Analysis of the profile of cardiovascular risk in Brazilian schoolchildren: metabolic and behavioral indicators.

OBJECTIVE: There is evidence demonstrating that cardiovascular diseases (CVD) manifesting during adulthood result from an intense interaction among risk factors that may have originated during childhood and adolescence. To compare the prevalence and clustering of cardiovascular risk factors in Brazilian schoolchildren with a 15-year interval between samples. METHODS: A cross-sectional analysis based on the scores for cardiovascular risk factors was used to investigate 1,232 Brazilian schoolchildren of both sexes aged 12 to 18 years. The data of 596 schoolchildren of the 2000 sample were compared to those of 636 schoolchildren of the 2015 sample. RESULTS: The prevalence of physical inactivity and abdominal obesity increased exponentially in both sexes from 2000 to 2015. The score for the clustering of cardiovascular risk factors showed that in 2000 the adolescents were exposed to 1 cardiovascular risk factor (31.7%), while in 2015 the greatest percentage was assigned to the category of 3 or more cardiovascular risk factors (34.9%), p < 0.001. CONCLUSION: The present results demonstrate a high prevalence of exposure to health risk behaviors of the adolescents studied over time. Considering the presence of modifiable risk factors, preventive measures regarding life style are essential.

Analysis of the profile of cardiovascular risk in Brazilian schoolchildren: metabolic and behavioral indicators

ABSTRACT Objective There is evidence demonstrating that cardiovascular diseases (CVD) manifesting during adulthood result from an intense interaction among risk factors that may have originated during childhood and adolescence. To compare the prevalence and clustering of cardiovascular risk factors in Brazilian schoolchildren with a 15-year interval between samples. Subjects and methods A cross-sectional analysis based on the scores for cardiovascular risk factors was used to investigate 1,232 Brazilian schoolchildren of both sexes aged 12 to 18 years. The data of 596 schoolchildren of the 2000 sample were compared to those of 636 schoolchildren of the 2015 sample. Results The prevalence of physical inactivity and abdominal obesity increased exponentially in both sexes from 2000 to 2015. The score for the clustering of cardiovascular risk factors showed that in 2000 the adolescents were exposed to 1 cardiovascular risk factor (31.7%), while in 2015 the greatest percentage was assigned to the category of 3 or more cardiovascular risk factors (34.9%), p < 0.001. Conclusion The present results demonstrate a high prevalence of exposure to health risk behaviors of the adolescents studied over time. Considering the presence of modifiable risk factors, preventive measures regarding life style are essential.

Increase in the prevalence of abdominal obesity in Brazilian school children (2000-2015).

INTRODUCTION: The prevalence of overweight and obese children and adolescents is a public health concern. Few studies have critically evaluated this problem in a Brazilian population, despite the growth of community-based programs to combat childhood obesity in this country. OBJECTIVE: To study the anthropometrics of Brazilian adolescents over a fifteen-year period. METHODS: In a cross-sectional analysis, we investigated the anthropometric status of male and female adolescents in Brazil. The anthropometric data and nutritional status of 595 schoolchildren in the year 2000 were compared to 636 schoolchildren in 2015. RESULTS: We found a significant increase in the prevalence of overweight or obese adolescents in 2015 compared to 2000 (23.4% vs. 18.3%, p = .027). A sub-analysis stratified by sex showed that this increase only occurred in females. No statistically significant difference was observed in body mass index between the groups. Waist circumference (73.5 cm vs. 77 cm, p < .001) and the prevalence of abdominal obesity (30% vs. 47.9%, p < .001) were significantly greater in 2015, regardless of sex. CONCLUSION: Overweight or obese children, as well as abdominal obesity were more prevalent in 2015 than in preceding decades. This is a worrying trend as abdominal obesity increases the risk for cardiometabolic morbidity and mortality in adult life.

Altered left ventricular twist is associated with clinical severity in adults and adolescents with homozygous sickle cell anemia.

