Is Neck Circumference a Marker for Cardiovascular Risk in Obese Adolescents?

Background: Weight excess has become a public health problem worldwide, reaching about 200 million children, of whom 40 to 50 million are obese. Obesity in childhood is associated with increased blood pressure (BP), high triglycerides, low HDL-cholesterol and abnormal glucose metabolism. Visceral fat is a stronger predictor of metabolic dysfunction and cardiovascular risk than total body adiposity. Assessment of neck circumference (NC) is an easy method, which can serve as screening to identify individuals with weight excess. Our study aim was to examine associations between NC with BP values, lipid profile, blood glucose and fasting insulin in obese adolescents and verify the reproducibility of measurements of NC. Methods: 82 adolescents aged 10 to 17 years were included in the study, being 43 (22 boys and 21 girls) with obesity and 39 with normal weight (20 boys and 19 girls). Results: Significant associations were observed between NC and BMI, BP, HDL cholesterol, insulin and HOMA-IR. Disagreement between both observers for NC was observed in 5.2% of the sample, only concerning obese individuals. Conclusion: Our findings strengthen the knowledge about the potential value of NC as a tool for identifying patients at risk for hypertension, insulin resistance, and obesity. However as with the waist circumference it may be flawed in obese individuals

Riesgos cardiovasculares en adolescentes con diferentes grados de obesidad

BACKGROUND: There have been few studies on cardiovascular risk factors in adolescents with different degrees of obesity. OBJECTIVE: To evaluate metabolic effects associated with different degrees of obesity in adolescents and their impact on cardiovascular risks. METHODS: Cross-sectional study of 80 obese adolescents, divided in two groups: 22.5, classified as obese with lower or higher degree of obesity, respectively. Physical examination was carried out, as well as biochemical and body composition assessment. The statistical analysis was performed with t-Student and Chi-square tests, aiming at comparing both groups. A multiple logistic model was used to verify the associations between the biochemical variables and the degree of obesity. Risk scores were developed for cardiovascular disease, according to the number of alterations found in the following variables: fasting glycemia, triglycerides, HDL and blood pressure. Association between these scores and degree of obesity were verified. RESULTS: The two groups differed regarding weight, waist circumference, fasting glycemia and insulin, HOMA-IR, triglycerides, HDL, blood pressure (BP) and body composition measurements (p2,5, denominados obesos con menor y mayor grado de obesidad, respectivamente. Se llevaron a cabo examen físico y evaluación bioquímica y de composición corporal. Para el análisis estadística, se aplicaron las pruebas t-Student y chi-cuadrado, con la finalidad de comparar los dos grupos. Modelo logístico múltiple se utilizó para verificar las asociaciones entre variables bioquímicas y grado de obesidad. Se desarrollaron scores de riesgo para enfermedad cardiovascular, de acuerdo con el número de alteraciones encontradas en las siguientes variables: glucemia de ayuno, triglicéridos, HDL y PA. Se verificaron asociaciones entre estos scores y el grado de obesidad. RESULTADOS: Los dos grupos difirieron en valores de peso, circunferencia de la cintura, glucemia e insulina de ayuno, HOMA-IR, triglicéridos, HDL, PA y mediciones de composición corporal (p2,5, denominados obesos com menor e maior grau de obesidade, respectivamente. Foram realizados exame físico e avaliação bioquímica e de composição corporal. Para a análise estatística, foram aplicados os testes t-Student e qui-quadrado, com a finalidade de comparar os dois grupos. Modelo logístico múltiplo foi utilizado para verificar as associações entre variáveis bioquímicas e grau de obesidade. Foram desenvolvidos escores de risco para doença cardiovascular, de acordo com o número de alterações encontradas nas seguintes variáveis: glicemia de jejum, triglicérides, HDL e PA. Foram verificadas associações entre esses escores e o grau de obesidade. RESULTADOS: Os dois grupos diferiram em valores de peso, circunferência da cintura, glicemia e insulina de jejum, HOMA-IR, triglicérides, HDL, PA e medidas de composição corporal (p<0,05). Os adolescentes com maior grau de obesidade apresentaram maiores frequências de alterações para glicemia, HOMA-IR, triglicérides, HDL e pressão arterial (p<0,05). O modelo logístico mostrou associações entre o grau de obesidade e as variáveis: HDL (OR=5,43), PA (OR=4,29), TG (OR=3,12). O escore de risco demonstrou que 57,7% dos adolescentes com maiores graus de obesidade tinham duas ou mais alterações metabólicas para 16,7% do outro grupo (p<0,001). CONCLUSÃO: O grau da obesidade influenciou no aparecimento de alterações que compõem a síndrome metabólica, aumentando o risco cardiovascular.Universidade Federal de São Paulo (UNIFESP)Universidade Federal do AmazonasUNIFESPSciEL

