Cardiovascular Risk Factors in Children and Adolescents with Fontan Circulation

Abstract Background: Long-term outcomes of patients with Fontan circulation are uncertain regarding the prevalence and role of risk factors (RFs) such as increased body mass index (BMI), arterial hypertension, and hypercholesterolemia. Objectives: To describe the prevalence of RFs in patients with univentricular heart, with variable follow-up times. Methods: This mixed cohort study was performed with 66 patients, who underwent blood count, fasting blood glucose, C-reactive protein (CRP), and lipid profile tests; systolic/diastolic blood pressure (SBP/DBP) measurements; and anthropometric and sociodemographic data collection. Cardiovascular RFs among first-degree relatives and physical activity habits were also assessed. Prevalence was described using proportions, with a 95% confidence interval. Continuous variables (height, weight, age, SBP, DBP) were described as means and standard deviations (m±SD). Associations between RFs were assessed using chi-squared or Fisher's exact tests. Spearman's correlation was used for analyzing CRP and the presence of 2 or more RFs. The Shapiro-Wilk test was used to check for data normality. Statistical significance considered p<0.05. Results: In our population, 19.7% were overweight, mean SBP was 89.44±37.4, and mean DBP was 60.0±26.08. The most prevalent diseases in the interviewees' families were systemic arterial hypertension (30.3%), obesity (16.7%), and 2 or more cardiovascular RFs among first-degree relatives (13.8%). We observed a trend towards significance between the presence of 2 familial RFs and overweight, as well as a risk profile for cardiovascular disease. There was an association between the BMI percentile, the presence of 2 or more RFs (p<0.05), and CRP (p<0.01). Conclusions: Overweight is common in patients with univentricular heart, being related to more than 2 cardiovascular RFs among first-degree relatives; physical inactivity and changes in lipid profiles are also frequent.

Interdisciplinary Group Intervention on Nutritional Profile, Quality of Life, and Stress During Cardiopulmonary Rehabilitation: A Randomized Clinical Trial

Abstract Background: Participating in therapeutic operative groups with nutritional and psychological interventions might influence the recovery of patients in cardiopulmonary rehabilitation programs. Objective: To evaluate the effectiveness of group interventions on the nutritional profile, stress, and quality of life of patients in cardiopulmonary rehabilitation. Methods: In this randomized clinical trial, adult patients of the Cardiopulmonary and Metabolic Rehabilitation (CPMR) unit were randomized into control group (CG), receiving standard follow-up assessment by the CPMR unit, and intervention group (IG), which additionally participated in 6 meetings of an interdisciplinary group with a nutritionist and a psychologist. Anthropometric data and results from a food frequency questionnaire (FFQ), Lipp's Inventory of Stress Symptoms for Adults (ISSL), and the 12-Item Short Form Health Survey (SF-12) were analyzed. Student's t-tests, Generalized Estimation Equations (GEE), Mann-Whitney tests, and Bonferroni tests were used for statistical analyses, with a significance level of 5%. Results: The sample consisted of 76 patients: 31 in the IG (64±9.2 years old) and 45 in the CG (61.4±11.8 years old). There was a significant reduction (p<0.001) in weight, body mass index, and waist circumference, and an increase (p=0.010) in the consumption of healthy food only in the IG. The consumption of unhealthy food was reduced in both groups (p<0.001), the physical aspect of quality of life improved (p=0.018), and women presented better physical (p=0.011) and mental results (p=0.008). Conclusions: This group intervention was effective regarding the nutritional status of patients in cardiopulmonary rehabilitation. The physical aspect of quality of life showed improvements in both groups.

Physical Activity and Cardiovascular Risk Factors in Children: a Meta-Analysis Update

Abstract Background Obesity and overweight in childhood can increase the risk of developing cardiovascular disease throughout live. Objectives This study provides an update of a meta-analysis of randomized clinical trials (RCT) published in 2014, to assess the effects of physical activity interventions on preventing cardiovascular risk factors in childhood. Methods This update combines data from the previous search with new data obtained from June 2013 to June 2020. Searches were performed on PubMed, EMBASE and Cochrane CENTRAL. The RCTs enrolled used interventions with physical activity longer than six months in school children aged 6-12 years, and evaluated body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels. Data analysis was performed using a random-effects model and a P value <0.05 was considered statistically significant. Results A total of 28,603 articles were retrieved, and 17 RCTs (11,952 subjects) were included. Physical activity interventions were associated with reduction in SBP [−2.11mmHg (95%CI −3.67, −0.54), I243%], DBP [−2.08mmHg (95%CI −3.68, −0,49), I265%] and TG [-0.08mmol/L (95% CI -0.13, -0.03), I20%], and increase in TC [0.17mmol/L (95%CI 0.04, 0.30), I20%]. However, the interventions were not associated with reductions in BMI [−0.03 kg/m2 (95%CI −0.17, 0.10), I20%]. Conclusion This update confirms and reinforces the beneficial effects of physical activity intervention in reducing systolic and diastolic blood pressure and TG levels.

