk fat and insulin resistance in post-pubertal obese adolescents.

CONTEXT AND OBJECTIVE: Insulin resistance is a metabolic disorder commonly associated with excess body fat accumulation that may increase chronic disease risk. The present study was undertaken to evaluate the relationship between body composition and insulin resistance among obese adolescents. DESIGN AND SETTING: Cross-sectional study, at the Adolescence Center, Pediatric Department, Universidade Federal de São Paulo. METHODS: Body composition was assessed using dual-energy X-ray absorptiometry. Dietary intake was evaluated using a three-day dietary record. The biochemical evaluation comprised glucose, insulin, serum lipid, leptin and ghrelin measurements. Insulin resistance was calculated by means of the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS: Forty-nine post-pubertal obese adolescents participated in the study: 12 boys and 37 girls of mean age 16.6 (1.4) years and mean body mass index (BMI) of 35.0 (3.9) kg/m(2). The mean glucose, insulin and HOMA values were 90.3 (6.4) mg/dl, 16.6 (8.1) microIU/ml and 3.7 (1.9), respectively. Hyperinsulinemia and insulin resistance were observed in 40.2% and 57.1% of the subjects, respectively. Adolescents with insulin resistance had higher BMI and body trunk fat. There was a trend towards higher leptin concentration in obese individuals with insulin resistance. Insulin resistance was positively correlated with body trunk fat, BMI, body fat mass (kg), leptin and body fat percentage. Furthermore, there was a negative correlation between HOMA-IR and lean body mass. The body composition predicted 30% of the HOMA-IR levels, according to linear regression models. CONCLUSION: Body trunk fat was significantly associated with insulin resistance, demonstrating the clinical importance of abdominal obesity during adolescence.

Evolution of body mass index in two historical series of adolescents.

OBJECTIVE: To verify the evolution of body mass index (BMI) between two studies of adolescent populations. METHODS: Data on the BMI of 8,020 adolescents aged 10 to 15 years living in the city of São Paulo, Brazil, and enrolled on the 2005 study entitled "The nutritional profile of adolescents at public and private schools in São Paulo" were compared with data from the 1989 National Nutrition and Health Census (PNSN - Pesquisa Nacional sobre Saúde e Nutrição). Binomial testing was used to compare proportions once both data sets had been transformed into percentiles. RESULTS: Comparing the two surveys, significant increases were identified in 85th and 95th percentile BMI values for male adolescents aged 10 to 15 years and for female adolescents aged 10 to 14 years. Analysis of the difference between the 5th and 95th BMI percentiles of the São Paulo and PNSN samples indicates that there was probably an increase in the number of adolescents in the higher BMI ranges in São Paulo in relation to the PNSN survey. CONCLUSIONS: These results demonstrate a tendency for the adolescents observed mean BMI values to increase during the period between the two surveys, indicating a need for increased monitoring of this measurement as a form of preventing overweight in this population.

[Prevalence of overweight and obesity in school children of Santos city, Brazil]. / Prevalência de sobrepeso e obesidade em escolares da cidade de Santos, SP.

The aim of this population-based study was to estimate the prevalence of overweight and obesity in public and private schools of Santos city, Brazil. We evaluated a total of 10,822 children aged 7 to 10 years old. Determination of overweight and obesity was obtained by the 85th and 95th percentiles of BMI for age, respectively, as proposed by CDC in 2000. The overall prevalence rates of overweight and obesity were 15.7% (CI 95%= 15.0% to 16.4%) and 18.0% (17.3% to 18.7%), respectively. The prevalence of overweight was 13.7% (12.6% a 14.8%) in boys and 14.8% (13.7% a 15.9%) in girls of public schools. In private schools, the rates were 17.7% (15.7% to 19.7%) in boys and 22.2% (20.0% to 24.4%) in girls. Obesity was found in 16.9% (15.7% to 18.1%) of the boys and 14.3% (13.2% to 15.4%) of the girls of public schools. In the private schools, 29.8% (27.4% to 32.2%) of the boys and 20.3% (18.2% to 22.4%) of the girls were obese. We concluded that the prevalence of obesity in public and private schools in the city of Santos is higher than other studies conducted in Brazil and in other countries of Latin America. Private schools showed higher prevalence rates of obesity than public schools (p= 0.001).

