Number of Daily Steps to Discriminate Abdominal Obesity in a Sample of Brazilian Children and Adolescents.

PURPOSE: Weight status-referenced pedometer step-count guidelines for young people have been developed for populations from high-income countries and may not be applicable to middle- and low-income countries. The objectives of this study were 1) to develop cut-off points for pedometer-determined step count in young Brazilians using waist circumference (WC) as a reference criterion, and 2) to analyze the capacity of previous recommendations to discriminate abdominal obesity in the sample studied. METHODS: A cross-sectional study was conducted on 1,044 schoolchildren (456 boys) aged 6-17 years from Northeastern Brazil. WC was measured and daily step counts were determined with a pedometer. RESULTS: The area under the curve (AUC) of step count was significant for boys (AUC = 0.55; 95%CI: 0.50-0.59) and girls (AUC = 0.57; 95%CI: 0.53-0.61). Our cut-off points (14,414 and 11,355 steps for boys and girls, respectively) were more balanced in terms of sensitivity and specificity compared with previous recommendations. The use of previous guidelines to classify step count in the sample provided very low sensitivity or specificity and wide variation in the prevalence of insufficient physical activity (39.3-77.0%). CONCLUSIONS: A universal step-count recommendation for young people may not be adequate and specific guidelines seem to be necessary for different countries or regions.

Cut-off values for step count and TV viewing time as discriminators of hyperglycaemia in Brazilian children and adolescents.

BACKGROUND: The use of step count and TV viewing time to discriminate youngsters with hyperglycaemia is still a matter of debate. AIM: To establish cut-off values for step count and TV viewing time in children and adolescents using glycaemia as the reference criterion. SUBJECTS AND METHODS: A cross-sectional study was conducted on 1044 schoolchildren aged 6-18 years from Northeastern Brazil. Daily step counts were assessed with a pedometer over 1 week and TV viewing time by self-report. RESULTS: The area under the curve (AUC) ranged from 0.52-0.61 for step count and from 0.49-0.65 for TV viewing time. The daily step count with the highest discriminatory power for hyperglycaemia was 13 884 (sensitivity = 77.8; specificity = 51.8) for male children and 12 371 (sensitivity = 55.6; specificity = 55.5) and 11 292 (sensitivity = 57.7; specificity = 48.6) for female children and adolescents respectively. The cut-off for TV viewing time with the highest discriminatory capacity for hyperglycaemia was 3 hours/day (sensitivity = 57.7-77.8; specificity = 48.6-53.2). CONCLUSION: This study represents the first step for the development of criteria based on cardiometabolic risk factors for step count and TV viewing time in youngsters. However, the present cut-off values have limited practical application because of their poor accuracy and low sensitivity and specificity.

Effects of a Physical Exercise Program and Health Advice on Sedentary Behavior of Adolescents.

Sedentary behavior (SB) is a risk factor for chronic non-communicable diseases. This study aimed to assess the effects of an extracurricular physical exercise program and health advice on SB in adolescents. This was a non-randomized experimental study involving 19 adolescents divided into an intervention group (IG) and a control group (CG), aged 13-16 years from a public school in a Brazilian municipality. SB was measured using self-reports and accelerometers. The intervention included physical exercise and health advice. Repeated measures analysis of variance with a significance level of α = 5% was used. There was a time*group interaction for the subscapular fold ((pre IG = 16.30 mm vs. CG = 13.44 mm, post IG = 14.00 mm vs. CG = 15.89 mm) p = 0.001), and VO2MAX ((pre IG = 32.75 mL/kg/min vs. CG = 30.66 mL/kg/min, post IG = 35.76 mL/kg/min vs. CG = 29.28 mL/kg/min) p = 0.008). The accelerometer showed significant differences between groups in the total SB ((pre IG = 647.49 min/day vs. CG = 535.24 min/day, post IG = 614.02 min/day vs. CG = 586.97 min/day) p = 0.045), with a significant decrease in the IG. In conclusion, an extracurricular physical exercise program and health advice was effective in reducing SB in adolescents.

Utility of anthropometric indicators to screen for clustered cardiometabolic risk factors in children and adolescents.

Background Anthropometric indicators are associated with cardiometabolic risk factors (CMRF), but there is no consensus as to which indicator is the most suitable to screen for clustered CMRF. This study aimed to evaluate the utility of five anthropometric indicators to screen for clustered CMRF in children and adolescents. Methods A cross-sectional study was conducted in 1139 schoolchildren aged 6-17 years from Northeastern Brazil. Body weight, height, waist circumference (WC) and subscapular (SSF) and triceps skinfold thickness (TSF) were measured. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. The following CMRF were evaluated: elevated total cholesterol, low high-density lipoprotein-cholesterol (HDL-C), elevated low-density lipoprotein-cholesterol (LDL-C), high triglyceride concentration, hyperglycemia and high blood pressure. The participants were categorized into no CMRF, 1 CMRF, 2 CMRF and ≥3 CMRF. Receiver operating characteristic (ROC) curves were constructed to assess the accuracy of the anthropometric indicators in predicting CMRF for age group and sex. Results Poor associations were observed between the anthropometric indicators and 1 CMRF (accuracy of 0.49-0.64). The indicators showed moderate associations with 2 CMRF (accuracy of 0.57-0.75) and ≥3 CMRF (accuracy of 0.59-0.79). In general, TSF exhibited the worst performance in predicting CMRF, followed by WHtR. The highest accuracies were observed for BMI, WC and SSF, with no significant difference between these indicators. Conclusions The routine use of BMI, WC and SSF as epidemiological screening tools for clustered CMRF in childhood and adolescence should be encouraged.

