Multiple cardiovascular risk factors in adolescents from a middle-income country: Prevalence and associated factors.

Multiple cardiovascular risk factors are directly related to the severity of atherosclerosis, even in children and adolescents. In this context accurate assessment of risk factors at the individual level play a decisive role in cardiovascular disease (CVD) prevention. The objective of this study was to estimate the prevalence of cardiovascular risk factors, the frequency of their coexistence in individuals, and identify possible determinants associated with this coexistence in Brazilian adolescents. A cross-sectional study with 1170 students (12-17 years) from public and private schools of a large city was conducted. In addition to family history, modifiable cardiovascular risk factors were assessed including: tobacco use, alcohol consumption, sedentary lifestyle, overweight/obesity, increased waist circumference, and high blood pressure (office and home). We built a linear regression model to identify determinants associated with increasing number of modifiable risk factors. Mean study population age was 14.7±1.6 years, 67% were enrolled in public schools and 33% in private ones. The majority of the adolescents had at least two risk factors (68.9%), more than 10% had more than 4 risk factors, and in only 6.7% of the sample no risk factor was identified. Family history of CVD (ß-coefficient = 1.20; 95%CI 1.07-1.34; p<0.001), increasing age (ß-coefficient = 0.08; 95%CI 0.04-0.11; p<0.001), and being enrolled in private schools (ß-coefficient = 0.16; 95%CI 0.02-0.30; p = 0.023) were directly associated with the modifiable CV risk factors. In conclusion, the prevalence of multiple cardiovascular risk factors was high in the population of adolescents studied. School based interventions should be addressed to change this scenario.

White-coat, masked and sustained hypertension detected by home blood pressure monitoring in adolescents: prevalence and associated factors.

PURPOSE: Population-based studies estimating prevalence's of white-coat, masked and sustained hypertension in non-European adolescents are needed, particularly in developing countries. Aiming to determine these estimates and, additionally identify factors associated to these conditions this study was conducted. MATERIALS AND METHODS: Cross-sectional study with a representative sample of secondary school students from a Brazilian state capital. Office measurements were performed with validated semi-automatic devices. Home BP (blood pressure) monitoring protocol included two day-time and two evening-time measurements over 6 days. Adolescents' were classified as: normotensives (office and home BP <95th percentile); sustained hypertensives (office and home BP ≥95th percentile); white-coat hypertensives (office BP ≥95th percentile and home BP <95th percentile) and masked hypertensives (office BP <95th percentile and home BP ≥95th percentile). Logistic regression models were built to identify if sex, age, BMI and family history of HTN were independently associated with white-coat, masked and sustained hypertension. RESULTS: In a sample of 1024 adolescents, prevalence of white-coat, masked and sustained hypertension was 7.5%, 2.2% and 1.7%, respectively. Male sex was positively associated with white-coat hypertension (OR 2.68; 95%CI 1.58-4.54; p < 0.001). BMI was positively associated with both white-coat (OR 1.23; 95%CI 1.16-1.30; p < 0.001) and sustained hypertension (OR 1.19; 95%CI 1.11-1.29; p < 0.001). None of the independent variables were associated with masked hypertension in this population. CONCLUSION: The estimated prevalence of white-coat hypertension, masked and sustained hypertension in a population of non-European adolescents assessed by home BP monitoring was 7.5%, 2.2% and 1.7% respectively. Male sex was positively associated with white-coat hypertension in these adolescents while BMI was positively associated with both white-coat and sustained hypertension.

Home Blood Pressure Monitoring as an Alternative to Confirm Diagnoses of Hypertension in Adolescents with Elevated Office Blood Pressure from a Brazilian State Capital / Monitorização Residencial da Pressão Arterial (MRPA) como alternativa para confirmação diagnóstica de Hipertensão Arterial em adolescentes de uma capital brasileira com pressão de consultório elevada