BACKGROUND: Sickle cell anemia (SCA) is associated with cardiac abnormalities and premature death. The aims of this study were to identify early markers of cardiac dysfunction through ventricular strain and ventricular twist and determine the relationships between these measures and other markers of cardiovascular risk. METHODS: Forty patients with SCA (mean age, 23.5 ± 9.3 years; 24 male patients) and 40 age- and sex-matched healthy individuals were compared. All subjects participated in structured interviews, and blood samples were collected. Standard echocardiography with subsequent offline evaluations using left ventricular (LV) and right ventricular systolic strain and rotational analyses of the left ventricle using two-dimensional speckle-tracking echocardiography were performed. RESULTS: There were no differences in LV ejection fraction, global LV strain (longitudinal, circumferential, and radial), and global right ventricular longitudinal strain between patients and controls; however, LV twist was significantly lower in the patient group (mean, 7.4 ± 1.2° vs 10.7 ± 1.8°; P < .0001). Several variables were strongly related to LV twist, including the clinical severity index (ρ = -0.97, Z score = -6.05, P < .0001), E/e' ratio (r = 0.78, P < .0001), LV end-diastolic volume index (r = 0.81, P < .0001), and pulmonary artery systolic pressure (r = 0.72, P < .0001). CONCLUSIONS: LV twist is altered in patients with SCA. There were strong correlations between left ventricular twist and clinical severity index, E/e' ratio, LV end-diastolic volume index, and pulmonary artery systolic pressure. These data suggest that decreased LV twist may indicate a subgroup of patients with SCA at greater cardiac risk.

Altered Left Ventricular Twist Is Associatedwith Clinical Severity in Adults and Adolescentswith Homozygous Sickle Cell Anemia

Sickle cell anemia (SCA) is associated with cardiac abnormalities and premature death. The aimsof this study were to identify early markers of cardiac dysfunction through ventricular strain and ventriculartwist and determine the relationships between these measures and other markers of cardiovascular risk.Methods: Forty patients with SCA (mean age, 23.5 6 9.3 years; 24 male patients) and 40 age- and sexmatchedhealthy individuals were compared. All subjects participated in structured interviews, and bloodsamples were collected. Standard echocardiography with subsequent offline evaluations using left ventricular(LV) and right ventricular systolic strain and rotational analyses of the left ventricle using two-dimensionalspeckle-tracking echocardiography were performed.Results: There were no differences in LV ejection fraction, global LV strain (longitudinal, circumferential, andradial), and global right ventricular longitudinal strain between patients and controls; however, LV twist wassignificantly lower in the patient group (mean, 7.4 6 1.2 vs 10.7 6 1.8 ; P < .0001). Several variables werestrongly related to LV twist, including the clinical severity index (r = 0.97, Z score = 6.05, P < .0001), E/e0 ratio(r = 0.78, P < .0001), LV end-diastolic volume index (r = 0.81, P < .0001), and pulmonary artery systolic pressure(r = 0.72, P < .0001).Conclusions: LV twist is altered in patients with SCA. There were strong correlations between left ventriculartwist and clinical severity index, E/e0 ratio, LV end-diastolic volume index, and pulmonary artery systolic pressure.These data suggest that decreased LV twist may indicate a subgroup of patients with SCA at greatercardiac risk.

Echocardiography in thalassemic patients on blood transfusions and chelation without heart failure.

