Cardiorespiratory fitness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

ABSTRACT Objective: To conduct a systematic review and meta-analysis assessing the cardiorespiratory fitness (CRF) among individuals with and without type 2 diabetes Materials and methods: The current review was registered in PROSPERO under the number CRD42018082718. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception through February 2022. Eligibility criteria consisted of observational or interventional studies that evaluated CRF through cardiopulmonary exercise testing or six-minute walk test in individuals with type 2 diabetes compared with individuals without type 2 diabetes. For data extraction, we used baseline CRF assessments of randomized clinical trials or follow-up CRF assessments in observational studies. We performed a meta-analysis using maximal oxygen consumption (VO2max), and distance walked in the 6MWT as primary outcomes. They were extracted and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. The meta-analysis was conducted using Review Manager (RevMan) software. Results: Out of 8,347 studies retrieved, 77 were included. Compared with individuals without type 2 diabetes, individuals with diabetes achieved a lower VO2max (−5.84 mL.kg−1.min−1, 95% CI −6.93, −4.76 mL.kg−1.min−1, p = <0.0001; I2 = 91%, p for heterogeneity < 0.0001), and a smaller distance walked in 6MWT (−93.30 meters, 95% CI −141.2, −45.4 meters, p > 0.0001; I2: 94%, p for heterogeneity < 0.0001). Conclusion: Type 2 diabetes was associated with lower cardiorespiratory fitness, as observed by lower VO2max on maximal tests, and smaller distance walked in 6MWT, however the quality of studies was low.

Knowledge about diabetes and its association with adherence to self-care and glycemic control in patients with type 1 diabetes in Southern Brazil

ABSTRACT Objective: To evaluate the association between knowledge about the disease, adherence to self-care, and glycemic control in people diagnosed with type 1 diabetes mellitus. Subjects and methods: A cross-sectional study of patients aged over 18 years diagnosed with type 1 diabetes mellitus, treated at an outpatient clinic of a Brazilian university hospital. Participants with other types of diabetes, cognitive impairment, pregnancy, and outpatient discharge were excluded. Data were collected from January to March 2021 (by telephone call), with questions about the participants' profile, diabetes knowledge questionnaire (DKN-A), and self-care inventory revised (SCI-R) translated into and adapted for Brazilian Portuguese. Data analysis involved chi-square associations, Mann-Whitney U tests, and Poisson regression. Results: Among 198 adult participants, the mean age was 42 ± 12 years, 53.5% were women, the mean glycated hemoglobin was 8.6 ± 1.6%, 140 (70.8%) had satisfactory knowledge about diabetes, 65 (32.8%) had adherence to self-care, and 46 (23.2%) had adequate glycemic control. We found an association between knowledge and adherence to self-care (p < 0.001). Knowledge was not associated with glycemic control (p = 0.705). Conclusion: Knowledge about diabetes was associated with greater adherence to self-care in people with type 1 diabetes mellitus, but it did not reflect in better glycemic control.

Is Frailty Syndrome a Predictor of Morbimortality in Postoperative Cardiac Surgery? - A Retrospective Cohort Study

Abstract Background Frailty is a biological syndrome suggested as a better predictor of morbimortality than chronological age. Objective To assess associations between frailty and morbimortality outcomes in postoperative cardiac surgery. Methods A retrospective cohort study was conducted with cardiac surgery patients. Frailty and maximal inspiratory pressure (MIP) were assessed before surgery. Postoperative outcomes were: extracorporeal circulation time; use of vasopressor; mean arterial pressure (MAP); red blood cell (RBC) transfusion; cardiac arrhythmia and/or heart arrest; presence of intra-aortic balloon pump; antibiotic use; extubation time; length of stay in the intensive care unit (ICU); length of postoperative stay; mortality. One-way ANOVA was used to compare postoperative variables between frailty categories; Spearman was used to evaluate the correlations between frailty and postoperative variables. Age, sex, and MIP were introduced into multiple regression models to find the independent association between postoperative variables and frailty. A significance level of p < 0.05 was adopted. Results The medical records of 200 patients were analyzed (65.7±7.2 years; 68.5% men; 63.5% non-frail, 22.5% pre-frail, 14% frail). Frailty was not a predictor of postoperative outcomes. Age was an independent predictor for alterations in MAP (PR: 1.028, 95% CI: 1.003-1.053, p=0.025), need for RBC transfusion (PR: 1.034, 95% CI: 1.007-1.062, p=0.014), longer extubation time (PR: 1.052, 95% CI: 1.023-1.083, p<0.001), length of stay in the ICU (ß: 0.031, 95% CI: 0.010-0.053, p=0.005), length of postoperative stay (ß: 0.017, 95% CI: 0.003-0.031, p=0.015). Conclusions Frailty was not a predictor of morbimortality following cardiac surgery in middle-aged and older adults; however, age did predict morbidities in this setting.

