Dietary patterns and cardiovascular risk factors in adolescents

Introdução: os hábitos alimentares são formados, boa parte, no período da adolescência, sendo esta fase considerada um risco para o desenvolvimento de fatores de risco cardiovascular, como o excesso de peso e dislipidemia, os quais podem ter implicações imediatas e a longo prazo na saúde dos adolescentes. Objetivo: identificar os padrões alimentares e avaliar, prospectivamente, seu impacto no estado nutricional e no perfil lipídico de adolescentes. Métodos: esta tese foi composta de três artigos, um de corte transversal e dois de corte longitudinal, todos utilizando dados do Estudo Longitudinal sobre Comportamento Sedentário, Atividade Física, Hábitos Alimentares e Saúde de Adolescentes - Estudo LONCAAFS. Foram analisados 1431 adolescentes em 2014, 1178 adolescentes em 2015, 959 em 2016 e, por fim, 773 adolescentes em 2017, pertencentes a rede pública de ensino de João Pessoa, cidade do Nordeste brasileiro. Para a obtenção de dados de consumo alimentar, aplicou-se o recordatório de 24 horas, duplicado em 30% da amostra, em todos os anos. Os padrões alimentares foram identificados por meio de análise fatorial exploratória por componentes principais. O estado nutricional foi obtido e classificado de acordo com a recomendação da Organização Mundial de Saúde, por meio do índice de massa corporal (IMC) para o sexo e a idade. As concentrações de colesterol total (CT), lipoproteína de alta densidade (HDL) e triglicerídeos (TG) foram determinadas pelo método de turbidimetria e a lipoproteína de baixa densidade (LDL) foi determinada pela equação de Friedwald, sendo posteriormente classificados de acordo com a Diretriz Brasileira de Dislipidemia e Aterosclerose. Foram coletados dados socioeconômicos, sobre comportamento sedentário e atividade física. As associações entre os padrões alimentares e estado nutricional, perfil lipídico e variáveis de interesse foram realizadas por equações de estimativas generalizadas (GEE). Resultados: a análise longitudinal do presente estudo identificou três padrões alimentares distintos que se mantiveram ao longo do estudo: o padrão \"Tradicional\", composto principalmente por alimentos típicos da dieta tradicional brasileira, como o arroz e o feijão, mas também por alimentos típicos da cultura nordestina, como mandioca e cuscuz; um padrão \"Lanches\" caracterizado pelo consumo de pães, manteigas e margarinas, queijos, carnes processadas e café; e um padrão \"Ocidental\" caracterizado pelo consumo de alimentos com alta densidade energética e pobres em nutrientes. Adolescentes do sexo masculino apresentaram uma maior redução no escore-z do IMC, ao longo do estudo. A prevalência de dislipidemia foi elevada, independentemente da idade. O sexo feminino foi positivamente associado a níveis elevados de CT e LDL e o sexo masculino com níveis baixos de HDL. O padrão alimentar \"Ocidental\" foi positivamente associado ao escore-z do IMC, independente do sexo e do nível de atividade física, ao longo do tempo e adolescentes com maior aderência aos padrões alimentares \"lanches\" e \"ocidental\" apresentaram maior chance de alterações nos níveis séricos de colesterol total. Conclusão: Estes resultados indicam que um padrão alimentar que é rico em densidade de energia, alto teor de gordura e açucares, além de baixo teor de fibra contribui para um estado nutricional e perfil lipídico que sinaliza risco para o desenvolvimento de doenças cardiovasculares nestes adolescentes. Além disso, os resultados desta tese sugerem a necessidade de ações de saúde pública multidisciplinar que estimulem mudanças nos hábitos alimentares e estilo de vida, prevenindo, desta forma, o desenvolvimento de doenças cardiovasculares na vida adulta.Introdução: eating habits are mostly formed during adolescence, and this phase is considered a risk for the development of cardiovascular risk factors, such as overweight and dyslipidemia, which may have immediate and long-term implications for the health of adolescents. Objetivo: identify dietary patterns and prospectively assess their impact on nutritional status and lipid profile in adolescents. Métodos: this thesis was composed of three articles, one cross-sectional and two longitudinal, all using data from the Longitudinal Study on Sedentary Behavior, Physical Activity, Eating Habits and Adolescent Health - LONCAAFS Study. We analyzed 1431 adolescents in 2014, 1178 adolescents in 2015, 959 in 2016 and, finally, 773 adolescents in 2017, belonging to the public school system of João Pessoa, city of Northeast Brazil. To obtain food consumption data, the 24-hour recall was applied, duplicated in 30% of the sample, every year. Dietary patterns were identified by exploratory factor analysis by principal components. Nutritional status was obtained and classified according to the World Health Organization recommendation through BMI for gender and age. The concentrations of total cholesterol (TC), high density lipoprotein (HDL) and triglycerides (TG) were determined by turbidimetry method and low density lipoprotein (LDL) was determined by Friedwald\'s equation, and were later classified according to the Brazilian Dyslipidemia and Atherosclerosis Guideline. Socioeconomic data, on sedentary behavior and physical activity were collected. Associations between dietary patterns and nutritional status, lipid profile and variables of interest were made by generalized estimation equations (GEE). Resultados: the longitudinal analysis of the present study identified three distinct dietary patterns that were maintained throughout the study: the \"Traditional\" pattern, consisting mainly of typical foods of the traditional Brazilian diet, such as rice and beans, but also typical foods of the Northeastern culture, as cassava and couscous; a \"Sandwuiches\" pattern characterized for the consumption of breads, butters and margarines, cheeses, processed meats and coffees; and a \"Western\" pattern characterized for the consumption of high energy density and nutrient poor foods. Male adolescents showed a greater reduction in BMI z-score throughout the study. The prevalence of dyslipidemia was high, regardless of age. Females were positively associated with elevated TC and LDL levels and males with low HDL levels. The \"Western\" dietary pattern was positively associated with BMI z-score, regardless of gender and level of physical activity over time and adolescents with greater adherence to \"Sandwuiches\" and \"Western\" dietary patterns were more likely to have changes in serum total cholesterol levels. Conclusão: these results indicate that a dietary pattern that is rich in energy density, high fat and sugars, and low fiber contributes to a nutritional status and lipid profile that signals risk for the development of cardiovascular disease in these adolescents. In addition, the results of this thesis suggest the need for multidisciplinary public health actions that stimulate changes in eating habits and lifestyle, thus preventing the development of cardiovascular disease in adulthood