Abstract Background: Regional differences of using home blood pressure monitoring (HBPM) as an alternative to ambulatory blood pressure monitoring (ABPM) in hypertensive adolescents are unknown. Objectives: Define if HBPM is an option to confirm diagnoses of hypertension in adolescents from a Brazilian capital with elevated office blood pressure (BP). Methods: Adolescents (12-18years) from public and private schools with BP > 90th percentile were studied to compare and evaluate the agreement among office BP measurements, HBPM and ambulatory BP monitoring. Office BP measurements, HBPM and ABPM were performed according to guidelines recommendations. Semi-automatic devices were used for BP measurements. Values of p < 0.05 were considered significant. Results: We included 133 predominantly males (63.2%) adolescents with a mean age of 15±1.6 years. HBPM systolic blood pressure and diastolic blood pressure mean values were similar to the daytime ABPM values (120.3 ± 12.6 mmHg x 121.5 ± 9.8 mmHg - p = 0.111 and 69.4 ± 7.7 mmHg x 70.2 ± 6.6 mmHg - p = 0.139) and lower than the office measurement values (127.3 ± 13.8 mmHg over 74.4 ± 9.5 mmHg - p < 0,001). The Bland-Altman plots showed good agreement between HBPM and ABPM. Conclusions: HBPM is an option to confirm diagnoses of hypertension in adolescents from a Brazilian state capital with elevated office BP and can be used as an alternative to ABPM.

Resumo Fundamentos: São desconhecidas as diferenças regionais na utilização da monitorização residencial da pressão arterial (MRPA) como alternativa à monitorização ambulatorial da pressão arterial (MAPA) em adolescentes hipertensos. Objetivos: Definir se MRPA é uma opção para confirmar diagnóstico de hipertensão arterial em adolescentes de uma capital brasileira com pressão arterial (PA) elevada. Métodos: Adolescentes (12-18 anos) de escolas públicas e privadas com percentil de PA > 90 foram estudados para comparar e avaliar a concordância entre as medidas de PA, MRPA e MAPA. As medidas de PA de consultório, MRPA e MAPA foram realizadas de acordo com as recomendações das diretrizes. Foram utilizados dispositivos semiautomáticos para medições de PA. Valores de p <0,05 foram considerados significativos. Resultados: Foram incluídos 133 adolescentes predominantemente do sexo masculino (63,2%) com idade média de 15 ± 1,6 anos. Os valores médios da pressão arterial sistólica e pressão arterial diastólica da MRPA foram semelhantes aos valores de MAPA diurnos (120,3 ± 12,6 mmHg x 121,5 ± 9,8 mmHg - p = 0,111 e 69,4 ± 7,7 mmHg x 70,2 ± 6,6 mmHg - p = 0,139) e inferiores aos valores de consultório (127,3 ± 13,8 mmHg por 74,4 ± 9,5 mmHg - p < 0,001). Os gráficos de Bland-Altman mostraram boa concordância entre MRPA e MAPA. Conclusões: MRPA é uma opção para confirmar diagnóstico de hipertensão arterial em adolescentes de uma capital brasileira com PA de consultório elevada e pode ser usada como alternativa à MAPA.

Overweight and associated factors in adolescents from a brazilian capital. / Excesso de peso e fatores associados em adolescentes de uma capital brasileira.

OBJECTIVE:: To evaluate the prevalence of overweight in adolescents and its associated factors. METHODS:: A cross-sectional study in public and private schools in Goiania, Brazil. Socioeconomic status, family history of obesity, lifestyle, blood pressure and Body Mass Index were studied in a sample of 1,169 Brazilian youth aged 12 - 18 years, who attended public and private schools. Data were obtained from a questionnaire and anthropometric measurements previously tested in a pilot study. Poisson regression was used to estimate the prevalence of overweight, prevalence ratios and associations with the other factors. RESULTS:: The prevalence of overweight was 21.2%, with a significant difference between boys and girls (26.3 and 16.8% respectively). Regression analysis showed that maternal obesity was associated with a higher prevalence of overweight in boys (PR = 1.86; p = 0.004), and boys aged 15 - 18 years had a lower prevalence of overweight than boys aged 12 - 14 years (PR = 0.70; p = 0.021). Among the girls, the presence of obese parents was associated with higher prevalence of overweight (PR = 2.42; p < 0.001), and the girls from a C class socioeconomic position were negatively associated with overweight (PR = 0.67; p = 0.035). CONCLUSIONS:: Overweight in adolescence is associated with gender, obesity family history, and socioeconomic position. These data should be considered when planning intervention programs.

