Diet quality and nutritional status in children with human immunodeficiency virus.

Background: Poor diet quality in children and adolescents may contribute to decreased immunity and lead to an increased risk of opportunistic diseases. Aim: To investigate diet quality and its relationship to nutritional status in human immunodeficiency virus (HIV)-infected pediatric patients (HIV-PIHIV). Methods: We conducted a cross-sectional study with 87 patients aged between 6 and 19 years carried out in two University Hospitals. Diet quality was analyzed by an adapted Healthy Eating Index (HEI) and nutritional status. The association between HEI with body mass index-for-age (BMI-for-age) and height-for-age was performed using a linear regression model. Clinical, maternal, anthropometric, and dietary data were collected through a semi-structured questionnaire, based on nutrition service protocols. Results: Diet quality was intermediate (median IAS = 54.8 interquartile range: 47.5 to 65.9 points), due to low consumption of fruits, vegetables, and dairy products and high empty calories and sodium by the PPIHIV. The multivariate regression model indicated that HEI was not significant for explaining BMI-for-age [ß = -0.01; 95% CI = (-0.03; 0.01); p 0.40] nor height-for-age [ß = 0.01; 95% CI = (-0.02; 0.03); p 0.51]. However, it was observed that adolescents showed 1 Z-score [95% CI = (-1.6; -0.44); p 0.001] a reduction in BMI-for-age compared with children, and those black patients showed an increase in BMI-for-age Z-score of 0.57 [95% CI = (0.7; 1.1); p 0.03] compared with non-blacks. Conclusion: The diet quality of the HIV-infected children and adolescents was below desired. No association was found between diet quality and inadequate nutritional status of HIV-PIHIV.

Treatment of childhood obesity based on the reduction of ultra-processed foods plus energy restriction: A randomised controlled trial based on the Brazilian guidelines.

Reducing ultra-processed foods (UPF) improves diet quality and may curb energy consumption. This study aimed to compare an intervention based on the reduction of UPF, according to the Dietary Guideline for the Brazilian Population (DGBP), with and without advice on energy intake. A parallel and randomised controlled trial was carried out with children with obesity from 7 to 12 years old. Both control (CG) and intervention groups (IG) participated monthly in 6 standardised educational activities based on the 10 steps of the DGBP. An individualised food plan was also provided to the IG. The rate of change for body mass index (BMI), waist circumference, body weight, and UPF consumption were investigated based on mixed-effect models. At the end of the study, the BMI declined in the IG (Δ = -0.27 kg/m2) compared to the CG (Δ = + 0.53 kg/m2) (p = .0002). Both groups showed a decline in grams of UPF until the fourth month and a gradual increase in the following months. Combining the qualitative approach of the DGBP with counselling on energy restriction through the diet plan proved to be effective in reducing childhood obesity. Clinical Trial Registration: This trial is registered at the Brazilian Registry of Clinical Trials (REBEC), under the RBR-3st5sn registry, available at http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn/. The datasets generated by the current study are not publicly available but are available from the corresponding author on reasonable request.

Physical and social activities constraint and its effects on Body Mass Index of former Neonatal Intensive Care children.

OBJECTIVE: It is reported weight gain in children due to the confinement measures during the Covid-19 pandemic. We aimed to describe the effect of these measures on the nutritional status of former Neonatal Intensive Care Unit children. METHODS: Cross-sectional study, including former Neonatal Intensive Care Unit children. The outcome was the Body mass index (BMI). RESULTS: We enrolled 126 children (74.6 % preterm; 31 % small-for-gestational-age). Weight excess was greater in the youngest group (≤5 years: 33.8 %; >5 years: 15.2 %). Prematurity was associated with weight excess in both groups (≤5 years: p value 0.006; >5 years: p value 0.046; Pearson test). Mealtime changes, lack of physical activity, socioeconomic factors and the perinatal morbidities significantly influenced the mean BMI. Birth length Z score less than -1.28 was negatively associated with BMI, while gestational age at birth presented a positive association with BMI (linear regression model). CONCLUSIONS: The BMI increase due to the confinement measures associated with the gestational age at birth and in those born with intrauterine growth restriction is a matter of concern, as it might indicate a risk for future obesity.

Effect of intake of iron-fortified milk on levels of ferritin and hemoglobin in preschoolers: A systematic review and meta-analysis.