BACKGROUND: Patients with thalassemia major present chronic hemolysis and require regular blood transfusions which may cause iron overload cardiomyopathy and chronic heart failure. Hemochromatosis is characterized by excessive iron accumulation in tissues, and heart involvement is the main cause of death in patients with thalassemia. OBJECTIVE: The aim of this study was to evaluate cardiac structure and function by conventional Doppler echocardiography and tissue Doppler imaging in patients with TM and no clinical evidence of heart failure. METHODS: This is a prospective observational study including 18 patients with thalassemia major (TM) receiving regular blood transfusion. To separately evaluate anemia and blood transfusion effects, two gender, age, weight, and height-matched control groups were included: one with healthy individuals (Healthy, n=18) and one with iron deficient anemia patients (Anemia, n=18). Statistical analysis was performed using ANOVA followed by Tukey's test or Kruskal-Wallis's and Dunn's test. RESULTS: The following echocardiographic variables presented significantly higher values in TM than the Anemia and Healthy groups: left atrium volume index (Healthy: 16.4±6.08; Anemia: 17.9±7.02; TM: 24.1±8.30 cm³/m²); mitral septal E/Em ratio (Healthy: 6.55±1.60; Anemia: 6.74±0.74; TM: 8.10±1.31); and duration of reverse pulmonary vein flow [Healthy: 74.0 (59.0-74.0); Anemia: 70.5 (67.0-74.0); TM: 111 (87.0-120) ms]. The mitral E/A ratio was higher in TM than Anemia (Healthy: 1.80±0.40; Anemia: 1.80±0.24; TM: 2.03±0.34). No differences were found in left ventricular structures and systolic function indexes. CONCLUSION: Conventional Doppler echocardiography and tissue Doppler allow changes in left ventricular diastolic function to be identified in asymptomatic patients with thalassemia major.

Ecocardiografia de pacientes talassêmicos sem insuficiência cardíaca em tratamento com transfusões sanguíneas e quelação / Echocardiography in thalassemic patients on blood transfusions and chelation without heart failure

FUNDAMENTO: Pacientes com talassemia major (TM) apresentam hemólise crônica e necessitam de transfusões sanguíneas egularmente que podem causar cardiomiopatia por sobrecarga de ferro e insuficiência cardíaca crônica. A hemocromatose é caracterizada por acúmulo excessivo de ferro nos tecidos; acometimento do coração é a principal causa de óbito em pacientes com talassemia. OBJETIVO: Avaliar as estruturas e a função cardíaca por meio de ecocardiografia com Doppler convencional e Doppler tecidual em pacientes com TM, sem evidência clínica de insuficiência cardíaca. MÉTODOS: Trata-se de estudo observacional prospectivo de 18 pacientes com TM que recebem transfusão sanguínea regularmente. Para avaliar, separadamente, os efeitos da anemia e da transfusão sanguínea, dois grupos controles pareados por gênero, idade, peso e altura foram incluídos: um com indivíduos saudáveis (Saudável, n = 18) e outro com pacientes com anemia por deficiência de ferro (Anemia, n = 18). Análise estatística foi realizada utilizando ANOVA seguida pelo teste de Tukey ou Kruskal-Wallis e teste de Dunn. RESULTADOS: As seguintes variáveis ecocardiográficas apresentaram valores significativamente mais elevados no grupo TM do que nos grupos Anemia e Saudável: índice de volume do átrio esquerdo (Saudável: 16,4 ± 6,08; Anemia: 17,9 ± 7,02; TM: 24,1 ± 8,30 cm/m); razão E/Em septal mitral (Saudável: 6,55 ± 1,60; Anemia: 6,74 ± 0,74; TM: 8,10 ± 1,31) e duração do fluxo reverso em veias pulmonares [Saudável: 74,0 (59,0-74,0); Anemia: 70,5 (67,0-74,0); TM: 111 (87,0-120) ms]. Arazão E/A mitral foi maior no grupo TM do que no grupo Anemia (Saudável: 1,80 ± 0,40; Anemia: 1,80 ± 0,24; TM: 2,03 ± 0,34). Não foram encontradas diferenças entre os grupos em variáveis estruturais do ventrículo esquerdo e em índices de função sistólica. CONCLUSÃO: A ecocardiografia com Doppler convencional e o Doppler tecidual permite que alterações na função diastólica do ventrículo esquerdo sejam identificadas em pacientes assintomáticos com talassemia major.

