The triglyceride-glucose index as an indicator of insulin resistance and cardiometabolic risk in Brazilian adolescents

ABSTRACT Objective: To set cutoff points for the triglyceride and glucose index (TyG) as a marker of insulin resistance (IR) for the pediatric population. Subjects and methods: This was a cross-sectional study with schoolchildren population-based data using data of 377 schoolchildren age 10 to 17 years of both sexes. We studied metabolic variables associated with IR indicators, such as fasting insulin and blood glucose, to calculate the homeostatic model assessment (HOMA-IR), and we studied triglycerides (TG) to determine the TyG index. We obtained TyG cutoff values for IR using the receiver operation characteristic (ROC), with definitions of sensitivity (Sen), specificity (Spe), and area under the ROC curve (AUC), with the HOMA-IR as reference. Results: The cutoff points of the TyG index for IR in adolescents are 7.94 for both sexes, 7.91 for boys, and 7.94 for girls, indicating moderate discriminatory power. When we also considered anthropometric variables of excess weight [TyG-BMI (body mass index)] and visceral fat [TyG-WC (waist circumference)], these indexes reached AUC values higher than 0.72, enhancing their potential use for a good diagnosis. Conclusion: TyG has proven to be a useful instrument for identifying IR in adolescent health screening, with high discrimination capacity when added to anthropometric variables, making it a feasible and inexpensive option.

Walkability and physical activity: a protocol for systematic review and meta-analysis / Associação entre walkability e atividade física: um protocolo para revisão sistemática e meta-análise

The appropriate area for walking, related to the flow of walking, on the sidewalks and crossing (walka-bility) influences the practice of physical activity. However, there is no evidence of meta-analyses that have evaluated this association. Therefore, this study presents a protocol to assess the association be-tween walkability and physical activity. The systematic review protocol was conducted following the PRISMA 2020 guidelines and will includes a search in the following databases: PubMed, SPORT-Discus, LILACS, Web of Science, Scopus, Embase, and Cochrane. It will include observational studies, cross-sectional and longitudinal, that assessed the association between walkability in the neighborhood and physical activity. The process of study selection will be conducted independently by two reviewers. The process will start by reading the titles and abstracts of interest, followed by the full reading of the articles through the Rayyan platform. We will assess the methodological and indi-vidual quality across the studies utilizing the Newcastle Ottawa Scale (NOS) and the Chi-Squared test (I2). To test the influence of variables in the meta-analysis results, we will use, whenever possible, the meta-regression technique. The meta-analysis results will be presented as Odds Ratio (OR) with 95% confidence interval, through a random or fixed-effects model, according to estimate of clinical, statistical, and methodological heterogeneity. If possible, stratifications will be performed according to age group, sex, and physical activity levels.With the expected results, we hope that the knowledge will be useful to encourage the implementation of public policies for walkability in the neighborhood to increase physical activity levels

A área adequada para caminhada, relacionada ao fluxo de caminhada, nas calçadas e travessias (walkability) influencia na prática de atividade física. No entanto, não há evidências de meta-análises que tenham avaliado essa associação. Portanto, este estudo apresenta um protocolo para avaliar a as-sociação entre walkability e atividade física. O protocolo de revisão sistemática será realizado seguin-do as recomendações do PRISMA 2020 e incluirá uma busca nas seguintes bases de dados: PubMed, SPORTDiscus, LILACS, Web of Science, Scopus, Embase e Cochrane. Serão incluídos estudos observacionais, transversais e longitudinais, que avaliaram a associação entre walkability na vizinhan-ça e atividade física. O processo de seleção dos estudos será conduzido de forma independente por dois revisores. O processo terá início pela leitura dos títulos e resumos de interesse, seguido da leitura completa dos artigos por meio da plataforma Rayyan. Avaliaremos a qualidade metodológica e in-dividual entre os estudos utilizando a Escala de Newcastle Ottawa (NOS) e o teste Qui-Quadrado (I2). Para testar a influência das variáveis nos resultados da meta-análise, utilizaremos, sempre que possível, a técnica de meta-regressão. Os resultados da meta-análise serão apresentados como Odds Ratio (OR) com intervalo de confiança de 95%, por meio de um modelo de efeitos aleatórios ou fixos, de acordo com a estimativa clínica, estatística e metodológica da heterogeneidade. Se possível, serão realizadas estratificações de acordo com faixa etária, sexo e níveis de atividade física. Com os resulta-dos do estudo, esperamos que o conhecimento seja útil para incentivar a implementação de políticas públicas de walkability no bairro para aumentar os níveis de atividade física

Hypertension and Different Levels of Body Mass Index and Cardiorespiratory Fitness Amongst Adolescents

Abstract Background Hypertension is an increasingly common problem in adolescents; amongst the associated factors, physical inactivity and obesity are increasing the risk of developing cardiovascular diseases. Objective To verify whether there is an association between higher blood pressure levels amongst adolescents with the relationship between different levels of body mass index (BMI) and cardiorespiratory fitness (CRF). Method Cross-sectional study consisting of 860 adolescents. Higher blood pressure (BP) was considered as borderline and hypertension as the classification. BMI was categorized as low-normal weight and overweight-obesity. The CRF was assessed by a nine-minute run/walk test and classified into low or appropriate levels (less and more favorable to health, respectively). Later, BMI and CRF were grouped into one categorical variable: (I) low/normal weight and appropriate CRF levels; (II) low/normal weight and low CRF levels; (III) overweight/obesity and appropriate CRF levels; and (IV) overweight/obesity and low CRF levels. Data were analyzed using Poisson regression, through the prevalence ratio (PR) and 95% confidence intervals (CI). The p-values of p <0.05 were considered significant. Results Adolescents with overweight/obesity and low CRF levels had a 22% higher BP prevalence. Moreover, children with overweight/obesity, but with appropriate CRF levels, have a 15% higher BP prevalence. Conclusion Adolescents with overweight/obesity had a higher prevalence of BP, regardless of CRF levels. It is suggested that maintaining normal BMI is a protective factor for less favorable BP.

Vitamin D deficiency in children and adolescents with obesity: a meta-analysis

Abstract Objective To evaluate the prevalence of vitamin D deficiency in obese children and adolescents when compared to eutrophic controls. Methods Systematic review with meta-analysis covering studies with patients aged 0-18 years old diagnosed with obesity and vitamin D deficiency and control group of eutrophic patients. The studies were retrieved in the PubMed, Embase, and LILACS databases in December 2019. The search used the terms "obesity" in combination with "pediatric population" and "vitamin D". Results Through the search 3155 articles were retrieved; and after analysis, 20 studies were selected according to the study objectives. A total of 24,600 children and adolescents were included. Through meta-analysis, the relative risk for the association between obesity and vitamin D deficiency in the pediatric population was 1.41 (95% CI: 1.26-1.59) (I² = 89%, p < 0.01). Conclusion Children and adolescents with obesity have higher risk of vitamin D deficiency.