High blood pressure screening in children and adolescents from Amargosa, Bahia: usefulness of anthropometric indices of obesity. / Triagem da pressão arterial elevada em crianças e adolescentes de Amargosa, Bahia: utilidade de indicadores antropométricos de obesidade.

OBJECTIVE: To determine the predictive power of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), and their respective cut-off points for high blood pressure (BP) screening in Brazilian children and adolescents. METHOD: Cross-sectional study conducted with 1,139 students aged 6 to 17years. Body weight, height, WC, and BP were measured. High BP was classified as systolic or diastolic ≥ 95th percentile. Receiver Operating Characteristic (ROC) curves were constructed, and the area under the curve, sensitivity, and specificity were calculated. RESULTS: The prevalence of high BP was 27.0%. Anthropometric indices showed a significant association with high BP (accuracy ranging from 0.62 - 0.81), except for WHtR among male adolescents.Sensitivity was low, regardless of the anthropometric index, gender, and age group. CONCLUSION: BMI, WC, and WHtR were associated with high BP, but the cut-off points tested showed low sensitivity. Determining specific cut-off points for each population can enable the use of anthropometric indices in high BP screening.

OBJETIVO: Determinar o poder preditivo do índice de massa corporal (IMC), perímetro da cintura (PC) e razão da cintura pela estatura (RCEst) e de seus respectivos pontos de corte para triagem de pressão arterial (PA) elevada em crianças e adolescentes brasileiros. MÉTODO: Estudo transversal realizado com1.139 escolares de 6 a 17 anos de idade. A massa corporal, a estatura, o PC e a PA foram mensurados. A PA elevada foi classificada como sistólica ou diastólica≥ percentil 95. Curvas Receiver Operating Characteristic (ROC) foram construídas e a área sob a curva, a sensibilidade e a especificidade foram calculadas. RESULTADOS: A prevalência de PA elevada foi de 27,0%. Os indicadores antropométricos apresentaram associação significativa com PA elevada (acurácia variando de 0,62 - 0,81), exceto RCEst entre adolescentes do sexo masculino.Observou-se baixa sensibilidade, independentemente do indicador antropométrico, do sexo e da faixa etária. CONCLUSÃO: OIMC, o PC e a RCEst estiveram associados a PA elevada, porém os pontos de corte testados apresentaram baixa sensibilidade. A determinação de pontos de corte específicos para cada população pode viabilizar a triagem de PA elevada por meio de indicadores antropométricos.

Body composition indicators in the metabolic syndrome risk prediction in 6-10-year-old children / Indicadores de composição corporal na predição de risco de síndrome metabólica em crianças de 6 a 10 anos de idade

ABSTRACT The aim of this study was to develop percentiles of body composition indicators and determine cutoff points to predict metabolic syndrome (MS) risk in 6-10-year-old children. This is a cross-sectional, population-based epidemiological study with the participation of 1480 schoolchildren aged 6-10-year. Anthropometric assessment (body mass, height, and skinfolds) and blood pressure measurement were performed in schools. The body mass index (BMI), as well as the body fat percentage (%BF), lean body mass (LBM), fat body mass (FBM), were calculated according to standardized formulas for children. Blood collection to assess the lipid and glycemic profile was also performed at school, on pre-established days and times. The MS diagnosis was determined based on changes in triglycerides, HDL-c, blood glucose, waist circumference, and blood pressure. The LMS method was used to develop the percentiles, the area under the ROC curve (AUC) to identify the accuracy of the indicators, and the sensitivity and specificity to determine the cutoff points. FBM and %BF had significantly higher values in girls, who also had lower values for %LM compared to boys (p<0.05). The indicators of body composition, BMI, FBM, and %BF were accurate in predicting the MS risk for both sex at all ages. The main indicators of body composition to predict the MS risk, in both sex, were BMI, FBM, and %BF. These findings suggest that simple anthropometric measurements, which can be performed in clinical practice, have the potential to direct non-pharmacological actions.

RESUMO Objetivou-se desenvolver percentis de indicadores de composição corporal e determinar pontos de corte para predizer o risco de síndrome metabólica (SM) em crianças de seis a 10 anos de idade. Estudo epidemiológico de corte transversal, de base populacional, com participação de 1480 escolares de seis a 10 anos de idade. A avaliação antropométrica (massa corporal, estatura e dobras cutâneas) e a aferição da pressão arterial foram realizadas nas escolas. O índice de massa corporal (IMC) bem como o percentual de gordura (%GC), percentual de massa magra (%MM), massa corporal gorda (MCG) foram calculados de acordo com fórmulas padronizadas para crianças. A coleta de sangue para avaliar o perfil lipídico e glicêmico também foi realizada na escola, em dias e horários pré-estabelecidos. O diagnóstico da SM foi determinado com base em alterações nos triglicerídeos, HDL-c, glicemia, perímetro de cintura e pressão arterial. O método LMS foi utilizado para desenvolver os percentis, a área sob a curva ROC (AUC) para identificar a acurácia dos indicadores e a sensibilidade e especificidade para determinar os pontos de corte. MCG e %GC apresentaram valores significativamente superior nas meninas e também valores inferiores para a MCM em relação aos meninos (p<0,05). Os indicadores de composição corporal, IMC, MCG e %GC apresentaram acurácia na predição do risco de SM para ambos os sexos em todas as idades. Os principais indicadores de composição corporal para predição do risco de SM, em ambos os sexos, foram o IMC, %GC e MCG. Esses achados sugerem que medidas antropométricas simples, que podem ser realizadas na prática clínica, tem potencial para direcionar ações não medicamentosas

ANTHROPOMETRY AND CLUSTERED CARDIOMETABOLIC RISK FACTORS IN YOUNG PEOPLE: A SYSTEMATIC REVIEW. / ANTROPOMETRIA E FATORES DE RISCO CARDIOMETABÓLICO AGRUPADOS EM JOVENS: REVISÃO SISTEMÁTICA.