Relationship between calcium intake and body mass index in adolescents.

Epidemiologic and experimental data support thee possibility that dietary calcium intake plays a role in human body weight regulation. The aim of the present study was to evaluate calcium intake and its relationship with body mass index (BMI) in adolescents. Weight, height, 3-day food record and a food frequency questionnaire were collected among all adolescents participants at the Outpatient Clinic for Adolescents at the Federal University of Sao Paulo between 2001 and 2003. The statistical analysis comprised Chi-square, Student's T-test, Pearson correlation and linear regression. One-hundred and twenty-one adolescents were studied (62.8% female), with a mean age of 14.9 +/- 2.2 years old. Mean energy and calcium intakes were 1729.9 +/- 557.8 kcal/day and 598.2 +/- 287.9 mg/day respectively, with no significant statistical differences between sex or age. Almost ninety-eight percent of adolescents presented a mean calcium intake lower than proposed values. Calcium intake adjusted for energy presented a significant negative correlation with body weight (r=-0.194, p=0.03) and BMI (r=-0.185, p=0.04). Furthermore, adolescents in the lowest quartile of calcium intake presented higher BMI (29.7 +/- 7.4 kg/m2) than adolescents in the highest calcium quartile. These results indicated a dietary calcium intake lower than recommendations for this life stage, and a contribution of this mineral in the body mass index.

Reference curves of the body fat index in adolescents and their association with anthropometric variables.

OBJECTIVES: To develop reference curves for the body fat index (BFI) in the pediatric population, in adolescents from the city of São Paulo, Brazil, and verify their association with body mass index and body fat percentage. METHODS: The study is part of the research project "Nutritional Profile of Adolescents from Public and Private Schools of São Paulo" that was performed in 2004-2005. A total of 4,686 adolescents (2,130 boys and 2,556 girls) aged 10-15 years were divided into two groups: 10-12 and 13-15 years of age. Body mass, height, body mass index, hip circumference, body fat percentage, body fat index, and sexual maturation performed by the self-assessment method (prepubertal, pubertal, and postpubertal) were analyzed. ANOVA was performed, as well as percentile distribution, Pearson's correlation, and Bland-Altman plot. RESULTS: In boys, there was an increase in body mass, height, body mass index, and hip circumference with advancing age and Tanner stage. In girls, there was an increase in body fat index and body fat percentage with advancing age and stage of sexual maturation. An association was found between body fat index and body mass index (r = 0.67 in boys and 0.80 in girls, p < 0.001) and body fat percentage (r = 0.71 in boys and 0.68 in girls, p<0.001). CONCLUSION: The body fat index seems to reflect well the phenomena of sexual dimorphism in adolescence, is easy to perform, and represents a method that should be used in population samples.

Pontos de corte de circunferência da cintura de acordo com o estadiamento puberal para identificar sobrepeso em adolescentes / Cut off values for waist circumference to predict overweight in brazilian adolescents, according to pubertal staging

RESUMO Objetivo: Elaborar pontos de corte de circunferência da cintura de acordo com o estadiamento puberal para identificar sobrepeso em adolescentes. Métodos: Trata-se de um estudo longitudinal, aprovado pelo Comitê de Ética em Pesquisa, com 557 adolescentes, de 10 a 15 anos de idade, selecionados em escolas públicas. Aferiram-se as medidas de circunferência de cintura, braço, pescoço e quadril, percentual de gordura, massa corporal, estatura e pressão arterial. Para determinar a maturação sexual, foi utilizada a autoavaliação da escala de Tanner. Aplicou-se a curva ROC (Receiver Operating Characteristic Curve) para determinar: poder preditivo, sensibilidade, especificidade e os pontos de corte de circunferência de cintura para identificação de sobrepeso. Resultados: Observou-se correlação positiva entre circunferência de cintura e massa corporal, índice de massa corporal (IMC), circunferência do braço e quadril, razão cintura/quadril e pressão arterial em ambos os sexos. Os pontos de corte para circunferência de cintura de acordo com o estadiamento puberal para identificação de sobrepeso que apresentaram maior desempenho na curva ROC foram: 71,65 cm para meninas pré-púberes, 67,90 cm para meninas púberes, 70,25 cm para meninas pós-púberes e 66,45 cm para meninos púberes. Faixa etária, massa corporal, estatura, IMC, porcentagem de gordura, circunferência do braço e do quadril foram considerados fatores preditores da circunferência da cintura alterada. Conclusões: Os pontos de corte de circunferência da cintura de acordo com o estadiamento puberal demonstraram excelente desempenho para a identificação de sobrepeso, podendo ser considerados fidedignos para a população de adolescentes brasileiros, uma vez que utilizar apenas a idade cronológica na adolescência pode subestimar o estado nutricional.