BACKGROUND: Patients with thalassemia major present chronic hemolysis and require regular blood transfusions which may cause iron overload cardiomyopathy and chronic heart failure. Hemochromatosis is characterized by excessive iron accumulation in tissues, and heart involvement is the main cause of death in patients with thalassemia. OBJECTIVE: The aim of this study was to evaluate cardiac structure and function by conventional Doppler echocardiography and tissue Doppler imaging in patients with TM and no clinical evidence of heart failure. METHODS: This is a prospective observational study including 18 patients with thalassemia major (TM) receiving regular blood transfusion. To separately evaluate anemia and blood transfusion effects, two gender, age, weight, and height-matched control groups were included: one with healthy individuals (Healthy, n=18) and one with iron deficient anemia patients (Anemia, n=18). Statistical analysis was performed using ANOVA followed by Tukey's test or Kruskal-Wallis's and Dunn's test. RESULTS: The following echocardiographic variables presented significantly higher values in TM than the Anemia and Healthy groups: left atrium volume index (Healthy: 16.4±6.08; Anemia: 17.9±7.02; TM: 24.1±8.30 cm³/m²); mitral septal E/Em ratio (Healthy: 6.55±1.60; Anemia: 6.74±0.74; TM: 8.10±1.31); and duration of reverse pulmonary vein flow [Healthy: 74.0 (59.0-74.0); Anemia: 70.5 (67.0-74.0); TM: 111 (87.0-120) ms]. The mitral E/A ratio was higher in TM than Anemia (Healthy: 1.80±0.40; Anemia: 1.80±0.24; TM: 2.03±0.34). No differences were found in left ventricular structures and systolic function indexes. CONCLUSION: Conventional Doppler echocardiography and tissue Doppler allow changes in left ventricular diastolic function to be identified in asymptomatic patients with thalassemia major.

Ventricular systolic reserve in asymptomatic children previously treated with low doses of anthracyclines: a longitudinal, prospective exercise echocardiography study.

BACKGROUND: The time course of mild cardiotoxicity induced by anthracycline remains unknown. The aim of this study was to evaluate the long-term evolution of decreased myocardial reserve in children previously treated with a cumulative dose of anthracycline up to 100 mg/m(2). PATIENTS AND METHODS: Twenty-seven asymptomatic cancer survival patients (25 with lymphoblastic leukemia), in continuous remission and off treatment for >12 months with no alterations in conventional echocardiograms were evaluated by exercise echocardiography at 37 ± 15.4 months (T1) and 101 ± 24 months (T2) after finishing treatment (ADRIA group). This group was compared with 25 healthy individuals (control group) similar to the ADRIA group with respect to age and body surface area (BSA). All individuals underwent treadmill exercise testing according to Bruce protocol. Echocardiograms were performed before and immediately after exercise. RESULTS: The groups were similar regarding cardiac structure and left ventricular (LV) systolic function at rest at T1 and T2. The growth of LV posterior wall thickness related to BSA was lower in the ADRIA group at T2. Post exercise, smaller LV ejection indexes and attenuated changes in the afterload in ADRIA group were observed at T1 and T2. CONCLUSION: The decreased systolic reserve induced by a low dose of anthracycline in asymptomatic children and adolescents remains unaffected over a 5-year period, suggesting that positive outcomes in chronic cardiotoxicity would be expected in patients with mild impairment after anthracycline treatment.

Improvements in insulin sensitivity and muscle blood flow in aerobic-trained overweight-obese hypertensive patients are not associated with ambulatory blood pressure.

To verify whether there are relationships between vascular and hormonal responses to aerobic training in hypertensive persons, sedentary hypertensive patients were randomized to an aerobic training or a callisthenic exercise group. The patients' 24-hour blood pressure, arterial compliance, forearm blood flow, and hormonal profile were evaluated at baseline and after 3-month training protocols. Mean maximal oxygen consumption (VO(2) max) increased by 8% in the aerobic group (P<.001), while no change was observed in the control group. There was a decrease in insulin resistance (homeostatic model assessment of insulin resistance, P=.039) and plasma cortisol (P=.006) in the aerobic group only, that also demonstrated an increase in forearm blood flow (P<.001) after training. No relationship was observed between change in blood pressure or change in body mass and other parameters. Aerobic training can promote a decrease in cardiovascular risk in hypertensive adults by improving vascular function and insulin resistance, despite no changes in ambulatory blood pressure after a 3-month intervention.