Association between Deep Subcutaneous Adipose Tissue Estimated by DAAT Index and Dietary Intake in Patients with Acute Coronary Syndrome

Abstract Background: Abdominal obesity has been associated with cardiovascular disease and may be modulated by dietary intake. The deep abdominal subcutaneous adipose tissue (dSAT) is a body fat compartment that can be estimated by using mathematical formulas. Objectives: To evaluate the association between dSAT estimated by the Deep-Abdominal-Adipose-Tissue (DAAT) index and dietary intake in patients with acute coronary syndrome (ACS). Methods: This is a cross-sectional study conducted with patients ≥ 18 years of age admitted to a tertiary hospital. Sociodemographic, clinical, and anthropometric (body weight [kg], height [m], waist, hip and neck circumferences [cm]) data were evaluated. A food frequency questionnaire was applied to identify each patient's nutrient intake. The DAAT index was calculated according to specific formulas for men and women. Possible association between food intake and the DAAT index was evaluated by multiple linear regression. The level of significance adopted was 0.05. Results: This study evaluated 138 patients, with a mean age of 61.2±10.8 years. Prevalence of obesity was 29.4% in men and 37.7% in women. Regarding waist circumference, 83% of the women showed values considered to be very high. The DAAT index was significantly higher in men when compared to woman (P < 0.0001) and proved to be positively correlated with proteins (r= 0.22, P= 0.01) and monounsaturated fatty acid (r= 0.18, P= 0.04) intake in the entire sample. After adjustment for sex, alcohol consumption, and levels of physical activity, the DAAT index was associated with the female sex (B= −129.84, P <0.001) and a sedentary lifestyle (B= 57.99, P <0.001). Conclusion: dSAT estimated by the DAAT index was not associated with dietary intake in patients with ACS.

Prevalence of breastfeeding in children with congenital heart diseases and down syndrome.

BACKGROUND: According to the World Health Organization, the worldwide incidence of Down syndrome is one in a thousand live births a year. Of these, it is estimated that 20-60% have congenital heart disease, a factor that hinders breastfeeding. Considering the numerous benefits of breastfeeding, a study verifying this prevalence in children with Down syndrome and congenital heart disease is indispensable, and this is not yet evidenced in the literature. The aim of this study is to verify the prevalence of breastfeeding in children with Down syndrome and congenital heart disease admitted to a referral hospital in cardiology. METHODS: Cross-sectional study with 62 patients, aged between 0 and 5 years. Anthropometric variables (weight, height) and data related to breastfeeding were collected. Statistical analysis was performed using the SPSS® version 26.0 statistical software. RESULTS: The prevalence of breastfeeding was of 80.6%, but the median of exclusive breastfeeding was of only 3 days. Only 38.7% received breastfeeding for more than 6 months. The main reasons for interruption were difficulty in sucking and tiredness to breastfeed. Statistical significance was evidenced when comparing the time of exclusive breastfeeding and maintenance with the mother's education, with p = 0.006 and p = 0.041, respectively. No relationship was found between nutritional status and breastfeeding. CONCLUSIONS: Despite the high prevalence of breastfeeding, the maintenance time is well below the recommendations. Therefore, further monitoring and promotion of breastfeeding is necessary for this population, given the countless benefits of breast milk.

Prevalence of breastfeeding and its obstacles in patients with CHD in southern Brazil.

INTRODUCTION: Breast milk is nutritionally adequate and is related to the reduction of various health problems in childhood. Its offer is widely recommended in health guidelines. OBJECTIVE: To estimate the prevalence and obstacles to breastfeeding in patients with CHD in southern Brazil. METHODS: Cross-sectional study of patients with CHD between 2 and 18 years of age. Patients with genetic syndromes and patients whose mothers had died were excluded from the analysis. The variables on breastfeeding in the first 2 years of life were collected through a phone call to the mothers, which was conducted by trained evaluators. Prevalence was described in proportions and the continuous variables as means and standard deviation. Bivariate analyses were evaluated using a chi-square test to measure the association between the variables and the outcome. RESULTS: A total of 351 patients with CHD were analysed. There was a predominance of males (53%) and a mean age of 9.54 ± 4.52 years. Breastfeeding up to the sixth month was present in 40% of the cases. CONCLUSION: The mothers of babies with CHD face great challenges to maintain the supply of breast milk, whether inherent to the practice of breastfeeding or related to CHD.

Healthy School, Happy School: Design and Protocol for a Randomized Clinical Trial Designed to Prevent Weight Gain in Children.