Healthy lifestyle gone bad: effect of the COVID-19 pandemic on the daily habits of children and adolescents with type 1 diabetes

ABSTRACT Objective: To assess caregivers' perception about the changes in the daily habits of children and adolescents with type 1 diabetes during the COVID-19 pandemic. Subjects and methods: Primary caregivers of youth aged ≤18 with or without type 1 diabetes were selected for the diabetes and the control groups. Caregivers estimated the youth's time (hours) of physical activity and screen time before and during the pandemic, and rated the quality of eating habits and medication adherence from 0 to 10. The primary outcome was the change in physical activity time, screen time, and eating habits scores during isolation. Between-group analyses and within-group comparisons were conducted. A post hoc analysis was performed using logistic regression to correct for confounding factors. Results: In total, 764 participants were included (381 diabetes group vs. 383 control group). Before the pandemic, the diabetes group presented a reduced median of physical activity (P < 0.001) and screen time (P < 0.001). During the pandemic, the difference between both groups remained similar (P = 0.58). Scores of quality of eating habits were similar in both groups before the pandemic [8.0 (7.0-9.0) vs. 8.0 (7.0-9.0), P = 0.31] but decreased during the pandemic [7.0 (5.1-8.1) vs. 8.0 (6.0-9.0), P < 0.001]. The diabetes group had a significantly worse change in eating habits scores (P < 0.01). Conclusion: During the pandemic, eating habits were significantly worse in youth with diabetes than in those without diabetes.

Maintenance of plasma glucose variability after an acute session of aerobic exercise despite changes in insulin and glucagon-like peptide-1 levels in type 2 diabetes

ABSTRACT Objective: The present study aimed to evaluate glucose variability and hormonal responses during and after an aerobic exercise session performed after breakfast in type 2 diabetes patients treated with metformin. Materials and methods: In this quasi-experimental study individuals underwent clinical and laboratory evaluations and maximal exercise test. After two weeks an aerobic exercise session (30 minutes at 60%-70% of the peak heart rate) was performed. At rest, during and after the exercise session, glucose variability (mean amplitude glucose excursions, glucose coefficient of variation, and glucose standard deviation) and levels of plasma glucose, insulin, glucagon, and glucagon-like-peptide-1 were evaluated. Results: Thirteen patients were enrolled in the study. Plasma glucose increased at 15 minutes during the exercise session (244.6 ± 61.9 mg/dL), and decreased at 60 min after exercise (195.6 ± 50.0 mg/dL). Glucose variability did not show any difference before and after exercise. Insulin levels at 15 min [27.1 µU/mL (14.2-42.1)] and 30 min [26.3 µU/mL (14.6-37.4)] during the exercise were higher than those at fasting [11.2 µU/mL (6.7-14.9)] but decreased 60 minutes after exercise (90 minutes) [16.6 µU/mL (8.7-31.7)]. Glucagon levels did not show any difference. GLP-1 levels increased at 30 min [7.9 pmol/L (7.1-9.2)] during exercise and decreased 60 min after exercise (90 minutes) [7.7 pmol/L (6.8-8.5)]. Conclusion: Subjects with type 2 diabetes presented expected changes in insulin, glucagon and GLP-1 levels after breakfast and a single aerobic exercise session, not accompanied by glycemic variability changes.