La falacia de los niños gordos anémicos / The fallacy of the fat anemic child

Fundamento: los estudios sugieren la presencia de deficiencia de hierro en niños obesos, lo que conduciría a una mayor incidencia de anemia en este grupo. Objetivo: evaluar la prevalencia de anemia entre niños con sobrepeso y obesidad de dos niveles socioeconómicos y dos regiones diferentes en Brasil. Métodos: se obtuvieron datos de hemoglobina y antropometría de 598 niños y adolescentes con sobrepeso y obesidad de dos servicios especializados en la atención de estos niños. Resultados: la prevalencia global de anemia fue del 5,8% y el nivel medio de hemoglobina fue de 13,2 mg / dL, sin diferencia estadística para los dos indicadores según sobrepeso u obesidad y grupo de edad. Sin embargo, la hemoglobina media fue mayor entre los varones y, en el servicio con atención prestada a una población de menor nivel socioeconómico, la prevalencia de anemia fue mayor. Conclusión: la prevalencia de anemia encontrada en niños y adolescentes con sobrepeso y obesidad fue bastante baja, siendo mayor en la población más pobre. Para los niños y adolescentes con sobrepeso, la anemia parece estar más relacionada con el nivel socioeconómico que con la presencia de exceso de peso.

Background: studies suggest the presence of iron deficiency among obese children, which would lead to a higher incidence of anemia in this group. Aim: to assess the prevalence of anemia among overweight and obese children from two socioeconomic levels and two different regions in Brazil. Methods: hemoglobin and anthropometric data on 598 overweight and obese children and adolescents were obtained from two services specialized in the care of these children. Results: the overall prevalence of anemia was 5.8% and mean hemoglobin level was 13.2 mg/dL, with no statistical difference for the two indicators according to overweight or obesity and age group. However, the mean hemoglobin was higher among boys and, in the service with care provided to a population of lower socioeconomic status, the prevalence of anemia was higher. Conclusion: the prevalence of anemia found among overweight and obese children and adolescents was quite low, being higher in the poorest population. For overweight children and adolescents, anemia seems to be more related to socioeconomic status than to the presence of excess weight.

Vitamin D deficiency in children and adolescents with obesity: a meta-analysis.

OBJECTIVE: To evaluate the prevalence of vitamin D deficiency in obese children and adolescents when compared to eutrophic controls. METHODS: Systematic review with meta-analysis covering studies with patients aged 0-18 years old diagnosed with obesity and vitamin D deficiency and control group of eutrophic patients. The studies were retrieved in the PubMed, Embase, and LILACS databases in December 2019. The search used the terms "obesity" in combination with "pediatric population" and "vitamin D". RESULTS: Through the search 3155 articles were retrieved; and after analysis, 20 studies were selected according to the study objectives. A total of 24,600 children and adolescents were included. Through meta-analysis, the relative risk for the association between obesity and vitamin D deficiency in the pediatric population was 1.41 (95% CI: 1.26-1.59) (I²â€¯= 89%, p < 0.01). CONCLUSION: Children and adolescents with obesity have higher risk of vitamin D deficiency.

Escore contínuo de risco metabólico em escolares com diferentes níveis de aptidão cardiorrespiratória / Índice de riesgo metabólico en escolares con diferentes niveles de aptitud cardiorrespiratoria / Students' continuous metabolic risk score with different levels of cardiorespiratory fitness

OBJETIVO: Comparar o escore de risco metabólico em escolares com diferentes níveis de aptidão cardiorrespiratória. MÉTODO: Estudo transversal, retrospectivo, realizado com escolares, no município de Santa Cruz do Sul (Brasil). Foram convidados alunos de 25 escolas públicas e privadas do município, que apresentassem idade entre 7 e 17 anos com termo de autorização assinado pelos pais/responsáveis. A amostra final foi composta por 1250 crianças e adolescentes. Foi realizada coleta de sangue para análise do perfil lipídico. Foi avaliada a pressão arterial, a circunferência da cintura e a aptidão cardiorrespiratória. O escore de risco metabólico foi calculado por meio da soma do escore Z dos seguintes parâmetros: circunferência da cintura, pressão arterial sistólica, triglicerídeos, colesterol total, colesterol LDL e colesterol HDL. Os dados foram expressos de forma contínua, sendo que, quanto maior o valor do escore de risco metabólico, maior o risco metabólico. RESULTADOS: Observa-se, em ambos os sexos, uma diminuição do escore de risco metabólico com o aumento da aptidão cardiorrespiratória. Dessa forma, escolares no 5º quintil, os quais apresentam maiores níveis de aptidão cardiorrespiratória, possuem menor risco metabólico. Entre os meninos, observou-se diferença significativa entre o 1º quintil com o 2º (p = 0.037), 4º (p = 0.009) e 5º quintil da aptidão cardiorrespiratória (p < 0.001), com uma diferença média de 0.56 para este último. Entre as meninas, o escore de risco metabólico foi significativamente diferente na comparação do 1º quintil da aptidão cardiorrespiratória para o 5ª quintil (p = 0.018). CONCLUSÃO: Escolares com baixa aptidão cardiorrespiratória apresentam maior escore de risco metabólico, tanto entre os meninos, quanto nas meninas

OBJETIVO: Comparar el índice de riesgo metabólico en escolares con diferentes niveles de aptitud cardiorrespiratoria. MÉTODO: Estudio transversal, retrospectivo, realizado con escolares del municipio de Santa Cruz do Sul (Brasil). Se estudiaron alumnos de 25 escuelas públicas y privadas de dicho municipio, de edades comprendidas entre 7 y 17 años en posesión de consentimiento informado firmado por los padres o tutores. La muestra final fue compuesta por 1250 niños y adolescentes. Se realizó la extracción de sangre para el análisis del perfil lipídico. Se evaluó la presión arterial, la circunferencia de la cintura y la aptitud cardiorrespiratoria. El índice de riesgo metabólico se calculó mediante la suma de la puntuación Z de los siguientes parámetros: circunferencia de la cintura, presión arterial sistólica, triglicéridos, colesterol total, colesterol LDL y colesterol HDL. Los datos fueron expresados como variable continua, siendo que, cuanto mayor era el índice de riesgo metabólico, mayor se considera el riesgo metabólico. RESULTADOS: Se observa, en ambos sexos, una disminución del índice de riesgo metabólico con el aumento de la aptitud cardiorrespiratoria. De esta forma, escolares en el 5º quintil, los cuales presentan mayores niveles de aptitud cardiorrespiratoria, poseen menor riesgo metabólico. En los niños, se observó una diferencia significativa entre el primer quintil con el 2º (p = 0.037), 4º (p = 0.009) y 5º quintil de la aptitud cardiorrespiratoria (p <0.001), con una diferencia media de 0.56 para este último. Entre las niñas, el índice de riesgo metabólico fue significativamente diferente en comparación del primer quintil de aptitud cardiorrespiratoria para el quinto quintil (p = 0.018). CONCLUSIÓN: Los escolares con baja aptitud cardiorrespiratoria presentan mayor índice de riesgo metabólico, tanto entre los niños, como en las niñas