BACKGROUND: Food fortification is often the simplest way to increase iron intake on a broad and sustainable basis. It is one of the most cost-effective global development efforts. OBJECTIVE: To systematize data from randomized and nonrandomized controlled trials investigating the effect of consumption of iron-fortified milk (IFM) on serum iron status in preschoolers. METHODS: The trials were systematically searched in five electronic databases that evaluated the effect of iron-fortified milk (IFM) consumption on hemoglobin and ferritin in children aged 1-6 years. The randomized the meta-analysis model was used to calculate total and stratified effects. RESULTS: Seven trials representing 1210 preschoolers showed a significant effect of IFM on hemoglobin [difference in means (MD) 0.33 g/dL (95% CI 0.23, 0.44; I2 = 3.85%, p (Q statistic) < 0.01)] and ferritin concentrations [effect size (SMD) 0.57 (95% CI 0.19, 0.95; I2 = 84.63%, p (Q statistic) < 0.01)]. In stratified analyses, hemoglobin showed an increase when subjects received iron with other co-interventions [MD 0.35 g/dL (95% CI 0.22, 0.48; I2 = 11.01%; p (Q statistic) = 0.36)]; and when the iron dose was above 5 mg/day [MD 0.34 g/dL (95% CI 0.23, 0.45; I2 = 2.33%; p (Q statistic) = 0.37)] and the intervention time was over 6 months [MD 0.39 g/dL (95% CI 0.18, 0.60; I2 = 37.90%; p (Q statistic) = 0.20)]. For ferritin, stratified analyses showed a larger effect size when they used dose higher than 5 mg/day [SMD 0.60 (95% CI 0.02, 1.18; I2 = 91.06, p (Q statistic) < 0.01)] and intervention was conducted longer than 6 months [SMD 0.96 (95% CI - 0.16, 1.76; I2 = 93.38%, p (Q statistic) < 0.01)]. CONCLUSIONS: Our findings indicate that although milk iron fortification modestly increases serum hemoglobin levels or the effect size of serum ferritin of participants, it cannot be considered in the coadjuvant treatment for anemia. Register: CRD42020213604.

Prevalence of vitamin B complex deficiencies in women in reproductive age, pregnant, or lactating woman in Brazil: a systematic review and meta-analysis protocol.

BACKGROUND: Vitamin B deficiencies are involved with several outcomes in fertility and pregnancy. In Brazil, the national prevalence rates of these micronutrient deficiencies in women of reproductive age were not known. This study aims to systematically identify, select, evaluate, analyze, and report the prevalence rates of vitamin B complex deficiencies in women of reproductive age in Brazil and identify variables that may modify the outcome rates. METHODS: A systematic review will be conducted guided by the following question: "What is the prevalence of vitamin B deficiencies in women of reproductive age in Brazil?". The studies will be identified and selected from a literature search using electronic databases, consultation with researchers/specialists, and reference lists of eligible studies and reviews on the topic. Major eligibility criteria include observational cross-sectional and cohort studies carried out in Brazil and performed in women 10-49 years old, or pregnant and lactating mothers, and investigated the deficiency of vitamin B complex by laboratory test. Two reviewers independently will perform the screening and selection of the studies, data extraction, and risk of bias assessment. For the data report, a narrative approach will be used to present the characteristics of the included studies and individual findings. A random meta-analysis model will be implemented to summarize the individual prevalence rates in a global value if the studies are sufficiently homogeneous. DISCUSSION: This study aims to identify the national and regional prevalence rates of vitamin B complex deficiencies in women of reproductive age; allow the policymakers discuss, plan, and implement public policies to screen; and prevent and/or treat these malnutrition conditions. This also aims to know the rates of nutritional deficiencies over the years, serving as an indirect indicator of the socioeconomic and dietary patterns of the population. Specifically for folate, this study allows to compare the prevalence rates of deficiency of this vitamin before and after the mandatory fortification of wheat and corn flours implemented since 2004 in Brazil, in this specific population. The evidence gathered may highlight the need for population-based studies to investigate the deficiency of these vitamins. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020188474.

Food practices and nutritional status of university students who use the University Restaurant / Práticas alimentares e o estado nutricional entre estudantes universitários usuários do Restaurante-Escola

ABSTRACT Objective To evaluate the food practices and nutritional status of students who use the University Restaurant at a public university. Methods This is a cross-sectional study carried out with 958 university students. Data related to regular eating practices (≥5 times/week), routine food consumption and nutritional status were collected. The association between University Restaurant attendance and dietary practices and body mass index was reviewed by bivariate logistic regression model and multiple regression. Results Students who attended the University Restaurant three or more times a week were more likely to regularly consume beans (OR: 1.35, p=0.041) and fresh salad (OR: 1.77, p<0.001) and less likely to have afternoon snack (OR: 0.68; p=0.008). In addition, an association between soda consumption and overweight was observed. Conclusion Thus, the importance of strategies that seek to promote incentives for healthy eating and lifestyle practices in the university population become evident.