Ventricular systolic reserve in asymptomatic children previously treated with low doses of anthracyclines.

Doppler echocardiography has been used for the diagnosis of anthracycline-induced cardiotoxicity. However, few data are available that include asymptomatic children previously treated with a low cumulative dose of this drug and therefore have a low risk of cardiac dysfunction. The aim of this study was to evaluate after-exercise cardiac function in asymptomatic children previously treated with a low cumulative dose of anthracycline and no clinical or laboratory evidence of cardiotoxicity. Doppler echocardiography was performed before and immediately after physical exercise in 29 children aged 5 to 17 years (anthracycline [ADRIA] group). All had finished cancer treatment with anthracycline derivatives for > or =1 year (cumulative dose 100 mg/m(2)). Results were compared with those from age- and gender-matched healthy children (control group; n = 26) using the Mann-Whitney rank test. Exercise-induced cardiac function changes within groups were analyzed using Wilcoxon's signed-rank test. Exercise induced significant increases in left ventricular systolic function indexes in both groups. However, the ADRIA group had significantly lower changes in left ventricular ejection fraction (ADRIA group 0.71 +/- 0.02 vs 0.80 +/- 0.04 and control group 0.71 +/- 0.02 vs 0.89 +/- 0.05, p = 0.0017) and end-systolic stress-volume index (ADRIA group 4.59 +/- 0.69 vs 6.4 +/- 2.0 g.cm(-2)/ml.m(-2) and control group 5.49 +/- 0.98 vs 11.54 +/- 2.86 g.cm(-2)/ml.m(-2); p <0.0001), indicating decreased functional systolic reserve. In conclusion, asymptomatic children previously treated with low cumulative doses of anthracycline had decreased functional systolic reserve evidenced by exercise, suggesting a nonclinically manifested cardiotoxicity.

Effects of intense and prolonged exercise on insulin sensitivity and glycogen metabolism in hypertensive subjects.

BACKGROUND: The information that insulin sensitivity and glycogen synthesis are reduced in hypertension arises primarily from studies using insulin infusions. Whether glycogen metabolism is actually altered in a physiological condition, such as during and after prolonged exercise, is currently unknown. METHODS AND RESULTS: To examine this issue, 9 hypertensive and 11 normotensive subjects were evaluated on a rest day and after intense and prolonged exercise on a separate day. Insulin sensitivity and hemodynamic variables were measured on both days. On the exercise day, whole-body substrate utilization was assessed and muscle biopsies were taken in the leg at baseline, immediately after exercise, and 2.5 and 4 hours after exercise. Insulin sensitivity at rest was lower in hypertensive than normotensive subjects (P<0.05) and increased after exercise in normotensive (P<0.01) but not in hypertensive (P=NS) subjects. Leg blood flow increased after exercise in both groups but to a lesser extent in hypertensive than normotensive subjects. Baseline glycogen content and maximal glycogen synthase activity were higher in hypertensive than normotensive subjects (P<0.001). Glycogen concentration decreased relatively less (-35 versus -66%) and returned to baseline levels faster in hypertensive subjects after exercise. Hypertensive subjects used approximately 40% less carbohydrates during exercise (P<0.001) at the expense of greater free fatty acid oxidation. CONCLUSIONS: It is concluded that increased intramuscular glycogen storage and resynthesis in hypertension are independent of blood flow and may represent compensatory mechanisms for the reduced insulin sensitivity and carbohydrate metabolism in this condition.

[Effect of environmental stress on blood pressure during the work shift]. / Efeito de estresse ambiental sobre a pressão arterial de trabalhadores.