OBJECTIVE: To compare the metabolic risk score in schoolchildren with different levels of cardiorespiratory fitness. METHOD: A cross - sectional, retrospective study carried out with schoolchildren in the municipality of Santa Cruz do Sul (Brazil). Students from 25 public and private schools in the municipality were invited, who were aged between 7 and 17 years with an authorization signed by parents / guardians. The final sample consisted of 1250 children and adolescents. Blood sampling was performed to analyze the lipid profile. Blood pressure, waist circumference and cardiorespiratory fitness were evaluated. The metabolic risk score was calculated by summing the Z score of the following parameters: waist circumference, systolic blood pressure, triglycerides, total cholesterol, LDL cholesterol and HDL cholesterol. The data were expressed continuously, and the higher the metabolic risk score, the greater the metabolic risk. RESULTS: In both sexes, a decrease of metabolic risk score was observed with the increase of the cardiorespiratory fitness. Thus, schoolchildren in the 5th quintile, who have higher levels of cardiorespiratory fitness, have lower metabolic risk. Among the boys, there was a significant difference between the 1st quintile and the 2nd quintile (p = 0.037), 4th (p = 0.009) and 5th quintile of the cardiorespiratory fitness (p <0.001), with a mean difference of 0.56 for the latter. Among girls, metabolic risk score was significantly different in the comparison of the first quintile of the cardiorespiratory fitness to the fifth quintile (p = 0.018). CONCLUSION: Schoolchildren with low cardiorespiratory fitness have higher metabolic risk scores, both among boys and girls

Vitamin D deficiency in pediatric patients using antiepileptic drugs: systematic review with meta-analysis / Deficiência de vitamina D em pacientes pediátricos que fazem uso de fármacos antiepilépticos - revisão sistemática com metanálise

Abstract Objectives: To measure the prevalence of vitamin D deficiency (through the 25-hydroxyvitamin D metabolite) in pediatric patients using antiepileptic drugs. Source of data: Meta-analysis of studies identified through search in the PubMed, Embase, LILACS, and Cochrane Library databases, on February 19, 2019. Summary of data: A total of 748 articles were identified, 29 of which were relevant to the objectives of this study. The prevalence of vitamin D deficiency found was 0.32 (95% CI = 0.25-0.41; I 2 = 92%, p < 0.01). In the subgroup analyses, the most significant results were observed in the group of patients using cytochrome P450-inducing antiepileptic drugs, with a prevalence of 0.33 (95% CI = 0.21-0.47; I 2 = 86%, p < 0.01) and, considering the study design, in the subgroup of cohort studies, with a prevalence of 0.52 (95% CI = 0.40-0.64; I 2 = 76%, p < 0.01). Conclusions: Taking into account the deleterious effects of vitamin D deficiency on the bone health of individuals using antiepileptic drugs, it is suggested to include in their care 25-hydroxyvitamin D monitoring, cholecalciferol supplementation, and treatment of the deficiency, when present.

Resumo Objetivos: Mensurar a prevalência de deficiência de vitamina D (através do metabólito 25-hidroxivitamina D) em pacientes pediátricos em uso de fármacos antiepilépticos. Fonte dos dados: Metanálise de estudos identificados por meio de pesquisa nas bases de dados Pubmed, Embase, LILACS e Cochrane em 19 de fevereiro de 2019. Síntese dos dados: Foram identificados 748 artigos, dos quais 29 mostraram-se relevantes aos objetivos deste estudo. A prevalência de deficiência de vitamina D encontrada foi de 0,32 (IC 95% = 0,25-0,41) (I2 = 92%, p < 0,01). Nas análises por subgrupos, os resultados mais expressivos foram observados no grupo de pacientes em uso de fármacos antiepilépticos indutores do citocromo P450, que apresentou prevalência de 0,33 (IC 95% = 0,21-0,47) (I2 = 86%, p < 0,01). Considerou-se o delineamento dos estudos, no subgrupo de estudos de coorte, com prevalência de 0,52 (IC 95% = 0,40-0,64) (I2 = 76%, p < 0,01). Conclusões: Levando-se em consideração os efeitos deletérios da deficiência de vitamina D na saúde óssea dos sujeitos em uso de fármacos antiepilépticos, sugere-se incluir em seu atendimento, o monitoramento de 25-hidroxivitamina D, suplementação com colecalciferol e tratamento de deficiência quando existente.

Vitamin D deficiency in pediatric patients using antiepileptic drugs: systematic review with meta-analysis.

OBJECTIVES: To measure the prevalence of vitamin D deficiency (through the 25-hydroxyvitamin D metabolite) in pediatric patients using antiepileptic drugs. SOURCE OF DATA: Meta-analysis of studies identified through search in the PubMed, Embase, LILACS, and Cochrane Library databases, on February 19, 2019. SUMMARY OF DATA: A total of 748 articles were identified, 29 of which were relevant to the objectives of this study. The prevalence of vitamin D deficiency found was 0.32 (95% CI=0.25-0.41; I2=92%, p<0.01). In the subgroup analyses, the most significant results were observed in the group of patients using cytochrome P450-inducing antiepileptic drugs, with a prevalence of 0.33 (95% CI=0.21-0.47; I2=86%, p<0.01) and, considering the study design, in the subgroup of cohort studies, with a prevalence of 0.52 (95% CI=0.40-0.64; I2=76%, p<0.01). CONCLUSIONS: Taking into account the deleterious effects of vitamin D deficiency on the bone health of individuals using antiepileptic drugs, it is suggested to include in their care 25-hydroxyvitamin D monitoring, cholecalciferol supplementation, and treatment of the deficiency, when present.