OBJECTIVE: To conduct a systematic review of the literature on the ability of anthropometric indicators to predict clustered cardiometabolic risk factors (CMRF) in children and adolescents. DATA SOURCE: Studies published from June 1st, 2011 to May 31st, 2016 in the PubMed, SciELO and LILACS databases were analyzed. The research was based on keywords derived from the terms "anthropometric indicators" AND "cardiometabolic risk factors". Observational studies on the ability of anthropometric indicators as predictors of clustered CMRF in children and adolescents in Portuguese, English and Spanish languages were included. Studies with a specific group of obese patients or with other diseases were not included. DATA SYNTHESIS: Of the 2,755 articles retrieved, 31 were selected for systematic review. Twenty-eight studies analyzed body mass index (BMI) as a predictor of clustered CMRF. Only 3 of the 25 cross-sectional studies found no association between anthropometric indicators and clustered CMRF. The results of six studies that compared the predictive ability of different anthropometric measures for clustered CMRF were divergent, and it was not possible to define a single indicator as the best predictor of clustered CMRF. Only six articles were cohort studies, and the findings suggested that changes in adiposity during childhood predict alterations in the clustered CMRF in adolescence. CONCLUSIONS: BMI, waist circumference and waist-to-height ratio were predictors of clustered CMRF in childhood and adolescence and exhibited a similar predictive ability for these outcomes. These findings suggest anthropometric indicators as an interesting screening tool of clustered CMRF at early ages.

OBJETIVO: Revisar sistematicamente a literatura sobre a habilidade de indicadores antropométricos para predizer fatores de risco cardiometabólico (FRC) agrupados em crianças e adolescentes. FONTE DE DADOS: Foram analisados estudos publicados de 1º de junho de 2011 até 31 de maio de 2016 nas bases PubMed, SciELO e LILACS. A pesquisa baseou-se em palavras-chave derivadas dos termos "indicadores antropométricos" AND "fatores de risco cardiometabólico". Foram incluídos estudos observacionais sobre a habilidade de indicadores antropométricos como preditores de FRC agrupados em crianças e adolescentes, nos idiomas português, inglês e espanhol. Não foram incluídos estudos com grupo específico de pacientes com obesidade ou outras doenças. SÍNTESE DOS DADOS: Dos 2.755 registros encontrados, 31 estudos foram selecionados para revisão sistemática. Vinte e oito estudos analisaram a habilidade do índice de massa corporal (IMC) como preditor de FRC agrupados. Dos 25 estudos transversais, apenas em 3 não foi observada associação entre indicadores antropométricos e FRC agrupados. Os resultados dos seis estudos que compararam a habilidade de diferentes medidas antropométricas como preditoras de FRC agrupados foram divergentes, não sendo possível definir um único indicador como melhor preditor de FRC agrupados. Apenas seis estudos eram de coorte, e os achados sugeriram que mudanças na adiposidade na infância predizem alterações nos FRC agrupados na adolescência. CONCLUSÕES: O IMC, o perímetro da cintura e a relação cintura-estatura foram preditores de FRC agrupados na infância e na adolescência e apresentaram habilidade similar para predizer esses desfechos. Esses achados sugerem que indicadores antropométricos podem representar uma interessante ferramenta para triagem epidemiológica de FRC agrupados em idades precoces.

Relação entre o perfil de adesão e as barreiras para a permanência no programa de extensão "yoga: awaken one" / Relationship between the membership profile and the barriers to stay in the "yoga: awaken one" extension program

Objetivo: Investigar a relação entre o perfil de adesão e barreiras percebidas por estudantes universitários para permanência no Programa de Extensão "Yoga: Awaken ONE". Métodos: Foram realizados dois cortes transversais com universitários da Universidade Federal do Recôncavo da Bahia. O primeiro foi composto por 16 indivíduos e investigou o perfil demográfico, socioeconômico, antropométrico, da aptidão física e da qualidade de vida dos universitários que ingressaram no Programa de Extensão. O segundo visou identificar as barreiras para permanência de 13 estudantes (dentre os 16 iniciais) que haviam se afastado do Programa após quatro meses do início. Resultados: Houve predominância de indivíduos do sexo feminino, dos cursos de graduação em Educação Física e Pedagogia e da classe socioeconômica C. A maioria dos participantes estava com indicadores adequados de gordura corporal. Observou-se grande proporção de indivíduos com indicadores baixos de flexibilidade e força muscular. Para a qualidade de vida, a menor mediana foi observada para o domínio meio ambiente e a maior para o domínio relações sociais. As principais barreiras percebidas para a prática de yoga pelos universitários foram "jornada de estudos extensa" e "jornada de trabalho extensa". Observou-se correlação do perfil sociodemográfico, indicadores de obesidade, variáveis hemodinâmicas, flexibilidade, força muscular e qualidade de vida com barreiras percebidas para permanência no Programa de Extensão universitária "Yoga: Awaken ONE". Conclusões: Estes achados sugerem que o perfil do público universitário pode ser determinante para a permanência ou evasão de programas de promoção de exercícios físicos e precisa ser considerado em propostas de programas de extensão universitária.