Precipitating factors of diabetic ketoacidosis in type 1 diabetes patients at a tertiary hospital: a cross-sectional study with a two-time-period comparison

ABSTRACT Objective: To evaluate the precipitating factors of diabetic ketoacidosis (DKA) in patients with type 1 diabetes hospitalized through the emergency department of a tertiary hospital. Materials and methods: Individuals with type 1 diabetes hospitalized for DKA from January 2005 to March 2010 (first period [P1], n = 75) and from April 2010 to January 2017 (second period [P2], n = 97) were identified through a query of electronic medical records. Data were collected by reviewing medical records. Only the first hospitalization of each participant in each period was included. Results: In P2, 44 patients (45.4%) were women, mean age was 26.2 ± 14.5 years, and 74 patients (76.3%) had a previous diagnosis of type 1 diabetes. Only 1 patient had glycated haemoglobin (HbA1c) below 64 mmol/mol (8.0%). Most patients (62.2%) had had a previous episode of DKA. In P1, non-adherence was the main cause of DKA (38.7%), followed by infection (24.0%). In P2, these rates were 34.0% and 24.7%, respectively; no statistical difference was observed between the two study periods (p = 0.790). Conclusion: Over time, non-adherence remained the main precipitating factor of DKA, followed by infection, and no significant difference was observed between the two study periods. Elevated HbA1c, outside the therapeutic range, indicates suboptimal diabetes care and may explain, at least in part, poor adherence as a precipitating factor of decompensation. Health strategies, such as improved self-management of type 1 diabetes, may contribute to a future reduction in DKA episodes.

Physical Activity and Cardiovascular Risk Factors in Children: a Meta-Analysis Update

Abstract Background Obesity and overweight in childhood can increase the risk of developing cardiovascular disease throughout live. Objectives This study provides an update of a meta-analysis of randomized clinical trials (RCT) published in 2014, to assess the effects of physical activity interventions on preventing cardiovascular risk factors in childhood. Methods This update combines data from the previous search with new data obtained from June 2013 to June 2020. Searches were performed on PubMed, EMBASE and Cochrane CENTRAL. The RCTs enrolled used interventions with physical activity longer than six months in school children aged 6-12 years, and evaluated body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels. Data analysis was performed using a random-effects model and a P value <0.05 was considered statistically significant. Results A total of 28,603 articles were retrieved, and 17 RCTs (11,952 subjects) were included. Physical activity interventions were associated with reduction in SBP [−2.11mmHg (95%CI −3.67, −0.54), I243%], DBP [−2.08mmHg (95%CI −3.68, −0,49), I265%] and TG [-0.08mmol/L (95% CI -0.13, -0.03), I20%], and increase in TC [0.17mmol/L (95%CI 0.04, 0.30), I20%]. However, the interventions were not associated with reductions in BMI [−0.03 kg/m2 (95%CI −0.17, 0.10), I20%]. Conclusion This update confirms and reinforces the beneficial effects of physical activity intervention in reducing systolic and diastolic blood pressure and TG levels.

Number of teeth lost on diet quality and glycemic control in patients with type 2 diabetes mellitus

ABSTRACT Objectives: To describe the oral health profile and evaluate the impact of tooth loss on diet quality and glycemic control among 66 patients with type 2 diabetes (T2DM) treated in an endocrinology outpatient clinic at a teaching hospital. Materials and methods: Questionnaires about diabetes self-care (SDSCA), masticatory ability, diet quality, anxiety level about dental treatment, and oral health were applied. Laboratory tests were retrieved from medical records or newly collected samples. Results: The presence of fewer than 21 teeth was associated with an unsatisfactory self-perceived masticatory ability (r = 0.44; p = 0.007). Most participants reported not having received guidance on oral health from their endocrinologists (81.8%) and having had the last visit to the dentist 2 years or more before the study (36.8%). The mean HbA1c level in the group with fewer than 21 teeth was comparable to that in the group with functional dentition (8.9 ± 1.5 and 8.7 ± 1.6%, respectively; p = 0.60). Conclusion: Adults with T2DM have a high prevalence of tooth loss and lack of information about oral hygiene care. Our results reinforce the need for more effective communication between medical and dental care teams.

Association between socioeconomic and nutritional factors and height of Brazilian adolescents: results from the Study of Cardiovascular Risk in Adolescents / Associação entre fatores socioeconômicos e nutricionais e altura de adolescentes brasileiros: resultados do Estudo de Riscos Cardiovasculares em Adolescentes / Asociación entre los factores socioeconómicos y nutricionales y la estatura de los adolescentes brasileños: resultados del Estudio de Riesgo Cardiovascular en Adolescentes