OBJECTIVE: To evaluate blood pressure (BP) and heart rate (HR) behavior in individuals during the working journey in two environments with different work stressors. METHODS: The study comprised 46 male individuals working in a wood processing factory in Botucatu, Brazil. Twenty seven (27.4+/-5.4 yrs, mean+/-SD) worked in the production line performing intense physical activity (G1) at high room temperatures and noise levels. Nineteen (33.2+/-7.6 yrs old) performed managerial tasks mostly comfortably seated at low noise, air-conditioned offices (G2). After anthropometric measurements (obesity, total and local adiposity) and blood biochemistry analyses (glucose, triglycerides and cholesterol), their BP and HR were registered during three consecutive days at 3 different time of the day: in the beginning, in the middle and at the end of the working journey. RESULTS: There were similar BP and HR changes during the journey for G1 and G2, but G1 showed higher rates. Due to the wide variability of BP responses within each group, participants were divided in two subgroups: responders (GR1 and GR2) with BP increase >10%, and non-responders (GN1 and GN2). Both subgroups showed similar anthropometric and biochemical patterns differing only in their BP response and, in the case of GR1,family history for hypertension. GR1 showed higher BP and HR than GR2. CONCLUSIONS: Individual changes of BP and HR responses to environmental stressors during the working journey indicates that these factors should be considered while evaluating BP measurements and might be considered as potential factors for hypertension.

Efeito de estresse ambiental sobre a pressäo arterial de trabalhadores / Effect of environmental stress on blood pressure during the working journey

OBJETIVO: Analisar o comportamento de pressäo arterial (PA) e a freqüência cardíaca (Fc) de indivíduos ao longo da jornada de trabalho em dois ambientes com estresses ambientais distintos. MÉTODOS: Foram avaliados 46 funcionários, trabalhadores de uma indústria processadora de madeira, de Botucatu, SP, sendo 27 funcionários da linha de produçäo (esforço físico moderado-intenso, altas temperaturas e elevados níveis de ruído) (G1), e 19 da administraçäo (sem esforço físico, salas aclimatadas, baixos níveis de ruído) (G2). Todos foram submetidos a avaliaçäo antropométrica da composiçäo corporal (obesidade e adiposidade) e bioquímica do sangue (lipidemia) e, adicionalmente, o registro da PA e da Fc em três momentos do turno de serviço: início, meio e fim. RESULTADOS: Houve semelhança na variaçäo da PA entre G1 e G2, mas com maiores elevaçöes de PA e Fc em G1. Os resultados mostraram grande variabilidade na resposta da PA, levando à subdivisäo dos grupos G1 e G2 em respondedores (GR, aumento maior de 10 por cento na PA média) e näo respondedores (GN). Os subgrupos GR e GN apresentaram semelhanças nos padröes antropométrico e bioquímico diferindo apenas na resposta pressórica e no caso do GR1 na história familiar de hipertensäo. Comparando os subgrupos GR1 e GR2, foi constatado que os primeiros apresentaram maiores variaçöes de PA e Fc que os segundos. CONCLUSOES: A variaçäo individual da resposta pressórica e da Fc conforme o tipo de estresse ambiental indica ser este um fator adicional a ser considerado na avaliaçäo da pressäo arterial e, talvez, na gênese da hipertensäo arterial de operários

Effects of mild exercise on insulin sensitivity in hypertensive subjects.

Physical exercise increases insulin sensitivity in conditions associated with insulin resistance, such as obesity and diabetes, but little is known in this regard in hypertension. Whether postexercise changes in hemodynamics and/or changes in insulin-induced vasodilatation could contribute to a postexercise increase in insulin sensitivity in hypertensive subjects is unknown. We investigated the effects of acute physical exercise on insulin sensitivity in 10 hypertensive and 10 normotensive subjects during a control evaluation (CTRL), during lower body negative pressure (LBNP), after 30 minutes of mild bicycle exercise (POSTEX), and during LBNP after exercise (POSTEX+LBNP). Insulin-induced vasodilatation was assessed from peak forearm blood flow during the intravenous glucose tolerance test. Cardiac output (4.9+/-0.3 versus 5.3+/-0.4 L/min, mean+/-SEM) and insulin sensitivity (the glucose disappearance rate over insulin area under the curve: 0.91+/-0.07 versus 1.38+/-0.25 min(-1)/[pmol. L(-1)]. minute) were lower (both P<0.05) in hypertensive than in normotensive subjects, respectively. Cardiac output decreased during LBNP, increased during POSTEX, and was similar to control during POSTEX+LBNP in both groups. Insulin sensitivity was unchanged during LBNP, increased during POSTEX, and remained elevated during POSTEX+LBNP in hypertensive subjects, whereas it remained unchanged in normotensives. Peak forearm blood flow was significantly lower in hypertensive than in normotensive subjects, despite higher insulin levels in hypertensives, and was not modified by LBNP or exercise. In conclusion, insulin sensitivity increases after exercise in hypertensive subjects, and the increase in cardiac output does not contribute to this effect. Endogenous insulin-induced vasodilatation is reduced in hypertensive subjects, and this insulin action is not affected by physical exercise.