Objective: Investigate the relationship between the member adherence profile and barriers perceived by university students to remain in the "Yoga: Awaken ONE" Extension Program. Methods: Two cross-sections were carried out with university students from the Federal University of Recôncavo da Bahia. The first was composed of 16 individuals and investigated the demographic, socioeconomic, anthropometric, physical fitness, and quality of life profile of university students joining the Extension Program. The second aimed at identifying the barriers to remain in the program faced by 13 students (out of the initial 16) who had withdrawn from the Program four months after the beginning. Results: There was a predominance of female individuals, from undergraduate courses in Physical Education and Pedagogy, and from the C socioeconomic class. Most participants had adequate body fat indexes. There was a large proportion of individuals with low flexibility and muscle strength. For quality of life, the lowest median was observed for the environment domain, while the highest could be noted for the social relationship domain. The main barriers perceived for the practice of yoga by university students were "long study hours" and "long work hours". There was a correlation between sociodemographic profile, obesity indicators, hemodynamic variables, flexibility, muscle strength, and QOL with the perceived barriers to stay in the "Yoga: Awaken ONE" university extension program. Conclusions: These findings suggest that the profile of the university audience can be a determinant for the permanence or dropout of programs that promote physical exercise and therefore, it should be taken into consideration in proposals for university extension programs.

[Epidemiological survey in schoolchildren: determinants and prevalence of cardiovascular risk factors]. / Inquérito epidemiológico em escolares: determinantes e prevalência de fatores de risco cardiovascular.

This study focused on the prevalence of dyslipidemia, high blood glucose, and high blood pressure in scho-olchildren and the associations with demographic, socioeconomic, biological, and behavior factors using a cross-sectional design with 1,139 schoolchildren from six to 18 years of age in Amargosa, Bahia State, Brazil. Prevalence ratio (PR) was used as the measure of association. Prevalence rates for dyslipidemia, high blood glucose, and high blood pressure were 62.1%, 6.6%, and 27%, respectively. Dyslipidemia was associated with the school's geographic location (PR = 1.52) and child's waist circumference (PR = 1.20), and high blood glucose with the school's geographic location (PR = 3.41) and child's peripheral adiposity (PR = 3.13). High blood pressure was associated with age bracket (PR = 2.34), waist-for-height ratio (PR = 1.62), sexual ma-turation (PR = 2.06), and physical activity (PR = 1.32). Intervention programs are needed to change life habits in schoolchildren.

Utility of body mass index, waist circumference and waist-to-height ratio as screening tools for hyperglycemia in young people.

OBJECTIVES: To evaluate the ability of BMI, WC and WHtR to discriminate hyperglycemia in young people, and to determine whether there is an increase in the accuracy with the addition of WC and/or WHtR to BMI. SUBJECTS AND METHODS: A cross-sectional study was conducted on 1,139 schoolchildren aged 6 to 17 years from Northeastern Brazil. Body weight, height, WC and fasting glucose levels were measured, and the BMI and WHtR were calculated. The presence of hyperglycemia was defined as a fasting glucose level ≥ 100 mg/dL. RESULTS: The prevalence of hyperglycemia was 6.6%. Strong correlations were observed between the anthropometric indicators studied (BMI vs. WC = 0.87; BMI vs. WHtR = 0.87; WC vs. WHtR = 0.90). Hyperglycemia was more likely to be present in young people with excess weight (PR = 1.70), high WC (PR = 1.85), and high WHtR (PR = 1.91). The accuracies to discriminate hyperglycemia were significant, but low, for the individual (BMI = 0.56; WC = 0.53; WHtR = 0.55) and combined indicators (BMI + WC = 0.55; BMI + WHtR = 0.55). CONCLUSION: Our findings do not support the use of BMI, WC or WHtR as screening tools for hyperglycemia in children and adolescents.

[Knowledge of pediatricians regarding physical activity in childhood and adolescence]. / Conhecimento de pediatras sobre a atividade física na infância e adolescência.

OBJECTIVE: To investigate the knowledge and guidance given by pediatricians regarding physical activity in childhood and adolescence. METHODS: A cross-sectional study involving a convenience sample of pediatricians (n=210) who participated in a national pediatrics congress in 2013. Sociodemographic and professional data and data regarding habitual physical activity and pediatricians' knowledge and instructions for young people regarding physical activity were collected using a questionnaire. Absolute and relative frequencies and means and standard deviations were calculated. RESULTS: Most pediatricians were females, had graduated from medical school more than 15 years ago, and had residency in pediatrics. More than 70% of the participants reported to include physical activity guidance in their prescriptions. On the other hand, approximately two-thirds of the pediatricians incorrectly reported that children should not work out and less than 15% answered the question about physical activity barriers correctly. With respect to the two questions about physical activity to tackle obesity, incorrect answers were marked by more than 50% of the pediatricians. Most participants incorrectly reported that 30 minutes should be the minimum daily time of physical activity in young people. Less than 40% of the pediatricians correctly indicated the maximum time young people should spend in front of a screen. CONCLUSIONS: In general, the pediatricians reported that they recommend physical activity to their young patients, but specific knowledge of this topic was limited. Programs providing adequate information are needed.

Predictive capacity of anthropometric indicators for dyslipidemia screening in children and adolescents.

