A comparison between overweight cutoff points for detection of high blood pressure in adolescents

OBJETIVOS: Avaliar a acurácia de três pontos de corte na determinação da pressão arterial elevada em adolescentes, dada a forte relação entre o excesso de peso e valores elevados de pressão arterial. MÉTODOS: Participaram do estudo 1.021 adolescentes de ambos os sexos, selecionados de maneira aleatória nas escolas públicas e particulares de Londrina (PR). O peso corporal foi aferido por meio de balança digital, e a estatura, por um estadiômetro portátil com extensão máxima de 2 metros. A pressão arterial foi avaliada através de um aparelho automático. A capacidade do índice de massa corporal de detectar a pressão arterial elevada foi averiguada por meio da curva ROC e seus parâmetros (sensibilidade, especificidade e área sob a curva). RESULTADOS: Os pontos de corte da proposta nacional apresentaram maior acurácia (masculino: 0,636±0,038; feminino: 0,585±0,043) quando comparados aos pontos de corte das propostas internacional (masculino: 0,594±0,040; feminino: 0,570±0,044) e norte-americana (masculino: 0,612±0,039; feminino: 0,578±0,044). CONCLUSÃO: A proposta nacional foi a que apresentou melhor acurácia na indicação de valores elevados de pressão arterial.OBJECTIVES: To evaluate the accuracy of three different cutoff points for the detection of high blood pressure in adolescents, given the strong relationship between overweight and high blood pressure levels. METHODS: A total of 1,021 adolescents of both sexes were enrolled in the study, selected at random from public and private schools in Londrina, Brazil. Their body weight was measured using a digital balance, and their height with a portable stadiometer with a maximum extension of 2 meters. Arterial blood pressure was measured using an automatic apparatus. The capacity of body mass index to detect high blood pressure was gauged using ROC curves and their parameters (sensitivity, specificity, and area under the curve). RESULTS: The cutoff points proposed in a Brazilian standard exhibited greater accuracy (males: 0.636±0.038; females: 0.585±0.043) than the cutoff points proposed in an international (males: 0.594±0.040; females: 0.570±0.044) and a North-American standard (males: 0.612±0.039; females: 0.578±0.044). CONCLUSIONS: The Brazilian proposal offered greatest accuracy for indicating high blood pressure levels

Abdominal obesity: prevalence, sociodemographic- and lifestyle-associated factors in adolescents

Objectives: The aim of this study was to determine the prevalence of abdominal obesity and its associated factors among adolescents, independent of confounders. Methods: A sample of 14–17-year-old individuals (n=1.231), who were students from Londrina/PR-Brazil public schools, was studied. A questionnaire about physical activity, sedentary behaviour and socioeconomic conditions was applied. Anthropometry was composed of body weight (kg), height (m), body mass index (BMI=kg/m²) and waist circumference (cm). The association of abdominal obesity and independent variables was assessed using the chi-square test and the magnitude of associations was verified using Binary Logistic Regression in an unadjusted model and adjusted for confounders (gender, age, socioeconomic status, physical activity and sedentary behaviour). The confidence interval and statistical significance were set at 95% and 5%, respectively, using SPSS v15.0. Results: The abdominal obesity prevalence was 17.5% (CI = 15.4%–19.6%), and was higher in boys than in girls. Adolescents with abdominal obesity had higher values of body weight, height, body mass index and sedentary behaviour compared to eutrophic individuals. Being male increased the risk of abdominal obesity by 36% in adolescents. This risk was two times higher in those with high levels of sedentary behaviour. Conclusion: Abdominal obesity was significantly associated with gender and high levels of sedentary behaviour, regardless of confounding factors. Lifestyle habits are important modifiable risk factors that can effectively contribute to the reduction of obesity from an early age

Influência da prática habitual de atividade física e da gordura de tronco sobre a glicemia de jejum em mulheres na menopausa