Instrumentos para avaliar o comportamento alimentar de crianças e adolescentes / Tools to evaluate eating behavior of children and adolescents

Introdução: O comportamento alimentar é capaz de desenvolver proteção ou risco para distúrbios alimentares, obesidade e doenças crônicas. Objetivo: Investigar instrumentos recentes válidos para avaliar o comportamento alimentar de crianças e adolescentes. Métodos: Revisão bibliográfica, através de busca de artigos nas bases de dados eletrônicas Scielo, LILACS e PubMed, correspondente ao período de 2014 a 2018. Os descritores utilizados foram "instrumento validado", "instrumento comportamento alimentar adolescentes", "instrumento comportamento alimentar crianças", "instrument validation", "eating behavior children", "eating behavior adolescent". Resultados: Obtiveram-se 14 instrumentos, que são capazes de detectar: comportamento alimentar de indivíduos com doenças como diabetes, autismo, transtorno alimentar, obesidade; aspectos sociais, familiares e de cuidadores do comportamento alimentar; atitudes alimentares transtornadas; autorregulação e controle de peso. Conclusão: Há instrumentos passíveis de aplicação para a população de crianças e adolescentes brasileiros. Sugere-se que a identificação precoce das referidas condições irá permitir intervenções para minimizar os danos nessa população. (AU)

Introduction: Eating behavior enables protection or risk for eating disorders, obesity, and chronic diseases. Objective: To investigate current valid tools used to evaluate the eating behavior of children and adolescents. Methods: Bibliographic review of articles published from 2014 to 2018 in the electronic databases Scielo, LILACS, and Pubmed. The descriptors used were "instrumento validado", "instrumento comportamento alimentar adolescentes", "instrumento comportamento alimentar crianças", "instrument validation", "eating behavior children", "eating behavior adolescent". Results: A total of 14 tools was found, able to detect eating behavior of subjects with diseases such as diabetes, autism, eating disorder, obesity; social, family and caregiver aspects of food behavior; disordered eating attitudes; self-regulation and weight control. Conclusion: There are tools that can be applied to the Brazilian population of children and adolescents. We suggest that the early identification of these issues will enable interventions to minimize damages in this population. (AU)

Escore contínuo de risco metabólico em escolares com diferentes níveis de aptidão cardiorrespiratória / Puntuación del riesgo metabólico en escolares con diferentes niveles de aptitud cardiorrespiratoria / Continuous metabolic risk score in schoolchildren with different levels of cardiorespiratory fitness

OBJETIVO: Comparar o escore de risco metabólico em escolares com diferentes níveis de aptidão cardiorrespiratória. MÉTODO: Estudo transversal, retrospectivo, realizado com escolares, no município de Santa Cruz do Sul - RS. Foram convidados alunos de 25 escolas públicas e privadas do município, que apresentassem idade entre 7 e 17 anos com termo de autorização assinado pelos pais/responsáveis. A amostra final foi composta por 1.250 crianças e adolescentes. Foi realizada coleta de sangue para análise do perfil lipídico. Foi avaliada a pressão arterial, a circunferência da cintura (CC) e a aptidão cardiorrespiratória (APCR). O escore de risco metabólico (ERM) foi calculado por meio da soma do escore Z dos seguintes parâmetros: CC, pressão arterial sistólica, triglicerídeos, colesterol total, colesterol LDL e colesterol HDL. RESULTADOS: Observa-se, em ambos os sexos, uma diminuição do ERM com o aumento da APCR. Dessa forma, escolares no 5º quintil, os quais apresentam maiores níveis de APCR, possuem menor risco metabólico. Entre os meninos, observou-se diferença significativa entre o 1º quintil com o 2º (p = 0.037), com o 4º (p = 0.009) e 5º quintil da APCR (p < 0.001), com uma diferença média de 0.56 para este último. Entre as meninas, o ERM foi significativamente diferente na comparação do 1º quintil da APCR para o 5ª quintil (p = 0.018). CONCLUSÃO: Escolares com baixa APCR apresentam maior escore de risco metabólico, tanto entre os meninos, quanto nas meninas

OBJETIVO: Comparar la puntuación de riesgo metabólico en escolares con diferentes niveles de aptitud cardiorrespiratoria. MÉTODO: Estudio transversal, retrospectivo, realizado con escolares, en el municipio de Santa Cruz do Sul - RS. Se invitaron alumnos de 25 escuelas públicas y privadas del municipio, que presentaran edad entre 7 y 17 años con término de autorización firmado por los padres/responsables. La muestra final fue compuesta por 1.250 niños y adolescentes. Se realizó la recolección de sangre para el análisis del perfil lipídico. Se evaluó la presión arterial, la circunferencia de la cintura (CC) y la aptitud cardiorrespiratoria (APCR). La puntuación de riesgo metabólico (PRM) se calculó mediante la suma de la puntuación Z de los siguientes parámetros: CC, presión arterial sistólica, triglicéridos, colesterol total, colesterol LDL y colesterol HDL. RESULTADOS: Se observa, en ambos sexos, una disminución del PRM con el aumento de la APCR. De esta forma, escolares en el 5º quintil, los cuales presentan mayores niveles de APCR, poseen menor riesgo metabólico. En los niños, se observó una diferencia significativa entre el primer quintil con el 2º (p = 0.037), el 4º (p = 0.009) y 5º quintil de la APCR (p <0.001), con una diferencia media de 0.56 para este último. Entre las niñas, el PRM fue significativamente diferente en la comparación del primer quintil de APCR para el quinto quintil (p = 0.018). CONCLUSIÓN: Los escolares con baja APCR presentan mayor puntuación de riesgo metabólico, tanto entre los niños, como en las niñas

OBJECTIVE: To compare the metabolic risk score in schoolchildren with different levels of cardiorespiratory fitness (CRF). METHOD: A retrospective cross-sectional study carried out with schoolchildren in the municipality of Santa Cruz do Sul - RS. Students from 25 public and private schools were invited, who were aged between 7 and 17 years with an authorization signed by parents/guardians. The final sample consisted of 1,250 children and adolescents. Blood sampling was performed to analyze the lipid profile. Blood pressure, waist circumference (WC) and CRF were evaluated. The continuous metabolic risk score (cMetS) was calculated by summing the Z score of the following parameters: WC, systolic blood pressure, triglycerides, total cholesterol, LDL cholesterol and HDL cholesterol. RESULTS: In both sexes, a decrease of cMetS was observed with the increase of CRF levels. Thus, schoolchildren in the 5th quintile, who have higher levels of CRF, have lower metabolic risk. Among boys, there was a significant difference between the 1st quintile to 2nd quintile (p = 0.037), to 4th (p = 0.009) and 5th quintile of CRF (p < 0.001). Among girls, cMetS was significantly different in the comparison of the 1st quintile to the 5th quintile (p = 0.018) of CRF. CONCLUSION: Schoolchildren with low levels of CRF have higher metabolic risk scores, both among boys and girls