Intelligent quotient of obese children and adolescents by the Weschler scale

The intellectual characteristics of 65 obese children and adolescents (weight for height &sup3;140% ), aged 8 to 13 years and 11 months, were compared to those of 35 eutrophic children and adolescents (weight for height between 90 and 110%; and stature for age > 95%) of the same age group, utilizing the Wechsler Intelligence Scale for Children - WISC. Children and adolescents of the two groups were paired according to age groups, schooling level and socioeconomic condition. The obese group was composed of new patients assisted at the Department of Pediatrics of the Federal University of S. Paulo (Escola Paulista de Medicina), Brazil. The control group was made up of children from public primary schools, from the same geographical area as those studied. The eutrophic group presented significantly better performance in the intelligence test (Intelligence Quotient - IQ) than the obese group (average IQ - 91 x 85; p < 0.05). Eutrophic children and adolescents revealed a wider range of interests, better capacity for social adaptability as well as greater speed and dexterity. Although weak, there was a positive correlation between income level, weight/stature relation (W/S) and IQ. There was no correlation between IQ and level of schooling. The eutrophic boys from higher income levels showed better perceptual and spacial organizing ability and a wider range of interests than those from the lower income groups. In spite of the fact that all the average IQ results presented consistently favored the eutrophic in relation to the obese, it is not possible to confirm one group's superiority over the other, due to the wide range of intervenient factors involved in the intelligence process.Foram estudadas as características intelectuais de 65 crianças obesas, de 8 a 13 anos e 11 meses, comparativamente às de 35 crianças eutróficas, através da Escala de Inteligência Wechsler para Crianças. Os dois grupos foram pareados de acordo com a faixa etária, série escolar e nível socioeconômico. O grupo de obesos foi composto por pacientes atendidos pelo Departamento de Pediatria da Universidade Federal São Paulo, e o grupo-controle, por crianças pertencentes a escolas públicas. O grupo de eutróficos apresentou significantemente melhor desempenho no teste de inteligência do que o grupo de obesos (Quociente de inteligência -QI médio - 91 x 85; p < 0,05). Crianças eutróficas revelaram maior amplitude de interesses e capacidade de adaptação social e, melhor velocidade e destreza. Houve correlação positiva entre o nível de renda, a relação peso/estatura e o QI. Apesar de todos os resultados médios de QI apresentarem dados consistentemente favoráveis aos eutróficos, não se pode afirmar total superioridade desse grupo em virtude da ampla gama de fatores emocionais intervenientes no processo de inteligência, não controlados pelo estudo.Universidade Federal de São Paulo (UNIFESP) Departamento de PediatriaUNIFESP, Depto. de PediatriaSciEL

Eating patterns of eutrophic and overweight adolescents in the city of São Paulo, Brazil