This study aims to describe the mean height of adolescents from the five regions of Brazil and to evaluate socioeconomic and nutritional factors associated with normal growth. This is a cross-sectional study conducted in the Brazilian urban and rural areas with students aged 12 to 17 years (n = 71,553). Anthropometry, socioeconomic variables, physical activity, and diet were evaluated. Height-for-age z-scores were calculated and multiple linear regression models were used to investigate the association of exposure variables with height (outcome) by sex and age (12-13, 14-15, and 16-17 years). We observed a lower mean height in adolescents from the North Region and in individuals with low socioeconomic status. At 17 years of age, the closest to the final height in this sample, mean heights for girls and boys were 160.9 ± 0.1cm and 173.7 ± 0.3cm, respectively. In multiple linear regression analysis, physical activity (girls β = 0.119, 95%CI: 0.035; 0.202; boys β = 0.092, 95%CI: 0.012; 0.172) and high level of maternal education (girls β = 0.103, 95%CI: 0.001; 0.204; boys β = 0.39, 95%CI: 0.245; 0.534) were positively associated with height-for-age z-score in 16- to 17-year-old boys and girls. Other factors positively associated with height-for-age z-score in older students include higher protein consumption (β = 0.022, 95%CI: 0.010; 0.035) and obesity (β = 0.217, 95%CI: 0.084; 0.350) for boys, and low weight (β = 0.205, 95%CI: 0.028, 0.382) for girls. We observed differences in the mean height among adolescents from the five Brazilian regions. Normal growth, especially among older adolescents, was associated with high maternal education, practice of physical activity, protein consumption, and body mass index (BMI) categories.

Buscou-se descrever a altura média dos adolescentes das cinco regiões do Brasil e avaliar os fatores socioeconômicos e nutricionais que estejam associados ao seu crescimento normal. Este é um estudo transversal realizado em ambientes urbanos e rurais no Brasil com estudantes de 12 a 17 anos (n = 71.553). Avaliamos antropometria, variáveis socioeconômicas, atividade física e dieta. Calculou-se os escores-z por idade e investigou-se a associação das variáveis de exposição com altura (desfecho) por sexo e idade (12-13, 14-15 e 16-17 anos) através de múltiplos modelos de regressão linear. Observou-se menor altura média em adolescentes da região Norte e em baixos níveis socioeconômicos. Aos 17 anos, o mais próximo da altura final nesta amostra, as alturas médias para meninas e meninos foram de 160,9 ± 0,1cm e 173,7 ± 0,3cm, respectivamente. Na análise de regressão linear múltipla, atividade física (meninas β = 0,119, IC95%: 0,035; 0,202; meninos β = 0,092, IC95%: 0,012; 0,172) e Ensino Médio materno (meninas β = 0,103, IC95%: 0,201; 0,204; meninos β = 0,39, IC95%: 0,245; 0,534) estiveram positivamente associados ao escore-z de altura por idade em meninos e meninas de 16-17 anos. Maior consumo de proteína (β = 0,022, IC95%: 0,010; 0,035) e obesidade (β = 0,217, IC95%: 0,084; 0,350) estiveram positivamente associados ao escore-z de altura para a idade meninos mais velhos, enquanto a variável associada às meninas foi baixo peso (β = 0,205, IC95%: 0,028; 0,382). Observou-se diferenças na altura média de adolescentes das cinco regiões brasileiras. O crescimento normal, especialmente entre adolescentes mais velhos, esteve associado à escolaridade materna, à prática de atividade física, ao consumo de proteínas e às categorias de índice de massa corporal (IMC).