BACKGROUND:: Schools have become a key figure for the promotion of health and obesity interventions, bringing the development of critical awareness to the construction and promotion of a healthy diet, physical activity, and the monitoring of the nutritional status in childhood and adolescence. OBJECTIVES:: To describe a study protocol to evaluate the effectiveness of an intervention designed to improve knowledge of food choices in the school environment. METHODS:: This is a cluster-randomized, parallel, two-arm study conducted in public elementary and middle schools in Brazil. Participants will be children and adolescents between the ages of 5 and 15 years, from both genders. The interventions will be focusing on changes in lifestyle, physical activities and nutritional education. Intervention activities will occur monthly in the school's multimedia room or sports court. The control group arm will receive usual recommendations by the school. The primary outcome variable will be anthropometric measures, such as body mass index percentiles and levels of physical activity by the International Physical Activity Questionnaire. RESULTS:: We expect that after the study children will increase the ingestion of fresh food, reduce excessive consumption of sugary and processed foods, and reduce the hours of sedentary activities. CONCLUSION:: The purpose of starting the dietary intervention at this stage of life is to develop a knowledge that will enable for healthy choices, providing opportunities for a better future for this population. FUNDAMENTO:: As escolas tornaram-se essenciais para a promoção de saúde e de intervenções para obesidade, propiciando o desenvolvimento de consciência crítica para a construção e promoção de dieta saudável, atividade física e monitoramento do status nutricional na infância e adolescência. OBJETIVOS:: Descrever um protocolo de estudo para avaliar a eficiência de uma intervenção projetada para aprimorar o conhecimento sobre escolhas alimentares no ambiente escolar. MÉTODOS:: Estudo clínico randomizado em cluster, paralelo, de dois braços, conduzido em escolas públicas de ensino fundamental e médio no Brasil. Os participantes serão crianças e adolescentes entre 5 e 15 anos de idade, dos dois sexos. As intervenções se concentrarão em mudanças de estilo de vida, atividade física e educação nutricional. As atividades de intervenção ocorrerão mensalmente na sala de multimídia ou quadra de esportes das escolas. O grupo controle receberá as recomendações usuais através da escola. O desfecho primário será a mudança nas medidas antropométricas, como índice de massa corporal e os níveis de atividade física conforme o Questionário Internacional de Atividade Física. RESULTADOS:: Esperamos que, após o estudo, as crianças aumentem o consumo de alimentos frescos, reduzam o consumo excessivo de alimentos açucarados e processados, e reduzam as horas gastas em atividades sedentárias. CONCLUSÃO:: O propósito de iniciar a intervenção dietética nessa fase da vida é desenvolver o conhecimento que permitirá escolhas saudáveis, propiciando oportunidades para um melhor futuro para essa população.

Healthy School, Happy School: Design and Protocol for a Randomized Clinical Trial Designed to Prevent Weight Gain in Children / Escola Saudável é mais Feliz: Design e Protocolo de um Ensaio Clinico Randomizado Desenvolvido para Prevenir o Ganho de Peso em Crianças

Abstract Background: Schools have become a key figure for the promotion of health and obesity interventions, bringing the development of critical awareness to the construction and promotion of a healthy diet, physical activity, and the monitoring of the nutritional status in childhood and adolescence. Objectives: To describe a study protocol to evaluate the effectiveness of an intervention designed to improve knowledge of food choices in the school environment. Methods: This is a cluster-randomized, parallel, two-arm study conducted in public elementary and middle schools in Brazil. Participants will be children and adolescents between the ages of 5 and 15 years, from both genders. The interventions will be focusing on changes in lifestyle, physical activities and nutritional education. Intervention activities will occur monthly in the school's multimedia room or sports court. The control group arm will receive usual recommendations by the school. The primary outcome variable will be anthropometric measures, such as body mass index percentiles and levels of physical activity by the International Physical Activity Questionnaire. Results: We expect that after the study children will increase the ingestion of fresh food, reduce excessive consumption of sugary and processed foods, and reduce the hours of sedentary activities. Conclusion: The purpose of starting the dietary intervention at this stage of life is to develop a knowledge that will enable for healthy choices, providing opportunities for a better future for this population.

Resumo Fundamento: As escolas tornaram-se essenciais para a promoção de saúde e de intervenções para obesidade, propiciando o desenvolvimento de consciência crítica para a construção e promoção de dieta saudável, atividade física e monitoramento do status nutricional na infância e adolescência. Objetivos: Descrever um protocolo de estudo para avaliar a eficiência de uma intervenção projetada para aprimorar o conhecimento sobre escolhas alimentares no ambiente escolar. Métodos: Estudo clínico randomizado em cluster, paralelo, de dois braços, conduzido em escolas públicas de ensino fundamental e médio no Brasil. Os participantes serão crianças e adolescentes entre 5 e 15 anos de idade, dos dois sexos. As intervenções se concentrarão em mudanças de estilo de vida, atividade física e educação nutricional. As atividades de intervenção ocorrerão mensalmente na sala de multimídia ou quadra de esportes das escolas. O grupo controle receberá as recomendações usuais através da escola. O desfecho primário será a mudança nas medidas antropométricas, como índice de massa corporal e os níveis de atividade física conforme o Questionário Internacional de Atividade Física. Resultados: Esperamos que, após o estudo, as crianças aumentem o consumo de alimentos frescos, reduzam o consumo excessivo de alimentos açucarados e processados, e reduzam as horas gastas em atividades sedentárias. Conclusão: O propósito de iniciar a intervenção dietética nessa fase da vida é desenvolver o conhecimento que permitirá escolhas saudáveis, propiciando oportunidades para um melhor futuro para essa população.

Serum C-reactive protein levels and body mass index in children and adolescents with CHD.