OBJECTIVE: To analyze the predictive capacity of anthropometric indicators and their cut-off values for dyslipidemia screening in children and adolescents. METHODS: This was a cross-sectional study involving 1139 children and adolescents, of both sexes, aged 6-18 years. Body weight, height, waist circumference, subscapular, and triceps skinfold thickness were measured. The body mass index and waist-to-height ratio were calculated. Children and adolescents exhibiting at least one of the following lipid alterations were defined as having dyslipidemia: elevated total cholesterol, low high-density lipoprotein, elevated low-density lipoprotein, and high triglyceride concentration. A receiver operating characteristic curve was constructed and the area under the curve, sensitivity, and specificity was calculated for the parameters analyzed. RESULTS: The prevalence of dyslipidemia was 62.1%. The waist-to-height ratio, waist circumference, subscapular, body mass index, and triceps skinfold thickness, in this order, presented the largest number of significant accuracies, ranging from 0.59 to 0.78. The associations of the anthropometric indicators with dyslipidemia were stronger among adolescents than among children. Significant differences between accuracies of the anthropometric indicators were only observed by the end of adolescence; the accuracy of waist-to-height ratio was higher than that of subscapular (p=0.048) for females, and the accuracy of waist circumference was higher than that of subscapular (p=0.029) and body mass index (p=0.012) for males. In general, the cut-off values of the anthropometric predictors of dyslipidemia increased with age, except for waist-to-height ratio. Sensitivity and specificity varied substantially between anthropometric indicators, ranging from 75.6 to 53.5 and from 75.0 to 50.0, respectively. CONCLUSIONS: The anthropometric indicators studied had little utility as screening tools for dyslipidemia, especially in children.

Comportamento sedentário em adolescentes brasileiros: uma revisão sistemática / Sedentary behavior in Brazilian adolescents: a systematic review

Objetivou-se descrever aspectos metodológicos da pesquisa em comportamento sedentário e identificar intervenções para redução do comportamento sedentário em adolescentes brasileiros. A busca de dados foi de outubro de 2014 a abril de 2019. As bases de dados utilizadas foram LILACS, Pub­med, SciELO e Scopus. Foram critérios de inclusão artigos originais publicados em revistas nacionais e internacionais, teses e dissertações completas disponíveis para download, com amostras que incluíssem adolescentes brasileiros. Encontrou-se 491 estudos e 38 foram incluídos na síntese qualitativa. Somente 13,1% dos trabalhos apresentaram desenho experimental. O tempo de tela foi o indicador mais utilizado para caracterizar o comportamento sedentário. O ponto de corte mais frequente foi o de 2 horas/dia, entretanto, identificou-se 17 pontos de corte diferentes. Apenas 13,1% das pesquisas utilizaram medidas objetivas para mensurar o comportamento sedentário. Conclui-se que a falta de padronização nos indicadores e pontos de corte do comportamento sedentário dificultam a comparação entre os resultados das pesquisas. É necessária a utilização de medidas objetivas para informações mais fidedignas. Há carência de estudos de intervenção na redução do comportamento sedentário em adolescentes brasileiros

The aim of this study was to describe methodological aspects of the research on sedentary behavior and to identify interventions to reduce sedentary behavior in Brazilian adolescents. Data search was from October 2014 to April 2019. The databases used were LILACS, Pubmed, SciELO and Scopus. Inclusion criteria were original articles published in national and international journals, complete thesis and master thesis available for download, with samples that included Brazilian adolescents. 491 studies were found and 38 were included in the qualitative synthesis. Only 13.1% presented experimental design. Screen time was the most used indicator to characterize the sedentary behavior. The most frequent cutoff point was 2 hours/day; however, 17 different cutoff points were identified. Only 13.1% of the surveys used objective measures to identify the sedentary behavior. It is concluded that the lack of standardization in the indicators and cutoff points of sedentary behavior make it difficult to compare the results of the research. It is necessary to use objective measures for more reliable information. There is a lack of intervention studies in the reduction of sedentary behavior of Brazilian adolescents

Sociodemographic determinants of university students' lifestyles.

OBJECTIVE: It has been observed during recent decades that a large percentage of the population has an inadequate lifestyle and that there is a need for identifying factors determining such behavior pattern. This study was thus aimed at determining the association between lifestyle and sociodemographic variables of freshmen attending a state university in southern Brazil. METHODS: The sample consisted of 716 students (59.6 % female). The Fantastic questionnaire was used for evaluating the students' lifestyles; their lifestyle was classified as being suitable or inadequate. The sociodemographic variables of interest were gender, age group (<20 and ≥ 20 years), paid work (yes or no), maternal education (≤ 4 years of study, 5-8 years and ≥ 9 years), study shift (daytime or night-time) and marital status (single and married). Binary logistic regression was used for determining associations between lifestyle and sociodemographic characteristics (p<0.05 being significant). RESULTS: Inadequate lifestyle prevalence was 5.3 %. Adjusted analysis results indicated that students over 20 years-old (OR=2.87: 1.37-6.03 95 %CI) whose mothers' formal education had lasted less than nine years (OR=2.23: 1.29-3.88 95 %CI) had a higher risk of having an inadequate lifestyle. CONCLUSION: These findings may be useful for developing university healthcare promotion programs, paying special attention to older freshmen whose mothers have had less formal education.