ABSTRACT Objective: To establish waist circumference cut off points according to pubertal staging to identify overweight in adolescents. Methods: Longitudinal study approved by the Ethics Research Committee and conducted with 557 adolescents, aged 10 to 15 years old, selected from public schools. Waist, arm, neck and hip circumferences, body fat percentage, body mass index (BMI), height and blood pressure were measured. Pubertal staging was evaluated by Tanner self assessment scale. The Receiver Operating Characteristic Curve (ROC curve) was used to determine predictive power, sensitivity, specificity and waist circumference cut off points to detect overweight. Results: There was a positive correlation between waist circumference and weight, BMI, upper arm and hip circumferences, waist-to-hip ratio and blood pressure in both sexes. Cut off points for waist circumference according to pubertal stage as related to overweight in adolescents with the best performances in ROC curve were: 71.65 cm for prepubescent girls, 67.90 cm for pubescent girls, 70.25 cm for post pubescent girls, and 66.45 cm for pubescent boys. Age, weight, height, BMI, body fat percentage, arm and hip circumferences were associated to altered waist circumference. Conclusions: The establishment of cut off points for waist circumference according to pubertal staging was proven a good means to identify overweight. These cut off points can be considered reliable for the Brazilian adolescent population, as the isolated use of chronological age in adolescents may underestimate their nutritional status.

Body mass index percentiles in adolescents of the city of São Paulo, Brazil, and their comparison with international parameters.

OBJECTIVE: To describe the percentile distribution of body mass index (BMI) in school adolescents, by gender and age, comparing them with international parameters. SUBJECTS AND METHODS: The study included 8,020 adolescents aged 10-15 years from 43 schools in the city of São Paulo, southeastern Brazil. BMI values of the study sample were distributed in percentiles and compared to international parameters (CDC, Must and cols. and Cole and cols.). RESULTS: Both male and female adolescents aged 10 to 14 years showed BMI cut-offs over the international parameters, especially in the P50-P85 percentile range. At the age of 15, the observed values were very similar to reference data; however, BMI values in the 95th percentile were much higher than international parameters. CONCLUSIONS: The study results show how important it is to use adequate BMI values for Brazilian adolescents aged 10-15 since international parameters may not reflect the actual nutritional status of this group.

Velocidade de leitura e desempenho escolar na última série do ensino fundamental / Reading rate and academic performance in the last grade of elementary school

A velocidade de leitura, calculada pelo número de palavras lidas por minuto, é um dos aspectos observados na fluência dessa habilidade. Esta pesquisa caracterizou a velocidade de leitura no último ano do ensino fundamental, segundo o texto e o desempenho acadêmico, investigando possíveis correlações entre essas variáveis. Trinta e dois estudantes do 9° ano, agrupados pela média escolar, leram dois textos diferentes, oral e silenciosamente. A velocidade calculada variou de 96,05 palavras por minuto, na leitura oral inédita, a 219,41 palavras por minuto, na segunda leitura oral. O texto influenciou a velocidade da leitura oral, provavelmente pela frequência ou número de caracteres das palavras. A velocidade da leitura silenciosa mostrou-se mais alta que a observada na leitura oral. Houve correlação entre velocidade de leitura e desempenho acadêmico. São necessários parâmetros brasileiros para avaliar a velocidade de leitura conforme as diferentes idades e ao níveis de escolaridade.

