Obese Vegetarians and Omnivores Show Different Metabolic Changes: Analysis of 1340 Individuals.

Our study evaluated the association between the increase in body mass index (BMI) in men and women (menstruating and non-menstruating) (n = 1340) with different dietary groups (omnivores, semi-vegetarians, lacto-ovo-vegetarian, and vegans) and the measurement of the biochemical markers high-sensitive C-reactive protein (hs-CRP), ferritin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), glycated hemoglobin (HbA1C), and insulin resistance index (HOMA-IR). Increasing BMI values in all groups and dietary profiles were related to a significant increase in hs-CRP (p < 0.0001), ALT (p = 0.02), ferritin (p = 0.009), and HbA1C (p < 0.0001), with no difference between dietary groups (p < 0.05). The increase in BMI increases the levels of HOMA-IR (p < 0.0001) and GGT (p < 0.05), with higher values found in men when compared to women (p < 0.0001 for HOMA- IR and p = 0.0048 for GGT). The association between ALT and BMI was different between dietary groups, as it showed a decrease in vegan women who do not menstruate compared to other dietary groups (p = 0.0099). When including only obese individuals (BMI ≥ 30 kg/m2, n = 153) in the analysis, we observed lower concentrations of GGT and ferritin in vegetarians than in omnivores, regardless of gender and menstrual blood loss (p = 0.0395). Our data showed that for both vegetarians and omnivores, the higher the BMI, the worse the metabolic parameters. However, regarding obesity, vegetarians showed better antioxidant status (lower GGT elevation) and lower inflammatory status (lower ferritin elevation), which may provide them with potential protection in the development of morbidities associated with overweight.

Iron Deficiency in Vegetarian and Omnivorous Individuals: Analysis of 1340 Individuals.

The objective of this study was to evaluate the serum levels of ferritin and the prevalence of iron deficiency in vegan and omnivorous individuals by taking into account the presence of elements that cause an elevation of ferritin levels, such as increased homeostatic model assessment of insulin resistance (HOMA-IR), body mass index (BMI), and high-sensitivity C-reactive protein (hs-CRP) values. The parameters were evaluated in 1340 individuals, i.e., 422 men and 225 women who do not menstruate and 693 women who do menstruate, based on omnivorous or vegetarian eating habits. The progressive increase in BMI, HOMA-IR, and inflammation caused an elevation in ferritin concentration, regardless of the eating habits in the groups studied. In the overall sample, omnivores had a higher prevalence of obesity, higher ferritin levels, and a lower prevalence of iron deficiency (ferritin < 30 ng/mL). However, after the exclusion of individuals with inflammation (with overweight/obesity and elevated hs-CRP levels), the actual iron deficiency was assessed and was not higher among vegetarians, except in women with regular menstrual cycles. Our data show that nutritional status and inflammation levels affect ferritin levels and may interfere with the correct diagnosis of iron deficiency in both vegetarian and omnivorous individuals. Compared to vegetarians, women who do not menstruate and men had the same prevalence of iron deficiency when following an omnivorous diet.

Comparing parents' and overweight adolescents' reports on parent mealtime actions.

This study aimed to compare answers given by parents and their adolescent children to the Portuguese version of the Parent Mealtime Action Scale (PMAS) and to assess associations among the reported behaviors. To compare these answers, a cross-sectional study was conducted in a sample of 72 patients of the Obesity Clinic of the Division of Nutrology of the Pediatrics Department at the Federal University of São Paulo (Unifesp), Brazil. These patients were aged from 10 years to 19 years and 11 months, and their parents or legal guardians also participated. First, parents were interviewed and instructed to answer how often they perform each behavior measured by the PMAS (never, sometimes or always). Next, the same questions were answered by the adolescents. The general linear model (GLM) showed the effects of the interviewees and of the interaction between interviewees and sex. We also observed a triple interaction effect (sex x interviewees x categorized age). The internal reliability of the PMAS was higher for parental answers than for those given by the children. This finding is probably observed because the scale has been developed and validated to evaluate the pattern of parental responses concerning their eating practices during their children's meals. In addition, although parents believe they are engaging in certain behaviors, the effectiveness of these strategies may not be recognized by their children. Very low intraclass correlation coefficients were observed between parents' and children's answers to the original domains of the PMAS (ICC: 0.130-0.578), suggesting that the factorial structure of the PMAS may only be used to assess parental behavior, as it is not sufficiently accurate to assess the children's understanding of parent mealtime actions.