Triagem da pressão arterial elevada em crianças e adolescentes de Amargosa, Bahia: utilidade de indicadores antropométricos de obesidade / High blood pressure screening in children and adolescents from Amargosa, Bahia: usefulness of anthropometric indices of obesity

RESUMO: Objetivo: Determinar o poder preditivo do índice de massa corporal (IMC), perímetro da cintura (PC) e razão da cintura pela estatura (RCEst) e de seus respectivos pontos de corte para triagem de pressão arterial (PA) elevada em crianças e adolescentes brasileiros. Método: Estudo transversal realizado com1.139 escolares de 6 a 17 anos de idade. A massa corporal, a estatura, o PC e a PA foram mensurados. A PA elevada foi classificada como sistólica ou diastólica≥ percentil 95. Curvas Receiver Operating Characteristic (ROC) foram construídas e a área sob a curva, a sensibilidade e a especificidade foram calculadas. Resultados: A prevalência de PA elevada foi de 27,0%. Os indicadores antropométricos apresentaram associação significativa com PA elevada (acurácia variando de 0,62 - 0,81), exceto RCEst entre adolescentes do sexo masculino.Observou-se baixa sensibilidade, independentemente do indicador antropométrico, do sexo e da faixa etária. Conclusão: OIMC, o PC e a RCEst estiveram associados a PA elevada, porém os pontos de corte testados apresentaram baixa sensibilidade. A determinação de pontos de corte específicos para cada população pode viabilizar a triagem de PA elevada por meio de indicadores antropométricos.

ABSTRACT: Objective: To determine the predictive power of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), and their respective cut-off points for high blood pressure (BP) screening in Brazilian children and adolescents. Method: Cross-sectional study conducted with 1,139 students aged 6 to 17years. Body weight, height, WC, and BP were measured. High BP was classified as systolic or diastolic ≥ 95th percentile. Receiver Operating Characteristic (ROC) curves were constructed, and the area under the curve, sensitivity, and specificity were calculated. Results: The prevalence of high BP was 27.0%. Anthropometric indices showed a significant association with high BP (accuracy ranging from 0.62 - 0.81), except for WHtR among male adolescents.Sensitivity was low, regardless of the anthropometric index, gender, and age group. Conclusion: BMI, WC, and WHtR were associated with high BP, but the cut-off points tested showed low sensitivity. Determining specific cut-off points for each population can enable the use of anthropometric indices in high BP screening.

Daily step count and cardiometabolic risk in young people: a systematic review / Número de passos por dia e risco cardiometabólico em jovens: revisão sistemática

The aim of this systematic review was to analyze the association between the number of daily steps and cardiometabolic risk factors in children and adolescents. Studies published from 1 January 2000 to 31 May 2016 in the PubMed, SciELO and LILACS databases were analyzed. Manual searches of the reference lists of the selected articles were also performed. Of the 4,454 articles retrieved, eight studies met the eligibility criteria and were included in the analysis. Seven of these studies reported some significant association between step count and cardiometabolic risk factors. However, the data suggested the lack of an association with hyperglycemia, were inconclusive regarding lipid profile alterations, divergent for high blood pressure, and indicated an association with insulin resistance and metabolic syndrome only in males. The findings of this systematic review do not permit to determine the association between step count and cardiometabolic risk factors in young people. The small number of articles that met the eligibility criteria and the different methodological problems of the studies reviewed were the main factors limiting inferences. Observational studies with a longitudinal design (cohort and casecontrol) and accurate methodological control are necessary.

O objetivo desta revisão sistemática foi analisar a associação entre o número de passos por dia e fatores de risco cardiometabólico em crianças e adolescentes. Foram analisados estudos publicados de 01 de janeiro de 2000 até 31 de maio de 2016 nas bases de dados PubMed, SciELO e LILACS. Buscas manuais nas listas de referências dos artigos incluídos também foram realizadas. Dos 4.454 registros encontrados, oito estudos atenderam aos critérios de elegibilidade e foram incluídos para análise. Desses, sete observaram alguma associação significativa entre número de passos e fatores de risco cardiometabólico. No entanto, as evidências sugerem ausência de associação com a hiperglicemia, foram inconclusivas para alterações no perfil lipídico, divergentes para pressão arterial elevada e indicaram associação com a resistência a insulina e síndrome metabólica somente para o sexo masculino. Os achados da presente revisão sistemática não permitem determinar a associação entre o número de passos e fatores de risco cardiometabólico em jovens. O reduzido número de artigos que atenderam aos critérios de elegibilidade e os diversos problemas metodológicos dos estudos revisados foram os principais fatores que limitaram maiores inferências. Investigações observacionais com delineamento longitudinal (coorte e caso-controle) e com acurado controle metodológico são necessárias.

Número de passos para discriminar pressão arterial elevada em jovens: quantos são o suficiente? / Step count to discriminate high blood pressure in young: how many steps are enough?

A relação entre a prática de atividade física e pressão arterial (PA) tem sido reportada entre jovens. Contudo, pontos de corte do número de passos para discriminar PA elevada na população pediátrica ainda são incertos. O objetivo do presente estudo foi avaliar quantos passos por dia são suficientes para discriminar PA elevada em crianças e adolescentes. Estudo transversal com 1.044 escolares (456 meninos), de seis a 17 anos de idade, do município de Amargosa, Bahia, Brasil. A PA foi mensurada e a PA elevada foi classificada como sistólica ou diastólica ≥ percentil 95 de acordo com sexo, idade e estatura. O número de passos diários foi estimado por pedômetro. Curvas Receiver Operating Characteristic foram construídas e a área sob a curva, sensibilidade, especificidade e intervalos de confiança (IC) de 95% foram calculados, com análises separadas por sexo. A prevalência de PA elevada foi de 27,8%. O número de passos foi preditor de PA elevada tanto para o sexo masculino (acurácia = 0,55; IC95%: 0,51-0,60) quanto para o feminino (acuraria = 0,58; IC95%: 0,54-0,62). Os pontos de corte com maior equilíbrio entre sensibilidade e especificidade foram 14.228 passos para o sexo masculino e 10.796 passos para o feminino. O número de passos por dia, avaliado por pedômetro, foi preditor de PA elevada nas crianças e adolescentes investigados. Em termos práticos, sugere-se a utilização de 14.000 e 11.000 passos por dia para discriminar PA elevada em jovens do sexo masculino e feminino, respectivamente. Esses achados podem ser úteis para subsidiar ações de enfrentamento à PA elevada na infância e adolescência