Relationship between Dyslipidemia, Cultural Factors, and Cardiorespiratory Fitness in Schoolchildren / Relação entre Dislipidemia, Fatores Culturais e Aptidão Cardiorrespiratória em Escolares

Abstract Background: The presence of dyslipidemia and behavioral aspects are determinants of cardiovascular risk, especially in childhood and adolescence. Objective: To verify possible relationships between dyslipidemia, cultural factors, and cardiorespiratory fitness (CRF) in schoolchildren. Methods: This cross-sectional study evaluated a sample of 1,254 children and adolescents between the ages of 7 and 17 from the South of Brazil, 686 of whom were female. Dyslipidemia was defined as increased levels of at least one of the following lipid profile parameters: triglycerides (TG), total cholesterol (TC) and fractions of high (HDL-c) and low-density lipoprotein (LDL-c). Cultural aspects were evaluated by a self-reported questionnaire. Data were analyzed by logistic regression, considering the odds ratios (OR) and confidence intervals (CI) at 95%. Results: The results revealed a high prevalence of dyslipidemia (41.9%), which was associated with female sex (OR: 1.56; IC: 1.24-1.96) and overweight/obese status (OR: 1.55; IC: 1.20-2.00). When lipid profile parameters were evaluated separately, high levels of LDL-c were observed to be associated with sedentary school transport (OR: 1.59; IC: 1.20-2.09). Schoolchildren who were overweight/obese had higher chances of elevated levels of TC (OR: 1.40; IC: 1.07-1.84) and TG (OR: 3.21; IC: 1.96-5.26). HDL-c was shown to be related to high television time (OR: 1.59; IC: 1.00-2.54). Conclusion: Alterations in lipid parameters are associated with cultural factors, especially those related to sedentary lifestyle and low levels of CRF.

Resumo Fundamento: A presença de dislipidemia e os aspectos comportamentais são fatores determinantes do risco cardiovascular, sobretudo na infância e adolescência. Objetivos: Verificar possíveis relações entre dislipidemia, fatores culturais e aptidão cardiorrespiratória (APCR) em escolares. Métodos: São sujeitos deste estudo transversal 1.254 crianças e adolescentes do Sul do Brasil, sendo 686 do sexo feminino, com idade entre 7 e 17 anos. Foi considerada dislipidemia a presença de níveis aumentados em pelo menos um dos parâmetros do perfil lipídico: triglicerídeos (TG), colesterol total (CT) e frações de alta (HDL-c) e baixa densidade (LDL-c). Os aspectos culturais foram avaliados por meio de questionário autorreferido pelo escolar. Os dados foram analisados pela regressão logística, considerando os valores de razão de chances (odds ratio; OR) e intervalos de confiança (IC) para 95%. Resultados: Foi encontrada elevada prevalência de dislipidemia (41,9%), a qual esteve associada com o sexo feminino (OR: 1,56; IC: 1,24-1,96) e com a presença de sobrepeso/obesidade (OR: 1,55; IC: 1,20-2,00). Quando os componentes do perfil lipídico foram avaliados de forma separada, observou-se que altos níveis de LDL-c se associaram ao deslocamento sedentário para a escola (OR: 1,59; IC: 1,20-2,09). Escolares com sobrepeso/obesidade apresentam maiores chances de elevação nos níveis de CT (OR: 1,40; IC: 1,07-1,84) e TG (OR: 3,21; IC: 1,96-5,26). O HDL-c apresentou associação com o elevado tempo em frente à televisão (OR: 1,59; IC: 1,00-2,54). Conclusão: A presença de alteração nos parâmetros lipídicos associa-se com fatores culturais, especialmente voltados ao sedentarismo e baixos níveis de APCR.

Relationship between Dyslipidemia, Cultural Factors, and Cardiorespiratory Fitness in Schoolchildren.

BACKGROUND: The presence of dyslipidemia and behavioral aspects are determinants of cardiovascular risk, especially in childhood and adolescence. OBJECTIVE: To verify possible relationships between dyslipidemia, cultural factors, and cardiorespiratory fitness (CRF) in schoolchildren. METHODS: This cross-sectional study evaluated a sample of 1,254 children and adolescents between the ages of 7 and 17 from the South of Brazil, 686 of whom were female. Dyslipidemia was defined as increased levels of at least one of the following lipid profile parameters: triglycerides (TG), total cholesterol (TC) and fractions of high (HDL-c) and low-density lipoprotein (LDL-c). Cultural aspects were evaluated by a self-reported questionnaire. Data were analyzed by logistic regression, considering the odds ratios (OR) and confidence intervals (CI) at 95%. RESULTS: The results revealed a high prevalence of dyslipidemia (41.9%), which was associated with female sex (OR: 1.56; IC: 1.24-1.96) and overweight/obese status (OR: 1.55; IC: 1.20-2.00). When lipid profile parameters were evaluated separately, high levels of LDL-c were observed to be associated with sedentary school transport (OR: 1.59; IC: 1.20-2.09). Schoolchildren who were overweight/obese had higher chances of elevated levels of TC (OR: 1.40; IC: 1.07-1.84) and TG (OR: 3.21; IC: 1.96-5.26). HDL-c was shown to be related to high television time (OR: 1.59; IC: 1.00-2.54). CONCLUSION: Alterations in lipid parameters are associated with cultural factors, especially those related to sedentary lifestyle and low levels of CRF.

Nutritional aspects in allogeneic hematopoietic stem cell transplantation in children and adolescents in a tertiary hospital.

INTRODUCTION: Introduction: during hematopoietic stem cell transplantation (HSCT) some factors may impact on the patient's nutritional status (NS). Conditioning regimen, as well as signs and symptoms of the gastrointestinal tract, can negatively infl uence on oral food intake. Patients may require the use of complementary nutritional therapies aiming at an adequate caloric intake with the objective of avoiding decreasing in NS. Objective: the study aims to describe the nutritional aspects relevant to the maintenance of NS during hospitalization of children and adolescents undergoing HSCT at a tertiary hospital. Method: a retrospective study with a review of medical records of patients undergoing HSCT, aged between 0 and 19 years of age (incomplete) between January 2009 and December 2014. Data were collected regarding food intake, nutritional therapies used, and clinical signs and symptoms in six times: hospitalization, D0 (day of cell infusion), D+7, D+14, D+21 and D+28. Results: sixty-three patients were evaluated, being 56% males, with a median age of ten years. At the time of hospitalization, 100% of patients had their energy needs met by mouth, decreasing from D0 (about 30%), with more prevalent use of parental nutritional and enteral nutrition from D+7. Loss of appetite, mucositis and nausea were the most frequent signs and symptoms. From D+21 it was possible to observe an increase in caloric intake by mouth. Conclusion: patients showed decreased food intake throughout hospitalization. However, it has been shown that the prescription of complementary nutritional therapies has reduced the impact of weight loss.