OBJECTIVE: This study identified the dietary patterns of normal weight and overweight adolescents. METHODS: This was a cross-sectional study of 239 adolescents from a public school in São Paulo, Brazil; of both sexes, aged 14 to 19 years. Anthropometric data and 4-day dietary records were collected. Nutritional status was assessed by body mass index, according to the criteria established by Must et al. Factor analysis was used to identify dietary patterns. RESULTS: This assessment resulted in the identification of four dietary patterns: Traditional, Urban, Healthy, and Junk Food. Normal weight was positively associated with the Traditional and Urban patterns, and overweight was positively associated with the Healthy and Junk Food patterns. Lastly, obesity was negatively associated with the Urban, Healthy and Junk Food patterns. CONCLUSION: The Healthy pattern was found among overweight adolescents who were concerned with weight control and trying to change eating habits. Among the obese, the occurrence of underreporting probably influenced the outcome of the associations.OBJETIVO: Identificar os padrões alimentares de adolescentes eutróficos e com excesso de peso. MÉTODOS: Estudo transversal envolvendo 239 adolescentes de ambos os sexos, na faixa etária de 14 a 19 anos, alunos de uma escola pública da cidade de São Paulo, Brasil. Foram coletados dados antropométricos e registro alimentar de 4 dias. O estado nutricional foi avaliado pelo índice de massa corporal de acordo com os critérios de Must et al., e foi aplicada análise fatorial para a identificação dos padrões alimentares. RESULTADOS: Foram identificados quatro padrões alimentares: tradicional, urbano, saudável e junk food. O estado nutricional de eutrofia teve associação positiva com os padrões tradicional e urbano, o sobrepeso com os padrões saudável e junk food, e a obesidade associou-se negativamente com os padrões urbano, saudável e junk food. CONCLUSÃO: O padrão saudável foi encontrado entre os adolescentes com sobrepeso, evidenciando preocupação com o controle do peso e tentativa de mudança do hábito alimentar. Entre os obesos, a ocorrência do sub-relato provavelmente tenha influenciado o resultado das associações.Universidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Departamento de PediatriaCentro Assistencial Cruz de MaltaUNIFESP, Depto. de PediatriaSciEL

Obesity and cardiovascular risk factors in adolescents attending public schools

BACKGROUND: Overweight in adolescence is a risk factor for the development of cardiovascular diseases in adulthood. OBJECTIVE: To study the association of cardiovascular risk factors (CRF) in overweight and normal-weight adolescents of both genders aged from 14 to 19 years, attending public schools. METHODS: Case-control study including 163 overweight and 151 normal-weight adolescents. Multiple logistic regression analysis was used to evaluate the associations between overweight and CRF (lipid profile, blood pressure and baseline insulin level). A set of CRF was defined for each individual, ranging from 0 (no risk factors) to 6 (all risk factors present). RESULTS: Overweight adolescents (body mass index > 85th percentile) presented a higher frequency of CRF in comparison to the normal- weight group. The CRF associated with overweight were HDLc 150 mg/dl (OR = 3.04; CI: 1.01-9.13), abnormal baseline insulin levels > 15 µU/ml (OR = 8.65; CI: 4.03-18.56) and abnormal blood pressure (OR = 3.69; CI: 1.76-7.72). Among overweight adolescents, 22.09% had more than three risk factors, whereas this percentage dropped to 6.12% among normal-weight adolescents. CONCLUSION: Overweight adolescents presented risk factors for cardiovascular diseases. The need for programs and policies targeted at the diagnosis and treatment of this condition is pointed out in order to reduce the risks of morbidity and mortality in adulthood.FUNDAMENTO: O excesso de peso na adolescência é fator de risco para o desenvolvimento de doenças cardiovasculares na vida adulta. OBJETIVO: Estudar a associação dos fatores de risco cardiovascular (FRC) em adolescentes com excesso de peso e eutróficos, de ambos os sexos, de 14 a 19 anos em escolas públicas. MÉTODOS: Estudo caso-controle com 163 adolescentes com excesso de peso e 151 eutróficos. Análise de regressão logística múltipla foi utilizada para avaliar as associações entre excesso de peso e os FRC (perfil lipídico, pressão arterial e insulina basal). Um conjunto de FRC foi definido para cada indivíduo, variando de 0 (nenhuma das condições) até 6 (presença de todas essas condições). RESULTADOS: Adolescentes com excesso de peso (índice de massa corporal > percentil 85) apresentaram maiores frequências dos FRC quando comparados ao grupo de eutróficos. Os FRC associados ao excesso de peso foram HDLc 150 mg/dl (OR = 3,04; IC: 1,01-9,13), insulina basal alterada > 15 µU/ml (OR = 8,65; IC: 4,03-18,56) e pressão arterial alterada (OR = 3,69; IC: 1,76-7,72). Entre os adolescentes com excesso de peso, 22,09% tinham mais do que três fatores de risco, enquanto que entre os eutróficos, este percentual foi de 6,12%. CONCLUSÃO: Adolescentes com excesso de peso apresentaram fatores de risco para doenças cardiovasculares. Ressalta-se a necessidade de programas e políticas de diagnóstico e de tratamento, a fim de reduzir os riscos de morbimortalidade na idade adulta.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Metabolic syndrome: comparison of diagnosis criteria