Reading rate (number of words read per minute) is one of the aspects observed in reading fluency. This study characterized reading rate in the ninth grade of elementary school, according to the text and academic performance, investigating possible correlations between these variables. Thirty-two students were grouped in accordance with their average achievement scores and they read two different texts aloud and silently. Reading rate ranged from 96.05 words per minute (unpracticed reading) to 219.41 (reading aloud preceded by initial reading aloud). The text exerted an influence on reading aloud (likely the frequency and number of characters in words of the Portuguese language). Estimated speed during silent reading was faster than the one observed during reading aloud. A correlation was found between reading rate and academic performance. Brazilian reference values are required to evaluate the reading rate at different ages and different levels of schooling.

Reference curves of the body fat index in adolescents and their association with anthropometric variables / Curvas de referência do índice de adiposidade corporal de adolescentes e sua relação com variáveis antropométricas

OBJECTIVES: To develop reference curves for the body fat index (BFI) in the pediatric population, in adolescents from the city of São Paulo, Brazil, and verify their association with body mass index and body fat percentage. METHODS: The study is part of the research project "Nutritional Profile of Adolescents from Public and Private Schools of São Paulo" that was performed in 2004-2005. A total of 4,686 adolescents (2,130 boys and 2,556 girls) aged 10-15 years were divided into two groups: 10-12 and 13-15 years of age. Body mass, height, body mass index, hip circumference, body fat percentage, body fat index, and sexual maturation performed by the self-assessment method (prepubertal, pubertal, and postpubertal) were analyzed. ANOVA was performed, as well as percentile distribution, Pearson's correlation, and Bland-Altman plot. RESULTS: In boys, there was an increase in body mass, height, body mass index, and hip circumference with advancing age and Tanner stage. In girls, there was an increase in body fat index and body fat percentage with advancing age and stage of sexual maturation. An association was found between body fat index and body mass index (r = 0.67 in boys and 0.80 in girls, p < 0.001) and body fat percentage (r = 0.71 in boys and 0.68 in girls, p < 0.001). CONCLUSION: The body fat index seems to reflect well the phenomena of sexual dimorphism in adolescence, is easy to perform, and represents a method that should be used in population samples. .

OBJETIVOS: Desenvolver curvas de referência do índice de adiposidade corporal para população pediátrica, em adolescentes da cidade de São Paulo, Brasil, e verificar a sua relação com o índice de massa corporal e percentual de gordura corporal. MÉTODOS: O estudo faz parte do projeto de pesquisa "Perfil Nutricional de Adolescentes de escolas Públicas e Privadas de São Paulo" realizado em 2004/2005. 4.686 adolescentes (2.130 meninos e 2.556 meninas) de 10-15 anos foram divididos em dois grupos: 10-12 e 13-15 anos. Massa corporal, estatura, índice de massa corporal, circunferência de quadril, porcentagem de gordura corporal, índice de adiposidade corporal e maturação sexual realizada pelo método de autoavaliação (pré-púbere, púbere e pós-púbere) foram analisadas. Foi feito ANOVA, distribuição percentilar, correlação de Pearson e o gráfico de Bland-Altman. RESULTADOS: Nos meninos, ocorreu aumento da massa corporal, estatura, índice de massa corporal e circunferência do quadril com o avanço da idade e estágio de Tanner. Nas meninas, ocorreu aumento do índice de adiposidade corporal e do percentual de gordura corporal com o avanço da idade e estágio de maturação. Foi encontrada uma associação entre o índice de adiposidade corporal com o índice de massa corporal (r = 0,67 nos meninos e 0,80 nas meninas; p < 0,001) e com o percentual de gordura (r = 0,71 nos meninos e 0,68 nas meninas; p < 0,001). CONCLUSÃO: O índice de adiposidade corporal parece refletir bem os fenômenos do dismorfismo sexual na adolescência, sendo um método de fácil realização que deveria ser mais utilizado em amostras populacionais. .