Study Model: Original Study. Objective: To examine the relationship between the practice of physical activity (PA) with total body fat, trunk fat and fasting glucose in postmenopausal women.Methods: Sixty postmenopausal women, mean age of 61.0 years, from the city of Presidente Prudente SP, were assessed. Body mass (BM) and height were measured to calculate Body Mass Index (BMI). Total body fat (BF) and trunk fat mass (TFM) were estimated using DEXA. Fasting glucose was measured and classified according to the reference values of the American Diabetes Association (1997). The usual practice of PA was estimated using triaxial accelerometer, model GT3X (Actigraph,Pensacola,FL,USA) and classified according to Sasaki (2010). Comparisons were made between women with normal blood fasting glucose levels (NBG) and high blood fasting glucose(HBG) levels by the Kruskal-Wallis test. Spearman correlation coefficient was used and then the binary logistic regression to test the association between PA level and body composition with fasting glucose.Results: Women with HBG showed higher values of BM (p=0,040), BMI (=0,002) and BF (=0,046), and lower values of light (p=0,019), moderate (p=0,041) and moderate+vigorous (p=0,041) PA. The moderate and moderate+vigorous PA showed, respectively, a significant negative correlation with BF (p=0,003 and p+0,003) and TFM (p=0,021 and p=0,021). The FM presented negative correlation with moderate + vigorous (p=0,049). Women with lower TFM and classified as active showed protective factor (OR=0.133 [CI 0.023 to 0.7841] for impaired fasting glucose. Conclusion: The practice of moderate+vigorous intensity PA, held at least 150 minutes per week, is associated with lower trunk fat, and presents protective factor for impaired fasting glucose and risk of diabetes mellitus ins postmenopausal women.Modelo de estudo: Estudo OriginalObjetivo: Examinar a relação entre a prática habitual da atividade física (AF) com a gordura corporal total, gordura do tronco e glicemia de jejum em mulheres na menopausa. Métodos: Foram avaliadas 60 mulheres na menopausa com média de idade de 61,0 anos, da cidade de Presidente Prudente - SP. A massa corporal (MC) e a estatura foram mensuradas para o cálculo de Índice de Massa Corporal (IMC). A gordura corporal total (GC) e a gordura de tronco (TrG) foram estimadas por meio do DEXA. A glicemia sanguinea foi dosada e classificada de acordo com os valores de referência da American Diabetes Association (1997). A prática habitual de AF foi estimada utilizando acelerômetro triaxial (Actigraph) e classificada de acordo com Sasaki (2010). Foi realizada a comparação entre mulheres com valores de glicemia normal e glicemia alterada por meio do teste Kruskal-Wallis. Foi utlizado o coeficiente de correlação de Spearman e em seguida a regressão logística binária para verificar a associação entre nível de AF e compoisção corporal com glicemia de jejum. Resultados: Mulheres que apresentavam hiperglicemia obtiveram maiores valores de MC (p=0,040), IMC (p=0,002) e GC (p=0,046), além de valores menores de AF (p=0,019), moderada (p=0,041) e de moderada+vigorosa (p=0,041). A variável AF moderada e moderada+vigorosa, apresentaram, respectivamente, correlação negativa significante percentual de GC (p=0,003) e com TrG(p=0,021 e p=0,021), quando analisado os valores absolutos de GC foi observado correlação negativa com a soma moderda+vigorosa (p=0,049). As mulheres que obtiveram menore valores de TrG e que foram classificadas como suficientemente ativas apresentaram fator de proteção (RC=0,133 [IC=0,023-0,784]) para glicemia de jejum alterada.Conclusão: A prática de AF de intensidade moderada-vigorosa, realizada pelo menos 150 minutos semanais, associado à baixa gordura de tronco, é um fator protetor para a hiperglicemia em mulheres na menopausa

Association between body composition, balance and mobility of elderly aged 80 years or older