BACKGROUND: The prevalence of overweight in children with CHD is about 26.9%. Increase in adipose tissue is related to the secretion of proinflammatory markers such as C-reactive protein. Assuming that children with CHD are exposed to other inherent risk factors for heart disease, our objective was to evaluate the correlation between levels of C-reactive protein and body mass index in children and adolescents with CHD. METHODS: A cross-sectional study with 377 children and adolescents with CHD in a clinical setting of a reference hospital was carried out. C-reactive protein data were collected after 12 hours of fasting. Nutritional status was classified according to body mass index. The patients were divided into three groups: cyanotic, acyanotic, and minimal heart defects (controls). RESULTS: The mean age was 9.9±4.2 years, and 53.6% of the sample included males. The cyanotic group represented 22.3%, acyanotic 42.2%, and minimal defects 35.5% of the sample. The average body mass index percentile was 57.23±32.06. The median values of C-reactive protein were as follows: cyanotic 0.340, acyanotic with clinical repercussion 0.203, and minimal defects 0.128. There was a significant difference between the minimal defects and the cyanotic groups (p=0.023). There was a significant correlation between C-reactive protein and body mass index percentile (r=0.293, p<0.01). C-reactive protein levels were higher in girls (p=0.034). There were no significant correlations between C-reactive protein and age or birth weight. CONCLUSION: The correlation between body mass index percentile and C-reactive protein was confirmed in this population. The prevention of overweight is paramount to avoid overlapping modifiable risk factors to those already inherent to the CHD.

Relação da espessura do músculo adutor do polegar e avaliação subjetiva global em unidade de terapia intensiva cardiológica / Relationship between adductor pollicis muscle thickness and subjective global assessment in a cardiac intensive care unit

RESUMO Objetivo: Verificar a relação do teste de espessura do músculo adutor do polegar com avaliação subjetiva global e correlacioná-lo a outros métodos antropométricos. Métodos: Estudo transversal observacional realizado em unidade de terapia intensiva de um hospital de cardiologia no Estado do Rio Grande do Sul. Os pacientes internados foram submetidos à avaliação subjetiva global, da espessura do músculo adutor do polegar em ambas as mãos e da circunferência da panturrilha da perna direita. Foram coletados parâmetros laboratoriais, tempo de internação, sinais vitais, dados e exames do prontuário eletrônico. Resultados: População composta de 83 pacientes, sendo 62% homens, com idade de 68,6 ± 12,5 anos. O motivo de internação mais frequente foi infarto agudo miocárdio (34,9%), e a patologia mais comum foi a hipertensão arterial sistólica (63,9%) seguida de diabetes mellitus (28,9%). Conforme a classificação da avaliação subjetiva global, 62,7% dos pacientes apresentaram-se sem risco nutricional, 20,5% moderadamente desnutridos e 16,9% gravemente desnutridos. As mulheres apresentaram maior risco nutricional, tanto pela avaliação subjetiva global quanto pela espessura do músculo adutor do polegar, que foi < 6,5mm (54,8%; p = 0,001). A patologia com maior risco nutricional foi a insuficiência cardíaca congestiva (p = 0,001). A avaliação da curva ROC entre espessura do músculo adutor do polegar e avaliação subjetiva global teve acuidade, com área de 0,822. Conclusão: A espessura do músculo adutor do polegar demonstrou ser um bom método de avaliação de risco nutricional.

ABSTRACT Objective: To verify the relationship between the adductor pollicis muscle thickness test and the subjective global assessment and to correlate it with other anthropometric methods. Methods: This observational cross-sectional study was conducted in the intensive care unit of a cardiology hospital in the state of Rio Grande do Sul, Brazil. The hospitalized patients underwent subjective global assessment and adductor pollicis muscle thickness tests on both hands, along with measurement of the right calf circumference. Laboratory parameters, length of stay, vital signs and electronic medical record data and tests were all collected. Results: The study population included 83 patients, of whom 62% were men. The average age was 68.6 ± 12.5 years. The most common reason for hospitalization was acute myocardial infarction (34.9%), and the most common pathology was systolic blood pressure (63.9%), followed by diabetes mellitus (28.9%). According to subjective global assessment classifications, 62.7% of patients presented no nutritional risk, 20.5% were moderately malnourished and 16.9% were severely malnourished. Women had a higher nutritional risk, according to both the subjective global assessment and the adductor pollicis muscle thickness test, the cutoff for which was < 6.5mm (54.8%; p = 0.001). The pathology presenting the greatest nutritional risk was congestive heart failure (p = 0.001). Evaluation of the receiver operating characteristic (ROC) curve between adductor pollicis muscle thickness and subjective global assessment showed the accuracy of the former, with an area of 0.822. Conclusion: Adductor pollicis muscle thickness proved to be a good method for evaluating nutritional risk.

Effectiveness of physical exercise to reduce cardiovascular risk factors in youths: a randomized clinical trial.

BACKGROUND: The aim of the current study was to test the effectiveness of a physical activity and exercise-based program in a clinical context to reduce cardiovascular risk factors in children and adolescents. METHODS: A randomized clinical trial was conducted in a pediatric preventive outpatient clinic. Intervention was 14 weeks of exercise for the intervention group or general health advice for the control group. The primary and the secondary outcomes were reduction of cardiovascular risk factors and the feasibility and the effectiveness of clinical advice plan to practice physical exercises at home. RESULTS: A total of 134 children were screened; 26 met eligibility criteria. Of these, 10 were allocated in the exercise intervention group and nine were included in the control group until the end of the intervention. Those patients who discontinued the intervention had the lowest scores of z-BMI (P = 0.033) and subscapular skin fold (P = 0.048). After 14 weeks of intervention, no statistical differences were found between the groups. High-density lipoprotein cholesterol (HDL-C) was higher in the exercise group, with a mild tendency to be significant (P = 0.066). Patients who adhere to treatment had diastolic blood pressure decreased from baseline to the end of the follow-up period in the control group (P = 0.013). Regardless of this result, the other comparisons within the group were not statistically different between T0 and T14. CONCLUSION: A low-cost physical activity advice intervention presented many barriers for implementation in routine clinical care, limiting its feasibility and evaluation of effectiveness to reduce cardiovascular risk factors.