Insulin resistance in obese children and adolescents / Resistência à insulina em crianças e adolescentes obesos

OBJECTIVE: To evaluate the presence of insulin resistance and its association with other metabolic abnormalities in obese children and adolescents. METHODS: Retrospective study of 220 children and adolescents aged 5-14 years. Anthropometric measurements were performed (weight, height, and waist circumference) and clinical (gender, age, pubertal stage, and degree of obesity) and biochemical (glucose, insulin, total cholesterol, and fractions, triglycerides) data were analyzed. Insulin resistance was identified by the homeostasis model assessment for insulin resistance (HOMA-IR) index. The analysis of the differences between the variables of interest and the HOMA-IR quartiles was performed by ANOVA or Kruskal-Wallis tests. RESULTS: Insulin resistance was diagnosed in 33.20% of the sample. It was associated with low levels of high-density lipoprotein cholesterol (HDL-C; p = 0.044), waist circumference measurement (p = 0.030), and the set of clinical and metabolic (p = 0.000) alterations. Insulin-resistant individuals had higher mean age (p = 0.000), body mass index (BMI; p = 0.000), abdominal circumference (p = 0.000), median triglycerides (p = 0.001), total cholesterol (p ≤ 0.042), and low-density lipoprotein cholesterol (LDL-C; p ≤ 0.027); and lower HDL-C levels (p = 0.005). There was an increase in mean BMI (p = 0.000), abdominal circumference (p = 0.000), and median triglycerides (p = 0.002) as the values of HOMA -IR increased, with the exception of HDL-C, which decreased (p = 0.001). Those with the highest number of simultaneous alterations were between the second and third quartiles of the HOMA-IR index (p = 0.000). CONCLUSION: The results confirmed that insulin resistance is present in many obese children and adolescents, and that this condition is associated with alterations that represent an increased risk for developing metabolic disorders in adulthood. .

OBJETIVO: Avaliar a presença de resistência à insulina e sua relação com outras alterações metabólicas, em crianças e adolescentes obesos. MÉTODOS: Estudo retrospectivo de 220 crianças e adolescentes de 5 a 14 anos. Foram realizadas avaliações antropométricas (peso, estatura e circunferência abdominal), clínicas (sexo, idade, estágio puberal e grau de obesidade) e bioquímicas (glicemia, insulina, colesterol total e frações, triglicerídeos). A resistência à insulina foi identificada pelo índice HOMA-IR. A análise das diferenças entre as variáveis de interesse e os quartis do HOMA-IR foi realizada pelos testes ANOVA ou Kruskal-Wallis. RESULTADOS: A resistência à insulina foi diagnosticada em 33,20% da amostra. Associou-se a níveis baixos de HDL-C (p = 0,044), medida da circunferência abdominal aumentada (p = 0,030) e ao conjunto de alterações clínicas e metabólicas (p = 0,000). Os indivíduos resistentes apresentaram maiores médias de idade (p = 0,000), IMC (p = 0,000), medida da circunferência abdominal (p = 0,000) e maiores medianas de triglicerídeos (p = 0,001), colesterol total (p ≤ 0,042), LDL-C (p ≤ 0,027) e menores de HDL-C (p = 0,005). Houve aumento das médias de IMC (p = 0,000), medida da circunferência abdominal (p = 0,000) e mediana de triglicerídeos (p = 0,002) à medida que os valores do HOMA-IR se elevavam, com exceção dos níveis de HDL-C que diminuíram (p = 0,001). Aqueles que apresentaram o maior conjunto de alterações simultâneas estavam entre o segundo e terceiro quartis do HOMA-IR (p = 0,000). CONCLUSÃO: Os resultados confirmaram que a resistência à insulina está presente em muitas crianças e em muitos adolescentes obesos, e ...