Alteração da pressão arterial em adolescentes e sua relação com estado nutricional / Blood pressure in adolescents and its relationship with nutritional status

Objetivo: Avaliar a correlação entre estado nutricional e pressão arterial em adolescentes. Métodos: Estudo descritivo, em corte transversal retrospectivo. Foram analisados prontuários de adolescentes de 10 a 18 anos incompletos que deram entrada em um Centro Especializado entre 1997 a 2006. Foi calculado o índice de massa corporal, os valores iniciais da pressão arterial sistólica e diastólica, convertidos em percentis. Para análise estatística foi utilizada correlação de Spearman, com nível de significância p<0,05. Resultados: Foram selecionados 983 adolescentes, entre 10 e 18 anos incompletos, 506 do sexo feminino e 477 do sexo masculino. Entre as 46,44% de meninas e os 37,53% de meninos, todos apresentavam excesso de peso. Em relação aos níveis pressóricos ficou evidente que os adolescentes com excesso de peso apresentaram maiores percentis de pressão arterial, tanto sistólica quanto diastólica. Todas as correlações de pressão arterial, sistólica e diastólica, em valores absolutos e em percentis, com índice de massa corporal foram significativas (p<0,001). Porém, os adoles-centes eutróficos também apresentaram alterações importantes das cifras pres-sóricas. Conclusão: Apesar do excesso de peso apresentar forte associação com a elevação da pressão arterial, verificou-se também esta alteração em adolescentes eutróficos. Este artigo demonstra a importância de se avaliar periodicamente a pressão arterial de adolescentes como forma de prevenir alterações na mesma, promovendo um estilo de vida mais adequado

Validade de medidas antropométricas autorreferidas em adolescentes: sua relação com percepção e satisfação corporal / Anthropometric self-reported measures: relationship to body image perception and satisfaction among adolescents

OBJETIVO: Verificar a validade da classificação do estado nutricional e da estatura para idade quando utilizadas massa corporal e estatura autorreferidas por adolescentes, bem como relacionar essa validade com percepção e com satisfação corporal. MÉTODOS: 304 adolescentes antes de terem suas medidas de massa e estatura aferidas autorreferiram essas medidas, foram questionados sobre a percepção de seu corpo e a classificação da imagem corporal foi obtida com o uso de uma escala de silhuetas corporais. Também foram aplicados testes específicos para avaliar a satisfação corporal e o comportamento alimentar. RESULTADOS: As classificações feitas com base nos dados autorreferidos e aferidos tiveram concordância alta (K = 1,00) para a classificação da estatura por idade e moderada (K < 0,75) para a classificação de índice de massa corporal. No entanto, adolescentes que se consideravam "abaixo do peso" subestimaram o índice de massa corporal autorrelatado e, os que se percebiam como "gordos", o superestimaram. As meninas e os que se classificaram como obesos tenderam a subestimar o índice de massa corporal, e os meninos, a superestimá-lo. CONCLUSÃO: Os adolescentes autorrelataram suas medidas de massa e estatura de maneira adequada. No entanto, o sexo, a percepção e a classificação da imagem corporal foram variáveis que influenciaram na obtenção de respostas não válidas.

OBJECTIVE: To assess the reliability of the classification for nutritional status and height-for-age when using self-reported weight and height and its relationships with self-reported data of body image perception and satisfaction among adolescents. METHODS: In this retrospective study, 304 adolescents before they had measured their height and weight, they self-reported these measures, they were asked about their body shape perception and body image classification was obtained by using a body silhouette scale. It was also used specific tests to assess body satisfaction and food behavior. RESULTS: It was found full agreement between height-for-age classification using self-reported and measured height (k = 1.00) and an intermediate level of agreement between body mass index calculated with self-reported and measured data (k < 0.75). However, adolescents who perceived themselves as "skinny" underestimated their self-reported body mass index whereas those who perceived themselves as "fat" overestimated it. Those who perceived themselves as fat in the silhouette scale underestimated their body mass index. Gender was also a factor for unreliable answers, as females tended to underestimate their self-reported body mass index and males to overestimate it. CONCLUSION: The adolescents adequately self-reported weight and height information. However, body shape perception and body image classification were factors affecting answer reliability.