Relationship between adductor pollicis muscle thickness and subjective global assessment in a cardiac intensive care unit.

OBJECTIVE: To verify the relationship between the adductor pollicis muscle thickness test and the subjective global assessment and to correlate it with other anthropometric methods. METHODS: This observational cross-sectional study was conducted in the intensive care unit of a cardiology hospital in the state of Rio Grande do Sul, Brazil. The hospitalized patients underwent subjective global assessment and adductor pollicis muscle thickness tests on both hands, along with measurement of the right calf circumference. Laboratory parameters, length of stay, vital signs and electronic medical record data and tests were all collected. RESULTS: The study population included 83 patients, of whom 62% were men. The average age was 68.6 ± 12.5 years. The most common reason for hospitalization was acute myocardial infarction (34.9%), and the most common pathology was systolic blood pressure (63.9%), followed by diabetes mellitus (28.9%). According to subjective global assessment classifications, 62.7% of patients presented no nutritional risk, 20.5% were moderately malnourished and 16.9% were severely malnourished. Women had a higher nutritional risk, according to both the subjective global assessment and the adductor pollicis muscle thickness test, the cutoff for which was < 6.5mm (54.8%; p = 0.001). The pathology presenting the greatest nutritional risk was congestive heart failure (p = 0.001). Evaluation of the receiver operating characteristic (ROC) curve between adductor pollicis muscle thickness and subjective global assessment showed the accuracy of the former, with an area of 0.822. CONCLUSION: Adductor pollicis muscle thickness proved to be a good method for evaluating nutritional risk.

Overweight and obesity in children with congenital heart disease: combination of risks for the future?

BACKGROUND: Children who have unhealthy lifestyles are predisposed to develop hypertension, dyslipidemia and other complications. The epidemic of obesity is also affecting children with congenital heart disease. The aim of this study is to estimate the prevalence of obesity and describe associated risk factors, including family history in children with congenital heart disease. METHODS: A cross-sectional study with 316 children and adolescents with congenital heart disease seen in an outpatient clinic of a reference hospital. Collected sociodemographic data included family history of chronic disease, dietary habits, laboratory tests (total cholesterol, HDL and LDL/cholesterol, triglycerides, fasting glucose, CRP, hematocrit and hemoglobin), and anthropometric assessment. Anthropometric data of the caregivers was self-reported. RESULTS: The prevalence of excess weight was 26.9%. Altered levels of total cholesterol were observed in 46.9%, of HDL in 32.7%, LDL in 23.6% and of triglycerides levels in 20.0%. A higher frequency of family history of obesity (42.6%; p = 0.001), dyslipidemia (48.1%; p = <0.001), diabetes (47.4%; p = 0.002), hypertension (39.2%; p = 0.006) and ischemic disease (43.7%; p = 0.023), as well as significantly higher values of triglycerides (p = 0.017), glycemia (p = 0.004) and C-reactive protein (p = 0.002) were observed among patients with excess weight. CONCLUSION: The presence of modifiable risk factors and the variables associated to excess weight in this population was similar to that described in the literature for children without congenital disease. As these children already present the risks associated to heart disease, it is particularly important to promote a healthy lifestyle in this group.

Physical activity and cardiovascular risk factors in children: meta-analysis of randomized clinical trials.

OBJECTIVE: To assess the effects of physical activity interventions in preventing cardiovascular risk factors in childhood through a systematic review and meta-analysis of randomized clinical trials (RCTs). METHODS: A search of online databases (PubMed, EMBASE and Cochrane CENTRAL) was conducted from inception until June 2013. RCTs enrolling children 6-12years old conducted physical activity interventions longer than 6months, assessing their effect on body mass index (BMI), systolic (SBP) and diastolic blood pressure (DBP), total cholesterol (TC) and triglycerides (TG) were included. Data analysis was performed using a random-effects model. RESULTS: Of 23.091 articles retrieved, 11 RCTs (10.748 subjects) were included. Physical activity interventions were not associated with reductions of BMI [-0.03kg/m(2) (95%CI -0.16, 0.13) I(2) 0%]. However, there was an association between the interventions and reduction of SBP [-1.25mmHg (95%CI -2.47, -0.02) I(2) 0%], DBP [-1.34mmHg (95%CI -2.57, -0.11) I(2) 43%] and TG [-0.09mmol/L (95%CI -0.14, -0.04) I(2) 0%], and increase of TC [0.14mmol/L (95%CI 0.01, 0.27) I(2) 0%]. CONCLUSION: As physical activity intervention programs lasting longer than 6months are associated with reductions in blood pressure levels and triglycerides, they should be considered to be included in prevention programs for cardiovascular diseases in schoolchildren.