Insulin resistance in obese children and adolescents.

OBJECTIVE: To evaluate the presence of insulin resistance and its association with other metabolic abnormalities in obese children and adolescents. METHODS: Retrospective study of 220 children and adolescents aged 5-14 years. Anthropometric measurements were performed (weight, height, and waist circumference) and clinical (gender, age, pubertal stage, and degree of obesity) and biochemical (glucose, insulin, total cholesterol, and fractions, triglycerides) data were analyzed. Insulin resistance was identified by the homeostasis model assessment for insulin resistance (HOMA-IR) index. The analysis of the differences between the variables of interest and the HOMA-IR quartiles was performed by ANOVA or Kruskal-Wallis tests. RESULTS: Insulin resistance was diagnosed in 33.20% of the sample. It was associated with low levels of high-density lipoprotein cholesterol (HDL-C; p=0.044), waist circumference measurement (p=0.030), and the set of clinical and metabolic (p=0.000) alterations. Insulin-resistant individuals had higher mean age (p=0.000), body mass index (BMI; p=0.000), abdominal circumference (p=0.000), median triglycerides (p=0.001), total cholesterol (p≤0.042), and low-density lipoprotein cholesterol (LDL-C; p≤0.027); and lower HDL-C levels (p=0.005). There was an increase in mean BMI (p=0.000), abdominal circumference (p=0.000), and median triglycerides (p=0.002) as the values of HOMA -IR increased, with the exception of HDL-C, which decreased (p=0.001). Those with the highest number of simultaneous alterations were between the second and third quartiles of the HOMA-IR index (p=0.000). CONCLUSION: The results confirmed that insulin resistance is present in many obese children and adolescents, and that this condition is associated with alterations that represent an increased risk for developing metabolic disorders in adulthood.

Preliminary validation of the Parent Mealtime Action Scale and its association with food intake in children from São Paulo, Brazil.

The present study aimed to translate the Parent Mealtime Action Scale (PMAS) into Portuguese and to evaluate the factorial structure and the psychometric characteristics of this version. Further, we investigated the associations between parent mealtime actions and the intake of fruits, vegetables and energy-dense foods in 6-10years-old children from São Paulo city, Brazil, controlling for potential confounding variables. A total of 582 parents (86% mothers) answered questions regarding their mealtime actions, their children's food intake, the characteristics of the family meals and their socioeconomic conditions. Factorial analyses grouped all of the 31 questions in the same factors as the original scale, except one item that was transferred to another dimension. Internal reliability and reproducibility analyses obtained satisfactory results. Children who ate fruits and vegetables more frequently had parents who often ate these foods and made them available; these parents also seldom offered their children special meals. Children who more often consumed energy-dense foods had parents who frequently ate this type of food and rarely set limits on its intake. The Portuguese version of the PMAS may be a good tool for evaluating the influence of parent mealtime actions on Brazilian children's food intake.

Padrões alimentares de adolescentes na cidade de São Paulo / Eating patterns of eutrophic and overweight adolescents in the city of São Paulo, Brazil

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.

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.

Sedentarismo e variáveis clínico-metabólicas associadas à obesidade em adolescentes / Inactivity and clinical and metabolic variables associated with adolescent obesity