The relationship between physical activity and blood pressure (BP) in children and adolescents has been extensively studied. However, step count cut-off points that discriminate high BP in the pediatric population are still uncertain. Thus, this study aimed to determine how many steps per day are enough to discriminate high BP in children and adolescents. Cross-sectional study involving 1,044 schoolchildren (456 boys) aged 6 to 17 years from the city of Amargosa, Bahia, Brazil. Blood pressure was measured and a high BP was defined as a systolic or diastolic value ≥ 95th percentile according to sex, age and height. The number of daily steps was estimated with a pedometer. Receiver operating curves were constructed and the area under the curve, sensitivity, specificity and 95% confidence interval (CI) were calculated, with analyzes separated by sex. The prevalence of high BP was 27.8%. Step count was a predictor of high BP in both boys (accuracy = 0.55; 95%CI: 0.51-0.60) and girls (accuracy = 0.58; 95%CI: 0.54-0.62). The cut-off points with the best balance between sensitivity and specificity were 14,228 steps for boys and 10,796 for girls. Pedometer-de-termined daily step count was a predictor of high BP in the children and adolescents studied. In practical terms, the use of 14,000 and 11,000 steps per day is recommended to discriminate high BP in young boys and girls, respectively. These findings could be useful to support actions designed to cope with high BP in childhood and adolescence

Mudanças na atividade física de universitários: associação com informações sobre saúde e acesso a locais para prática / Changes in the physical activity of university students: association with health information and access to places for practicing / Cambios en la actividad física de universitarios: asociación con informaciones sobre salud y acceso a lugares para práctica

RESUMO Objetivo Avaliar mudanças no nível de atividade física (NAF) de estudantes durante os dois primeiros anos de graduação e sua associação com o acesso a informações sobre saúde e locais para prática de atividade física. Métodos Participaram do estudo universitários que ingressaram na Universidade Federal do Recôncavo da Bahia no ano 2010 e foram acompanhados durante os dois primeiros anos da graduação. Fatores socioeconômicos, demográficos, massa corporal, estatura, informações sobre saúde e acesso a locais para prática de atividade física foram avaliados pelo autorelato. O NAF foi mensurado através do Questionário Internacional de Atividade Física (IPAQ) e classificado com base nos critérios do Comitê de Pesquisas sobre o IPAQ. Para a análise estatística recorreu-se ao teste qui-quadrado e teste de McNemar (p<0,05). Resultados A amostra que participou de todo o período de seguimento foi composta por 92 universitários (64,1 % do sexo feminino). A proporção de universitários insuficientemente ativos aumentou de 7,6 % para 12,0 % durante os dois primeiros anos de graduação, porém esta mudança não foi significativa (p>0,05). Universitários que não receberam informações sobre cuidados com a saúde durante a graduação foram mais prováveis para permanecerem/se tornarem insuficientemente ativos (p<0,001). Não houve associação entre o NAF e o acesso a locais para prática de atividade física (p>0,05). Conclusão Houve tendência para aumento da proporção de universitários insuficientemente ativos durante o ensino superior. Políticas voltadas para capacitação dos estudantes sobre cuidados à saúde nas Universidades podem auxiliar no aumento da prática de atividade física, contribuindo para a melhoria da saúde dos universitários.(AU)

ABSTRACT Objective To evaluate changes in the physical activity level (PAL) of students within the first two years of studies and their association with access to health information and places for physical activity. Methods The sample included students who were admitted to the Federal University of Reconcavo in Bahia, Brazil, and were observed during their first two years of studies. Socioeconomic and demographic aspects, as well as body mass, height, health information and access to places for physical activity were assessed through a self-report. PAL was measured using the International Physical Activity Questionnaire (IPAQ) and classified based on the criteria of the Research Committee for IPAQ. Chi-square test and McNemar test (p<0.05) were used for statistical analysis. Results The sample that participated during the entire observation period was composed of 92 students (64.1% female). The insufficiently active students ratio increased from 7.6% to 12.0% during the first two years of undergraduate studies, but this difference was not significant (p>0.05). Students who did not receive information about health care during the course of their studies were more likely to remain/become insufficiently active (p<0.001). There was no association between PAL and access to places for physical activity (p>0.05). Conclusion A tendency to an increase in insufficiently active ratio during higher education was observed. Policies aimed at training students about health care in universities may be useful for increasing physical activity, thus contributing to improve the health condition of the students.(AU)

RESUMEN Objetivo Evaluar cambios en el nivel de actividad física (NAF) de estudiantes durante los dos primeros años de graduación y su asociación con el acceso a informaciones sobre salud y locales para práctica de actividad física. Métodos Participaron del estudio, universitarios que ingresaron en la Universidad Federal del Recôncavo de Bahia en el año 2010 y fueron acompañados durante los dos primeros años de la graduación. Los factores socioeconómicos, demográficos, masa corporal, estatura, información sobre salud y acceso a lugares para práctica de actividad física fueron evaluados por el auto relato. El NAF fue medido a través del Cuestionario Internacional de Actividad Física (IPAQ) y clasificado con base en los criterios del Comité de Investigaciones sobre el IPAQ. Para el análisis estadístico se recurrió a la prueba Chi cuadrado y prueba de McNemar (p<0,05). Resultados La muestra que participó de todo el período de seguimiento fue compuesta por 92 universitarios (64,1 % del sexo femenino). La proporción de universitarios insuficientemente activos aumentó del 7,6 % al 12,0 % durante los dos primeros años de graduación, sin embargo este cambio no fue significativo (p>0,05). Los universitarios que no recibieron información sobre el cuidado de la salud durante la graduación fueron más probables para permanecer/ tornarse insuficientemente activos (p<0,001). No hubo asociación entre el NAF y el acceso a lugares para práctica de actividad física (p>0,05). Conclusión Hubo tendencia a aumentar la proporción de universitarios insuficientemente activos durante la enseñanza superior. Las políticas dirigidas a la capacitación de los estudiantes sobre cuidados a la salud en las Universidades pueden auxiliar en el aumento de la práctica de actividad física, contribuyendo a la mejora de la salud de los universitarios.(AU)