Home Blood Pressure Monitoring as an Alternative to Confirm Diagnoses of Hypertension in Adolescents with Elevated Office Blood Pressure from a Brazilian State Capital.

BACKGROUND: Regional differences of using home blood pressure monitoring (HBPM) as an alternative to ambulatory blood pressure monitoring (ABPM) in hypertensive adolescents are unknown. OBJECTIVES: Define if HBPM is an option to confirm diagnoses of hypertension in adolescents from a Brazilian capital with elevated office blood pressure (BP). METHODS: Adolescents (12-18years) from public and private schools with BP > 90th percentile were studied to compare and evaluate the agreement among office BP measurements, HBPM and ambulatory BP monitoring. Office BP measurements, HBPM and ABPM were performed according to guidelines recommendations. Semi-automatic devices were used for BP measurements. Values of p < 0.05 were considered significant. RESULTS: We included 133 predominantly males (63.2%) adolescents with a mean age of 15±1.6 years. HBPM systolic blood pressure and diastolic blood pressure mean values were similar to the daytime ABPM values (120.3 ± 12.6 mmHg x 121.5 ± 9.8 mmHg - p = 0.111 and 69.4 ± 7.7 mmHg x 70.2 ± 6.6 mmHg - p = 0.139) and lower than the office measurement values (127.3 ± 13.8 mmHg over 74.4 ± 9.5 mmHg - p < 0,001). The Bland-Altman plots showed good agreement between HBPM and ABPM. CONCLUSIONS: HBPM is an option to confirm diagnoses of hypertension in adolescents from a Brazilian state capital with elevated office BP and can be used as an alternative to ABPM.

Excesso de peso e fatores associados em adolescentes de uma capital brasileira / Overweight and associated factors in adolescents from a brazilian capital

RESUMO: Objetivo: Avaliar a prevalência de excesso de peso (EP) e fatores associados em adolescentes. Métodos: Estudo transversal realizado em escolas públicas e privadas de Goiânia (GO). Foram analisados adolescentes de 12 a 18 anos (n = 1.169) por meio de questionário padronizado. A prevalência de EP foi avaliada pelas curvas de crescimento da Organização Mundial da Saúde (OMS) de Índice de Massa Corporal (IMC) por idade. As associações entre as variáveis sociodemográficas, de antecedentes familiares de obesidade, de estilo de vida e de pressão arterial com o EP foram analisadas por intermédio da razão de prevalência bruta e ajustada por meio da regressão múltipla de Poisson. Resultados: A prevalência de EP foi de 21,2%, sendo 14,1% de sobrepeso e 7,1% de obesidade, com diferenças significativas entre gêneros (26,3% dos rapazes versus 16,8% das moças). Na análise de Poisson, a obesidade materna (RP = 1,86; p = 0,004) foi associada com a maior prevalência de EP no sexo masculino, e aqueles com idade entre 15 e 18 anos tiveram menor prevalência de EP quando comparados àqueles com idade entre 12 e 14 anos (RP = 0,70; p = 0,021). No sexo feminino, a presença de pais obesos (RP = 2,42; p < 0,001) associou-se a maior prevalência de EP, e as moças pertencentes à classe C tiveram menor prevalência de EP (RP = 0,67; p = 0,035). Conclusões: O EP em adolescentes esteve associado ao gênero, à obesidade familiar, e a melhor classificação socioeconômica - fatores que devem ser o foco do planejamento de intervenções específicas na promoção da saúde.

ABSTRACT: Objective: To evaluate the prevalence of overweight in adolescents and its associated factors. Methods: A cross-sectional study in public and private schools in Goiania, Brazil. Socioeconomic status, family history of obesity, lifestyle, blood pressure and Body Mass Index were studied in a sample of 1,169 Brazilian youth aged 12 - 18 years, who attended public and private schools. Data were obtained from a questionnaire and anthropometric measurements previously tested in a pilot study. Poisson regression was used to estimate the prevalence of overweight, prevalence ratios and associations with the other factors. Results: The prevalence of overweight was 21.2%, with a significant difference between boys and girls (26.3 and 16.8% respectively). Regression analysis showed that maternal obesity was associated with a higher prevalence of overweight in boys (PR = 1.86; p = 0.004), and boys aged 15 - 18 years had a lower prevalence of overweight than boys aged 12 - 14 years (PR = 0.70; p = 0.021). Among the girls, the presence of obese parents was associated with higher prevalence of overweight (PR = 2.42; p < 0.001), and the girls from a C class socioeconomic position were negatively associated with overweight (PR = 0.67; p = 0.035). Conclusions: Overweight in adolescence is associated with gender, obesity family history, and socioeconomic position. These data should be considered when planning intervention programs.