OBJETIVO: Estudar a associação da obesidade com variáveis metabólicas, variáveis clínicas e sedentarismo, em adolescentes pós-púberes de escolas públicas de São Paulo. MÉTODOS: Estudo caso-controle com 128 adolescentes obesos (índice de massa corporal > percentil 95) e 151 adolescentes eutróficos (índice de massa corporal entre percentis 5 e 85). Foram realizados exame físico, avaliação bioquímica e de composição corporal. RESULTADOS Por meio da análise de variância, foi identificado um gradiente nos valores médios das variáveis metabólicas e clínicas com piora dessas variáveis em paralelo ao aumento do grau de sedentarismo, o que foi confirmado pelo teste qui-quadrado. Na análise bivariada de riscos para obesidade, os adolescentes obesos apresentaram maiores frequências de sedentarismo, de alterações nos níveis de lipoproteína de alta densidade e triglicérides, de hiperinsulinemia e homeostasis model assessment for insulin resistence alterado, e de pressão arterial alterada (p<0,05). O modelo logístico múltiplo mostrou associações entre obesidade e variáveis de sedentarismo (OR=2,23), lipoproteína de alta densidade reduzida (OR=3,05), pressão arterial alterada (OR=3,57), triglicerídeos aumentados (OR=4,13) e homeostasis model assessment for insulin resistence aumentado (OR=11,65). CONCLUSÃO: Sedentarismo, lipoproteína de alta densidade reduzida, hipertrigliceridemia, resistência insulínica e hipertensão estão fortemente associados com a obesidade em adolescentes. Estratégias para redução do peso corporal por meio de mudanças nos hábitos de vida devem fazer parte das políticas e programas de saúde pública, especialmente para essa faixa etária.

OBJECTIVE: This study investigated the association of obesity with metabolic and clinical variables and inactivity in post-pubertal adolescents attending public schools in São Paulo City. METHODS: This was a case-control study with 128 obese adolescents (body mass indices >the 95th percentile), and 151 normal weight adolescents (body mass indices between the 5th and 85th percentiles). Physical examination and biochemical and body composition assessments were done. A pretested questionnaire was administered, generating an inactivity score. Analysis of variance was performed with multiple comparison tests (Bonferroni and Pearson's chi-Square). A multiple regression model was used to ascertain the association among clinical variables, metabolic variables, inactivity score and nutritional status. RESULTS: Analysis of variance allowed the identification of a gradient of mean metabolic and clinical variables which worsened as activity decreased, confirmed by the chi-square test. In the bivariate analysis for obesity risk, obese adolescents were more frequently inactive, presented low high-density lipoprotein and high triglyceride levels, hyperinsulinemia, high homeostasis model assessment for insulin resistance, and high blood pressure (p<0.05). The multiple logistic model showed associations between obesity and inactivity (OR=2.23), low high-density lipoprotein levels (OR=3.05), high blood pressure (OR=3.57), high triglyceride levels (OR=4.13) and high homeostasis model assessment for insulin resistance (OR=11.65). CONCLUSION: Inactivity, low high-density lipoprotein, hypertriglyceridemia, insulin resistance and hypertension are strongly associated with obesity in adolescents. Strategies to reduce body weight by changing life habits should be part of public health programs and policies, especially for this age group.

Riscos cardiovasculares em adolescentes com diferentes graus de obesidade / Cardiovascular risks in adolescents with different degrees of obesity / Riesgos cardiovasculares en adolescentes con diferentes grados de obesidad

FUNDAMENTO: Há poucos estudos sobre riscos cardiovasculares em adolescentes com diferentes graus de obesidade. OBJETIVO: Avaliar repercussões metabólicas associadas a diferentes graus de obesidade em adolescentes e seu impacto nos riscos cardiovasculares. MÉTODOS: Estudo transversal com 80 adolescentes obesos, divididos em dois grupos: 2

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: 2

FUNDAMENTO: Existen pocos estudios sobre riesgos cardiovasculares en adolescentes con diferentes grados de obesidad. OBJETIVO: Evaluar repercusiones metabólicas asociadas a diferentes grados de obesidad en adolescentes y su impacto en los riesgos cardiovasculares. MÉTODOS: Estudio transversal con 80 adolescentes obesos, divididos en dos grupos: 2

Mother/child bond in mothers of overweight and eutrophic children: depression and socioeconomic factors / Vínculo mãe/filho de mães de crianças com excesso de peso e eutróficas: depressão e fatores socioeconômicos