Modelo do estudo: Estudo transversal. Objetivo: O objetivo do presente estudo foi analisar a associação entre composição corporal, mobilidade e equilíbrio de idosos com idade igual ou superior a 80 anos. Métodos: A amostra foi composta por 123 idosos com idade entre 80 e 95 anos (83,2±2,7 anos), sendo 78 mulheres (83,2±2,9 anos) e 45 homens (83,2±2,4 anos) residentes na área urbana de Presidente Prudente - SP. A avaliação da composição corporal foi feita pelo método de Absorciometria por Dupla Emissão de Raios-X (DEXA). A mobilidade e o equilíbrio foram avaliados por meio dos testes de velocidade para caminhar, equilíbrio estático e força de membros inferiores. Para tratamento estatístico realizou-se o teste qui-quadrado, o software utilizado foi SPSS (13.0) e o nível de significância estabelecido foi de 5%. Resultados: No grupo masculino, os idosos com maior desempenho nos testes funcionais apresentaram maiores valores percentuais de massa muscular (MM) (35,6%) comparados aos de menor desempenho (15,6%), p=0,026. No grupo feminino, as idosas com maior desempenho nos testes apresentaram maiores valores de densidade mineral óssea (DMO) (30,8%) comparadas as de menor desempenho (20,5%) p=0,041. Conclusão: A MM para idosos do sexo masculino e a DMO para o sexo feminino foram os componentes da composição corporal que se associaram com a capacidade funcional.Study design: cross-sectional study. Objective: The objective of this study was to analyze the association between body composition, mobility and balance of elderly aged 80 years or older. Methods: The sample consisted of 123 elderly aged 80 and 95 years (83.2 ± 2.7 years) with 78 women (83.2 ± 2.9 years) and 45 men (83.2 ± 2, 4 years) residing in the city of Presidente Prudente - SP. Assessment of body composition was made by absorpiometria dual energy X-ray (DXA). The mobility and balance were assessed by means of tests of speed walking, and static balance lower limb strength. For statistical analysis we carried out the chi-square test, the software used was SPSS (13.0) and the significance level was set at 5%. Results: In males, those with higher performance in the functional tests showed higher percentages of muscle mass (MM) (35.6%) compared to lower performance (15.6%), p = 0.026. In the female group,the elderly with higher performance on tests showed higher bone mineral density (BMD) values (30.8%)compared with those with lower performance (20.5%) p = 0.041. Conclusion: MM for elderly males and BMD for females were the components of body composition that is associated with functional capacity

Associação Entre Doenças Metabólicas e Parâmetros Hemodinâmicos de Filhos Obesos e Suas Mães

Modelo do estudo: Estudo originalObjetivo: Verificar possíveis associações entre o perfil hemodinâmico e metabólico de crianças e adolescentes obesos e suas mães. Metodologia: Realizou-se um estudo transversal com 69 crianças e adolescentes obesos, de ambos os sexos, com faixa etária compreendida entre seis e 15 (10,6 ± 3,04) anos. Por meio de avaliações específicas foram analisadas as variáveis de composição corporal (massa corporal magra, massa de gordura em quilos e percentual), hemodinâmicas (pressão arterial sistólica e diastólica) e bioquímicas (glicemia, colesterol total e suas frações) dos filhos. Entre as mães foi realizado uma avaliação de composição corporal por meio de antropometria e impedância bioelétrica, aferição de pressão arterial e aplicação de questionário auto referido de doenças. Para o tratamento estatístico foram realizados análise descritiva, teste t de Student independente e análise de associação entre alterações maternas com seus respectivos filhos por meio de teste de Mc Nemar, adotando-se pd” 0,05. Todo o tratamento estatístico foi realizado por meio do software SPSS, 17.0. Resultados: Ser filho de mães diabéticas ou hipertensas associa-se com a presença de alterações nas variáveis de glicemia, pressão arterial sistólica ou diastólica. Quando a mãe apresenta mais de uma variável de risco cardiovascular a sua prole também possui alguma alteração metabólica ou em variáveis dos parâmetros hemodinâmicos (PA). Conclusão: No presente estudo observaram-se associações entre variáveis metabólicas e parâmetros hemodinâmicos entre crianças e adolescentes obesos com suas respectivas mães.Study Model: Original StudyObjective: To analyze possible associations between hemodynamic and metabolic profile of obese children and adolescents and their mothers. Methods: The study had longitudinal design with 69 children and adolescents, aged between six and 15 (10,6 ± 3,04) years old. Specific assessments to body composition (fat free mass, fat mass and percentage fat), blood pressure (blood pressure systolic and diastolic) and biochemical analysis of blood plasma (glucose, total cholesterol and its fractions) of children were analyzed. Among the mothers was carried out an assessment of body composition by anthropometry and bioelectrical impedance, blood pressure and application of inquiry self-report diseases. To treatment statistic were applied descriptive analyze, independent Student‘s test and test for association between maternal disorders with their children by Mc Nemar test, adopting pd” 0,05. Statistical analyses were performed using SPSS software version 17.0 (Statistical Package for Social Science, SPSS Inc,Illinois, USA). Results: Diabetic or hypertensive mothers contribute to the presence or absence of disorders in glucose, blood pressure systolic or diastolic in their children, as well as, when mothers has more than one cardiovascular risk variable their children had some disorder metabolic or hemodynamic too. Conclusion: The present study notes association between metabolic and hemodynamic variables of children and adolescents with their mothers