INTRODUCCIÓN: Introducción: durante el trasplante de células madre hematopoyéticas (TCMH) algunos factores pueden influir en el estado nutricional (EN) del paciente. El régimen de acondicionamiento, así como los signos y síntomas del tracto gastrointestinal, pueden influir negativamente en la ingesta oral de alimentos. Los pacientes pueden requerir el uso de terapias nutricionales complementarias dirigidas a una ingesta calórica adecuada con el objetivo de evitar el deterioro del EN. Objetivo: el estudio tiene como objetivo describir los aspectos nutricionales relevantes para el mantenimiento del EN durante la hospitalización de niños y adolescentes sometidos al TCMH en un hospital terciario. Método: un estudio retrospectivo con una revisión de los registros médicos de los pacientes sometidos al TCMH, con edades comprendidas entre 0 y 19 años (incompletos) entre enero de 2009 y diciembre de 2014. Se recopilaron datos sobre la ingesta de alimentos, las terapias nutricionales utilizadas y los signos y síntomas clínicos en seis tiempos: hospitalización, D0 (día de infusión celular), D+7, D+14, D+21 y D+28. Resultados: se evaluaron sesenta y tres pacientes, siendo 56% del sexo masculino, con una edad media de diez años. En el momento de la hospitalización 100% de los pacientes cubrían sus necesidades energéticas con la alimentación oral, disminuyendo en el D0 (alrededor del 30%), con un uso más prevalente de nutrición enteral y parenteral en el D+7. La inapetencia, mucositis y náuseas fueron los signos y síntomas más frecuentes. Desde el D+21 fue posible observar un aumento en la ingesta calórica por vía oral. Conclusión: los pacientes mostraron una disminución en la ingesta de alimentos durante la hospitalización. Sin embargo, se ha demostrado que la prescripción de terapias nutricionales complementarias ha reducido el impacto de la pérdida de peso.

Nutritional aspects in allogeneic hematopoietic stem cell transplantation in children and adolescents in a tertiary hospital / Aspectos nutricionales en el trasplante alogénico de células madre hematopoyéticas en niños y adolescentes en un hospital terciario

Introduction: during hematopoietic stem cell transplantation (HSCT) some factors may impact on the patient's nutritional status (NS). Conditioning regimen, as well as signs and symptoms of the gastrointestinal tract, can negatively infl uence on oral food intake. Patients may require the use of complementary nutritional therapies aiming at an adequate caloric intake with the objective of avoiding decreasing in NS. Objective: the study aims to describe the nutritional aspects relevant to the maintenance of NS during hospitalization of children and adolescents undergoing HSCT at a tertiary hospital. Method: a retrospective study with a review of medical records of patients undergoing HSCT, aged between 0 and 19 years of age (incomplete) between January 2009 and December 2014. Data were collected regarding food intake, nutritional therapies used, and clinical signs and symptoms in six times: hospitalization, D0 (day of cell infusion), D+7, D+14, D+21 and D+28. Results: sixty-three patients were evaluated, being 56% males, with a median age of ten years. At the time of hospitalization, 100% of patients had their energy needs met by mouth, decreasing from D0 (about 30%), with more prevalent use of parental nutritional and enteral nutrition from D+7. Loss of appetite, mucositis and nausea were the most frequent signs and symptoms. From D+21 it was possible to observe an increase in caloric intake by mouth. Conclusion: patients showed decreased food intake throughout hospitalization. However, it has been shown that the prescription of complementary nutritional therapies has reduced the impact of weight loss

Introducción: durante el trasplante de células madre hematopoyéticas (TCMH) algunos factores pueden infl uir en el estado nutricional (EN) del paciente. El régimen de acondicionamiento, así como los signos y síntomas del tracto gastrointestinal, pueden infl uir negativamente en la ingesta oral de alimentos. Los pacientes pueden requerir el uso de terapias nutricionales complementarias dirigidas a una ingesta calórica adecuada con el objetivo de evitar el deterioro del EN. Objetivo: el estudio tiene como objetivo describir los aspectos nutricionales relevantes para el mantenimiento del EN durante la hospitalización de niños y adolescentes sometidos al TCMH en un hospital terciario. Método: un estudio retrospectivo con una revisión de los registros médicos de los pacientes sometidos al TCMH, con edades comprendidas entre 0 y 19 años (incompletos) entre enero de 2009 y diciembre de 2014. Se recopilaron datos sobre la ingesta de alimentos, las terapias nutricionales utilizadas y los signos y síntomas clínicos en seis tiempos: hospitalización, D0 (día de infusión celular), D+7, D+14, D+21 y D+28. Resultados: se evaluaron sesenta y tres pacientes, siendo 56% del sexo masculino, con una edad media de diez años. En el momento de la hospitalización 100% de los pacientes cubrían sus necesidades energéticas con la alimentación oral, disminuyendo en el D0 (alrededor del 30%), con un uso más prevalente de nutrición enteral y parenteral en el D+7. La inapetencia, mucositis y náuseas fueron los signos y síntomas más frecuentes. Desde el D+21 fue posible observar un aumento en la ingesta calórica por vía oral. Conclusión: los pacientes mostraron una disminución en la ingesta de alimentos durante la hospitalización. Sin embargo, se ha demostrado que la prescripción de terapias nutricionales complementarias ha reducido el impacto de la pérdida de peso

Impacto de uma estratégia de manejo do excesso de peso infanto-juvenil / Impact of a management strategy on child and adolescent overweight

OBJETIVOS: Avaliar, através de parâmetros antropométricos e bioquímicos, o impacto de uma estratégia de manejo do excesso de peso implantada em um ambulatório de obesidade infanto-juvenil de um hospital público. MÉTODOS: Análise retrospectiva de uma coorte, realizada a partir de fichas de 206 crianças e adolescentes com diagnóstico de obesidade ou sobrepeso, com idade entre 5 a 17 anos, atendidos entre 2010 e 2014 com periodicidade média de três meses durante um ano. A estratégia avaliada consistiu em aconselhamento, com orientações visando redução do tempo de atividade sedentária e aumento de atividade física e orientações nutricionais para escolhas alimentares mais saudáveis. Foram avaliados parâmetros antropométricos (índice de massa corporal (IMC), escore z de IMC por idade, circunferências da cintura (CC) e do quadril (CQ), razão cintura quadril (RCQ)) e bioquímicos (glicemia de jejum, insulinemia de jejum, índice do Homeostasis Model Assessment, colesterol total (CT), lipoproteína de alta densidade (HDL-c), lipoproteína de baixa densidade (LDL-c), triglicerídeos (TG) no início, aos 6 e aos 12 meses de acompanhamento. As análises estatísticas foram realizadas no programa IBM SPSS Statistics 22.0, com aplicação do modelo de Equações de Estimativas Generalizadas. RESULTADOS: Em 12 meses, houve redução significativa do IMC, do escore z do IMC/idade, do percentual de indivíduos com escore z de IMC / idade ≥ +2, da CC, do percentual de indivíduos com CC > p90 e da RCQ (p<0,001). Os níveis séricos de glicemia e insulina não apresentaram redução significativa, apenas uma tendência, assim como os de CT, LDL-c e TG, porém os níveis de HDL-c tiveram um aumento significativo (p=0,035). CONCLUSÕES: Esta estratégia de manejo do excesso de peso infanto-juvenil, baseada em aconselhamento, possibilitou redução significativa dos níveis de excesso de peso, embora os parâmetros bioquímicos não tenham sido reduzidos na mesma proporção.

