Association between dietary inflammatory index and anthropometric indicators of adiposity in Brazilian adolescents.

BACKGROUND: Diet may play a role in the regulation of obesity-related low-grade chronic inflammation. OBJECTIVE: Assess the association of the Dietary Inflammatory Index (DII) with anthropometric indicators of adiposity in Brazilian adolescents. METHODS: Data were collected from 71 740 adolescents (12-17 years old) examined in the Study of Cardiovascular Risks in Adolescents. Food consumption was assessed by means of one 24-h dietary recall, and DII was estimated using 39 food parameters. The body mass index (weight/height2 ) for age and sex was used to define overweight (>1 z-score). Abdominal obesity was indicated by waist circumference (WC) values >80th percentile and waist-to-height ratio (WHtR) > 0.50. The association between DII and anthropometric indicators was assessed using logistic regression models. RESULTS: The mean DII score was higher in girls than in boys (0.77; SD = 0.04 vs. 0.04; SD = 0.05). Adolescents in the 4th quartile of DII, compared with those in the 1st quartile, had increased odds of being overweight (boys: OR = 1.76; 95% CI: 1.37; 2.25; girls: OR = 1.63; 95%CI: 1.36; 1.95), having abdominal obesity (boys: OR = 1.61; 95%CI: 1.33; 1.95; girls: OR = 1.73; 95%CI: 1.48; 2.03), and having high WHtR (boys: OR = 1.91; 95%CI: 1.52; 2.39; girls: OR = 1.75; 95%CI: 1.46; 2.11). CONCLUSIONS: The findings showed a direct association between the dietary inflammatory potential measured by DII and adiposity.

Comparison of Quality of Carbohydrate Metrics Related to Fasting Insulin, Glycosylated Hemoglobin and HOMA-IR in Brazilian Adolescents.

Low glycemic index (GI) and glycemic load (GL) diets are effective for glycemic control (GC) associated with a carbohydrate-controlled meal plan. However, whether GI and GL peaks are related to GC is unknown. Objective: To compare the daily GI (DGI)/GL (DGL) and average GI (AvGI)/GL (AvGL) of meals (accounting for peaks) related to GC markers (GCM) in Brazilian adolescents. Methods: A representative national school-based (public/private) sample of students without diabetes, 12−17 years of age, was evaluated. Food intake was based on a 24 h recall. The models for complex cluster sampling were adjusted (sex, sexual maturation, age, and physical activity). Results: Of 35,737 students, 74% were from public schools, 60% girls, 17% overweight, and 8% obese. The minimum DGI and DGL were observed at lunch, with higher values at night. Fasting insulin was 1.5 times higher in overweight/obese (OW) girls, and 1.7 times higher in OW boys than in normal-weight (NW) girls. The same trend was observed for the homeostatic model assessment for insulin resistance (HOMA-IR) (OW = 2.82 vs. NW = 1.84 in girls; OW = 2.66 vs. NW = 1.54 in boys; p < 0.05). The daily and average metrics were greater for NW adolescents. Glycosylated hemoglobin was not associated with these metrics, except for AvGL. Insulin and HOMA-IR were associated with all metrics in NW adolescents, with greater coefficients associated with AvGL. Among overweight/obese adolescents, only GI metrics were associated (ß = 0.23; AvGI and insulin) and appeared to have the best association with GCM. Conclusions: Among NW adolescents, GL is a better measure of carbohydrate quality, but for those with overweight/obesity, carbohydrate consumption is more associated with GC, probably because they eat/report small amounts of carbohydrates.

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.

High cesarean prevalence in a national population-based study in Brazil: the role of private practice.

BACKGROUND: Excessive use of cesarean sections (CSs) is a serious problem worldwide. OBJECTIVE: To estimate the frequency and identify factors associated with cesarean deliveries in Brazil. DESIGN: Cross-sectional study conducted in 2006-2007 as part of the third edition of the Children's and Women's National Demographic and Health Survey. SETTING: Brazil. SAMPLE: Brazilian women in reproductive age. METHODS: Socioeconomic and demographic data were utilized, including maternal age, education level, per capita income, skin color, smoking habit, marital status, age at first delivery, parity, and type of prenatal services. MAIN OUTCOME MEASURES: Adjusted estimate of the prevalence ratios of the type of delivery performed (cesarean or vaginal). RESULTS: Cesarean prevalence was 43.9% (95% CI: 40.9-46.9), 68.7% for women who had per capita income greater than US$ 125 per month, and 77.2% for those who had attended private or privately insured prenatal services. In the adjusted analysis, the variables that presented significant prevalence ratios (95% confidence interval) were macro-region [southeast = 1.45 (1.21-1.73); south = 1.48 (1.24-1.77), and midwest = 1.43 (1.21-1.71)], maternal age above 25 years [26-30 years = 1.57 (1.25-1.97); > or = 31 years = 1.77 (1.39-2.27)], education levels > or = 9 years (PR = 1.86, 95% CI: 1.55-2.23), and having attended private or privately insured prenatal services (PR = 1.87, 95% CI: 1.65-2.12) and parity [primipara = 1.87 (1.47-2.36)]. CONCLUSIONS: CS rates are generally very high in Brazil. They are significantly higher than the average among women attending private/insured antenatal care, among the highly educated, and in provinces with higher socioeconomic levels.