Excesso de Peso, Variáveis Antropométricas e Pressão Arterial em Escolares de 10 a 18 Anos / Excess Weight, Anthropometric Variables and Blood Pressure in Schoolchildren aged 10 to 18 years

Fundamento: Estima-se que a prevalência de hipertensão em crianças e adolescentes varie entre 1-13%. O excesso de peso e a obesidade central estão relacionados aos níveis pressóricos em adultos e podem ser importantes na patogênese precoce da HAS quando presentes na infância. Objetivos: Identificar a associação entre variáveis antropométricas e níveis pressóricos em escolares de 5.ª a 8.ª séries e avaliar qual medida obteve maior correlação com a medida dos níveis pressóricos. Métodos: Estudo transversal contemporâneo com amostra de base populacional probabilística por conglomerados em escolas públicas do ensino fundamental de Porto Alegre, de alunos matriculados entre a 5.ª e a 8.ª série. Foram coletados dados sobre fatores de risco familiares e antropometria. A análise estatística incluiu correlações e ajuste dos intervalos de confiança para conglomerados. Resultados: A média de idade dos participantes foi de 12,57 (± 1,64) anos, dos quais 55,2% eram do sexo feminino. Encontraram-se 11,3% da amostra com níveis pressóricos alterados e 16,2% com valores limítrofes. Das variáveis antropométricas analisadas, a que demonstrou maior correlação com valores pressóricos aumentados foi o diâmetro do quadril (r = 0,462, p < 0,001) seguido de circunferência abdominal menor (r = 0,404, p < 0,001) e prega cutânea abdominal (r = 0,291, p < 0,001). Conclusão: Foi observada associação entre as circunferências da cintura e dobras cutâneas e níveis pressóricos aumentados nos escolares da amostra. Portanto, é de fundamental importância que a aferição da pressão arterial e as medidas de cintura e quadril sejam rotina nos serviços de saúde ...

Background: The prevalence of hypertension among children and adolescents is estimated to range between 1% and 13%. Excess weight and central obesity are related to blood pressure levels in adults, and may be important in the early pathogenesis of SH when present in childhood. Objectives: To study the association between anthropometric variables and blood pressure levels in schoolchildren from the 5th and 8th grades, and to identify which parameter was more strongly correlated with blood pressure levels. Methods: Contemporary cross-sectional study with probabilistic population-based cluster sampling of schoolchildren enrolled from the 5th to the 8th grades in public elementary schools of Porto Alegre. Data on familial risk factors and anthropometry were collected. Statistical analysis included correlations and cluster-adjusted confidence intervals. Results: The mean age of participants was 12.57 (± 1.64) years, and 55.2% of them were females. Abnormal blood pressure levels were found in 11.3% of the sample and borderline values, in 16.2%. Among the anthropometric variables analyzed, hip circumference was the one with the strongest correlation with increased blood pressure (r = 0.462, p < 0.001), followed by waist circumference (r = 0.404, p < 0.001) and abdominal skinfold (r = 0.291, p < 0.001). Conclusion: We observed an association of waist circumference and skinfolds with increased blood pressure levels in the schoolchildren of the sample. Therefore, it is of the utmost importance that early measurements of blood pressure, and waist and hip circumferences become a routine in health services in order to prevent this condition. .

Excess weight, anthropometric variables and blood pressure in schoolchildren aged 10 to 18 years.

BACKGROUND: The prevalence of hypertension among children and adolescents is estimated to range between 1% and 13%. Excess weight and central obesity are related to blood pressure levels in adults, and may be important in the early pathogenesis of SH when present in childhood. OBJECTIVES: To study the association between anthropometric variables and blood pressure levels in schoolchildren from the 5th and 8th grades, and to identify which parameter was more strongly correlated with blood pressure levels. METHODS: Contemporary cross-sectional study with probabilistic population-based cluster sampling of schoolchildren enrolled from the 5th to the 8th grades in public elementary schools of Porto Alegre. Data on familial risk factors and anthropometry were collected. Statistical analysis included correlations and cluster-adjusted confidence intervals. RESULTS: The mean age of participants was 12.57 (± 1.64) years, and 55.2% of them were females. Abnormal blood pressure levels were found in 11.3% of the sample and borderline values, in 16.2%. Among the anthropometric variables analyzed, hip circumference was the one with the strongest correlation with increased blood pressure (r = 0.462, p < 0.001), followed by waist circumference (r = 0.404, p < 0.001) and abdominal skinfold (r = 0.291, p < 0.001). CONCLUSION: We observed an association of waist circumference and skinfolds with increased blood pressure levels in the schoolchildren of the sample. Therefore, it is of the utmost importance that early measurements of blood pressure, and waist and hip circumferences become a routine in health services in order to prevent this condition.