RESUMO Objetivo O objetivo do estudo foi avaliar as práticas alimentares e o estado nutricional de estudantes usuários do restaurante-escola em uma universidade pública. Métodos Trata-se de um estudo transversal realizado com 958 estudantes universitários. Foram coletados dados relacionados às práticas alimentares regulares (≥5 vezes/semana), à rotina alimentar e ao estado nutricional. A associação entre a frequência de ida ao restaurante-escola, práticas alimentares e índice de massa corporal foi analisada por modelo de regressão logística bivariada e regressão múltipla. Resultados Os estudantes que frequentaram o restaurante-escola 3 ou mais vezes por semana apresentaram maiores chances de consumir regularmente feijão (OR: 1,35, p=0,041) e salada crua (OR: 1,77, p<0,001) e menos chances de realizar o lanche da tarde (OR: 0,68; p=0,008). Além disso, foi observada associação entre o consumo de refrigerante e o excesso de peso. Conclusão Dessa forma, evidencia-se a importância de estratégias que busquem promover incentivos a práticas alimentares e de vida saudáveis na população universitária.

Conflict of Interests in the Scientific Production on Vitamin D and COVID-19: A Scoping Review.

The use of scientific evidence to support the process of formulating and implementing public policies might be biased by studies funded by the pharmaceutical and food industry, which more often than not meet corporate interests. This review aimed to analyze the occurrence of conflict of interest (COI) in academic production regarding vitamin D and COVID-19, considering the facility offered during the pandemic for academic publications of heterogeneous quality. A scoping review of observational studies published in Medline, Lilacs, and Google Scholar databases was carried out. The selected studies were published between December 2019 and August 2021, focused on the relationship between vitamin D and prevention or treatment of COVID-19 in non-institutionalized individuals, with no language restrictions. Twenty-nine studies met eligibility criteria. COI was disclosed in five papers and further identified by review authors in eight other papers, meaning COI was present in thirteen papers (44.8%). Studies were funded by companies in the diagnostics, pharmaceutical and food sectors. Conclusions favorable to vitamin D supplementation were more prevalent in papers where COI was identified (9/13, 69.2%) than among papers where COI was not found (4/16, 25.0%). Omissions of disclosure of COI, funding source, and sponsor functions were observed. The identification of possible corporate political activities in scientific papers about vitamin D published during the COVID-19 pandemic signals a need for greater transparency and guideline development on the prevention of COI in scientific production.

Comparison of growth curves in very low birth weight preterm infants after hospital discharge.

Monitoring preterm infants' growth is essential to ensure the best prognosis for their growth and development. We aimed to compare growth curves in very low birth weight preterm infants after hospital discharge. In this retrospective longitudinal study, 178 preterm infants' growth was assessed by z-scores for weight for age and length to age and compared between Fenton and Kim and Intergrowth-21st charts from hospital discharge until 50 weeks postnatal, and between Intergrowth-21st and WHO charts, 50 and 64 weeks postnatal. The Kappa test was used to evaluate the agreement of the number of cases classified above or below the -2 Z-score concerning weight-for-age and length-for-age indicators to each proposed curve. Our results found that the agreement between Fenton and Kim and Intergrowth-21st curves was almost perfect for most of the weeks investigated, except 35-38 (k = 0.79) and 47-50 (k = 0.61) weeks postnatal. When evaluating the agreement between WHO and Intergrowth-21st, it was substantial for most of the weeks investigated, except for 55-58 and 69-64 weeks postnatal, in which the agreement was almost perfect (k = 0.84; k = 0.81, respectively). Furthermore, we observed that Fenton and Kim curve identified 8.4% and WHO, 5.8% more cases of preterm infants below -2 z than Intergrowth-21st.Conclusion: Although the agreement of the curves was substantial to almost perfect, the Fenton and Kim and WHO curve seem to identify more cases of preterm infants compared to the Intergrowth-21st, a finding that deserves more in-depth investigation in clinical practice. What is Known: • The adequate interpretation of postnatal growth depends on the standard growth chart. • Studies comparing the classification of anthropometric indicators of preterm infants between growth curves consider only the period from birth to hospital discharge. What is New: • This is the first study that compares the classification of weight-for-age and length-for-age indicators of VLBW preterm infants between Intergrowth-21st and Fenton and Kim curves until 64 weeks postnatal. • Substantial to almost perfect agreement of length-for-age indicator was found between the two growth curves of preterm infants during outpatient follow-up.