Avaliação dos sintomas emocionais e comportamentais em adolescentes obesos / Emotional and behavioral symptoms evaluation in obese adolescents

Investigou-se neste trabalho sintomas emocionais e comportamentais em adolescentes obesos. Participaram desse estudo 248 adolescentes de ambos os sexos, com idades entre 11 e 18 anos, sendo 54 obesos acompanhados em um ambulatório-escola e 194 eutróficos, estudantes de escolas da região. Os adolescentes responderam ao Young Self Report (YSR), que é um questionário para triagem de habilidades sociais e problemas de comportamento. Não houve diferença estatisticamente significante entre obesos e eutróficos em relação aos escores obtidos no instrumento, embora um quarto dos obesos tivessem apresentado problemas com o contato social e quase um terço comportamentos agressivos. Conclui-se que não se pode considerar os obesos como um grupo homogêneo em relação aos seus comportamentos ou saúde mental. (AU)

The study investigated emotional and behavioral symptoms in 54 obese adolescents of both sex, aged 11 to 18 years old, attending the Centro de Atendimento e Apoio ao Adolescente (CAAA). Other 194 eutrophic teenagers, paired by gender and age, formed the control group. Two instruments were used in the investigation: Young Self Report (YSR) and a file of social demographic data, especially designed for this study. In relation to the study variables, no statistical differences between obese and eutrophic adolescents were observed although 25 percent of the obese adolescents presented problems of social contact and almost 33 percent showed aggressive behavior. (AU)

Body mass index percentiles in adolescents of the city of São Paulo, Brazil, and their comparison with international parameters / Percentis do índice de massa corporal de adolescentes na cidade de São Paulo, Brasil, e sua comparação com parâmetros internacionais

OBJECTIVE: To describe the percentile distribution of body mass index (BMI) in school adolescents, by gender and age, comparing them with international parameters. SUBJECTS AND METHODS: The study included 8,020 adolescents aged 10-15 years from 43 schools in the city of São Paulo, southeastern Brazil. BMI values of the study sample were distributed in percentiles and compared to international parameters (CDC, Must and cols. and Cole and cols.). RESULTS: Both male and female adolescents aged 10 to 14 years showed BMI cut-offs over the international parameters, especially in the P50-P85 percentile range. At the age of 15, the observed values were very similar to reference data; however, BMI values in the 95th percentile were much higher than international parameters. CONCLUSIONS: The study results show how important it is to use adequate BMI values for Brazilian adolescents aged 10-15 since international parameters may not reflect the actual nutritional status of this group.

OBJETIVO: Distribuição do índice de massa corporal (IMC) em percentis dos adolescentes escolares, divididos por sexo e idade, comparando-os com os parâmetros internacionais. SUJEITOS E MÉTODOS: Participaram do estudo 8.020 adolescentes de 10 a 15 anos de 43 escolas da cidade de São Paulo. Os valores do IMC dessa população foram distribuídos em percentis e comparados com os parâmetros internacionais (CDC, Must e Cole). RESULTADOS: Os adolescentes dos 10 aos 14 anos de idade, do sexo masculino e feminino, apresentaram pontos de corte do IMC acima dos internacionais, especialmente no intervalo P50-85. Aos 15 anos de idade, os valores observados foram muito semelhantes, no entanto, o IMC no valor do percentil 95 foi muito mais elevado do que os parâmetros internacionais. CONCLUSÕES: Os resultados deste estudo demonstram a importância de utilizar valores adequados para adolescentes brasileiros de 10 a 15 anos, uma vez que os parâmetros internacionais podem não refletir a real condição do estado nutricional dessa população.

Adolescentes modelos de passarela: como é o consumo alimentar deste grupo? / Adolescent runway models: how is the food intake of this group?

OBJETIVO: Avaliar a adequação da ingestão de energia, macro e micronutrientes em adolescentes modelos de passarela. MÉTODOS: Estudo transversal de 33 adolescentes modelos e 33 não modelos, de 15 a 18 anos, pareadas por idade e índice de massa corpórea (IMC). A ingestão alimentar foi avaliada por meio de registro alimentar de três dias, sendo calculados os valores médios de energia, em kcal, os valores proporcionais dos macronutrientes em relação ao valor calórico total da dieta consumida, bem como os valores médios/medianos dos seguintes micronutrientes: cálcio, ferro, zinco, fósforo, magnésio, folato, vitamina D, vitamina C, vitamina A e vitamina E. RESULTADOS: Verificou-se que 24 por cento das adolescentes do estudo apresentaram IMC abaixo dos valores mínimos para a idade. A média de ingestão de energia foi menor entre as modelos, em comparação às adolescentes não modelos (1.480,93±582,95 versus 1.973,00±557,63 kcal) (p<0,05). A ingestão de gorduras acima do recomendado foi semelhante entre os grupos - 30,3 por cento das adolescentes modelos e 36,4 por cento das adolescentes não modelos (p>0,05). O consumo inadequado de micronutrientes como o cálcio, ferro, zinco, magnésio, fósforo, vitaminas lipossolúveis, folato e ácido ascórbico ocorreu em ambos os grupos. CONCLUSÕES: A baixa ingestão energética (kcal) entre as modelos e a ingestão insuficiente de minerais e vitaminas alertam para que as agências de modelos comprometam-se com a saúde dessas adolescentes, garantindo um acompanhamento médico e nutricional.

