Efeitos de um programa de intervenção interdisciplinar sobre o agrupamento de variáveis cardiometabólicas em adolescentes com excesso de peso / Effects of an interdisciplinary intervention program on the grouping of cardiometabolic variables in adolescents with excessive weight

O estudo tem por objetivo investigar alterações nas características de agrupamento de variáveis cardiometabólicas relacionados a resistência à insulina em resposta à um programa de intervenção interdisciplinar em adolescentes com excesso de peso. Estudo realizado em adolescentes co m excesso de peso, composto por grupo controle (n=19) e grupo intervenção (n=20), o qual p articipou de programa interdisciplinar de seis meses. Foi avaliado o índice de massa corporal, a circun ferência da cintura, pressão arterial sistólica e diastólica; realizada coleta sanguínea para avaliação da glicose, insulina e ácido úrico e calculado o índice HOMA-IR, antes e após o programa. Foi realizada análise fatorial exploratória por meio de análise de componentes principais, tendo sido consideradas cargas fatoriais associadas os valores ≥ 0,50. No período pré intervenção, três componentes fatoriais explicavam a variabilidade das variáveis em ambos os grupos, sendo a composição dos componentes igual entre estes, em que variáveis antropométricas e de pressão arterial compunham o fator 1; o segundo componente dizia respeito as variáveis relacionadas à resistência à insulina, insulina e HOMA-IR; e o terceiro comp onente era composto da glicemia e ácido úrico. Pós intervenção, dois componentes explicavam em ambos grupos e a composição era distinta, sendo que no grupo intervenção insulina e HOMA-IR passaram a fazer p arte do fator 1; já no grupo controle, a glicemia correlacionou-se negativamente com os indicadores antropométricos e de pressão arterial no componente 1; e glicemia, insulina, HOMA -IR e ácido úrico associaram-se no fator 2. Conclui-se que o programa de intervenção promoveu modificação no agrupamento das variáveis cardiometabólicas de adolescentes obesos, em que as variáveis insulina e HOMA-IR passaram a pertencer ao fator 1. Não foi encontrado nenhum fator central que ex p licasse o agrupamento das variáveis em nenhuma das análises, confirmando assim, a complexa relação en tre as variáveis analisadas...(AU)

The aim of the study was to investigate changes in the characteristics of grouping of cardiometabolic variables related to insulin resistance in response to an interdisciplin ary in tervention program in overweight adolescents. This study was performed in overweight adolescents, composed o f a control group (n = 19) and an intervention group (n = 20), who participated in a six month interdisciplinary program. Body mass index, waist circumference, systolic and diastolic blo o d p ressure were evaluated; blood collection for glucose, insulin and uric acid assessment and HOMA-IR index, before and after the program. An exploratory factorial analysis was performed through analy sis o f m ain components, and factorial loads associated with values ≥ 0.50 were considered. In the p re -interv en tion period, three factorial components explained the variability of the variables in bo th gro ups, an d t he composition of the components was equal, where anthropometric and blood pressure variables comprised factor 1; the second component related to the variables related to insulin resistance, insulin an d HOMAIR; and the third component was composed of glycemia and uric acid. Post-intervention, two components explained in both groups and the composition was distinct, and in the interventio n gro up , in sulin an d HOMA-IR became part of factor 1; in the control group, glycemia was negatively co rrelated wit h t he anthropometric and blood pressure indicators in component 1; and glycemia, insulin, HOMA-IR and uric acid were associated with factor 2. It was concluded that the intervention program promoted modification in the grouping of the cardiometabolic variables of obese adolescents, in which the insulin and HOMA-IR variables belonged to the factor 1. No central factor was found to explain the grouping of variables in an y of the analyzes, thus confirming the complex relationship between the analyzed variables...(AU)

Efeitos de um programa de intervenção no perfil de risco cardiometabólico de adolescentes com excesso de peso / Effects of an intervention program on the cardiometabolic risk profile of overweight adolescents