The Cardiovascular Health Integrated Lifestyle Diet (CHILD) Lowers LDL-Cholesterol Levels in Brazilian Dyslipidemic Pediatric Patients.

OBJECTIVE: To analyze the impact of the CHILD-2 diet on the lipid profile of Brazilian children and adolescents with dyslipidemia. METHODS: This is a quasi-experimental study, where 149 participants (5-17 years) with mild-to-moderate hypercholesterolemia were divided into two groups (GI: low or normal weight; n = 58 and GII: overweight; n = 91). Both groups underwent the CHILD-2 diet, characterized by 25-30% total fat and less than 7% of low-saturated fat (SF) for 6 months. Changes from baseline in the lipid profile, including Total cholesterol (TC), LDL-C, triacylglycerols and glucose concentrations, dietary and anthropometric data were examined at 3 and 6 months. Longitudinal analyses were performed using linear mixed-effects models in SAS. RESULTS: Serum LDL-C concentrations reduced over time compared with baseline (Δ = -5.1 mg/dL; p < 0.01), with no difference between groups (p = 0.35). TC concentrations decreased by -2.0 mg/dL (p < 0.01); but no difference was observed between groups. We found no significant changes in body mass index/age Z scores after a dietary intervention compared with baseline in both groups (p = 0.94). CONCLUSION: Despite the modest reduction, our findings confirm that children with dyslipidemia can benefit from the CHILD-2 diet combined with a healthy lifestyle.

Eating habits of children and adolescents during the COVID-19 pandemic: The impact of social isolation.

BACKGROUND: The social isolation enforced as a result of the new coronavirus (COVID-19) pandemic may impact families' lifestyle and eating habits. The present study aimed to assess the behaviour and dietary patterns of Brazilian children and adolescents during the social isolation imposed by the COVID-19 pandemic. METHODS: The present study was conducted using an online, anonymous cross-sectional survey with 589 children and 720 adolescents from Brazil during a nationwide social isolation policy. The Mann-Whitney U-test or the Kruskal-Wallis with the Dunn post-hoc method and a radar chart were used to compare the weekly consumption of each food by age group and isolation status. p < 0.05 was considered statistically significant. Analyses were conducted using R statistical software, version 4.0.2 (R Foundation for Statisitical Computing). RESULTS: We found that isolated families showed breakfast eating habits and the consumption of raw salad, vegetables, beans and soft drinks. Lower-class isolated families and those from the Northeast region consumed fruits, juices, vegetables and beans less frequently. Compared to children, adolescents were less isolated (p = 0.016), less active (p < 0.001), exposed to longer screen time (p < 0.001), showed an inadequate sleeping pattern (p = 0.002) and were from lower-class families (p < 0.001). CONCLUSIONS: Social isolation affected the eating habits of children and adolescents. Non-isolated families presented a lower consumption of healthy food, especially those among the lower class, from Northeast Brazil, as well as adolescents.

Effect of phytosterol capsule supplementation associated with the National Cholesterol Education Program Step 2 diet on low-density lipoprotein in children and adolescents with dyslipidemia: A double-blind crossover trial.

OBJECTIVE: To evaluate the effect of phytosterol capsule supplementation associated with the National Cholesterol Education Program (NCEP) Step 2 diet on LDL-C levels in children and adolescents with dyslipidemia. METHODS: This is a randomized, double-blind, crossover trial conducted with children and adolescents (n = 31; mean ± SD, age 9.0 ± 2.22 years, BMI zscore 1.65 ± 1.47 kg/m2) with dyslipidemia. After a run-in period, the participants were randomly allocated to control or intervention groups. The intervention group received capsules containing 1.5 g/day of phytosterols, and the control group received capsules containing 2 g/day of sunflower oil for 8 weeks. Patients in both groups were instructed to follow the NCEP Step 2 diet during the study. The primary outcome was LDL-C and secondary outcomes were total cholesterol (TC), HDL-C, triglyceride, insulin, blood pressure, and anthropometric measures. Intention-to-treat analyses were performed using the proc mixed procedure in SAS. RESULTS: The rate of change for LDL-C was not different between intervention and control groups (p=0.30). No significant reduction was also observed for TC (p=0.47), HDL-C (p=0.97), insulin (p=0.27), triglycerides (p=0.38), systolic blood pressure (p=0.11), and diastolic blood pressure (p=0.57) compared to control group. Although we observed a high adherence to the capsule intake (95.7% in phytosterol and 93.8% in the control group), the low adherence to the diet may have contributed to explaining the results. CONCLUSION: Daily phytosterol capsules supplementation associated with the NCEP Step 2 diet did not reduce LDL-cholesterol concentrations in children and adolescents with dyslipidemia.