Objective: To verify the presence of depression, age, level of schooling, occupation, marital status, number of children and nutritional status (maternal and of the child) in mothers of overweight and eutrophic children and relate the data to mother/child bonding. Methods: A total of 120 mothers of children aged up to 10 years participated; 30 of them were overweight and 30 were eutrophic (low-income bracket); 30 were overweight and 30 eutrophic (high-income bracket). The control group was composed of eutrophic children paired according to sex, age, level of schooling, and social condition. Data collection was made through interviews. The assessment instruments were: Mother/Child Bonding Assessment Protocol and Beck Depression Inventory. The nutritional classification was defined by calculation of the body mass index, as per the curves of the World Health Organization. For statistics, McNemar, X2, and Fisher's exact tests were used. A 5% level of rejection of the null hypothesis was set. Results: There was no significant result between mother/child bonding and the variables studied, or between the presence of depression and level of schooling, marital status, occupation, and maternal nutritional status. Nevertheless, mothers of eutrophic children (high-income bracket) showed less depression than mothers of eutrophic children (low-income bracket). Mothers with three or more children displayed more depression than mothers with less than three children. Mothers under 30 years of age showed more depression than mothers aged 30 years or older. Conclusion: There was no significant result between mother/child bonding and the variables studied, but the bond was compromised in all mothers of the sample. There was a significant result regarding the presence of depression.

Objetivo: Verificar presença de depressão, idade, escolaridade, ocupação, condição marital, número de filhos e condição nutricional (materna e da criança) em mães de crianças com excesso de peso e eutróficas e relacionar dados ao vínculo mãe/filho. Métodos: Participaram 120 mães de crianças (até 10 anos): 30 com excesso de peso e 30 eutróficas (baixa condição econômica); 30 com excesso de peso e 30 eutróficas (alta condição econômica). O Grupo Controle foi composto por crianças eutróficas pareadas por sexo, idade, escolaridade e condição social. A coleta de dados foi realizada por meio de entrevistas. Os instrumentos para avaliação foram: Protocolo de Avaliação do Vínculo Mãe/Filho, Inventário Beck de Depressão. A classificação nutricional foi definida pelo cálculo do índice de massa corporal, de acordo com as curvas da Organização Mundial de Saúde. Para estatística, foram utilizados os testes de McNemar, X2 e exato de Fisher. Fixou-se em 5% o nível de rejeição da hipótese de nulidade. Resultados: Não houve resultado significante entre vínculo mãe/filho e as variáveis estudadas, bem como entre presença de depressão e escolaridade, condição marital, ocupação e condição nutricional materna. Entretanto, mães de crianças eutróficas (alta condição econômica) apresentaram menos depressão que mães de crianças eutróficas (baixa condição econômica). Mães com 3 filhos ou mais apresentaram mais depressão que mães com menos de 3 filhos. Mães com menos 30 anos apresentaram mais depressão que mães com 30 anos ou mais. Conclusão: Não houve resultado significante entre vínculo mãe/filho e as variáveis estudadas, mas seu comprometimento foi alto em todas as mães da amostra. Houve resultado significante de presença de depressão.

Padrões alimentares de adolescentes obesos e diferentes repercussões metabólicas / Dietary patterns of obese adolescents and different metabolic effects