OBJECTIVE: To evaluate the adequacy of energy, macro and micronutrients intake in adolescent runway models. METHODS: This cross-sectional study enrolled 33 models and 33 non-models, with ages ranging from 15 to 18 years, paired by age and body mass index (BMI). Food intake was evaluated by a three-day food record. The average energy values were estimated in kcal, the proportional values of macronutrients as to the total caloric value of the consumed diet were also calculated, as well as the mean/medium values of the following micronutrients: calcium, iron, zinc, phosphorus, magnesium, folate, vitamin D, vitamin C, vitamin A and vitamin E. RESULTS: Among the studied adolescents, 24 percent presented BMI below the minimum values for the age. Mean energy intake was lower among the models compared to non-models (1,480.93±582.95 versus 1,973.00±557.63 kcal) (p<0.05). The fat intake, higher than the recommended, was similar in both groups (30.3 percent in models and 36.4 percent of the non-model adolescents - p>0.05). The inadequate consumption of micronutrients such as calcium, iron, zinc, magnesium, phosphorus, liposoluble vitamins, folate and ascorbic acid was observed in both groups. CONCLUSIONS: The low energy intake (kcal) among models and the insufficient intake of minerals and vitamins are red flags for model agencies to be more committed to the health of these adolescents, ensuring that they get nutritional and medical follow-up.

Composição corporal, gasto energético e ingestão alimentar em modelos brasileiras / Body composition, energy expenditure and food intake in brazilian fashion models

O objetivo desse estudo foi comparar a composição corporal, taxa demetabolismo em repouso e ingestão alimentar entre adolescentes modelos e nãomodelos. Participaram do estudo 33 modelos e 33 não modelos, de 15 a 18 anos,pareadas por idade e IMC. A avaliação da composição corporal foi realizada pormeio da técnica de pletismografia. A taxa de metabolismo em repouso (TMR) foiobtida pelo método da calorimetria indireta e a avaliação da ingestão alimentarfoi realizada por meio de um registro alimentar de 3 dias alternados. Não houvediferença estatisticamente significante em relação aos valores médios de percentualde gordura corporal entre os grupos estudados (p>0,05). Entretanto, ao classificar asadolescentes quanto ao percentual de gordura corporal, observou-se que nenhumamodelo apresentou percentual de gordura corporal menor do que 15%, enquanto15,2% das adolescentes não modelos apresentaram baixo percentual de gorduracorporal (p<0,05). Os valores de TMR (kcal/d) foram semelhantes entre modelos(1367,22) e não modelos (1309,43) (p>0,05). Em relação à ingestão de energia, observou-se que a média de ingestão energética foi 1480,93kcal ± 582,95 e 1973,00kcal± 557,63 entre modelos e não modelos, respectivamente (p=0,001). Conclui-se queas modelos, em sua maioria, apresentaram composição corporal dentro dos valoresconsiderados normais para esta fase da vida. Os valores de TMR foram similaresentre os grupos. Entretanto, a ingestão energética (kcal) foi menor entre as modelosem relação às adolescentes não modelos.

The objective of this study was to compare body composition, restingmetabolic rate (RMR) and food intake between adolescent fashion models and nonmodels.Thirty-three models and 33 non-models ranging in age from 15 to 18 years andmatched for age and BMI participated in the study. Body composition was evaluated byplethysmography. RMR was determined using an indirect calorimetry method and foodintake was evaluated based on three-day food records obtained on alternate days. Nosignificant difference in mean body fat percentage was observed between groups (p>0.05).However, when the adolescents were classified according to body fat percentage, noneof the models presented a body fat percentage lower than 15%, whereas 15.2% of thenon-models presented a low body fat percentage (p<0.05). RMR values (kcal/day) weresimilar in models (1367.22) and non-models (1309.43) (p>0.05). Mean energy intake was1480.93 ± 582.95 kcal in models and 1973.00 ± 557.63 kcal in non-models (p=0.001).In conclusion, most models presented a body composition within the limits considered tobe normal for this phase of life. RMR was similar in the two groups. However, energyintake was lower among adolescent models compared to non-models.