O objetivo do estudo é analisar os efeitos de um programa de intervenção interdisciplinar no perfil de risco cardiometabólico de adolescentes com diagnóstico de sobrepeso/ obesidade. Estudo de intervenção, realizado com adolescentes com excesso de peso, constituído por grupo controle e grupo intervenção, o qual participou de um programa interdisciplinar com duração de seis meses. O grupo experimental final é composto por 23 adolescentes (12 sexo feminino e 11 sexo masculino). No início do programa, quatro adolescentes apresentavam sobrepeso e 19 obesidade. O grupo controle é composto pelo mesmo número de sujeitos, uma vez que este foi composto pelos pares dos escolares do grupo experimental. A intervenção contou com sessões de exercícios físicos, em três dias da semana e orientações nutricionais e psicológicas, uma vez por semana. Uma avaliação foi realizada antes do inicio do programa e logo após seu término. As avaliações consistiram em variáveis antropométricas - índice de massa corporal, circunferência da cintura, razão cintura-estatura e razão cintura -quadril, avaliação da pressão arterial, da aptidão cardiorrespiratória e coleta sanguínea para avaliação do perfil lipídico. Para a comparação das variáveis no período pré e pós-intervenção foi utilizado o teste t para amostras pareadas, para as variáveis de distribuição normal e, para as variáveis não paramétricas, foi aplicado o t este de Wilcoxon, considerando o nível de significância de p<0,05. O programa de intervenção foi eficaz n a redução de todos os indicadores antropométricos, na melhora dos níveis de aptidão cardiorrespiratória e na redução dos níveis de colesterol LDL. Entretanto, não modificou de forma significativa o s níveis de pressão arterial e demais parâmetros do perfil lipídico (colesterol total, HDL e triglicerídeos)...(AU)

: The objective of the study is to analyze the effects of an interdisciplinary in terven tion program on the cardiometabolic risk profile of adolescents diagnosed as overweight / obese. Intervention study with overweight adolescents, consisting of a control group and an intervention group, which participated in an interdisciplinary program lasting six months. The final experimental group co nsists o f 23 adolescents (12 females and 11 males). At the beginning of the program, four adolescents were overweight and 19 were obese. The control group is composed of the number of subject s, sin ce it was composed by the pairs of students in the experimental group. The intervention coun ted o n sessio n s o f physical exercises, in three days of the week and nutritional and psychological orientations, once a week . An evaluation was carried out before the start of the program and soon after its completion. The evaluations consisted of anthropometric variable - body mass index, waist circumference, waist-to-waist ratio, and waist-to-hip ratio, arterial pressure, cardiorespiratory fitness evaluation and blood collection t o evaluate the lipid profile. For the comparison of the variables in the pre- and post-intervention period, t he t-test for paired samples was used for the variables of normal distribution and fo r th e n on-parametric variables the Wilcoxon test was used, considering the level of significance of p < 0.05. The intervention program was effective in reducing all anthropometric indicators, improving cardiorespiratory fitness levels and reducing LDL cholesterol levels. However, it did not significantly modify the blood pressure levels and other parameters of the lipid profile (total cholesterol, HDL and triglycerides)...(AU)

Health-related quality of life in adolescents with excess weight / Qualidade de vida relacionada à saúde em adolescentes com excesso de peso