OBJETIVO: Avaliar a associação de padrões alimentares com alterações metabólicas em adolescentes obesos. MÉTODOS: Estudo transversal envolvendo 76 estudantes (ambos os sexos, 14-19 anos, IMC³P95 e Tanner ³4) de escolas públicas da cidade de São Paulo, Brasil. Foram coletados dados antropométricos e bioquímicos, e aplicados questionários com informações sociodemográficas e registro alimentar de 4 dias, entre 2006 e 2007. Escores fatoriais foram obtidos na análise fatorial e, após ajustes, três padrões alimentares identificados foram associados a fatores de risco biológico por regressão linear múltipla. RESULTADOS: O padrão Tradicional (arroz e massas, feijões, carnes vermelhas, embutidos, óleos e doces) foi positivamente associado com insulina, glicemia e triglicérides e negativamente associado com lipoproteína de alta densidade. O padrão Em Transição (peixe, aves, ovos, pães, manteiga, leite e derivados, hortaliças, frutas, sucos de frutas e açúcar refinado) apresentou as mesmas associações, além de associação similar com a pressão arterial diastólica. O padrão Fast Food (cafeteria, hambúrguer, maionese, bolacha, bolos e tortas, chocolate e refrigerantes) apresentou associação positiva com o colesterol, lipoproteína de baixa densidade e pressão arterial sistólica e diastólica, e associação negativa com insulina e lipoproteína de alta densidade. CONCLUSÃO: Os padrões Tradicional e Em transição apresentaram associações diferentes com o metabolismo lipídico e glicídico quando comparados com o padrão Fast Food. Os três padrões podem ser considerados obesogênicos, porém o padrão Fast Food pareceu ser o mais aterogênico e promotor de hipertensão arterial.

OBJECTIVE: This study assessed the association between dietary patterns and metabolic changes in obese adolescents. METHODS: This was a cross-sectional study of 76 students (both genders, 14-19 years old, BMI³P95 and Tanner stage ³4) enrolled in public schools from 2006 to 2007 in São Paulo city, Brazil. A sociodemographic questionnaire and 4-day food record were administered and anthropometric and biochemical data were collected. Scores for dietary patterns were assessed by factor analysis and after potential confounders were controlled, multilinear regression was used to associate the three identified patterns with biological risk factors. RESULTS: The Traditional Pattern (rice and cereals, beans, red meat, sausage, oils and sweets) was positively associated with insulin, blood glucose and triglycerides and negatively associated with high-density lipoprotein. The In-Transition pattern (fish, poultry, eggs, bread, butter, milk and dairy products, vegetables, fruits, fruit juice and white sugar), presented the same positive associations in addition to an association with diastolic blood pressure. The Fast Food pattern (high fat bakery products, hamburger, mayonnaise, cookies and crackers, chocolate and sodas) presented a positive association with cholesterol, low-density lipoprotein, systolic and diastolic blood pressure and a negative association with insulin and high-density lipoprotein. CONCLUSION: The Traditional and In-Transition patterns were differently related to glucose and lipid metabolism when compared with the fast food pattern. The three patterns could be considered obesogenic, however the Fast Food pattern seems to be the most atherogenic and promoter of hypertension.

Mother/child bond in mothers of overweight and eutrophic children: depression and socioeconomic factors.

OBJECTIVE: To verify the presence of depression, age, level of schooling, occupation, marital status, number of children and nutritional status (maternal and of the child) in mothers of overweight and eutrophic children and relate the data to mother/child bonding. METHODS: A total of 120 mothers of children aged up to 10 years participated; 30 of them were overweight and 30 were eutrophic (low-income bracket); 30 were overweight and 30 eutrophic (high-income bracket). The control group was composed of eutrophic children paired according to sex, age, level of schooling, and social condition. Data collection was made through interviews. The assessment instruments were: Mother/Child Bonding Assessment Protocol and Beck Depression Inventory. The nutritional classification was defined by calculation of the body mass index, as per the curves of the World Health Organization. For statistics, McNemar, χ2, and Fisher's exact tests were used. A 5% level of rejection of the null hypothesis was set. RESULTS: There was no significant result between mother/child bonding and the variables studied, or between the presence of depression and level of schooling, marital status, occupation, and maternal nutritional status. Nevertheless, mothers of eutrophic children (high-income bracket) showed less depression than mothers of eutrophic children (low-income bracket). Mothers with three or more children displayed more depression than mothers with less than three children. Mothers under 30 years of age showed more depression than mothers aged 30 years or older. CONCLUSION: There was no significant result between mother/child bonding and the variables studied, but the bond was compromised in all mothers of the sample. There was a significant result regarding the presence of depression.

Cardiovascular risks in adolescents with different degrees of obesity.