Comparação das curvas NCHS, CDC e OMS em crianças com risco cardiovascular / Comparison of NCHS, CDC, and WHO curves in children with cardiovascular risk

OBJETIVO: O objetivo deste trabalho foi comparar a prevalência de sobrepeso e obesidade de acordo com três curvas de crescimento: OrganizaçãoMundialde Saúde(OMS/2006), National Centre for Health Statistics (NCHS/1977) e Centers for Disease Control and Prevention (CDC/2000) em crianças com fatores de risco cardiovascular. MÉTODOS: Foram avaliados dados de 118 crianças e adolescentes, com idade entre 2 e 19 anos, atendidos entre os anos de 2001 a 2009 no Ambulatório de Cardiologia Pediátrica Preventiva do Instituto de Cardiologia de Porto Alegre. As variáveis analisadas foram: peso, altura, idade e sexo. Estas foram classificadas quanto aos critérios peso/idade, estatura/idade e índice de massa corpórea (IMC). Os pontos de corte adotados foram de três curvas de crescimento OMS/2006, NCHS/1977, CDC/2000. RESULTADOS: Quanto ao critério peso/idade pelo NCHS, 18% das crianças foram classificadas com eutrofia e 82% com peso elevado; pelo CDC, 28% eutróficas e 72% peso elevado; e pela OMS, 16,0% com eutrofia e 84% com peso elevado. Segundo o IMC, foram classificadas com baixo peso 0,8% da população, segundo CDC e OMS; eutróficos 7,6% e 6,8%, sobrepeso 26,3% e 11,9%, e com obesidade 65,3% e 80,5%, pelo CDC e OMS, respectivamente. Quanto ao critério estatura/idade, não houve diferença significativa entre os referenciais; em média, 98,3% da população estudada apresentou estatura adequada para idade. CONCLUSÃO: Conclui-se que as novas curvas da OMS são mais sensíveis para identificar obesidade em uma população de risco, o que tem importantes implicações para o manejo preventivo e terapêutico.

OBJECTIVE: The study aimed to compare the prevalence of overweight and obesity according to three growth curves, created by theWorld Health Organization (WHO/2006), by the National Center for Health Statistics (NCHS/1977), and by the Centers for Disease Control and Prevention (CDC/2000) in children with cardiovascular risk factors. METHODS: Data from 118 children and adolescents, aged between 2 and 19 years, treated between the years 2001 to 2009 at the Pediatric Preventive Cardiology Outpatient Clinic of the Instituto de Cardiologia de Porto Alegre were evaluated. The variables analyzed were: weight, height, age, and gender. Variables were classified according to the following criteria: weight/age, height/age, and body mass index (BMI). The cutoff points used were obtained from the three growth curves: WHO/2006, NCHS/1977, and CDC/2000. RESULTS: Regarding the criterion weight/age by the NCHS curve, 18% of the children were classified as having normal weight, and 82% had excess weight; by the CDC curve, 28% had normal and 72% had excess weight; by the WHO curve, 16.0% had normal weight and 84% had excess weight. According to the BMI, 0.8% of the population was underweight. According to the CDC and WHO curves, 7.6% and 6.8% had normal weight; 26.3% and 11.9% were overweight; and 65.3% and 80.5% were obese, respectively. Regarding the height/age criterion, there was no significant difference between the references and, on average, 98.3% of the population showed adequate height for age. CONCLUSION: The new WHO curves are more sensitive to identify obesity in a population at risk, which has important implications for preventive and therapeutic management.

Comparison of NCHS, CDC, and WHO curves in children with cardiovascular risk.

OBJECTIVE: The study aimed to compare the prevalence of overweight and obesity according to three growth curves, created by the World Health Organization (WHO/2006), by the National Center for Health Statistics (NCHS/1977), and by the Centers for Disease Control and Prevention (CDC/2000) in children with cardiovascular risk factors. METHODS: Data from 118 children and adolescents, aged between 2 and 19 years, treated between the years 2001 to 2009 at the Pediatric Preventive Cardiology Outpatient Clinic of the Instituto de Cardiologia de Porto Alegre were evaluated. The variables analyzed were: weight, height, age, and gender. Variables were classified according to the following criteria: weight/age, height/age, and body mass index (BMI). The cutoff points used were obtained from the three growth curves: WHO/2006, NCHS/1977, and CDC/2000. RESULTS: Regarding the criterion weight/age by the NCHS curve, 18% of the children were classified as having normal weight, and 82% had excess weight; by the CDC curve, 28% had normal and 72% had excess weight; by the WHO curve, 16.0% had normal weight and 84% had excess weight. According to the BMI, 0.8% of the population was underweight. According to the CDC and WHO curves, 7.6% and 6.8% had normal weight; 26.3% and 11.9% were overweight; and 65.3% and 80.5% were obese, respectively. Regarding the height/age criterion, there was no significant difference between the references and, on average, 98.3% of the population showed adequate height for age. CONCLUSION: The new WHO curves are more sensitive to identify obesity in a population at risk, which has important implications for preventive and therapeutic management.

Educational interventions in childhood obesity: a systematic review with meta-analysis of randomized clinical trials.

OBJECTIVE: To assess the effectiveness of educational interventions including behavioral modification, nutrition and physical activity to prevent or treat childhood obesity through a systematic review and meta-analysis of randomized trials. METHOD: A search of databases (PubMed, EMBASE and Cochrane CENTRAL) and references of published studies (from inception until May 2012) was conducted. Eligible studies were randomized trials enrolling children 6 to 12 years old and assessing the impact of educational interventions during 6 months or longer on waist circumference, body mass index (BMI), blood pressure and lipid profile to prevent or treat childhood obesity. Calculations were performed using a random effects method and pooled-effect estimates were obtained using the final values. RESULTS: Of 22.852 articles retrieved, 26 trials (23.617 participants) were included. There were no differences in outcomes assessed in prevention studies. However, in treatment studies, educational interventions were associated with a significant reduction in waist circumference [-3.21 cm (95%CI -6.34, -0.07)], BMI [-0.86 kg/m(2) (95%CI -1.59, -0.14)] and diastolic blood pressure [-3.68 mmHg (95%CI -5.48, -1.88)]. CONCLUSIONS: Educational interventions are effective in treatment, but not prevention, of childhood obesity and its consequences.