Abstract Objective: To identify health-related quality of life in adolescents with excess weight and associated factors, such as gender, age, and weight categories. Method: A cross-sectional study with collected and secondary data from 276 adolescents aged between 10 and 19 years with overweight and obesity, and whose parents or guardians authorized their participation. Anthropometric data, pubertal development, and the PedsQL 4.0 questionnaire were collected for the health-related quality of life assessment. Categorical data were described as numbers and percentages. For the description of health-related quality of life subscales, medians and the 25th and 75th percentiles were used, as well as the Mann -Whitney test for comparisons between age group, gender, and weight categories. Results: The median health-related quality of life total score was 78.3 (68.5 -87.4). The lowest scale was the "emotional score", 65 (50 -80). Higher health-related quality of life was found in boys in most of the scores (p < 0.05), except for the "school score" (p = 0.09). Regarding the age group, the median of the "physical scores" (p = 0.03) and "social score" (p = 0.02) were significantly lower in the group younger than 14 years. When separated according to weight categories, it was verified that obese adolescents differed significantly in relation to the "physical score" (p = 0.00), "school score" (p = 0.04), and "total score" (p = 0.02) of the health-related quality of life. However, there was no significant difference between the emotional, social, and psychosocial scores. Conclusions: Adolescents with overweight and obesity show losses in the health-related quality of life and also between the different domains, when separated by age, gender, and weight categories.

Resumo Objetivo: Identificar a qualidade de vida relacionada à saúde entre adolescentes com excesso de peso e fatores associados, como gênero, idade e categorias de peso. Método: Estudo transversal com dados coletados e secundários de 276 adolescentes entre 10 e 19 anos, com sobrepeso e obesidade, cujos responsáveis autorizaram a participação. Foram coletados dados antropométricos, desenvolvimento puberal e questionário PedsQL 4.0 para a avaliação da qualidade de vida relacionada à saúde. Os dados categóricos foram descritos por contagens e percentuais. Para a descrição das subescalas da qualidade de vida relacionada à saúde foram usadas medianas e percentis 25 e 75 e teste de Mann-Whitney para comparações entre grupos de faixa etária, gênero e categorias de peso. Resultados: A mediana do escore total da qualidade de vida relacionada à saúde foi de 78,3 (68,5-87,4). A menor escala foi o "escore emocional" 65 (50-80). Encontramos a qualidade de vida relacionada à saúde maior nos meninos na maioria dos escores (p < 0,05), exceto o "escore escolar" (p = 0,09). Quanto à faixa etária, a mediana dos "escores físico" (p = 0,03) e "escore social" (p = 0,02) foram significativamente menores no grupo menor de 14 anos. Ao separar as categorias de peso, percebe-se que os adolescentes obesos diferem significativamente com relação ao "escore físico" (p = 0,00); "escore escolar" (p = 0,04) e "escore total" (p = 0,02) da qualidade de vida relacionada à saúde. Contudo, não houve diferença significativa entre os escores emocional, social e psicossocial. Conclusões: Adolescentes com sobrepeso e obesidade têm prejuízos na qualidade de vida relacionada à saúde e também entre os diferentes domínios, quando separados por faixa etária, gênero e categorias de peso.

Health-related quality of life in adolescents with excess weight.

OBJECTIVE: To identify health-related quality of life in adolescents with excess weight and associated factors, such as gender, age, and weight categories. METHOD: A cross-sectional study with collected and secondary data from 276 adolescents aged between 10 and 19 years with overweight and obesity, and whose parents or guardians authorized their participation. Anthropometric data, pubertal development, and the PedsQL 4.0 questionnaire were collected for the health-related quality of life assessment. Categorical data were described as numbers and percentages. For the description of health-related quality of life subscales, medians and the 25th and 75th percentiles were used, as well as the Mann-Whitney test for comparisons between age group, gender, and weight categories. RESULTS: The median health-related quality of life total score was 78.3 (68.5-87.4). The lowest scale was the "emotional score", 65 (50-80). Higher health-related quality of life was found in boys in most of the scores (p<0.05), except for the "school score" (p=0.09). Regarding the age group, the median of the "physical scores" (p=0.03) and "social score" (p=0.02) were significantly lower in the group younger than 14 years. When separated according to weight categories, it was verified that obese adolescents differed significantly in relation to the "physical score" (p=0.00), "school score" (p=0.04), and "total score" (p=0.02) of the health-related quality of life. However, there was no significant difference between the emotional, social, and psychosocial scores. CONCLUSIONS: Adolescents with overweight and obesity show losses in the health-related quality of life and also between the different domains, when separated by age, gender, and weight categories.