AIMS: To evaluate, through anthropometric and biochemical parameters, the impact of an overweight management strategy implemented in an outpatient clinic for childhood obesity in a public hospital. METHODS: Retrospective analysis of a cohort of 206 children and adolescents with a diagnosis of obesity or overweight, aged between 5 and 17 years, attended between 2010 and 2014 with an average period of three months during one year. The strategy evaluated consisted of counseling, with guidelines aimed at reducing sedentary activity time and increased physical activity and nutritional guidelines for healthier food choices. Were evaluated anthropometric parameters (body mass index, z-escore of body mass index by age, waist circumference, hip circumference and waist hip ratio) and biochemistry (fasting glucose, fasting insulinemia, homeostasis model assessment, total cholesterol (CT), high density lipoprotein (HDL-c), low density lipoprotein (LDL-c), triclycerides (TG) at the baseline, at 6 and 12 months of follow-up. Statistical analyzes were performed in the IBM SPSS Statistics 22.0, using the Generalized Estimating Equations model. RESULTS: In 12 months, there was a significant reduction in BMI, Z score of BMI/age, percentage of individuals with BMI/age z score ≥ +2, WHR, percentage of individuals with WC > p90 and HC (p<0,001). Serum glycemia and insulin levels did not show significant reduction, only a trend, as did TC, LDL-c and TG, but HDL-c levels had a significant increase (p=0.035). CONCLUSIONS: This strategy of management of childhood and adolescent overweight, based on counseling, made it possible to reduce significantly the levels of overweight, although the biochemical parameters were not reduced in the same proportion.

O comportamento alimentar aos 30 dias de vida está associado à adequação do peso ao nascimento? / Is eating behavior at 30 days of age associated with adequate birth weight?

Introdução: O objetivo principal é avaliar o comportamento alimentar de recémnascidos (RN) pequenos (PIG) e grandes (GIG) para a idade gestacional através de questionário específico e comparar com RN adequados para a idade gestacional (AIG) com 1 mês de vida. Métodos: É um estudo de coorte, cuja primeira fase consistiu na realização de uma entrevista com mães que tiveram seus filhos a termo no Hospital de Clínicas de Porto Alegre. Dados perinatais foram coletados de prontuários eletrônicos. Na segunda fase do estudo, após 1 mês do nascimento, foi aplicado o Questionário sobre Comportamento Alimentar do Bebê (Baby Eating Behaviour Questionnaire, BEBQ) através de contato telefônico. Resultados: Foram avaliados 126 RN (43 AIG, 43 PIG e 41 GIG). Foi observada uma maior escolaridade em mães de RN PIG (p=0,004) e uma menor prevalência de aleitamento materno exclusivo até a alta hospitalar em RN GIG (p=0,002). A análise de variância não encontrou diferença significativa entre os grupos em relação aos domínios do BEBQ, mesmo quando corrigidos por sexo do RN. Conclusão: O estudo demonstrou que alterações do comportamento alimentar ainda não estão presentes com 1 mês de vida, sugerindo que não são inatas, e sim desenvolvidas com o passar do tempo. O estudo está limitado a avaliações de crescimento baseadas em registros de terceiros. (AU)

Introduction: The main purpose of this paper was to evaluate the feeding behavior of infants born small and large for gestational age (SGA and LGA, respectively) using a specific questionnaire and to compare them with infants born adequate for gestational age (AGA) at 1 month of age. Methods: The first phase of this cohort study consisted of an interview with mothers whose babies were born at term at Hospital de Clínicas de Porto Alegre. Perinatal data were collected from electronic medical records. In the second phase of the study, at 1 month of birth, the Baby Eating Behaviour Questionnaire (BEBQ) was administered through telephone interview. Results: A total of 126 infants (43 AGA, 43 SGA and 41 LGA) with a mean gestational age of 39.4 weeks were assessed. A higher level of education was observed in mothers of SGA infants (p = 0.004) and a lower prevalence of exclusive breastfeeding in the LGA group (p = 0.002). The analysis of variance found no significant difference between the groups in any of the BEBQ domains, even when corrected for sex of the baby. Conclusions: This study demonstrated that changes in feeding behavior are not yet present at 1 month of age, suggesting that they are not innate, but rather developed over time. The study is limited to growth assessments based on third-party records. (AU)

Use of fibers in childhood constipation treatment: systematic review with meta-analysis / Uso de fibras no tratamento da constipação infantil: revisão sistemática com metanálise

Abstract Objective: To gather current evidence on the use of fiber for constipation treatment in pediatric patients. Source of data: Systematic review with meta-analysis of studies identified through Pubmed, Embase, LILACS and Cochrane databases published up to 2016. Inclusion criteria: Randomized controlled trials; patients aged between 1 and 18 years and diagnosed with functional constipation receiving or not drug treatment for constipation; articles published in Portuguese, English, Spanish, French, and German in journals accessible to the researchers. Synthesis of data: A total of 2963 articles were retrieved during the search and, after adequate evaluation, nine articles were considered relevant to the study objective. A total of 680 children were included, of whom 45% were boys. No statistical significance was observed for bowel movement frequency, stool consistency, therapeutic success, fecal incontinence, and abdominal pain with fiber intake in patients with childhood constipation. These results should be interpreted with care due to the high clinical heterogeneity between the studies and the methodological limitation of the articles selected for analysis. Conclusions: There is a scarcity of qualified studies to evaluate fiber supplementation in the treatment of childhood constipation, generating a low degree of confidence in estimating the real effect of this intervention on this population. Today, according to the current literature, adequate fiber intake should only be recommended for functional constipation, and fiber supplementation should not be prescribed in the diet of constipated children and adolescents.