Prevalência de síndrome metabólica em pacientes de um ambulatório do Instituto de Cardiologia do Rio Grande do Sul (RS) / Prevalence of metabolic syndrome in outpatients of the Institute of Cardiology of Rio Grande do Sul / Prevalencia del síndrome metabólico en pacientes de un ambulatorio del Instituto de Cardiología de Río Grande del Sur (RS)

FUNDAMENTO: A síndrome metabólica (SM) é considerada um fator muito importante no desenvolvimento de doenças cardiovasculares (DCV). OBJETIVO: Avaliar a prevalência de síndrome metabólica (SM) nos pacientes atendidos no ambulatório para a prevenção secundária de doença arterial coronariana do IC-FUC, bem como verificar o excesso de peso por meio do índice de massa corporal (IMC) e a prevalência de obesidade abdominal na doença cardiovascular (DCV). MÉTODOS: A amostra final foi composta por 151 indivíduos (de 26 a 84 anos), cujos dados foram retirados da primeira consulta que apresentou exames sanguíneos de jejum, medidas da pressão arterial (PA), circunferência abdominal (CA) em centímetros, peso e estatura, associando sexo e idade. Para A avaliação de SM, foi utilizado o conceito do NCEP-ATP III. RESULTADOS: O sexo masculino representou 64,9 por cento da amostra. Foram encontrados índices de sobrepeso de 50 por cento e obesidade de 21,3 por cento, estando a CA aumentada presente em 30,8 por cento dos indivíduos, 20 homens e 25 mulheres. Atendendo aos critérios do NCEP-ATP III para o diagnóstico de SM, a prevalência dessa síndrome foi de 61,5 por cento, incluindo 54 homens e 39 mulheres. CONCLUSÃO: Verifica-se que a prevalência de SM em pacientes portadores de DCV no ambulatório para a prevenção secundária de DAC do IC-FUC é elevada, tendo também como característica a alta prevalência de sobrepeso, obesidade e CA aumentada.

BACKGROUND: Metabolic syndrome (MS) is considered a very important factor in the development of cardiovascular diseases (CVD). OBJECTIVE: To assess the prevalence of metabolic syndrome (MS) in outpatients undergoing secondary prevention of coronary artery disease in the Institute of Cardiology, University Foundation of Cardiology - IC-UFC, as well as to detect excess weight through body mass index (BMI) and the prevalence of abdominal obesity in patients with cardiovascular disease (CVD). METHODS: The final sample was comprised of 151 individuals (aged between 26 and 84 years) whose data were obtained from the first visit in which the following parameters were available: fasting blood tests, blood pressure (BP) measurement, waist circumference (WC) in centimeters, weight and height, gender and age. The NCEP-ATP III criteria were used for the assessment of MS. RESULTS: 64.9 percent of the sample was comprised of males. The overweight and obesity rates found were 50 percent and 21.3 percent, respectively; increased WC was found in 30.8 percent of the individuals, 20 of whom were men and 25 were women. The prevalence of MS, as diagnosed according to the NCEP-ATP III criteria, was 61.5 percent, including 54 men and 39 women. CONCLUSION: We verified that the prevalence of MS in patients with CVD in the outpatient clinic for secondary prevention of CAD at IC-UFC is high, and so are the prevalences of overweight, obesity and increased WC.

FUNDAMENTO: El síndrome metabólico (SM) es considerado un factor muy importante en el desarrollo de enfermedades cardiovasculares (ECV). OBJETIVO: Evaluar la prevalencia del síndrome metabólico (SM) en los pacientes atendidos en el ambulatorio para la prevención secundaria de una enfermedad arterial coronaria del IC-FUC, así como verificar el exceso de peso por medio del índice de masa corporal (IMC) y la prevalencia de obesidad abdominal en la enfermedad cardiovascular (ECV). MÉTODOS: La muestra final estuvo compuesta por 151 individuos (de 26 a 84 años), cuyos datos se retiraron de la primera consulta que presentó los análisis de sangre en ayuno, mediciones de la presión arterial (PA), circunferencia abdominal (CA) en centímetros, peso y estatura, asociando sexo y edad. Para la evaluación del SM se utilizó el concepto del NCEP-ATP III. RESULTADOS: El sexo masculino representó el 64,9 por ciento de la muestra. Se encontraron índices de sobrepeso del 50 por ciento y obesidad del 21,3 por ciento, estando la CA aumentada presente en el 30,8 por ciento de los individuos, 20 varones y 25 mujeres. Atendiendo a los criterios del NCEP-ATP III para el diagnóstico del SM, la prevalencia de ese síndrome fue del 61,5 por ciento, incluyendo a 54 varones y 39 mujeres. CONCLUSIÓN: Se verifica que la prevalencia del SM en pacientes portadores de ECV en el ambulatorio para la prevención secundaria de la EAC del IC-FUC es elevada, teniendo también como característica la alta prevalencia de sobrepeso, obesidad y CA aumentada.