Protein and energy intake and nutritional evolution of preterm infants after hospital discharge: A longitudinal study.

BACKGROUND: Preterm infants, especially those with very low birth weight, are more susceptible to nutritional deficiencies and growth restriction after hospital discharge than term infants. AIMS: To investigate the association between energy and protein intake and nutritional evolution of preterm infants during the first year of life of corrected age after hospital discharge. STUDY DESIGN: This is a retrospective longitudinal study with 131 preterm infants born at a high-risk neonatal clinic. SUBJECTS: Neonates born at <32 weeks of gestational age and with birth weight < 1500 g were included in the study. OUTCOMES MEASURES: Growth was assessed by z-scores for weight- and length-to age. Energy and protein intake were assessed by caloric and protein intake rate per kilogram of body weight. Changes in growth were evaluated according to caloric rate and energy intake using linear mixed-effect models. RESULTS: We found that most of the followed-up children (62.3%) had an average daily energy intake <120 kcal/kg of body weight. At the end of the first year of life based on corrected age, the variation in weight gain was greater among those with more severe nutritional deficit at born and who had daily intakes over 130 kcal/kg of body weight (p=0.02) or over 3.5 g of protein/kg of body weight (p=0.03). CONCLUSION: Individualized dietary plans for preterm infants should be based on the continuous assessment of growth and weight gain.

Treatment of Childhood Obesity Based on Brazilian Dietary Guidelines Plus Energy Restriction (PAPPAS HUPE Study): Protocol for a Randomized Clinical Trial.

BACKGROUND: The Food Guide for the Brazilian Population relies on natural or minimally processed foods mainly of plant origin such as beans and rice with low oil, salt, and sugar content and limited consumption of ultraprocessed foods. Reduction of ultraprocessed foods improves diet quality and energy consumption. OBJECTIVE: The goal of this study is to evaluate the effectiveness of an intervention for the treatment of obesity in children, with counseling based on the Brazilian Food Guide plus control of total energy intake. METHODS: A parallel, randomized clinical trial will include children aged 7 to 12 years. Randomization will be performed in blocks of 10 individuals using computer-generated random sequence numbers. Both the control and intervention groups will participate in 6 standardized educational activities based on the 10 steps of the Brazilian Food Guide. These activities will be conducted at the University Hospital Toy Library, located in the pediatric outpatient clinic. For the intervention group, in addition to the educational activities, an individualized food plan based on the nutritional recommendations of the Brazilian Society of Pediatrics will be prescribed and discussed with the mothers and fathers. The primary outcome of the study will be variations in body mass index, and secondary outcomes will include analysis of insulin resistance, blood pressure, body fat percentage, and waist and neck circumference. RESULTS: This project was funded by the National Council for Scientific and Technological Development in December 2017 (grant no 408333/2017-0). Recruitment began in August 2018 and by September 2019, we had enrolled the 101 participants. In addition to the patients referred by the national system of regulation, recruitment was made by medical outpatient referral and external indication. This is an ongoing study. We expect the results to be published in November 2020. CONCLUSIONS: At the end of the project, in case of a positive result, a protocol for the treatment of obesity based on the Brazilian Food Guide will be proposed to the Unified Health System. A successful method to reduce childhood obesity is expected. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials RBR-3st5sn; http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/16170.

Effects of psyllium on LDL-cholesterol concentrations in Brazilian children and adolescents: a randomised, placebo-controlled, parallel clinical trial.

The present study investigated the LDL-cholesterol (LDL-C)-lowering effects of psyllium in Brazilian dyslipidaemic children and adolescents. A total of fifty-one individuals (6-19 years) with mild-to-moderate hypercholesterolaemia were evaluated by conducting a randomised, double-blind, placebo-controlled, parallel clinical trial. Over an 8-week trial period, the participants were randomly allocated to one of two groups (control: n 25 and psyllium: n 26) using a computer-generated random number sequence. Fasting blood samples, dietary records and anthropometric data were collected. Both groups were treated with the National Cholesterol Education Program Step 2 diet for 6 weeks before randomisation. After this run-in period, a daily supplement of 7·0 g psyllium was given to the intervention group, while an equivalent amount of cellulose was given to the control group. Statistically significant changes between the control and intervention groups over time were observed for total cholesterol (7·7%; - 0·39 mmol/l; P= 0·003) and LDL-C (10·7%; - 0·36 mmol/l; P= 0·01). None of the participants reported any aversion to the smell, taste, appearance or texture of psyllium. No serious adverse effects were reported during the study. In addition to causing a significant reduction in LDL-C concentrations, psyllium therapy was found to be both safe and acceptable for the treatment of hypercholesterolaemic children and adolescents.