Efeito de diferentes protocolos de atividade física sobre a pressäo arterial e capacidade aeróbica de indivíduos adultos do sexo masculino: relaçäo com variáveis nutricionais, bioquímicas e hormonais / Effect of different protocols of physical activity on the arterial pressure and aerobic capacity of male adult subjects: relation with nutritional, biochemical and hormonal variables

Este trabalho foi realizado no período de março de 1991 a dezembro de 1993, tendo como objetivo avaliar o efeito de diferentes protocolos de atividade física sobre a pressäo arterial e capacidade aeróbia de indivíduos adultos do sexo masculino, com idade média de 56 ñ 5 anos, previamente sedentários. Para tanto, foram analisadas variáveis cardio-circulatórias (frequência cardíaca, pressäo arterial, desempenho em esteira ergométrica), nutricionais (ingestäo alimentar + antropometria), bioquímicas (colesterol), triglicérides, glicemia, ácido úrico, potássio, creatinina, cálcio e sódio urinário) e hormonais (catecolaminas, cortisol, insulina e peptídeo C), observadas antes e após 18 semanas de participaçäo nos protocolos de atividade física. Os indivíduos participantes dos protocolos de atividade aeróbia foram agrupados de acordo com a frequência semanal e tipo de seguimento ao programa em: GI (maior ou igual 3x/semana, supervisionado), GII (menor e maior ou igual 2x/semana) e GIII (maior ou igual 3x/semana, näo supervisionado). Os indivíduos do GIV participaram de um programa de relaxamento-alongamento por 12 semanas. A reduçäo da pressäo arterial foi associada à assiduidade, supervisäo pela equipe multiprofissional, diminuiçäo da adiposidade, da descarga adrenérgica, da insulinemia e dos níveis séricos de peptídeo C e cortisol. Estas adaptaçöes ao treinamento aeróbio foram encontradas somente no GI. A ingestäo alimentar näo variou em nenhum dos grupos. Houve variaçäo significativa, do ponto de vista biológico, da colesterolemia e calcemia somente no GI. A reduçäo de pressäo arterial, tanto sistólica como diastólica, observada no GI, foi significativamente maior que aquela observada no GIV e suficiente para aumentar a proporçäo de normotensos naquele grupo. Näo houve modificaçäo pressórica nos GII e GIII. O fato da reduçäo pressórica ter sido observada no mesmo grupo em que ocorreram adaptaçöes antropométricas e hormonais (GI), decorrentes do treinamento físico, indica que este tipo de protocolo pode ser utilizado como arma terapêutica eficaz no tratamento näo farmacológico da hipertensäo arterial.