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 (p<0.05). The adolescents with the higher degree of obesity presented higher frequencies of alterations for glycemia, HOMA-IR, triglycerides, HDL and BP (p<0.05). The logistic model showed associations between the degree of obesity and the variables: HDL (OR=5.43), BP (OR=4.29), TG (OR=3.12). The risk score demonstrated that 57.7% of the adolescents with higher degrees of obesity had two or more metabolic alterations versus 16.7% from the other group (p<0.001). CONCLUSION: The degree of obesity influenced the onset of alterations that comprise the metabolic syndrome, increasing the cardiovascular risk.

Estado nutricional e fatores de risco cardiovascular em crianças e adolescentes filhos ou netos de coronariopatas jovens / Nutritional status and cardiovascular risk factors in children and adolescents children or grandchildren of young coronary disease

Objetivo: Avaliar o estado nutricional e sua relação com fatores de risco cardiovascular em filhos ou netos de coronariopatas jovens. Método: Estudo transversal com 100 crianças e adolescentes, de 5 a 17 anos, filhos ou netos de coronariopatas jovens. As variáveis estudadas foram: sexo, idade, peso, estatura, índice de massa corporal (IMC), circunferência abdominal, estado nutricional, pressão arterial, presença de síndrome metabólica, hábitos alimentares, prática de atividades física, resultados de exames laboratoriais (glicemia, colesterol total e frações, triglicérides). Para analisar as associações entre as variáveis estudadas foi utilizado o teste exato de Fisher, com nível de significância de 5%. Resultados: Quanto ao estado nutricional, observou-se que 60% deles eram eutróficos e 40% apresentavam excesso de de peso. Na avaliação dos exames, 29% tinham colesterol total aumentado, 8% LDL aumentado, 45% HDL baixo e 13% triglicérides aumentados. No grupo com excesso de peso, foram mais elevados os percentuais de triglicérides aumentados (p=0,005) e de circunferência abdominal aumentado (p<0,001); 22,5% apresentavam pressão arterial alterada e 5% glicemia alterada. O sedentarismo esteve presente em 40% deles e 87% apresentavam ingestão excessiva de gorduras aterogênicas. Além da história familiar positiva para doença coronariana, 30% da população estudada apresentava mais de dois fatores de risco cardiovascular e 41% mais de três. Conclusão: A associação de fatores de risco cardiovascular entre as crianças e os adolescentes, filhos ou netos de coronariopatas jovens, deste estudo, confirmam a influência da história familiar e a sua contribuição no risco para o desenvolvimento das doenças cardiovasculares.

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.

Obesidade e fatores de risco cardiovascular em adolescentes de escolas públicas / Obesity and cardiovascular risk factors in adolescents attending public schools

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 < 35 mg/dl (OR = 3,41; IC: 1,24-9,38), triglicérides > 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 por cento tinham mais do que três fatores de risco, enquanto que entre os eutróficos, este percentual foi de 6,12 por cento. 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.

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 < 35 mg/dl (OR = 3.41; CI: 1.24-9.38), triglycerides > 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 percent had more than three risk factors, whereas this percentage dropped to 6.12 percent 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.

Síndrome metabólica: comparação de critérios diagnósticos / Metabolic syndrome: comparison of diagnosis criteria

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 por cento, 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.

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 percent 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.

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 < 35 mg/dl (OR = 3.41; CI: 1.24-9.38), triglycerides > 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.

Atherosclerosis prevention and treatment in children and adolescents.

The atherosclerotic process starts in childhood and studies show its development in fetuses. Clinical manifestation often occurs only in the sixth decade of life. Adolescence is a critical period in the development of atherosclerosis, because fatty streaks may change to transition plaque owing to genetic and environment factors. Healthcare by professionals plays a crucial role in the prevention and treatment of atherosclerosis, identifying poor lifestyle, positive family history of early cardiovascular disease, or other diseases such as dyslipidemia, obesity, arterial hypertension and diabetes. Dyslipidemia in childhood and adolescence should be treating by dietary therapy and change in lifestyle. Children with high-risk lipid abnormalities should be considered for drug treatment.