Antropometria e fatores de risco cardiometabólico agrupados em jovens: revisão sistemática / Anthropometry and clustered cardiometabolic risk factors in young people: a systematic review

RESUMO Objetivo: Revisar sistematicamente a literatura sobre a habilidade de indicadores antropométricos para predizer fatores de risco cardiometabólico (FRC) agrupados em crianças e adolescentes. Fonte de dados: Foram analisados estudos publicados de 1º de junho de 2011 até 31 de maio de 2016 nas bases PubMed, SciELO e LILACS. A pesquisa baseou-se em palavras-chave derivadas dos termos "indicadores antropométricos" AND "fatores de risco cardiometabólico". Foram incluídos estudos observacionais sobre a habilidade de indicadores antropométricos como preditores de FRC agrupados em crianças e adolescentes, nos idiomas português, inglês e espanhol. Não foram incluídos estudos com grupo específico de pacientes com obesidade ou outras doenças. Síntese dos dados: Dos 2.755 registros encontrados, 31 estudos foram selecionados para revisão sistemática. Vinte e oito estudos analisaram a habilidade do índice de massa corporal (IMC) como preditor de FRC agrupados. Dos 25 estudos transversais, apenas em 3 não foi observada associação entre indicadores antropométricos e FRC agrupados. Os resultados dos seis estudos que compararam a habilidade de diferentes medidas antropométricas como preditoras de FRC agrupados foram divergentes, não sendo possível definir um único indicador como melhor preditor de FRC agrupados. Apenas seis estudos eram de coorte, e os achados sugeriram que mudanças na adiposidade na infância predizem alterações nos FRC agrupados na adolescência. Conclusões: O IMC, o perímetro da cintura e a relação cintura-estatura foram preditores de FRC agrupados na infância e na adolescência e apresentaram habilidade similar para predizer esses desfechos. Esses achados sugerem que indicadores antropométricos podem representar uma interessante ferramenta para triagem epidemiológica de FRC agrupados em idades precoces.

ABSTRACT Objective: To conduct a systematic review of the literature on the ability of anthropometric indicators to predict clustered cardiometabolic risk factors (CMRF) in children and adolescents. Data source: Studies published from June 1st, 2011 to May 31st, 2016 in the PubMed, SciELO and LILACS databases were analyzed. The research was based on keywords derived from the terms "anthropometric indicators" AND "cardiometabolic risk factors". Observational studies on the ability of anthropometric indicators as predictors of clustered CMRF in children and adolescents in Portuguese, English and Spanish languages were included. Studies with a specific group of obese patients or with other diseases were not included. Data synthesis: Of the 2,755 articles retrieved, 31 were selected for systematic review. Twenty-eight studies analyzed body mass index (BMI) as a predictor of clustered CMRF. Only 3 of the 25 cross-sectional studies found no association between anthropometric indicators and clustered CMRF. The results of six studies that compared the predictive ability of different anthropometric measures for clustered CMRF were divergent, and it was not possible to define a single indicator as the best predictor of clustered CMRF. Only six articles were cohort studies, and the findings suggested that changes in adiposity during childhood predict alterations in the clustered CMRF in adolescence. Conclusions: BMI, waist circumference and waist-to-height ratio were predictors of clustered CMRF in childhood and adolescence and exhibited a similar predictive ability for these outcomes. These findings suggest anthropometric indicators as an interesting screening tool of clustered CMRF at early ages.

Utility of body mass index, waist circumference and waist-to-height ratio as screening tools for hyperglycemia in young people

ABSTRACT Objectives To evaluate the ability of BMI, WC and WHtR to discriminate hyperglycemia in young people, and to determine whether there is an increase in the accuracy with the addition of WC and/or WHtR to BMI. Subjects and methods A cross-sectional study was conducted on 1,139 schoolchildren aged 6 to 17 years from Northeastern Brazil. Body weight, height, WC and fasting glucose levels were measured, and the BMI and WHtR were calculated. The presence of hyperglycemia was defined as a fasting glucose level ≥ 100 mg/dL. Results The prevalence of hyperglycemia was 6.6%. Strong correlations were observed between the anthropometric indicators studied (BMI vs. WC = 0.87; BMI vs. WHtR = 0.87; WC vs. WHtR = 0.90). Hyperglycemia was more likely to be present in young people with excess weight (PR = 1.70), high WC (PR = 1.85), and high WHtR (PR = 1.91). The accuracies to discriminate hyperglycemia were significant, but low, for the individual (BMI = 0.56; WC = 0.53; WHtR = 0.55) and combined indicators (BMI + WC = 0.55; BMI + WHtR = 0.55). Conclusion Our findings do not support the use of BMI, WC or WHtR as screening tools for hyperglycemia in children and adolescents.