Office blood pressure measurements with oscillometric devices in adolescents: a comparison with home blood pressure.

PURPOSE: Compare multiple in office BP measurements in adolescents using an oscillometric device with out-of-office blood pressure measurements (home blood pressure monitoring - HBPM). MATERIALS AND METHODS: Office measurements were performed with validated semi-automatic devices twice (3 minutes interval) in two different moments (1 week apart), with a total of four readings. These BP readings were named R1, R2, R3 and R4 (following the sequence they were performed), FDM (mean of two readings on first day) and SDM (mean of two readings on second day) and SRM (R2-R4 means). The HBPM protocol included two day-time and two evening-time measurements over 6 days. RESULTS: A total of 1024 students between 12 and 17 years were included (mean age 14.68 years; 52.4% females). The mean systolic blood pressure (SBP) values of R2, SDM and SRM were similar to HBPM values. Regarding diastolic blood pressure (DBP) HBPM value was different than R4. High SBP and DBP correlation coefficients with HBPM values were found for R2, SDM and SRM values. CONCLUSION: The second office BP measurement performed with an oscilometric device in adolescents was comparable to HBPM values, suggesting that two office readings might be suitable to rule out hypertension in this age group.

Sedentary lifestyle and its associated factors among adolescents from public and private schools of a Brazilian state capital.

BACKGROUND: Adolescence is a transition stage between childhood and adulthood and is an important phase for the acquisition of future lifestyles, including the practice of physical activity (PA). The prevalence of sedentary lifestyle in adolescents is often high, creating the need for studies addressing the practice of PA and its associated factors for a better understanding of the phenomenon and possible interventions that would encourage positive changes. METHODS: Cross-sectional study of a representative sample of students aged 14-18 years enrolled in both public and private schools of a large Brazilian city to determine the level of physical activity (PA) and its associated factors. Sedentary lifestyle was measured by applying the International Physical Activity Questionnaire. The independent variables were gender, age, race, tobacco use and alcohol consumption in the past 30 days, socioeconomic status, body mass index, waist circumference and blood pressure. The crude prevalence ratio was used as a measure of association and was estimated from a Poisson regression. RESULTS: The sample consisted of 862 adolescents with a mean age of 15.4 ± 1.1 years. Females were predominant (52.8%), and the age between 14 and 15 years was the most frequent (52.2%). The majority of the group reported themselves as Caucasians (51.2%), belonging to socioeconomic class C (52.5%) and were attending to public schools (69.1%). The prevalence of sedentary lifestyle was 66.8% (95% confidence interval [CI]: 63.5-69.9), where values of 65.4% and 69.9% were observed among students from public and private schools, respectively (p = 0.196). Sedentary lifestyle was more frequent in females (78.0% vs 54.3%; p < 0.001). The factor directly associated with sedentary lifestyle was female gender both in public and private schools and the only independent variable related to sedentarism was also female gender. CONCLUSION: The prevalence of sedentary lifestyle was extremely high in the population of adolescents studied both in public and private schools. Female sex was directly associated with sedentary lifestyle.

Correlation of Insulin Resistance with Anthropometric Measures and Blood Pressure in Adolescents / Correlação da Resistência à Insulina e Medidas Antropométricas com Pressão Arterial de Adolescentes