OBJECTIVE: To propose a new criterion for the diagnosis of metabolic syndrome (MS) in adolescents and to check its consistency with those proposed by Jolliffe and Janssen and by the International Diabetes Federation (IDF). METHOD: This is a cross-sectional study of 80 obese adolescents aged 14 to 19 years. Anthropometric (weight, height, and waist circumference) and laboratory (fasting triglycerides, HDLc, glucose, and insulin) parameters, as well as blood pressure were evaluated. The HOMA-IR index was used to characterize insulin resistance, and the presence of steatosis was assessed by hepatic ultrasound. Agreement analyses across the three criteria were made using the kappa coefficient. RESULTS: The prevalence of MS was 13.5, 15, and 25% for IDF and Jolliffe and Janssen's criteria and the proposed method, respectively. A nearly perfect agreement between Jolliffe and Janssen's and IDF (kappa = 0.94) criteria and a moderate agreement between the new criteria and the previous two (kappa = 0.46 and 0.41, respectively) were observed. CONCLUSIONS: The highest prevalence of MS was observed with the criterion proposed in this study, which included steatosis and insulin resistance as parameters, thus being able to diagnose a larger number of adolescents at metabolic risk.OBJETIVO: Propor um critério para o diagnóstico da síndrome metabólica em adolescentes e verificar a sua concordância com os propostos por Jolliffe e Janssen e pela International Diabetes Federation (IDF). MÉTODO: Estudo transversal com 80 adolescentes obesos de 14 a 19 anos. Foram realizadas avaliações antropométricas (peso, estatura e circunferência da cintura), laboratoriais [triglicérides, high density lipoprotein cholesterol (HDLc), glicemia e insulinemia de jejum] e da pressão arterial. O índice HOMA-IR foi utilizado para caracterizar a resistência insulínica, e a presença de esteatose foi verificada pela ultrassonografia hepática. Análise de concordância entre os três critérios foi feita pela estatística de kappa. RESULTADOS: Foram encontradas prevalências para síndrome metabólica de 13,75, 15 e 25%, utilizando os critérios da International Diabetes Federation, de Jolliffe e Janssen e da nova proposta, respectivamente. Verificou-se concordância quase perfeita entre Jolliffe e Janssen e a IDF (kappa = 0,94) e moderada entre a nova proposta e as duas anteriores (kappa = 0,46 e 0,41, respectivamente). CONCLUSÕES: A prevalência mais alta da síndrome metabólica foi verificada pelo critério proposto neste estudo, que incluiu a esteatose hepática e a resistência insulínica entre os seus componentes, diagnosticando, desta forma, maior número de adolescentes com risco metabólico.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Estadual de CampinasUniversidade Federal de São Paulo (UNIFESP) Departamento de Pediatria Setor de ObesidadeUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP Departamento de PediatriaUNIFESP, Depto. de Pediatria Setor de ObesidadeUNIFESP, EPMUNIFESP, Depto. de PediatriaFAPESP: 0754490-8RSciEL