Los objetivos fueron describir la estatura media de los adolescentes de las cinco regiones de Brasil y evaluar los factores socioeconómicos y nutricionales asociados al crecimiento normal. Estudio transversal realizado en entornos urbanos y rurales de Brasil con estudiantes de 12 a 17 años (n = 71.553). Se evaluaron la antropometría, las variables socioeconómicas, la actividad física y la dieta. Se calculó la puntuación Z de la altura para la edad y se utilizaron modelos de regresión lineal múltiple para investigar la asociación de las variables de exposición con la altura (resultado) por sexo y edad (12-13, 14-15 y 16-17 años). Se observó una estatura media más baja en los adolescentes de la región norte y en los de nivel socioeconómico bajo. A los 17 años, la edad más cercana a la estatura final en esta muestra, las estaturas medias de las chicas y los chicos eran de 160,9 ± 0,1cm y 173,7 ± 0,3cm, respectivamente. En el análisis de regresión lineal múltiple, la actividad física (chicas β = 0,119, IC95%: 0,035; 0,202; chicos β = 0,092, IC95%: 0,012; 0,172) y la madre con educación secundaria (chicas β = 0,103, IC95%: 0,001; 0,204; chicos β = 0,39, IC95%: 0,245; 0,534) se asociaron positivamente con la puntuación z de la altura para la edad en chicos y chicas de 16-17 años. En el caso de los chicos, el mayor consumo de proteínas (β = 0,022, IC95%: 0,010; 0,035) y la obesidad (β = 0,217, IC95%: 0,084; 0,350), mientras que, en el caso de las chicas, el bajo peso (β = 0,205, IC95%: 0,028; 0,382) también se asociaron positivamente con la puntuación z de la altura para la edad en los estudiantes mayores. Se observaron diferencias en la estatura media entre los adolescentes de las cinco regiones brasileñas. El crecimiento normal, especialmente entre los adolescentes de mayor edad, se asoció con la alta escolaridad de la madre, la práctica de actividad física, el consumo de proteínas y las categorías de índice de masa corporal (IMC).

Impact of the COVID-19 pandemic on mental health of pregnant women with diabetes mellitus and hypertension

SUMMARY OBJECTIVE: Psychological effects of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women with diabetes and hypertension are not yet studied. Besides the pregnancy, these women have additional risk factors for severe acute respiratory syndrome due to COVID-19 and are considered a particularly vulnerable, unique population. We aimed to assess their mental health during this pandemic. METHODS: This is a cross-sectional study carried out at a Brazilian tertiary hospital. Women with pregnancies complicated by hypertension and/or diabetes were evaluated. The primary outcome was anxiety, and depressive symptoms evaluated with the State-Trait Anxiety Inventory and Patient Health Questionnaire. Perception of changing habits during quarantine was evaluated as a secondary outcome. RESULTS: Seventy-nine patients were included. The prevalence of State-Trait Anxiety Inventory ≥40 was 79.7% and that of Patient Health Questionnaire ≥10 was 59.2%. Lower social support was correlated with higher scores on both scales. Time spent with electronic devices was perceived as greater by 62% of the women. CONCLUSIONS: Pregnant women with diabetes and hypertension presented high levels of anxiety and depressive symptoms during the COVID-19 pandemic. Considering that these symptoms can affect both the mother's and offspring's health, it is necessary to implement tools to improve their mental health.

Medical adherence in the time of social distancing: a brief report on the impact of the COVID-19 pandemic on adherence to treatment in patients with diabetes

ABSTRACT We conducted a cross-sectional study to evaluate the impact of social distancing determined by the COVID-19 pandemic on treatment adherence using the Self-Care Inventory-revised in adults with diabetes mellitus. In type 1 diabetes, the adherence score was lower during than before social distancing.

Hypoglycemia frequency and treatment satisfaction in patients receiving insulin analogues for treatment of type 1 diabetes mellitus

ABSTRACT Objective: The aim of this study was to evaluate the frequency of hypoglycemia and the treatment satisfaction in patients with type 1 diabetes (T1D) using insulin analogues. Subjects and methods: This observational retrospective study included 516 adult patients with T1D from 38 cities in Southern Brazil. Demographics and clinical data were collected using a self-report questionnaire. Hypoglycemia was defined as an event based on either symptoms or self-monitored blood glucose < 70 mg/dL. Treatment satisfaction was evaluated using the Diabetes Treatment Satisfaction Questionnaire status version (DTSQs) and with a specific question with scores ranging from 0-10. Common mental disorders were assessed using the General Health Questionnaire (GHQ-12). Results: Overall, the mean age was 38 ± 14 years and 52% of the participants were women. The median diabetes duration was 18 years. The scores for insulin analogue treatment satisfaction were higher than those for previous treatments. DTSQ scores had a median value of 32 (interquartile range 29-35) and remained unchanged over time. The percentage of patients with hypoglycemia (including severe and nocturnal) was comparable across groups divided according to duration of use of insulin analogues. Most patients (n=395, 77%) screened positive for common mental disorders. Conclusions: Patient satisfaction with insulin analogue treatment was high and remained unchanged with time. Episodes of hypoglycemia also remained unchanged over time among patients using insulin analogues.