Body trunk fat and insulin resistance in post-pubertal obese adolescents / Gordura corporal central e resistência à insulina em adolescentes obesos pós-púberes

CONTEXT AND OBJECTIVE: Insulin resistance is a metabolic disorder commonly associated with excess body fat accumulation that may increase chronic disease risk. The present study was undertaken to evaluate the relationship between body composition and insulin resistance among obese adolescents. DESIGN AND SETTING: Cross-sectional study, at the Adolescence Center, Pediatric Department, Universidade Federal de São Paulo. METHODS: Body composition was assessed using dual-energy X-ray absorptiometry. Dietary intake was evaluated using a three-day dietary record. The biochemical evaluation comprised glucose, insulin, serum lipid, leptin and ghrelin measurements. Insulin resistance was calculated by means of the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS: Forty-nine post-pubertal obese adolescents participated in the study: 12 boys and 37 girls of mean age 16.6 (1.4) years and mean body mass index (BMI) of 35.0 (3.9) kg/m². The mean glucose, insulin and HOMA values were 90.3 (6.4) mg/dl, 16.6 (8.1) µIU/ml and 3.7 (1.9), respectively. Hyperinsulinemia and insulin resistance were observed in 40.2 percent and 57.1 percent of the subjects, respectively. Adolescents with insulin resistance had higher BMI and body trunk fat. There was a trend towards higher leptin concentration in obese individuals with insulin resistance. Insulin resistance was positively correlated with body trunk fat, BMI, body fat mass (kg), leptin and body fat percentage. Furthermore, there was a negative correlation between HOMA-IR and lean body mass. The body composition predicted 30 percent of the HOMA-IR levels, according to linear regression models. CONCLUSION: Body trunk fat was significantly associated with insulin resistance, demonstrating the clinical importance of abdominal obesity during adolescence.

CONTEXTO E OBJETIVO: A resistência à insulina é uma desordem metabólica, comumente associada ao acúmulo excessivo de gordura corporal, que pode aumentar o risco de doenças crônicas. O objetivo foi avaliar a relação entre a composição corporal e a resistência à insulina em adolescentes obesos. TIPO DE ESTUDO E LOCAL: Estudo transversal, realizado no Centro de Atendimento e Apoio ao Adolescente, Departamento de Pediatria, Universidade Federal de São Paulo. MÉTODOS: Realizou-se avaliação da composição corporal, avaliação do consumo alimentar e avaliação bioquímica (dosagem de glicose, insulina, colesterol total e frações, leptina e grelina). A resistência à insulina (RI) foi calculada pelo HOMA-IR (Homeostasis Model Assessment of Insulin Resistance). RESULTADOS: 49 adolescentes obesos [12 meninos e 37 meninas; idade média de 16.6 (1.4) anos; média de índice de massa corpórea (IMC) 35.0 (3.9) kg/m²] participaram do estudo. A concentração média de glicose, insulina e HOMA-IR foram de 90.3 (6.4) mg/dl, 16.6 (8.1) µUI/ml e 3.7 (1.9), respectivamente. Hiperinsulinemia e RI foram observadas em 40,2 por cento e 57,1 por cento dos adolescentes, meninos e meninas, respectivamente. Adolescentes com RI apresentaram maior IMC e gordura do tronco. A concentração de leptina apresentou tendência a ser maior nestes indivíduos. A RI foi positivamente correlacionada com a gordura do tronco, IMC, massa adiposa (kg), leptina e percentual de gordura corporal. Além disso, houve correlação negativa entre HOMA-IR com a massa magra. A composição corporal foi capaz de predizer 30 por cento do HOMA-IR segundo os modelos de regressão linear. CONCLUSÃO: A gordura do tronco foi significativamente associada com a resistência à insulina, demonstrando a importância clínica da obesidade abdominal durante a adolescência.