Hepatic steatosis in a school population of overweight and obese adolescents

OBJECTIVE: To assess hepatic steatosis by ultrasound method as a concomitant risk factor among overweight adolescents. METHODS: A case-control study including 83 cases (47 overweight and 36 obese) and 89 controls (normal weight), frequency matched by gender, year of birth, pubertal stage (Tanner 4/5), and income. Cases and controls were selected from 1,420 students enrolled in a Vila Mariana public high school, in São Paulo, Brazil. Must et al. criteria were used for nutritional status classification. Nonalcoholic fatty liver disease was diagnosed through hepatic ultrasonography performed and analyzed by one radiologist. Hepatic enzymatic activities (alanine and aspartate transaminases, alkaline phosphatase, gamma-glutamyl transpeptidase) and direct bilirubin were measured. Eight covariables were fitted into logistic regression models; criterion for inclusion of variables was the association with overweight in the bivariate analyses (p 24 U/L were 10.77 (2.45-47.22) and 4.18 (1.46-11.94), respectively. CONCLUSIONS: This is the first population-based study showing that hepatic steatosis is strongly associated with overweight/obesity among adolescents attending a Brazilian public school. The diagnostic tool used in this investigation is a non-invasive method that might be applied to monitor overweight and obese adolescents and to propose actions for preventing more severe hepatic diseases in adulthood.OBJETIVO: Avaliar esteatose hepática pelo método de ultrassom como fator de risco concomitante entre adolescentes com sobrepeso. MÉTODOS: Estudo de caso-controle incluindo 83 casos (47 com sobrepeso e 36 obesos) e 89 controles (peso normal), frequência pareada por gênero, ano de nascimento, estágio pubertário (Tanner 4/5) e renda. Casos e controles foram selecionados de 1.420 alunos matriculados em uma escola pública de ensino médio na Vila Mariana, São Paulo. Os critérios de Must et al. foram usados para classificação do estado nutricional. A doença hepática gordurosa não-alcoólica foi diagnosticada por meio de ultrassonografia realizada e analisada por um radiologista. Foram medidas atividades enzimáticas hepáticas (alanina e aspartato transaminases, fosfatase alcalina, gama-glutamil transpeptidase) e bilirrubina direta. Oito co-variáveis foram inseridas em modelos de regressão logística; o critério de inclusão de variáveis foi a associação com sobrepeso nas análises bivariadas (p 24 U/L foram 10,77 (2,45-47,22) e 4,18 (1,46-11,94), respectivamente. CONCLUSÕES: Este é o primeiro estudo populacional mostrando que a esteatose hepática tem forte associação com sobrepeso/obesidade entre adolescentes matriculados em uma escola pública brasileira. A ferramenta de diagnóstico usada nesta investigação é um método não-invasivo que poderia ser aplicado para monitorar adolescentes com sobrepeso e obesos e propor ações para prevenir doenças hepáticas mais graves na fase adulta.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP-EPM Department of PediatricsUNIFESP, EPM, Department of PediatricsFAPESP: 03/00415-4SciEL

Precisión del diagnóstico de obesidad en adolescentes brasileños: comparación de los criterios de COLE y cols. y de MUST y cols. con el porcentaje DXA sobre masa grasa

Objectives: to assess the accuracy of the two most used anthropometric criteria: Must and Cole to diagnose obesity in adolescence comparing with percentage of fat mass determined by DXA.Methodology: cross-sectional study with 418 adolescents (52.4% males) attending a private school in Se Paulo/Brazil. Anthropometric measures of height and weight were taken and BMI was calculated. Analysis of body composition was performed using the DXA to detect percentage of fat mass. Using the method proposed by Ellis & Wong (ERM) two sex-specific linear regression models of fat percentage for age in years were fitted. The comparison between the methods was carried out through the analyses of specificity and sensitivity with two residual percentiles as cutoff points (ERM85(th) and ERM95th) as standards. A logistic model was fitted to estimate the probability curves of obesity classification.Results: the comparison of the two classic criteria for the diagnosis of obesity with the ERM85(th) and ERM 95(th), yields for females the same sensitivities of 0.50 and 0.20 for both criteria. For males sensitivities for ERM 85(th) were 0.61(Must) and 0.49 (Cole); while for ERM95(th) the sensitivities were 0.81 (Must) and 0.64 (Cole). Therefore, there are high probabilities that those criteria diagnose adolescents as obese, when actually they are not.Conclusion: the Must and Cole criteria were similar and present flaws for the diagnosis of obesity. In clinical practice and field studies anthropometric criteria should be evaluated as to the diagnostic accuracy along with other clinical parameters and, when feasible, the analysis of fatness percentage. However, the anthropometric criteria evaluated are efficient in the identification of nonobese adolescent in the two cutoff points considered.UNIFESP, EPM, Depto Pediat, Disciplina Nutrol, BR-04040032 Sao Paulo, BrazilState Univ Rio de Janeiro, Dept Nutr, Rio De Janeiro, BrazilUNISINUS, Dept Nutr, Porto Alegre, RS, BrazilUNIFESP, EPM, Depto Pediat, Disciplina Nutrol, BR-04040032 Sao Paulo, BrazilWeb of Scienc

Concentrações de oligoelementos (ferro, cobre, zinco) e minerais (cálcio, fósforo, magnésio) no colostro de nutrizes adultas de dois níveis sócio-econômicos

BV UNIFESP: Teses e dissertaçõe