Evaluation of severe hypoglycemia and common mental disorders in patients receiving insulin analogues for treatment of type 1 diabetes

ABSTRACT This is a retrospective report of the frequency of severe hypoglycemia and the association between common mental disorders and type 1 diabetes mellitus treated with insulin analogues. Patients with severe hypoglycemia compared with those without this complication had a higher prevalence of positive screening for common mental disorders (88% vs.77%, respectively, p = 0.03).

Validation to Brazilian Portuguese of the Self-Care Inventory-revised for adults with type 2 diabetes

ABSTRACT Objective The aim of this study was to cross-culturally adapt and validate the Brazilian Portuguese version of SCI-R to adults with type 2 diabetes. Materials and methods The SCI-R is a 15-question survey that reflects how well patients with diabetes have adhered to treatment recommendations. A pretest (n = 40) was first performed to improve comprehension of the survey items. A final version was then self-administered in another 75 adults with type 2 diabetes to determine the survey's reliability and validity according to its association with HbA1c. Finally, we conducted a test-retest reliability analysis over three weeks to stabilize the sample and determine intra-observer variability. Results After the pretest phase, the final sample's (N = 75) mean age was 59.9 ± 7.5 years and mean HbA1c level was 8.6 ± 1.5% (70 ± 16.4 mmol/mol). The initial Cronbach's alpha was 0.61; however, further analysis showed that four items had low item correlation and were excluded from the final version, which increased the Cronbach's alpha to 0.63. In predictive validity analysis, HbA1c levels correlated significantly with total survey scores (r = -0.38, P = 0.001). The intra-class correlation coefficient between baseline and three-week scores was 0.93, which indicates high reproducibility. Conclusions The Brazilian Portuguese version of the SCI-R is a valid tool for measuring treatment adherence in adults with type 2 diabetes.

Self-perceived body image, dissatisfaction with body weight and nutritional status of Brazilian adolescents: a nationwide study / Auto-imagem corporal, insatisfação com o peso corporal e estado nutricional deadolescentes brasileiros: um estudo nacional

Abstract Objectives The purpose of this study was to evaluate the agreement and risk factors for underestimation and overestimation between nutritional status and self-perceived body image and to assess the prevalence and associated factors for dissatisfaction with body weight among Brazilian adolescents. Methods Students aged 12-17 years participating in the Study of Cardiovascular Risk in Adolescents ("ERICA"), a multicenter, cross-sectional, school-based country-wide study, were included (n = 71,740). Variables assessed as covariates were sex, age, skin color, socioeconomic status, and common mental disorders (screened by the General Health Questionnaire, GHQ-12). Multinomial logistic regression was used to explore the association between covariates and combinations between self-perceived body image and body mass index (agreement, underestimation and overestimation). The associations between dissatisfaction with body weight and exposure variables were investigated using multivariable Poisson regression models. Results Approximately 66% students rightly matched their body mass index with self-perceived weight (kappa coefficient was 0.38 for boys and 0.35 for girls). Agreement was higher among younger students and adolescents from low income households. Male sex, older age, and GHQ-12 score ≥3 were associated with weight overestimation. Prevalence of dissatisfaction with body weight was 45.0% (95% CI: 44.0-46.0), and higher among girls, older adolescents, those with underweight or overweight/obesity, as well as those who were physically inactive and with GHQ-12 ≥3. Conclusions Most of the sample rightly self-perceived their body image according to body mass index. Students with body image misperception and those dissatisfied with their weight were more likely to present a positive screening for common mental disorders.