Physical Activity Is Associated With Improved Eating Habits During the COVID-19 Pandemic

The aim of this study was to analyze the association between physical activity andeating habits during the COVID-19 pandemic among Brazilian adults. A sample of1,929 participants answered an online survey, however 1,874 were included in theanalysis. The impact of the COVID-19 pandemic on eating habits was assessedinquiring about participants’ intake of fruits, vegetables, fried foods, and sweetsduring the pandemic. Physical activity was assessed by asking participants abouttheir weekly frequency, intensity and number of minutes/hours engaging in structuredphysical activities per week. Participants were then stratified into categories based onmoderate-to-vigorous intensity (0–30; 31–90; 91–150; 151–300; and >300 min/week)and into active (≥150 min) or inactive (<150 min). Increased sweets consumption wasthe most commonly reported change to eating habits (42.5%), followed by an increase inthe consumption of vegetables (26.6%), fruits (25.9%), and fried foods (17.9%). Physicalactivity practice was related to lower consumption of fried foods (OR = 0.60; p < 0.001)and sweets (OR = 0.53; p < 0.001). A cluster analysis revealed subjects with higherthe level of physical activity was more likely to follow a healthy diet (p < 0.001). Thus,physical activity was positively associated with healthier eating habits. Health authoritiesmust recommend regular physical as a strategy to improve overall health during theCOVID-19 pandemic. Future studies should address the physical activity interventionsto improve health status during a pandemic

Increased Screen Time Is Associated With Alcohol Desire and Sweetened Foods Consumption During the COVID-19 Pandemic

Background: Elevated screen time has been associated with addictive behaviors, such as alcohol and sugar intake and smoking. Considering the substantial increase in screen time caused by social isolation policies, this study aimed to analyze the association of increased screen time in different devices during the COVID-19 pandemic with consumption and increased desire of alcohol, smoking, and sweetened foods in adults. Methods: A sample of 1,897 adults with a mean age of 37.9 (13.3) years was assessed by an online survey, being composed by 58% of women. Participants were asked whether screen time in television, cell phone, and computer increased during the pandemic, as well as how much time is spent in each device. Closed questions assessed the frequency of alcohol and sweetened food consumption, smoking, and an increased desire to drink and smoke during the pandemic. Educational level, age, sex, feeling of stress, anxiety, depression, and use of a screen device for physical activity were covariates. Binary logistic regression models considered adjustment for covariates and for mutual habits. Results: Increased television time was associated with increased desire to drink (OR = 1.46, 95% CI: 1.12; 1.89) and increased sweetened food consumption (OR = 1.53, 95% CI: 1.18; 1.99), while an increase in computer use was negatively associated with consumption of alcohol (OR = 0.68, 95% CI: 0.53; 0.86) and sweetened foods (OR = 0.78, 95% CI: 0.62; 0.98). Increased cell phone time was associated with increased sweetened food consumption during the pandemic (OR = 1.78, 95% CI: 1.18; 2.67). Participants with increased time in the three devices were less likely to consume sweetened foods for ≥5 days per week (OR = 0.63, 95% CI: 0.39; 0.99) but were twice as likely to have sweetened food consumption increased during pandemic (OR = 2.04, 95% CI: 1.07; 3.88). Conclusion: Increased screen time was differently associated with consumption and desire for alcohol and sweets according to screen devices. Increased time in television and cell phones need to be considered for further investigations of behavioral impairments caused by the pandemic

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe