ERICA: prevalence of fish consumption and its association with cardiovascular risk factors and healthy behavior in Brazilian adolescents

Abstract Objective: To describe the prevalence of fish consumption and its association with cardiovascular risk factors and healthy behavior in Brazilian adolescents. Method: The authors investigated data from 71,533 participants of the Study of Cardiovascular Risk in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA), a nationwide, cross-sectional, school-based study. Of these, 37,815 adolescents were included for blood analyses. All prevalence estimates were presented proportionally with their 95% confidence intervals. Bivariate relationships were evaluated with Pearson's Chi-square test, and a multinomial logistic regression model was applied, considering p < 0.05. Results: Prevalence of fish consumption in the 7 days prior to the interview was 28.6% (95%CI 26.9-30.3), significantly higher among male adolescents (p = 0.0049), Asian descendants (p = 0.0270), private and rural school students (p < 0.001), and who resided in the Northern region (p < 0.001). A positive association between fish consumption and healthy behavior (breakfast consumption: OR=1.16; 95%CI 1.10-1.22; meals with family members: lunch: OR=1.07; 95%CI 1.01-1.13; dinner: OR=1.13; 95%CI 1.04-1.23; physical activity: OR=1.14; 95%CI 1.02-1.28) and an inverse association with hypertriglyceridemia (OR = 0.84; 95%CI 0.73-0.98) remained significant even after adjustment for possible confounding factors. Conclusion: This study demonstrated that fish consumption was associated with lower cardiovascular risk and may represent a marker of a healthy lifestyle in Brazilian adolescents.

Relationship between fiber intake and cardiovascular risk factors in adolescents with systemic lupus erythematosus / Relação entre consumo de fibra e fatores de risco cardiovascular em adolescentes portadores de lúpus eritematoso sistêmico

ABSTRACT Objective: To evaluate the fiber intake and the relationship with cardiovascular risk factors in adolescents with juvenile systemic lupus erythematosus. Methods: This is a cross-sectional in which adolescents with juvenile systemic lupus erythematosus were evaluated. The dietary consumption was assessed by the 24-hour recall; nutritional status was classified according to the Body Mass index/Age by Sex; abdominal obesity was assessed through waist circumference, waist-to-height ratio and glucose and lipid metabolism. The data were analyzed using Statistical Software for Professionals 14 and all statistical analyses used an alpha error of 5%. Results: 52 patients were evaluated, with a mean age of 16.7±1.5 years. Inadequate fiber consumption occurred in 61.5% (n=32) of them. Average of waist circumference measures (81.4 vs. 75.5 cm; p=0.02), waist-to-height ratio (0.51 vs. 0.47; p=0.02) and systolic blood pressure (122.1 vs. 114.8 mmHg; p=0.03) were higher in those who had inadequate fiber intake. Among the cardiovascular risk factors evaluated, the waist/height ratio showed a significant negative correlation with fiber consumption (r=-0.3; p=0.04), that is, the higher the fiber consumption, the lower the value of the waist ratio /stature. Conclusions: Low dietary fiber intake in adolescents with systemic lupus erythematosus juvenile is related to higher abdominal adiposity and consequently with increased cardiovascular risk.

RESUMO Objetivo: Avaliar o consumo de fibras e analisar a sua relação com os fatores de risco cardiovascular em adolescentes portadores de lúpus eritematoso sistêmico juvenil. Métodos: Trata-se de um estudo transversal em que foram avaliados adolescentes com lúpus eritematoso sistêmico juvenil. O consumo alimentar foi avaliado pelo recordatório de 24 horas; o estado nutricional, classificado de acordo com o índice de massa corporal/idade, segundo o sexo; e a obesidade abdominal, analisada por meio da circunferência da cintura e razão cintura/estatura e do metabolismo glicídico e lipídico. Os dados foram analisados no Statistical Software for Professionals 14, e todas as análises estatísticas usaram erro alfa de 5%. Resultados: Foram avaliados 52 pacientes, com média de idade de 16,7±1,5 anos. O consumo inadequado de fibras ocorreu em 61,5% (n=32) dos adolescentes e evidenciou que a média das medidas da circunferência da cintura (81,4 vs. 75,5 cm; p=0,02), a relação cintura/estatura (0,51 vs. 0,47; p=0,02) e a pressão arterial sistólica (122,1 vs. 114,8 mmHg; p=0,03) foram maiores naqueles que tiveram consumo inadequado de fibras. Entre os fatores de risco cardiovascular avaliados, a relação cintura/estatura apresentou correlação negativa significante com consumo de fibras (r=-0,3; p=0,04). Ou seja, quanto maior o consumo de fibras, menor o valor da relação cintura/estatura. Conclusões: A baixa ingestão de fibras da dieta nos adolescentes com lúpus eritematoso sistêmico juvenil está relacionada com maior adiposidade abdominal e, consequentemente, com maior risco cardiovascular.

Adductor Pollicis Muscle Thickness as a Marker of Nutritional Status in Heart Failure

Malnutrition is associated with morbidity and mortality in patients with heart failure (HF). Thus, it is essential to apply reliable indicators to assess the nutritional status of these individuals. Objective: To evaluate the thickness of the adductor pollicis muscle (APM) in patients with HF as an indicator of somatic protein status and correlate the obtained values with conventionally used parameters and electrical bioimpedance (EBI) markers. Methods: Cross-sectional study with patients with HF undergoing regular outpatient treatment. APM thickness was measured in the dominant arm, and the values obtained were classified according to gender and age. The anthropometric parameters assessed included the body mass index (BMI) and specific parameters to assess the muscle (arm muscle circumference [AMC] and arm muscle area [AMA]). Values of phase angle (PA), standard PA (SPA), and lean mass were obtained by EBI. Statistical analyses were performed with the software Statistical Package for the Social Sciences, version 19, using unpaired Student's t, Mann-Whitney, or one-way analysis of variance (ANOVA) tests for comparisons between groups, as appropriate. The correlation between variables of interest was performed using Pearson's or Spearman's correlation coefficient, as adequate. The level of significance was set at 5%. Results: About 70% of the 74 patients evaluated were classified as malnourished according to the APM thickness. Values of AMC, AMA, and lean mass correlated positively with APM thickness (p < 0.005). The APM thickness also correlated positively with PA and SPA (r = 0.49, p < 0.001 and r = 0.31, p = 0.008, respectively). Conclusion: Patients with HF presented a high frequency of protein malnutrition when APM thickness was used as an indicator of nutritional status. APM thickness values correlated with conventional measures of somatic protein evaluation and may be related to the prognosis of these patients, since they correlated positively with PA and SPA

Dyslipidemia in Adolescents Seen in a University Hospital in the city of Rio de Janeiro/Brazil: Prevalence and Association / Dislipidemia em Adolescentes Atendidos em um Hospital Universitário no Rio de Janeiro/Brasil: Prevalência e Associação

Abstract Background: Early exposure to obesity favors greater risks of cardiovascular factors such as dyslipidemia. Objectives: To establish the prevalence of dyslipidemia, and to evaluate its association with nutritional status of the adolescents attended at the ambulatory of the Adolescent Health Studies Center of the University Hospital Pedro Ernesto. Methods: This is a cross-sectional, observational study, the sample of which was of convenience, consisting of adolescents from 12 to 18 years old of both genders. The lipid profile was evaluated, along with its association with the anthropometric indicators: body mass index and waist circumference. For statistical analysis, a significance level of 5% was used. Results: A total of 239 adolescents, 104 boys (43.5%) and 135 girls (56.5%) were evaluated and, of these, 52 (21.8%) were eutrophic, 60 (25.1%) overweight, and 127 (53.1%) obese. Obeseadolescents had significantly lower mean values of HDL-cholesterol (44.7 mg/dl vs 53.9 mg/dl; p < 0.001) and higher triglycerides (109.6 mg/dl vs 87.3 mg/dl; p = 0.01). The changes with higher prevalence were low HDL-cholesterol (50.6%), hypercholesterolemia (35.1%), and hypertriglyceridemia (18.4%). A negative association of HDL-cholesterol with body mass index and a positive association of triglycerides with body mass index could be observed, even after adjustment for gender and skin color. Conclusion: This study demonstrated high prevalence of dyslipidemia among adolescents. In view of the significant association between lower levels of HDL-cholesterol and increased triglycerides with overweight, the control of these factors should receive attention, with the precocious diagnosis of the dyslipidemia being important, mainly if it is associated with another cardiovascular risk, to develop effective intervention strategies.

Resumo Fundamentos: Exposição precoce à obesidade favorece maiores riscos de fatores cardiovasculares como dislipidemias. Objetivos: Estabelecer a prevalência de dislipidemia e avaliar sua associação com o estado nutricional de adolescentes atendidos no ambulatório de atenção secundária do Núcleo de Estudos da Saúde do Adolescente do Hospital Universitário Pedro Ernesto. Métodos: Estudo transversal observacional, cuja amostra foi de conveniência e compreendeu adolescentes de 12 a 18 anos de ambos os sexos. Avaliado o perfil lipídico e sua associação com os indicadores antropométricos: índice de massa corporal e circunferência da cintura. Para as análises estatísticas foi utilizado nível de significância de 5%. Resultados: Foram avaliados 239 adolescentes, 104 meninos (43,5%) e 135 meninas (56,5%) e destes, 52 (21,8%) apresentaram eutrofia, 60 (25,1%) sobrepeso e 127 (53,1%) obesidade. Os adolescentes com obesidade apresentaram valores médios de HDL-colesterol significativamente menores (44,7 mg/dl vs. 53,9 mg/dl; p < 0,001) e triglicerídeos maiores (109,6 mg/dl vs. 87,3 mg/dl; p = 0,01). As alterações com maior prevalência foram HDL-colesterol baixo (50,6%), hipercolesterolemia (35,1%) e hipertrigliceridemia (18,4%). Foi possível observar associação negativa do HDL-colesterol com o índice de massa corporal e associação positiva dos triglicerídeos com o índice de massa corporal, mesmo após ajuste para gênero e cor da pele. Conclusão: Este estudo demonstrou alta prevalência de dislipidemia entre os adolescentes. Tendo em vista a associação significativa entre baixos níveis de HDL-colesterol e triglicerídeos aumentados com excesso de peso, o controle destes fatores deve receber atenção, sendo importante o diagnóstico precoce da dislipidemia principalmente se associada a outro risco cardiovascular, para desenvolvimento de estratégias de intervenção.

Insuficiência cardíaca: relação entre parâmetros antropométricos, composição corporal e integridade celular / Heart failure: correlation between anthropometric parameters, body composition and cell integrity

Fundamentos: O conhecimento do ângulo de fase e seu uso como determinante prognóstico em pacientes com insuficiência cardíaca ainda é escasso. Objetivo: Avaliar a relação entre indicadores antropométricos, função cardíaca e integridade celular em pacientes com insuficiência cardíaca com fração de ejeção reduzida. Métodos: Trata-se de um estudo transversal que avaliou pacientes com insuficiência cardíaca com fração de ejeção reduzida por meio da antropometria e da bioimpedância elétrica. Foram empregados os testes do Qui-quadrado e teste t de student para analisar as diferenças e a correlação linear de Pearson para avaliar associação, adotando p < 0,05 para indicar significância estatística.Resultados: Foram avaliados 41 indivíduos, com idade entre 30-74 anos, sendo 34 homens (82,9%). O ângulo de fase mostrou-se com maior média entre as mulheres (7,1°), porém houve diferença estatisticamente significativa entre os sexos apenas para as médias do percentual de gordura. O ângulo de fase correlacionou-se com o índice de massa corporal (r = 0,44; p = 0,004) e houve uma tendência na correlação do ângulo de fase com a razão cintura/estatura (r = 0,29; p = 0,06) e fração de ejeção do ventrículo esquerdo (r = 0,29; p = 0,07). Conclusões: O ângulo de fase apresentou boa correlação com o índice de massa corporal e mostrou uma tendência de correlação com a fração de ejeção do ventrículo esquerdo, sustentando o paradoxo da obesidade e a importância prognóstica deste marcador. Ressalta-se ainda, a necessidade de novos estudos sobre a aplicabilidade do ângulo de fase no prognóstico nesta população

Background: Knowledge about phase angle and its use as a prognostic determinant in patients with heart failure is still scarce. Objective: To evaluate the correlation between anthropometric indicators, cardiac function and cell integrity in patients with heart failure with reduced ejection fraction. Methods: This was a cross-sectional study that evaluated patients with heart failure with reduced ejection fraction by anthropometry and bioelectrical impedance analysis. Chi-square test and Student's t test were used to analyze differences, and Pearson's linear correlation was used to evaluate associations, using p < 0.05 to indicate statistical significance. Results: We evaluated 41 subjects aged 30-74 years, of which 34 were men (82.9%). Mean phase angle was higher among women (7.1%), but significant differences between men and women were found only for body fat percentage. Phase angle correlated with body mass index (r = 0.44, p = 0.004) and there was a trend of correlation of the phase angle with waist-to-height ratio (r = 0.29, p = 0.06) and the left ventricular ejection fraction (r = 0.29, p = 0.07). Conclusions: Phase angle showed a good correlation with body mass index and showed a trend of correlation with the left ventricular ejection fraction, supporting the obesity paradox and the prognostic importance of this marker. Further studies on the applicability of the phase angle in the prognosis of these patients are still needed

ERICA: intake of macro and micronutrients of Brazilian adolescents / ERICA: ingestão de macro e micronutrientes em adolescentes brasileiros

ABSTRACT OBJECTIVE To describe food and macronutrient intake profile and estimate the prevalence of inadequate micronutrient intake of Brazilian adolescents. METHODS Data from 71,791 adolescents aged from 12 to 17 years were evaluated in the 2013-2014 Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). Food intake was estimated using 24-hour dietary recall (24-HDR). A second 24-HDR was collected in a subsample of the adolescents to estimate within-person variability and calculate the usual individual intake. The prevalence of food/food group intake reported by the adolescents was also estimated. For sodium, the prevalence of inadequate intake was estimated based on the Tolerable Upper Intake Level (UL). The Estimated Average Requirement (EAR) method used as cutoff was applied to estimate the prevalence of inadequate nutrient intake. All the analyses were stratified according to sex, age group and Brazilian macro-regions. All statistical analyses accounted for the sample weight and the complex sampling design. RESULTS Rice, beans and other legume, juice and fruit drinks, breads and meat were the most consumed foods among the adolescents. The average energy intake ranged from 2,036 kcal (girls aged from 12 to 13 years) to 2,582 kcal (boy aged from14 to 17 years). Saturated fat and free sugar intake were above the maximum limit recommended (< 10.0%). Vitamins A and E, and calcium were the micronutrients with the highest prevalence of inadequate intake (> 50.0%). Sodium intake was above the UL for more than 80.0% of the adolescents. CONCLUSIONS The diets of Brazilian adolescents were characterized by the intake of traditional Brazilian food, such as rice and beans, as well as by high intake of sugar through sweetened beverages and processed foods. This food pattern was associated with an excessive intake of sodium, saturated fatty acids and free sugar.

RESUMO OBJETIVO Descrever o perfil de consumo alimentar e de macronutrientes, e estimar a prevalência de inadequação da ingestão de micronutrientes em adolescentes brasileiros. MÉTODOS Foram avaliados dados de 71.791 adolescentes de 12 a 17 anos que participaram do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA), realizado em 2013-2014. O consumo alimentar foi estimado por meio de recordatório alimentar de 24h; em uma subamostra dos adolescentes foi coletado um segundo R24h para a estimativa da variância intrapessoal e o cálculo de ingestão alimentar usual. Estimou-se prevalência de consumo de alimentos ou grupos de alimentos referidos pelos adolescentes. Para ingestão inadequada de sódio considerou-se valores acima do nível de ingestão máxima tolerável. Prevalências de inadequação foram calculadas pelo método da Necessidade Média Estimada (Estimated Average Requirement –EAR) como ponto de corte. Todas as análises foram estratificadas segundo sexo, faixa etária e macrorregiões do País, e levaram em consideração o peso amostral e a complexidade do desenho do estudo. RESULTADOS Os alimentos mais consumidos pelos adolescentes foram arroz, feijão e outras leguminosas, sucos e refrescos, pães, e carne bovina. A ingestão média de energia dos adolescentes variou de 2.036 kcal (meninas de 12 a 13 anos) a 2.582 kcal (meninos de 14 a 17 anos). O consumo de ácidos graxos saturados e de açúcar livre ultrapassaram limites máximos recomendados da ingestão energética total (< 10,0%). Maiores prevalências de inadequação (> 50,0%) foram para cálcio e vitaminas A e E. O consumo de sódio foi acima dos limites máximos recomendados em mais de 80,0% dos adolescentes. CONCLUSÕES A dieta dos adolescentes brasileiros é caracterizada pelo consumo de alimentos tradicionais, como arroz e feijão, e ingestão elevada de bebidas açucaradas e alimentos ultraprocessados. Esse padrão associa-se à elevada inadequação da ingestão de cálcio, vitaminas A e E e ao consumo excessivo de ácidos graxos saturados, sódio e açúcar livre.

Síndrome Metabólica em Pacientes com Insuficiência Cardíaca / Metabolic Syndrome in Patients with Chronic Heart Failure

Fundamentos: A insuficiência cardíaca é a via final comum da maioria das doenças que acometem o coração, considerada um dos mais importantes desafios clínicos atuais na área da saúde. Evidências epidemiológicas demonstram cada vez mais a associação entre síndrome metabólica e presença de alterações cardiovasculares, já que, de forma independente, os fatores de risco que estão relacionados à insuficiência cardíaca são os mesmos que compõe a síndrome metabólica, contribuindo, substancialmente, para o aumento da morbimortalidade cardiovascular. Objetivo: Avaliar a presença de síndrome metabólica em pacientes com insuficiência cardíaca crônica, atendidos em clínica de insuficiência cardíaca. Métodos: Trata-se de estudo transversal que avaliou pacientes portadores de insuficiência cardíaca crônica, atendidos na Clínica de insuficiência cardíaca de Hospital Universitário. A coleta de dados compreendeu aavaliação antropométrica, clínica e bioquímica. O diagnóstico de síndrome metabólica foi estabelecido peloscritérios da International Diabetes Federation. Resultados: Foram avaliados 90 pacientes, sendo 51% (n=46) do sexo masculino, com média de idade de62,7±12,3 anos. O estudo identificou elevada frequência de síndrome metabólica (71%; n=64) correlacionando-se significativamente com o aumento do índice de massa corporal (p<0,001). Ao comparar os grupos, observou-seque o diabetes mellitus foi significativamente mais frequente no grupo com síndrome metabólica (p<0,001). Conclusão: Os indivíduos portadores de insuficiência cardíaca apresentaram elevada frequência de síndrome metabólica, sendo o diabetes mellitus a alteração mais frequente no grupo com síndrome metabólica.

Background: Heart failure is the final common pathway of most diseases involving the heart. It is considered one of the most important current clinical challenges in health care. Epidemiological evidence increasingly demonstrates the association between metabolic syndrome and the presence of cardiovascular disorders, since, in an independent manner, risk factors related to heart failure are the same that comprise metabolic syndrome, substantially contributing to the increase of cardiovascular morbidity and mortality.Objective: To evaluate the presence of metabolic syndrome in patients with chronic heart failure assisted in the heart failure service. Methods: This cross-sectional study evaluated patients with chronic heart failure treated at the heart failure Clinic of a University Hospital. Data collection included anthropometric, clinical and biochemistry evaluation. Diagnosis of metabolic syndrome was established by the criteria of the International Diabetes Federation. Results: The study evaluated 90 patients, including 51% (n=46) males with a mean age of 62.7±12.3 years. The study found ahigh frequency of metabolic syndrome (71%; n=64) correlating significantly with increased body mass index (p<0.001). By comparing the two groups, it was observed that diabetes mellitus was significantly more frequent in patients with metabolic syndrome (p<0.001). Conclusion: Individuals with heart failure showed high frequency of metabolic syndrome, and diabetes mellitus was the most frequent alteration in the group with metabolic syndrome.

Síndrome metabólica em pacientes atendidos em programa de reabilitação cardíaca / Metabolic syndrome among patients enrolled in a cardiac rehabilitation program

Fundamentos: Síndrome metabólica (SM) constitui importante fator de risco para o desenvolvimento de doenças cardiovasculares e, quando associada às cardiopatias, torna-se responsável por alto e crescente número de mortalidade. Objetivo: Estimar a frequência de SM em cardiopatas do Programa de Reabilitação Cardíaca de hospital universitário do Rio de Janeiro. Métodos: Estudo transversal, descritivo, com participantes do programa de Reabilitação Cardíaca,a partir de avaliação antropométrica e laboratorial,utilizando-se para diagnóstico de SM os critérios da International Diabetes Federation, 2005. Resultados: Foram avaliados 40 indivíduos, 26 homens e 14 mulheres, com média de idade 61,1±8,4 anos. De acordo com o índice de massa corporal, 77,5 % apresentavam sobrepeso e obesidade. Os valores médios de circunferência da cintura e relação cintura/altura encontravam-se, em ambos os sexos, superiores ao recomendado. A frequência de SM foi 83,0 %, sendo 77,0 % no sexo masculino e 93,0 % no sexo feminino. Entre os pacientes com diagnóstico de SM, as médias das medidas antropométricas foram significativamente maiores do que entre aqueles sem diagnóstico. Conclusões: Verificou-se elevada frequência de SM nos pacientes submetidos ao programa de RC, alertando para a importância da implementação de ações terapêuticas que visem à reversão da SM em pacientes já cardiopatas.

Background: Metabolic syndrome is a major risk factor for the development of cardiovascular disease, resulting in a high (and still rising) mortality rate when associated with cardiopathies. Objective: To estimate the frequency of metabolic syndrome in a Cardiac Rehabilitation Program at auniversity hospital in Rio de Janeiro. Methods: Cross-sectional descriptive study conducted with patients participating in a Cardiac Rehabilitation Program, grounded on anthropometric and laboratory assessments, with metabolic syndrome diagnosed through the criteria established by the International Diabetes Federation, 2005. Results: Forty subjects were assessed (26 men and14 women), with a mean age of 61.1±8.4 years. Based on the Body Mass Index, 77.5% were overweight and obese. The mean waist circumference and waist/height values were higher than recommended for both genders, with the overall prevalence of metabolic syndrome reaching 83.0% (77.0% males and 93.0%females). Among patients diagnosed with metabolic syndrome, the mean anthropometric measurements were significantly larger than among those without this diagnosis. Conclusions: A high frequency of metabolic syndrome was found among patients in a Cardiac Rehabilitation Program, underscoring the importance of implementing therapeutic actions aimed at reversing metabolic syndrome among patients with heart disease.