Abstract Background: Blood pressure is directly related to body mass index, and individuals with increased waist circumference have higher risk of developing hypertension, insulin resistance, and other metabolic changes, since adolescence. Objective: to evaluate the correlation of blood pressure with insulin resistance, waist circumference and body mass index in adolescents. Methods: Cross-section study on a representative sample of adolescent students. One group of adolescents with altered blood pressure detected by casual blood pressure and/or home blood pressure monitoring (blood pressure > 90th percentile) and one group of normotensive adolescents were studied. Body mass index, waist circumference were measured, and fasting glucose and plasma insulin levels were determined, using the HOMA-IR index to identify insulin resistance. Results: A total of 162 adolescents (35 with normal blood pressure and 127 with altered blood pressure) were studied; 61% (n = 99) of them were boys and the mean age was 14.9 ± 1.62 years. Thirty-eight (23.5%) adolescents had altered HOMA-IR. The group with altered blood pressure had higher values of waist circumference, body mass index and HOMA-IR (p<0.05). Waist circumference was higher among boys in both groups (p<0.05) and girls with altered blood pressure had higher HOMA-IR than boys (p<0.05). There was a significant moderate correlation between body mass index and HOMA-IR in the group with altered blood pressure (ρ = 0.394; p < 0.001), and such correlation was stronger than in the normotensive group. There was also a significant moderate correlation between waist circumference and HOMA-IR in both groups (ρ = 0.345; p < 0.05). Logistic regression showed that HOMA-IR was as predictor of altered blood pressure (odds ratio - OR = 2.0; p = 0.001). Conclusion: There was a significant association of insulin resistance with blood pressure and the impact of insulin resistance on blood pressure since childhood. The correlation and association between markers of cardiovascular diseases was more pronounced in adolescents with altered blood pressure, suggesting that primary prevention strategies for cardiovascular risk factors should be early implemented in childhood and adolescence.

Resumo Fundamentos: A pressão arterial (PA) está diretamente relacionada com o índice de massa corporal (IMC), e indivíduos com circunferência da cintura (CC) aumentada apresentam risco maior de desenvolver hipertensão arterial e resistência à insulina, além de outras alterações metabólicas, desde a adolescência. Objetivos: Avaliar a correlação entre resistência à insulina, CC e IMC com PA de adolescentes. Métodos: Estudo transversal com amostra representativa de adolescentes escolares. Foram avaliados um grupo com PA alterada pela medida casual e/ou medida residencial da PA (percentil de PA > 90) e outro com PA normal. Foram também avaliados IMC e CC. Glicemia de jejum e insulina plasmática foram dosados utilizando o índice de HOMA-IR para resistência à insulina. Resultados: Foram estudados 162 adolescentes (35 no Grupo PA normal e 127 no Grupo PA alterada); 61,1% (n = 99) deles eram meninos, e a idade média foi 14,9 ± 1,62 anos. Foram observados 38 adolescentes (23,5%) com HOMA-IR alterado. Os adolescentes com PA alterada apresentaram valores maiores de CC, IMC e HOMA-IR (p < 0,05). A CC foi superior nos meninos dos dois grupos (p < 0,05) e só no Grupo PA alterada foram observados valores de HOMA-IR superiores entre meninas (p < 0,05). A correlação entre IMC e HOMA-IR no Grupo PA alterada foi moderada e significativa (ρ = 0,394; p < 0,001) e superior ao encontrado no Grupo PA normal. A correlação entre CC e HOMA-IR também foi significativa, moderada e semelhante em ambos os grupos (ρ = 0,345; p = < 0,05). Pela regressão logística, HOMA-IR foi preditor de alteração da PA (odds ratio - OR = 2,0; p = 0,001). Conclusões: Houve associação significativa entre resistência à insulina e PA com impacto desde a infância. A correlação e a associação entre os marcadores de risco cardiovasculares mais forte no Grupo PA alterada sugere que medidas de prevenção primária desses fatores de risco devem ser implementadas precocemente.

Correlation of Insulin Resistance with Anthropometric Measures and Blood Pressure in Adolescents.