Avaliaçäo da ingestäo dietética de cálcio em indivíduos adultos portadores de hipertensäo arterial / Evaluation of dietary intakes of calcium in adult subjects carrier state idiopathic arterial hypertension

Foi estudada a relaçäo entre a ingestäo dietética de cálcio e os demais parâmetros alimentares e antropométricos em 60 indivíduos adultos, portadores de hipertensäo arterial idiopática (10 homens e 50 mulheres), com média etária de 48,6 anos, seguidos no Centro de Hipertensäo Arterial do Hospital das Clínicas da Faculdade de Medicina de Botucatu (SP), Brasil. Foram utilizados três métodos diferentes de inquérito alimentar em três diferentes ocasiöes: recordatório de 24h, questionário de freqüência alimentar, dirigido para ingestäo de cálcio, e registro alimentar de 3 dias. As médias de ingestäo de cálcio, extraídas desses inquéritos, foram semelhantes, mostrando que, em relaçäo à ingestäo de cálcio, esses métodos de inquérito alimentar podem ser utilizados indistintamente com o objetivo de se mensurar à ingestäo de cálcio de um grupo de indivíduos. Além da ingestäo de cálcio, foi avaliada a ingestäo protéico-calórica e de diversos nutrientes, assim como realizada a antropometria desse grupo de hipertensos em três ocasiöes diferentes, com intervalos variando de duas semanas a 15 meses. Quando comparado a um grupo de referência local, constituído de indivíduos sadios, com média etária semelhante, o grupo de hipertensos mostrou ter menor ingestäo média de cálcio. Comparandos por sexo, os homens dos dois grupos exibiram perfis nutricional e antropométrico semelhantes. Em relaçäo às mulheres, houve diferenças quanto à ingestäo protéico-calórica, o que se supöe ser devido à ingestäo menor do leite e derivados entre as hipertensas. Estas estavam mais pesadas que as mulheres do grupo de referências, à custa de maior massa muscular, provavelmente devido a maior atividade física. Concluiu-se que o cálcio dietético foi o principal item alimentar que distinguiu hipertensos de normotensos. Como existem estudos clínicos comprovando o efeito benéfico da suplementaçäo de cálcio na reduçäo dos níveis pressóricos de indivíduos hipertensos, sugere-se a repetiçäo deste tipo de trabalho, em outros locais, visando ao embasamento de programa nacional de suplementaçäo de cálcio dietético entre indivíduos hipertensos idiopáticos

Aplicaçäo dos métodos de inquérito alimentar na avaliaçäo da ingestäo de cálcio em estudos epidemiológicos / Use of food survey methods in the evaluation of calcium ingestion in epidemiological studies

O número crescente de informaçöes envolvendo o cálcio na patogênese de diversas doencas tem justificado o interesse atual para o melhor conhecimento dos métodos disponíveis para a avaliaçäo do estado nutricional com relaçäo a ese íon. Assim, dentre as diversas técnicas para avaliaçäo da ingestä dietética de cálcio, o inquérito alimentar constitui a menos onerosa e a mais prática para os estudos clínicos e epidemiológicos, uma vez que, nesses estudos, mais importante é o conhecimento da ingestäo média do grupo que permita relacionar dieta e doença. Na análise dos dados deve-se considerar o tipo de populaçäo estudada, a regiäo geográfica, seus hábitos e condiçöes socieconômicas. Nesse sentido, a preocupaçäo demasiada com a precisäo quantitativa das porçöes alimentares passa a ser desnecessária quando se pretende classificar os indivíduos em grupos de risco. Por outro lado, a conversäo das porçöes alimentares em quantidade de cálcio, mediante o uso de tabelas de conversäo, deve ser feita de modo crítico. A validaçäo do inquérito alimentar é feita, geralmente, contra os métodos de registro alimentar de três ou sete dias. Com relaçäo à ingestäo do cálcio, estes métodos têm mostrado semelhança para as médias grupais. Näo säo recomendáveis, entretanto, comparaçöes de ingestöes de grupos populacionais distintos avaliados por metodologias diferentes. É descrito que o questionário da freqüência alimentar (QFA), usualmente, superestima, enquanto a história dietética (HD) subestima a ingestäo de cálcio do indivíduo. O método recordatório de 24 horas tem-se demonstrado satisfatório e confiável para a avaliaçäo do cálcio dietético de grupos de indivíduos. A associaçäo desse método com outros que complementem a noçäo do hábito alimentar (QFA ou HD) dos indivíduos fortalece os dados no sentido da sua validaçäo para estudos clínicos e epidemiológicos...