Hyperuricemia is associated with low cardiorespiratory fitness levels and excess weight in schoolchildren / Hiperuricemia está associada com baixos níveis de aptidão cardiorrespiratória e excesso de peso em escolares

Abstract Objective: To evaluate the possible association between hyperuricemia and cardiorespiratory fitness levels/nutritional profile, grouped into a single variable, in schoolchildren. Method: Cross-sectional study of 2335 students from Elementary schools, aged 7-17 years of both genders, stratified by conglomerates of a municipality in Southern Brazil. Body mass index (BMI) was calculated and cardiorespiratory fitness (CRF) was assessed by the 6-minute run/walk test. The BMI and CRF were grouped into a single variable, considering: (1) low and normal weight/fit; (2) low and normal weight/unfit; (3) overweight-obesity/fit; (4) overweight-obesity/unfit. The Poisson regression (prevalence ratio, PR) was used for the association between hyperuricemia and BMI/CRF ratio with 95% confidence intervals and differences were considered significant when p < 0.05. Results: There is an association, although subtle, between the presence of hyperuricemia with low levels of CRF and the presence of excess weight, when grouped into a single variable. Boys and girls with this condition have higher prevalence of hyperuricemia (PR: 1.07; p = 0.007 for boys; PR: 1.10; p < 0.001 for girls). Conclusion: Together, excess weight and low levels of cardiorespiratory fitness are associated with the presence of hyperuricemia in schoolchildren.

Resumo Objetivo: Avaliar a possível relação entre hiperuricemia com aptidão cardiorrespiratória e o estado nutricional, agrupados, em escolares. Método: Estudo transversal com 2.335 escolares da educação básica de 7 a 17 anos, de ambos os sexos, estratificados por conglomerados de um munícipio do sul do Brasil. Foi calculado o índice de massa corporal (IMC) e a aptidão cardiorrespiratória (APCR) foi avaliada pelo teste de corrida/caminhada de 6 minutos. O IMC e a APCR foram agrupados em uma única variável, considerando: 1) baixo peso-normal/apto; 2) baixo peso-normal/inapto; 3) sobrepeso-obesidade/apto; 4) sobrepeso-obesidade/inapto. A regressão de Poisson (razão de prevalência; RP) foi usada para associação entre hiperuricemia e a relação APCR/IMC com intervalos de confiança de 95% e diferenças significativas consideradas para p < 0,05. Resultados: Observa-se associação, embora sutil, entre a presença de hiperuricemia com baixos níveis de APCR e a presença de excesso de peso, de forma agrupada. Meninos e meninas, com essa condição, têm maior prevalência de hiperuricemia (RP: 1,07; p = 0,007; RP: 1,10; p < 0,001, respectivamente), em comparação com seus pares com bons níveis de APCR e estado nutricional adequado. Conclusão: De forma conjunta, o excesso de peso e os baixos níveis de aptidão cardiorrespiratória estão associados com a presença de hiperuricemia em escolares.

Hyperuricemia is associated with low cardiorespiratory fitness levels and excess weight in schoolchildren.

OBJECTIVE: To evaluate the possible association between hyperuricemia and cardiorespiratory fitness levels/nutritional profile, grouped into a single variable, in schoolchildren. METHOD: Cross-sectional study of 2335 students from Elementary schools, aged 7-17 years of both genders, stratified by conglomerates of a municipality in Southern Brazil. Body mass index (BMI) was calculated and cardiorespiratory fitness (CRF) was assessed by the 6-minute run/walk test. The BMI and CRF were grouped into a single variable, considering: (1) low and normal weight/fit; (2) low and normal weight/unfit; (3) overweight-obesity/fit; (4) overweight-obesity/unfit. The Poisson regression (prevalence ratio, PR) was used for the association between hyperuricemia and BMI/CRF ratio with 95% confidence intervals and differences were considered significant when p<0.05. RESULTS: There is an association, although subtle, between the presence of hyperuricemia with low levels of CRF and the presence of excess weight, when grouped into a single variable. Boys and girls with this condition have higher prevalence of hyperuricemia (PR: 1.07; p=0.007 for boys; PR: 1.10; p<0.001 for girls). CONCLUSION: Together, excess weight and low levels of cardiorespiratory fitness are associated with the presence of hyperuricemia in schoolchildren.