Resumo Objetivo: Reunir evidências atuais sobre o uso de fibras no tratamento da constipação funcional em pacientes pediátricos. Fontes dos dados: Revisão sistemática com metanálise de estudos identificados por pesquisa nas bases de dados Pubmed, Embase, LILACS e Cochrane publicados até o ano 2016. Critérios de inclusão: estudos controlados randomizados; pacientes com idade entre 1 e 18 anos com diagnóstico de constipação funcional em uso ou não de tratamento medicamentoso para constipação; artigos publicados em língua portuguesa, inglesa, espanhola, francesa e alemã em revistas acessíveis aos pesquisadores. Síntese dos dados: Foram encontrados 2.963 artigos na busca e, após avaliação adequada, nove artigos mostraram-se relevantes frente aos objetivos do estudo. Um total de 680 crianças foram incluídas, sendo 45% meninos. Não foi demonstrada significância estatística da frequência evacuatória, da consistência evacuatória, do sucesso terapêutico, da incontinência fecal e da dor abdominal com o uso de fibras nos pacientes com constipação infanto-juvenil. Esses resultados devem ser interpretados com atenção devido à alta heterogeneidade clínica entre os estudos e à limitação metodológica dos artigos analisados. Conclusões: Existe uma grande falta de estudos qualificados para avaliar a suplementação de fibras no tratamento da constipação infanto-juvenil, gerando um baixo grau de confiança para se estimar o efeito real dessa intervenção na população em questão. Até esse momento, conforme a literatura atual, deve-se apenas recomendar a ingestão adequada de fibras na constipação funcional, não se podendo prescrever a suplementação de fibras na dieta das crianças e adolescentes constipados.

Correlation of body mass index Z-scores with glucose and lipid profiles among overweight and obese children and adolescents / Correlação dos escores-z de IMC com os perfis glicêmico e lipídico entre crianças e adolescentes com sobrepeso e obesidade

Abstract Objective To evaluate the prevalence of abnormalities in plasma lipid and glucose profiles among overweight and obese children and adolescents, and to assess the presence of a correlation between body mass index Z-scores and indicators of comorbidities related to both profiles. Methods This was a multicenter cross-sectional study conducted at two outpatient clinics. The study included all 417 comers for the first visit from 2008 to 2012, aged between 7 and 18 years, with BMI above the Z-score +1. Anthropometry and blood sampling were obtained. The prevalence of dyslipidemias, hyperglycemia, and insulin resistance were evaluated, together with the correlations of these variables with the increase of Z-BMI. Results Dyslipidemia was observed in 43.4% of the boys and 66.1% of the girls, with no difference between genders. High glucose levels were detected in 6.2% of the individuals. Insulin resistance was present in 32.3% and 41.7% of the cases, with no statistical significance between boys and girls. Correlations between the Z-BMI were noted for triglycerides in the entire group and among girls; for HDL-c, only among girls; for glucose, a correlation was observed for the entire group, but not when stratified by gender. The indicators of insulin resistance were all correlated with Z-BMI, even when corrected for age. Conclusions Overweight and obesity give origin to a high prevalence of dyslipidemia and insulin resistance. BMI Z-scores showed a weak positive correlation with glucose and triglyceride, and negative with HDL-c. In turn, the strongest positive correlation was found with insulin resistance indicators.

Resumo Objetivo Avaliar a prevalência de anormalidades nos perfis lipídico e glicêmico entre crianças e adolescentes com sobrepeso e obesidade e também verificar se existe correlação entre os escores-z de índice de massa corporal (z-IMC) e indicadores de comorbidades ligados a esses perfis. Métodos Estudo de corte transversal multicêntrico, incluiu 417 pacientes entre 7 e 18 anos e IMC acima do escore-z > + 1 que fizeram a consulta de caso novo entre 2008 e 2012. Antropometria e coleta de sangue foram realizadas. As prevalências de dislipidemia, hiperglicemia e resistência insulínica foram avaliadas, juntamente com as correlações entre essas variáveis e o z-IMC. Resultados Dislipidemia foi encontrada em 43,4% dos meninos e 66,1% das meninas, sem diferença entre os sexos. Hiperglicemia foi encontrada em 6,2% dos indivíduos. Resistência insulínica esteve presente entre 32,3 e 41,7% dos casos, sem diferença estatística entre os sexos. Foi observada correlação com z-IMC para triglicerídeos quando considerado o grupo todo e entre as meninas; e para HDL-c apenas entre as meninas. A glicemia apresentou correlação quando considerado o grupo todo, mas não quando separados por sexo. Os indicadores de resistência insulínica estiveram todos correlacionados com IMC, mesmo quando se executou correção para a idade. Conclusões Sobrepeso e obesidade levam a prevalências elevadas de dislipidemia e resistência insulínica. Os escores-z de IMC mostraram discreta correlação positiva com glicose e triglicerídeos e negativa com HDL-c. Por outro lado, correlação positiva mais forte foi observada com os indicadores de resistência insulínica.

Classificação da obesidade infantil / Classification of childhood obesity

Importância do Problema: A obesidade na infância e na adolescência é considerada, atualmente, grave problema de saúde pública com prevalência crescente em todo o mundo. Objetivo: atualizar a classificação da obesidade infantojuvenil publicada originalmente em 2004, incorporando as novas evidências científicas. Métodos: revisão da Literatura Científica que abordou os fatores etiopatogênicos da obesidade, buscando-se aprimorar a classificação anteriormente publicada incluindo os novos conhecimentos científicos. Resultados: apresentação de uma classificação que sugere como primeira estratégia a definição da presença de resistência periférica à insulina e, a seguir, sugere a divisão em quatro subgrupos de obesidade: sindrômica, epigenética, induzida (endocrinológica, neurológica, distúrbios do sono, fármacos e agentes infecciosos) e clássica (somática e psicossocial). Conclusão: a classificação permite auxiliar o clínico na tomada de decisões e na individualização do tratamento. (AU)

Importance of the Problem: obesity in childhood and adolescence is currently considered a serious public health problem with a growing prevalence worldwide. Objective: to update the classification of child and adolescent obesity originally published in 2004, incorporating the new scientific evidence. Methods: a review of the Scientific Literature that addressing etiopathogenic factors of obesity, in order to improve the previously published classification including the new scientific knowledge. Results: a classification that suggests as the first strategy the definition of the presence of peripheral resistance to insulin and then suggests the division into four subgroups of obesity: syndromic, epigenetic, induced (endocrinological, neurological, sleep disorders, drugs and infectious agents) and classical (somatic and psychosocial). Conclusion: this classification could help the clinicians to make decisions and to personalize the treatment (AU)