BACKGROUND: Blood pressure is directly related to body mass index, and individuals with increased waist circumference have higher risk of developing hypertension, insulin resistance, and other metabolic changes, since adolescence. OBJECTIVE: to evaluate the correlation of blood pressure with insulin resistance, waist circumference and body mass index in adolescents. METHODS: Cross-section study on a representative sample of adolescent students. One group of adolescents with altered blood pressure detected by casual blood pressure and/or home blood pressure monitoring (blood pressure > 90th percentile) and one group of normotensive adolescents were studied. Body mass index, waist circumference were measured, and fasting glucose and plasma insulin levels were determined, using the HOMA-IR index to identify insulin resistance. RESULTS: A total of 162 adolescents (35 with normal blood pressure and 127 with altered blood pressure) were studied; 61% (n = 99) of them were boys and the mean age was 14.9 ± 1.62 years. Thirty-eight (23.5%) adolescents had altered HOMA-IR. The group with altered blood pressure had higher values of waist circumference, body mass index and HOMA-IR (p<0.05). Waist circumference was higher among boys in both groups (p<0.05) and girls with altered blood pressure had higher HOMA-IR than boys (p<0.05). There was a significant moderate correlation between body mass index and HOMA-IR in the group with altered blood pressure (ρ = 0.394; p < 0.001), and such correlation was stronger than in the normotensive group. There was also a significant moderate correlation between waist circumference and HOMA-IR in both groups (ρ = 0.345; p < 0.05). Logistic regression showed that HOMA-IR was as predictor of altered blood pressure (odds ratio - OR = 2.0; p = 0.001). CONCLUSION: There was a significant association of insulin resistance with blood pressure and the impact of insulin resistance on blood pressure since childhood. The correlation and association between markers of cardiovascular diseases was more pronounced in adolescents with altered blood pressure, suggesting that primary prevention strategies for cardiovascular risk factors should be early implemented in childhood and adolescence.

Efeito de suplemento hidroeletrolítico na hidratação de jogadores juniores de futebol / Effects of a carbohydrate-electrolytic drink on the hydration of young soccer players

O estado de hidratação de jogadores sub-18 de um time de futebol foi avaliado após a ingestão de suplemento hidroeletrolítico mais aceito em teste afetivo. A aceitação de três suplementos elaborados foi avaliada por meio de teste afetivo em laboratório. O estudo foi realizado com nove jogadores de futebol, do sexo masculino, submetidos a 80 minutos de treinamento, com a ingestão de 900mL de suplemento hidroeletrolítico comercial (controle) ou suplemento mais aceito no teste sensorial e 300mL de água. Para avaliação do estado de hidratação foram determinados o tempo de movimentação, a intensidade do exercício, a densidade de urina, o peso corporal, a perda de peso corporal, a porcentagem de perda de peso corporal, o grau de hidratação e a taxa de sudorese. A bebida com 8 por cento de carboidrato teve melhor aceitação. A intensidade de exercício dos jogadores foi maior no dia de ingestão da bebida teste em comparação ao dia de ingestão da bebida controle, já o tempo de movimentação em relação à bebida teste foi significativamente menor do que a bebida controle (p = 0,008). A perda de peso, o grau de desidratação e a taxa de sudorese dos atletas com ingestão da bebida teste foram maiores quando comparadas à ingestão da bebida controle. Os atletas concluíram a partida mais desidratados com a ingestão de bebida teste; contudo, o limite de 2 por cento de perda de peso corporal não foi ultrapassado. A intensidade do exercício (de leve a moderada) e as condições climáticas (temperatura mais baixa e umidade relativa do ar mais elevada) no dia da ingestão da bebida controle podem ter favorecido os melhores resultados de capacidade de hidratação da bebida comercial.

The hydration status of nine male under 18 soccer players was evaluated after ingestion of the most accepted carbohydrate-electrolyte drink between three tests. The study was conducted during 80 minutes of training. The soccer players ingested 900 mL of a commercial carbohydrate-electrolyte drink (control) plus 300 mL of water or 900 mL of the most accepted drink (test) plus 300 mL of water. The time of training, exercise intensity, urinary status, weight, weight loss, the weight loss rate, the dehydration degree and the sweat rate were determined to verify the hydration status. The drink with 8 percent carbohydrate was the best accepted. The exercise intensity of the players was higher on the days that they ingested the tested drink. The time of training in relation to the tested drink was significantly lower than the control beverage (p = 0.008). The weight loss, the dehydration degree and sweat rate of the athletes with fluid intake test was higher when compared to control fluid intake. The athletes completed the game more dehydrated with the drinking fluid test; however, the limit of 2 percent weight loss was not exceeded. The exercise intensity (mild to moderate) and climatic conditions (lower temperature and higher relative humidity) on the day of the fluid control intake control may have helped the best results from the hydration capacity of the fluid control.