Genotypic carriers of the obesity-associated FTO polymorphism exhibit different cardiometabolic profiles after an intervention.

BACKGROUND:: Children and adolescents with at-risk genotypes (AA/AT) of the rs9939609 polymorphism in FTO, a fat mass and obesity-associated gene, may exhibit different cardiometabolic profile responses than subjects with the TT genotype after an interdisciplinary intervention. METHODS:: The sample consisted of 36 school children from southern Brazil. We used DNA quantitation and real-time polymerase chain reaction (PCR) for polymorphism genotyping. We measured anthropometric parameters (body mass index (BMI), waist circumference, hip circumference, waist-hip ratio, body fat percentage and skinfold sum), biochemical parameters (glucose, lipid profile, ultra-sensitive C-reactive protein, uric acid, alanine aminotransferase, aspartate aminotransferase, insulin and adiponectin) and blood pressure. The 4-month intervention consisted of physical education classes, nutritional counseling, and postural and oral health counseling. RESULTS:: We observed no significant differences among the groups (AA, AT and TT) after the intervention. However, we observed improvements in three parameters (waist circumference, hip circumference and C-reactive protein) in the AT/AA genotype group and in two parameters (hip circumference and uric acid) in the TT genotype group. CONCLUSIONS:: After an intervention program, carriers of at-risk genotypes for obesity (AA/AT) do not exhibit differences in biochemical parameters, blood pressure and anthropometric parameters compared with carriers of the TT genotype.

Association of IL-6 and CRP gene polymorphisms with obesity and metabolic disorders in children and adolescents.

Activation of adipose tissue inflammation is associated with obesity caused by lipid accumulation in adipocytes. Through this activation, proinflammatory cytokines, such as Interleukin-6 (IL-6) and C-reactive protein (CRP) seem to influence metabolic disorders. The present study evaluated whether polymorphisms in the CRP (rs1205) and IL-6 (rs1800795, rs2069845) genes are associated with the development of metabolic disorders in children and adolescents. A cross-sectional study was performed, consisting of 470 students from the municipality of Santa Cruz do Sul, Brazil, aged 7-17 years. Body mass index (BMI) was classified according to overweight and obesity. Genotyping was performed by real-time Polymerase Chain Reaction (PCR). Anthropometric characteristics, biochemical markers, immunological markers and blood pressure were assessed. Descriptive statistics, chi-square and logistic regression were used for the analyses. No association was detected between the rs1800795 polymorphism and the assessed variables. Individuals with the risk genotype in the rs1205 gene were associated with the risk of developing hypercholesterolemia (OR 2.79; CI 1.40, 5.57; p = 0.003). Carriers of the risk genotype in the rs2069845 gene are associated with the risk of developing obesity (OR 3.07; CI 1.08, 8.72; p = 0.03). The polymorphism rs2069845 was associated with obesity and rs1205 was associated with the risk of developing hypercholesterolemia in Brazilian schoolchildren.

DNA damage in children and adolescents with cardiovascular disease risk factors.

The risk of developing cardiovascular disease (CVD) is related to lifestyle (e.g. diet, physical activity and smoking) as well as to genetic factors. This study aimed at evaluating the association between CVD risk factors and DNA damage levels in children and adolescents. Anthropometry, diet and serum CVD risk factors were evaluated by standard procedures. DNA damage levels were accessed by the comet assay (Single cell gel electrophoresis; SCGE) and cytokinesis-blocked micronucleus (CBMN) assays in leukocytes. A total of 34 children and adolescents selected from a population sample were divided into three groups according to their level of CVD risk. Moderate and high CVD risk subjects showed significantly higher body fat and serum CVD risk markers than low risk subjects (P<0.05). High risk subjects also showed a significant increase in DNA damage, which was higher than that provided by low and moderate risk subjects according to SCGE, but not according to the CBMN assay. Vitamin C intake was inversely correlated with DNA damage by SCGE, and micronucleus (MN) was inversely correlated with folate intake. The present results indicate an increase in DNA damage that may be a consequence of oxidative stress in young individuals with risk factors for CVD, indicating that the DNA damage level can aid in evaluating the risk of CVD.