[Cardiovascular risk and associated factors in schoolchildren in Belém, Pará State, Brazil]. / Fatores de risco cardiovascular e fatores associados em escolares do Município de Belém, Pará, Brasil.

This cross-sectional study aimed to identify risk factors for cardiovascular disease in a stratified cluster sample of 557 schoolchildren (6-19 years) in Belém, Pará State, Brazil. Potential risk factors were obesity, hypertension, dyslipidemia, diabetes, smoking, physical inactivity, and atherogenic diet. Socio-demographic and lifestyle variables were tested in a binary logistic regression model. The most prevalent risk factors were overweight (20.4%), dyslipidemia (48.1%), and physical inactivity (66.2%). Children below ten years of age and those from higher-income families and with higher maternal schooling showed greater odds of developing overweight; meanwhile, those with overweight were more prone to developing hypercholesterolemia and hypertriglyceridemia. The findings point to the need to implement strategies to prevent overweight in early childhood, through balanced nutrition and regular physical activity, in order to effectively reduce the prevalence of risk factors in schoolchildren.

Dislipidemia e fatores de risco (y factores de riesgo) cardiovascular na (en la) população pediátrica brasileira / Dyslipidemia and cardiovascular risk factors among the pediatric population in Brazil

Os fatores de risco (Los factores de riesgo) (FR) para doenças (enfermedades) cardiovasculares (DCV) não são mais uma (no son más una) exclusividade dos (de los) adultos, e estima-se que tais fatores já atinjam um (ya alcanzan un) quarto das crianças (de los niños) e adolescentes no mundo. O propósito deste estudo foi revisar as prevalências dos principais FR para DCV na (en la) população pediátrica brasileira. Pelo (Con el) método de revisão sistemática, realizou-se a busca de periódicos indexados nas bases Pubmed, Medline, Embase, Lilacs, Cochrane e Scielo publicados no período de 2001 a 2011, utilizando os seguintes (los siguientes) descritores em português e inglês: fatores de risco cardiovascular, hipertensão arterial, diabetes, dislipidemia, obesidade, tabagismo, atividade física, dieta e sedentarismo. Dos 190 resumos (De los 190 resúmenes) encontrados, 28 foram (fueron) selecionados para análise final. Os resultados confirmaram a ocorrência concomitante (aparición concomitante) de vários FR cardiovasculares já na faixa etária (ya en el grupo etario) pediátrica, porém não foi possível (todavía no ha sido posible) comparar sua distribuição entre as regiões brasileiras devido à falta (a causa de la falta) de padronização nos critérios (estandarización de los criterios) e pontos de corte de referência (valores decorte de referencia) e também pela carência (por la ausencia) de estudos realizados nas regiões Norte e Centro-Oeste. Diante destas (Frente a estas) limitações, recomenda-se que as (se recomienda que las) organizações de fomento no Brasil continuem apoiando projetos e (apoyando proyectos y) programas que visem mapear e padronizar os (con vistas a mapear y estandarizar los) critérios metodológicos e epidemiológicos para FR e para DCV, e que estes sejam adequados à (estos sean adecuados a la) população pediátrica, principalmente em regiões carentes de mais estudos...

Fatores de risco cardiovascular e fatores associados em escolares do Município de Belém, Pará, Brasil / Cardiovascular risk and associated factors in schoolchildren in Belém, Pará State, Brazil / Factores de riesgo cardiovascular y los factores asociados en escolares en Belém, Pará, Brasil

Este estudo transversal visou a identificar fatores de risco para doença cardiovascular em uma amostra, estratificada por conglomerados, de 557 escolares (6-19 anos) de Belém, Pará, Brasil. Os fatores de risco investigados foram obesidade, hipertensão arterial, dislipidemia, diabetes, tabagismo, sedentarismo e dieta aterogênica. Variáveis sociodemográficas e relacionadas ao estilo de vida foram testadas no modelo de regressão binária logística. Os fatores de risco prevalentes foram excesso de peso (20,4%), dislipidemia (48,1%) e sedentarismo (66,2%). Constatou-se que os escolares abaixo de dez anos e os provenientes das famílias de maior renda e com maior escolaridade materna apresentaram mais chances de desenvolverem excesso de peso; por sua vez, os escolares com excesso de peso foram os mais propensos a desenvolver hipercolesterolemia e hipertrigliceredemia. Diante desse quadro, faz-se necessária, ainda na primeira infância, a implantação de estratégias para controle de excesso de peso, por meio da alimentação balanceada e da prática física regular, para que se possa reduzir de forma efetiva a prevalência de fatores de risco em escolares nesta cidade.