Índice de conicidade como preditor de alterações no perfil lipídico em adolescentes de uma cidade do Nordeste do Brasil

Resumo: O objetivo foi avaliar o indice de conicidade (Índice C) como preditor de alterações no perfil lipídico em adolescentes e estabelecer seus pontos de corte. Estudo transversal com 774 adolescentes de ambos os sexos (55% do sexo feminino), de 10 a 14 anos de idade. O Índice C foi calculado de acordo com a fórmula proposta por Valdez, considerando as medidas de massa corporal, estatura e circunferência da cintura (CC). As alterações no perfil lipídico dos adolescentes foram definidas segundo uma das seguintes condições: elevados níveis de colesterol total, lipoproteína de alta densidade (LDL), triglicerídeos e níveis baixos de lipoproteína de baixa densidade (HDL). O poder preditivo do Índice C para alterações no perfil lipídico, assim como seus pontos de corte, foi determinado por meio das curvas ROC (Receiver Operating Characteristic). O Índice C foi um bom preditor para alterações lipídicas em adolescentes, com destaque para os níveis de triglicerídeos em adolescentes do sexo masculino de 10 a 11 anos (ROC = 0,67; IC95%: 0,50-0,85) e de 12 a 14 anos (ROC = 0,69; IC95%: 0,59-0,80), assim como em adolescentes do sexo feminino de 10 a 11 anos (ROC = 0,65; IC95%: 0,50-0,79); e LDL em adolescentes do sexo feminino de 10 a 11 anos (ROC = 0,70; IC95%: 0,59-0,80) e adolescentes do sexo masculino (ROC = 0,65; IC95%: 0,55-0,75) e adolescentes do sexo feminino (ROC = 0,62; IC95%: 0,50-0,75) de 12 a 14 anos. Os pontos de corte do Índice C variaram de 1,12 a 1,16 entre meninos e meninas. O Índice C pode ser utilizado para predizer alterações lipídicas, bem como seus pontos de corte podem ser utilizados para triagem de adolescentes em risco de alterações no perfil lipídico

Association between sedentary behavior, diet and nutritional status in adolescents: baseline results from the LONCAAFS Study

The aim of the present study was to analyze the relationship between time spent engaged in sedentary behaviors, type of diet, and overweight in adolescents. A cross-sectional study using data from the Longitudinal Study on Sedentary Behavior, Physical Activity, Eating Habits, and Health of Adolescents - LONCAAFS Study. A total of 1,438 adolescents (10 to 14 years old) from public schools in the city of João Pessoa, Brazil, participated in the study. To evaluate the combined effects of excessive time in sedentary behavior and consumption from two food groups: Convenience and Prudent on overweight, we performed multiple logistic regression analyses, adjusted for energy, level of physical activity, sex, and age. Excessive time in sedentary behavior increased the chance of adolescents being overweight by 37% (OR = 1.37; 95%CI: 1.04-1.80). This chance increased to 43% when the adolescents were simultaneously engaged in excessive sedentary behavior and had high consumption of the Convenience food group (OR = 1.43; 95%CI: 1.05-1.94) and increased to 39% on those who engaged in excessive sedentary behavior and had low consumption of foods from the Prudent (OR = 1.39; 95%CI: 1.04-1.84). Excessive sedentary behavior is associated with being overweight and the chance increases with the consumption of convenient foods

Effects of preoperative sarcopenia-related parameters on the musculoskeletal and metabolic outcomes after bariatric surgery: a one-year longitudinal study in females