Resumo Objetivos A finalidade deste estudo foi avaliar a concordância e os fatores de risco para subestimação e superestimação entre o estado nutricional e a autoimagem corporal e para avaliar a prevalência e os fatores associados à insatisfação com o peso corporal entre adolescentes brasileiros. Métodos Foram incluídos estudantes entre 12 e 17 anos que participavam do Estudo de Riscos Cardiovasculares em Adolescentes ("ERICA"), um estudo multicêntrico, transversal, nacional e de base escolar (n = 71.740). As variáveis analisadas como covariáveis foram sexo, idade, cor da pele, situação socioeconômica e transtornos mentais comuns (triados pelo Questionário de Saúde Geral, QSG-12). A regressão logística multinomial foi usada para explorar a associação entre as covariáveis e as combinações entre a autoimagem corporal e o índice de massa corporal (concordância, subestimação e superestimação). As associações entre a insatisfação com o peso corporal e as variáveis de exposição foram investigadas com os modelos multivariáveis de regressão de Poisson. Resultados Aproximadamente 66% dos estudantes associaram corretamente seu índice de massa corporal com o peso autopercebido (o coeficiente kappa foi 0,38 para meninos e 0,35 para meninas). A concordância foi maior entre jovens e adolescentes de baixa renda. Sexo masculino, adolescentes mais velhos e um escore QSG 12 ≥ 3 foram associados à superestimação do peso. A prevalência de insatisfação com o peso corporal foi 45,0% (IC de 95%: 44,0-46,0), maior entre meninas, adolescentes mais velhos, aqueles abaixo do peso ou com sobrepeso/obesidade, fisicamente inativos e com QSG-12 ≥ 3. Conclusões A maior parte da amostra associou corretamente sua imagem corporal de acordo com o índice de massa corporal. Estudantes com distorção da autoimagem corporal e aqueles insatisfeitos com seu peso foram mais propensos a apresentar rastreamento positivo para transtornos mentais comuns.

Association between body weight perception and quality of diet in brazilian adolescents / Associação da percepção do peso corporal com a qualidade da dieta de adolescentes brasileiros

ABSTRACT Objective: To evaluate the association between body weight perception and quality of diet among Brazilian adolescents. Methods: The sample was composed of 71,740 adolescents aged from 12 to 17 years-old enrolled in the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA), carried out during 2013-2014. Body weight perception was self-reported. Food consumption was assessed by food record and quality of diet index for Brazilian adolescents (DQIA-BR) was calculated, considering the balance, diversity, and diet composition. The quality of diet was compared according to weight perception for the entire sample and after stratification by nutritional status. Linear regression models were used to assess the association between body weight perception and quality of diet. Results: Among the studied adolescents, 14.7 and 30.3% reported to be underweight or overweight in relation to their desired weight, respectively. Those who perceived themselves as overweight had lower quality of diet (DQIA-BR=16.0 vs. 17.4 points; p<0.001). After stratification by BMI, adolescents with normal weight (DQIA-BR=15.3 points) or overweight (DQIA-BR=16.1 points), but who perceived themselves as overweight showed lower quality of diet when compared to their peers. In adjusted analysis, overweight perception (β= -0.51; 95%CI -0.77; -0.24) was associated to lower quality of diet. However, this association was no longer significant after stratification by BMI status. Conclusions: Body weight perception can influence the consumption of healthy foods and the quality of diet, especially for those who consider themselves overweight. However, this association is influenced by nutritional status.

RESUMO Objetivo: Avaliar a associação entre percepção de peso corporal e qualidade da dieta de adolescentes brasileiros. Métodos: A amostra estudada foi composta de 71.740 adolescentes de 12-17 anos participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA) realizado entre 2013 e 2014. A percepção do peso corporal foi avaliada por questionário autoaplicável; o consumo alimentar, por recordatório alimentar; e a qualidade da dieta pelo índice de qualidade da dieta de adolescentes brasileiros (IQDA-BR), considerando o equilíbrio, a diversidade e a composição da dieta. A qualidade da dieta foi comparada de acordo com a percepção do peso para toda a amostra e após estratificação por índice de massa corpórea (IMC). Modelos de regressão linear foram utilizados para avaliar a associação entre distúrbios na percepção do peso e qualidade da dieta. Resultados: Entre os adolescentes, 14,7 e 30,3% percebiam-se abaixo ou acima do peso, respectivamente. Aqueles que se percebiam acima do peso apresentaram menor qualidade da dieta (IQDA-BR=16,0 vs. 17,4 pontos; p<0,001). Após estratificação por IMC, adolescentes com peso normal (IQDA-BR=15,3 pontos) ou excesso de peso (IQDA-BR=16,1 pontos), mas que se percebiam como acima do peso, apresentaram pior qualidade da dieta se comparados ao demais. Em análise ajustada, perceber-se acima do peso (β= -0,51; intervalo de confiança de 95% - IC95% -0,77; -0,24) foi associado a pior qualidade da dieta, porém essa associação perdeu significância após a estratificação por IMC. Conclusões: A percepção do peso corporal parece influenciar o consumo de alimentos saudáveis e a qualidade da dieta principalmente daqueles que se consideram acima do peso, contudo essa associação é influenciada pelo estado nutricional.