This cross-sectional study aimed to identify risk factors for cardiovascular disease in a stratified cluster sample of 557 schoolchildren (6-19 years) in Belém, Pará State, Brazil. Potential risk factors were obesity, hypertension, dyslipidemia, diabetes, smoking, physical inactivity, and atherogenic diet. Socio-demographic and lifestyle variables were tested in a binary logistic regression model. The most prevalent risk factors were overweight (20.4%), dyslipidemia (48.1%), and physical inactivity (66.2%). Children below ten years of age and those from higher-income families and with higher maternal schooling showed greater odds of developing overweight; meanwhile, those with overweight were more prone to developing hypercholesterolemia and hypertriglyceridemia. The findings point to the need to implement strategies to prevent overweight in early childhood, through balanced nutrition and regular physical activity, in order to effectively reduce the prevalence of risk factors in schoolchildren.

Este estudio transversal tuvo por objetivo identificar los factores de riesgo para enfermedades cardiovasculares en una muestra de 557 escolares (6-19 años) de Belém, Pará, Brasil, estratificada y por conglomerados. Los factores de riesgo investigados fueron: la obesidad, la hipertensión, la dislipidemia, la diabetes, el tabaquismo, la inactividad física y dieta aterogénica. Las variables sociodemográficas y relacionadas con el estilo de vida se probaron con el modelo de regresión logística binaria. Los factores de riesgo más prevalentes fueron: sobrepeso (20,4%), dislipidemia (48,1%) e inactividad física (66,2%). Se descubrió que los estudiantes menores de 10 años, provenientes de familias con mayores ingresos y mayor educación de la madre eran más propensos a desarrollar sobrepeso y son más propensos a desarrollar hipercolesterolemia y hipertrigliceredemia. En este contexto, es necesario, incluso en la infancia, la implementación de estrategias para controlar el exceso de peso mediante una dieta equilibrada y ejercicio físico regular, puesto que puede reducir eficazmente la prevalencia de factores de riesgo en escolares de esta ciudad.

Dyslipidemia in schoolchildren from private schools in Belém.

BACKGROUND: Currently, childhood dyslipidemia, associated to other non-transmissible diseases such as diabetes, hypertension and obesity, represent a significant public health problem in Brazil. OBJECTIVE: To investigate the prevalence of dyslipidemia in children and adolescents from private schools in the city of Belem, state of Para, Brazil. METHODS: Transversal and prospective study that assessed 437 schoolchildren, paired by sex. The age range was established between 6 and 19 years of age and stratified in four subgroups (6 to 9 years; 10 to 12 years; 13 to 15 years and 16 to 19 years). To obtain the anthropometric variables, weight and height were measured for the calculation of the body mass index and skin folds were measured for the calculation of body fat percentage. The serum lipoprotein profile was obtained through the measurement of total cholesterol, triglycerides, LDL-cholesterol and HDL-cholesterol after a 12-hour fasting period, by enzymatic methods. RESULTS: Of the total number of schoolchildren analyzed, 126 (28.8%) were overweight and 158 (36.2%) presented a high adiposity index. The children (33.6%) presented a higher prevalence of obesity when compared to the adolescents (10.1%; p < 0.001). Regarding the biochemical characteristics, it was observed that 214 (41%) presented some alteration in the lipid profile and that children and adolescents in the age range of 10 to 15 years were the age groups that presented the highest rates of dyslipidemia (34.6% and 25.5%), respectively. CONCLUSION: These findings demonstrate the importance of establishing an early diagnosis of the lipid profile, mainly if it is already associated to another risk factor, such as obesity.

Dislipidemia em escolares na rede privada de Belém / Dislipidemia en escolares del sistema de educación privada de la ciudad de Belém / Dyslipidemia in schoolchildren from private schools in Belém