Abstract Reduced muscle mass and/or strength are risk factors for metabolic and musculoskeletal impairment. The present study evaluated anthropometric, metabolic, and musculoskeletal outcomes in females with and without sarcopenic-obesity parameters who underwent bariatric surgery during a 1-year follow-up. A prospective, single-center cohort study was conducted in females with obesity undergoing preoperative evaluation for surgery. In the preoperative period, females were allocated into obesity with sarcopenic-obesity parameters (SOP group, n = 15) and without sarcopenic-obesity parameters (obesity group, n = 21). Sarcopenic obesity parameters were defined as lower appendicular skeletal mass adjusted for weight (ASM/wt) and/or low handgrip strength (HGS). Anthropometric, metabolic, and musculoskeletal parameters were assessed before surgery and at 3 months, 6 months, and a 1-year after bariatric surgery. Weight loss was similar between groups (p > 0.05). Weight, body mass index, fat mass, body fat percentage, skeletal muscle mass, fat-free mass, fat-free mass index, HGS were reduced in both groups during the 1-year follow-up (p < 0.05). However, when muscle mass and strength were analyzed relative to body size, an improvement after bariatric surgery was found in both groups (p < 0.05). Total cholesterol, LDL-c, triglycerides, fasting glucose, glycated hemoglobin, insulin, and insulin resistance were reduced in both groups during the 1-year follow-up (p < 0.05). In addition, HDL-c serum concentration increased in females with and without sarcopenic-obesity parameters over the 1-year follow-up (p < 0.05). Both groups had decreased bone mineral density (BMD) at all sites (lumbar spine, femoral neck, and total femur) over the 1-year follow-up (p < 0.05). The highest quartile of ASM/wt was positively associated with BMD variables in a longitudinal analysis, suggesting that preserved ASM/wt in pre-surgery may be beneficial for BMD after 1 year of bariatric surgery. The results showed that bariatric surgery promotes similar musculoskeletal and metabolic changes in females with preserved muscle mass and strength or in females with sarcopenia-related parameters

Effects of Preoperative Sarcopenia-Related Parameters on Cardiac Autonomic Function in Women with Obesity Following Bariatric Surgery: A One-Year Prospective Study

Objectives: Investigate changes in blood pressure (BP) and heart rate variability (HRV) in women with and without sarcopenia-related parameters who underwent bariatric surgery (BS) during a one-year follow-up. Subjects and Methods: Women were separated into obesity (OB, n = 20) and women with obesity displaying sarcopenia-related parameters (SOP, n = 14) and evaluated before BS and 3, 6, and 12 months after BS. SOP was defined as low handgrip strength (HS) and/or low appendicular skeletal mass adjusted for weight (ASM/wt × 100, %) in the lowest quartile of the sample. ASM/wt × 100, % and HS were significantly lower in SOP than OB over a one-year follow-up of BS (p p p p p = 0.00) and positively associated with the HF band (r = 0.22, p = 0.01). Conversely, HS had no association with LF (r = −0.14, p = 0.09) and HF (r = 0.11, p = 0.19). ASM/wt × 100, % and HS were negatively associated with the LF/HF ratio (p < 0.05). Conclusions: Women who underwent BS had an improved HRV over a one-year follow-up. However, the improvement in HRV variables was less pronounced in women with low muscle mass and/or HS during the follow-up period

Tracking of Dietary Patterns in the Secondary Prevention of Cardiovascular Disease after a Nutritional Intervention Program&mdash;A Randomized Clinical Trial

Individuals with a history of previous cardiovascular events have an increased risk of mortality and morbidity, so adherence to a healthy dietary pattern is essential. We aimed to evaluate and compare dietary patterns between the control and the experimental group from the BALANCE Program. A total of 2360 individuals aged 45 years or older with previous cardiovascular disease were included. The individuals were randomized into two groups: intervention (dietary prescription with nutritional recommendations, nutritional education program based on playful strategies, suggestions of typical and accessible Brazilian foods and intensive monitoring) and control (conventional nutritional counseling). The dietary patterns were identified using factor analysis with the principal component extraction method, and the t-Student tests and ANOVA test were performed to evaluate the associated factors. Four dietary patterns were identified for both groups: &ldquo;Traditional&rdquo;, &ldquo;Snack&rdquo;, &ldquo;Western&rdquo;, &ldquo;Cardioprotective&rdquo;. There was an increase in the variances of the &ldquo;Cardioprotective&rdquo; pattern in both groups. Regarding the &ldquo;Western&rdquo; pattern, there was a significant reduction in the variances of the experimental group (10.63% vs. 8.14%). Both groups had improvements in eating habits, especially in the first year of follow-up. The greater increase in adherence to the traditional and cardioprotective pattern in the experimental group justifies the initiative of the BALANCE program

Dietary Pattern Influences Gestational Weight Gain: Results from the ProcriAr Cohort Study—São Paulo, Brazil

The maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) influence maternal and infant outcomes. This study identified patterns of habitual dietary intake in 385 pregnant women in São Paulo and explored their associations with excessive weight gain (EGWG). Weight at the first visit (p = 0.04) and age > 35 years (p = 0.03), while subjects overweight at baseline had a higher probability of EGWG (p = 0.02), suggesting that the identification of dietary and weight inadequacies should be observed from the beginning of pregnancy, accompanied by nutritional intervention and weight monitoring throughout the gestational period to reduce risks to the mother and child’s health