Interacción del perfil antropométrico y la actividad física con la tensión arterial en niños y adolescentes / Interaction between the anthropometric and physical activity with blood pressure in clidren and adolescents

Objetivo: El presente estudio tuvo como objetivo identificar las posibles asociaciones entre el factores de riesgo cardiovascular de niños y adolescentes, en lo que se refiere a la obesidad, la inactividad física y a la hipertensión arterial. Materiales y métodos: La muestra fue constituida de 230 escolares (107 niños y 123 niñas), con edad de 7 a 18 años de una escuela pública estadual de Santa Cruz do Sul/RS. Además de las variables control, sexo y edad, fueron evaluados peso, talla, índice de masa corporal (IMC), circunferencia de la cintura (CC), relación cintura/cadera (RCC), suma de los pliegues cutáneos (EPC), porcentaje de grasa (%G), consumo máximo de oxígeno (VO2máx), y tensión arterial en reposo (TA). Los datos fueron analizados a través del Programa Statistical Package for the Social Science (SPSS), por medio de Coeficiente de Correlación de Pearson, Chi-cuadrado y Regresión Lineal Múltiple pelo método Stepwise. Fueron considerados significantes las diferencias con p<0,05, para un intervalo de confianza de 95%.Resultados: Los resultados apuntan que la hipertensión arterial presentó relaciones más fuertes con peso y circunferencia de la cintura, siendo la tensión arterial sistólica y diastólica explicada en 44,8% e 35,2% por la CC, RCQ, ΣPC y edad. Todavía, estudiantes con poca actividad física o con un IM Calto (sobrepeso y la obesidad), tienen mayor porcentaje de hipertensión. Conclusiones: Los resultados del estudio sugieren que estudiantes con índices antropométricos y con distribución de gordura elevados, pueden presentar patrones también elevados de tensión arterial. Se resalta, así, la necesidad de profundizar estudios de esa naturaleza, controlando los demás factores de riesgo asociados, con la intención de asegurar una niñez saludable (AU)

Objective: The present study is aimed at identifying the possible associations between cardiovascular risk factors of children and adolescents, with regard to obesity and lack of physical activity and arterial hypertension. Materials and methods: The sample consisted of 230 students (107 boys and 123 girls), aged 7 to 18, from a public state school in Santa Cruz do Sul/RS. In addition to the control of the variables, sex and age, other evaluations included weight, height, body-mass index (BMI), waist circumference (WC),waist-hip ratio (WHR), sum of cutaneous creases (SCC), body fat percentage (BF%), maximum consumption of oxygen (VO2max), and arterial oxygen tension (AT). The data were analyzed through the Statistical Package for the Social Sciences (SPSS), by means of Pearson’s Correlation Coefficient, through the stepwise Multiple Linear Regression Approach to “Chi Square” hypotheses. The differences with p<0.005 for a confidence interval of 95% were considered significant. Results: The results show that arterial hypertension presents stronger relations with weight and waist circumference, and the systolic and diastolic arterial tension is explained in 44.8% and 35.2% for the WC, WHR, SCC and age. Yet, students with little physical activity or a high BMI (overweight and obesity), have higher rate of hypertension. Conclusions: The results of this study suggest that students with high anthropometric indices and body fat distribution are also likely to present high arterial tension indices. It is therefore emphasized that there is a need to do further studies into this matter, controlling all other associated risk factors, with the intention to assure a healthy childhood (AU)