FUNDAMENTO: Atualmente, a dislipidemia infanto-juvenil associada a outros agravos não transmissíveis como diabete, hipertensão e obesidade representam um grave problema de saúde pública no Brasil. OBJETIVO: Investigar a prevalência de dislipidemia em crianças e adolescentes da rede particular de ensino na cidade de Belém. MÉTODOS: Estudo transversal e prospectivo, no qual foram avaliados 437 escolares pareados por sexo. A faixa etária foi delimitada entre 6 a 19 anos, estratificada em quatro subgrupos (6 a 9 anos; 10 a 12 anos; 13 a 15 anos e 16 a 19 anos). Para obtenção das variáveis antropométricas foram mensurados peso e estatura, para o cálculo do índice de massa corporal; e pregas cutâneas para o cálculo do percentual de gordura. O perfil lipoprotéico sérico foi obtido através da dosagem do colesterol total, triglicerídeo, LDL-colesterol e o HDL-colesterol após 12 horas de jejum, determinado por métodos enzimáticos. RESULTADOS: Do total de escolares analisados 126 (28,8 por cento) apresentaram excesso de peso e 158 (36,2 por cento) índice de adiposidade elevado. As crianças (33,6 por cento) apresentaram maior prevalência de obesidade quando comparadas com os adolescentes (10,1 por cento) (p<0,001). Em relação às características bioquímicas constatou-se que 214 (49 por cento) apresentaram alguma alteração no perfil lipídico e que as crianças e os adolescentes da faixa de 10 a 15 anos foram os grupos etários que apresentaram maiores taxas de dislipidemia (34,6 e 25,5 por cento), respectivamente. CONCLUSÃO: Esses achados demonstram a importância de se diagnosticar precocemente o possível perfil lipídico, principalmente se este já apresentar associação com outro fator de risco como a obesidade.

BACKGROUND: Currently, childhood dyslipidemia, associated to other non-transmissible diseases such as diabetes, hypertension and obesity, represent a significant public health problem in Brazil. OBJECTIVE: To investigate the prevalence of dyslipidemia in children and adolescents from private schools in the city of Belem, state of Para, Brazil. METHODS: Transversal and prospective study that assessed 437 schoolchildren, paired by sex. The age range was established between 6 and 19 years of age and stratified in four subgroups (6 to 9 years; 10 to 12 years; 13 to 15 years and 16 to 19 years). To obtain the anthropometric variables, weight and height were measured for the calculation of the body mass index and skin folds were measured for the calculation of body fat percentage. The serum lipoprotein profile was obtained through the measurement of total cholesterol, triglycerides, LDL-cholesterol and HDL-cholesterol after a 12-hour fasting period, by enzymatic methods. RESULTS: Of the total number of schoolchildren analyzed, 126 (28.8 percent) were overweight and 158 (36.2 percent) presented a high adiposity index. The children (33.6 percent) presented a higher prevalence of obesity when compared to the adolescents (10.1 percent; p < 0.001). Regarding the biochemical characteristics, it was observed that 214 (41 percent) presented some alteration in the lipid profile and that children and adolescents in the age range of 10 to 15 years were the age groups that presented the highest rates of dyslipidemia (34.6 percent and 25.5 percent), respectively. CONCLUSION: These findings demonstrate the importance of establishing an early diagnosis of the lipid profile, mainly if it is already associated to another risk factor, such as obesity.

FUNDAMENTO: Actualmente, la dislipidemia infanto-juvenil asociada a otros trastornos no transmisibles como diabetes, hipertensión y obesidad representan un grave problema de salud pública en el Brasil. OBJETIVO: Investigar la prevalencia de dislipidemia en niños y adolescentes del sistema privado de enseñanza de la ciudad de Belém. MÉTODOS: Estudio transversal y prospectivo, en el que se evaluaron a 437 escolares pareados por sexo. El grupo de edad se limitó entre 6 y 19 años, estratificado en 4 subgrupos (6 a 9 años; 10 a 12 años; 13 a 15 años y 16 a 19 años). Para obtenerse las variables antropométricas se midieron el peso y la estatura, para el cálculo del índice de masa corporal; y pliegues cutáneos para el cálculo del porcentaje de grasa. El perfil lipoproteico sérico se obtuvo por medio de dosificación del colesterol total, triglicérido, LDL-colesterol y el HDL-colesterol tras 12 horas de ayuno, determinado por métodos enzimáticos. RESULTADOS: Del total de escolares analizados, 126 (28,8 por ciento) presentaron exceso de peso y 158, (36,2 por ciento) índice de adiposidad elevado. Los niños (33,6 por ciento) presentaron mayor prevalencia de obesidad cuando comparados con los adolescentes (10,1 por ciento) (p<0,001). Con relación a las características bioquímicas se constató que 214 (49 por ciento) presentaron alguna alteración en el perfil lipídico y que los niños y los adolescentes de edades entre 10 y 15 años fueron los grupos de edad que presentaron mayores tasas de dislipidemia (el 34,6 por ciento y un 25,5 por ciento), respectivamente. CONCLUSIÓN: Esos hallazgos evidenciaron la importancia de diagnosticarse precozmente el posible perfil lipídico, principalmente si éste ya presentar asociación con otro factor de riesgo como la obesidad.