Cardiovascular risk factors in children and adolescents living in an urban area of Southeast of Brazil: Ouro Preto Study

XbaI polymorphism in the APOB gene and its association with increased cholesterol in children and adolescents: Ouro Preto study

Atherosclerotic vascular changes can begin during childhood, providing risk for cardiovascular disease (CVD) in adulthood. Identifiable risk factors such as dyslipidemia accelerate this process for some children. The apolipoprotein B (APOB) gene could help explain the inter-individual variability in lipid levels among young individuals and identify groups that require greater attention to prevent CVD. A cross-sectional study was conducted with school-aged children and adolescents in Ouro Preto, Minas Gerais. The study evaluated cardiovascular risk factors' variables and XbaI polymorphism in the APOB gene for associations with increased total cholesterol (TC). The prevalence of increased TC was notably high, reaching 68.9% in the study population. Carriers of the variant T allele were 1.45 times more likely to develop increased TC in a dominant model (1.09-1.94, p = 0.011). After adjustments, excess weight and a family history of dyslipidemia interacted significantly with XbaI polymorphism in increased TC, resulting in Odds Ratio of 1.74 (1.11-2.71, p = 0.015) and 2.04 (1.14-3.67, p = 0.016), respectively. The results suggest that XbaI polymorphism in the APOB gene may affect the lipid profile of Brazilian children and adolescents and could contribute to the CVD in adulthood.

High levels of chemerin associated with variants in the NOS3 and APOB genes in rural populations of Ouro Preto, Minas Gerais, Brazil

Chemerin is an adipokine that has been associated with components of metabolic syndrome. It has been described to affect adipocyte metabolism and inflammatory responses in adipose tissue, as well as the systemic metabolism of lipids and glucose. Few epidemiological studies have evaluated classical and genetics cardiovascular risk factors (CVRFs) in the mixed adult rural population in Brazil. Therefore, the present study explored possible associations between CVRFs and chemerin. This cross-sectional study included 508 adults from the rural localities of Lavras Novas, Chapada, and Santo Antônio do Salto in Ouro Preto, Minas Gerais, Southeast Brazil. Demographic, behavioral, clinical, biochemical, anthropometric variables, and 12 single nucleotide polymorphisms (SNPs) linked with metabolic syndrome phenotypes were evaluated for associations with chemerin level. There was a significant association of high triglyceride levels [odds ratio (OR)=1.91, 95%CI: 1.23-2.98], insulin resistance (OR=1.82, 95%CI: 1.03-3.22), age (OR=1.64, 95%CI: 1.08-2.49), and sex (OR=1.99, 95%CI: 1.35-2.95) with high levels of chemerin. High chemerin levels were significantly associated with the genetic polymorphisms rs693 in the APOB gene (OR=1.50, 95%CI: 1.03-2.19) and rs1799983 in the NOS3 gene (OR=1.46, 95%CI: 1.01-2.12) for the AA and GT+TT genotypes, respectively. In the concomitant presence of genotypes AA of rs693 and GT+TT of rs1799983, the chance of presenting high levels of chemerin showed a 2.21-fold increase (95%CI: 1.25-3.88) compared to the reference genotype. The development of classical CVRFs in this population may be influenced by chemerin and by two risk genotypes characteristic of variants in well-studied genes for hypertension and dyslipidemia.

Prevalence of cardiovascular risk factors in schoolchildren from a rural and urban area in Colombia

Introduction: Cardiovascular risk factors (CVRF) have their origin in childhood. Several studies have shown differences in the prevalence of CVRFs between rural and urban areas, probably related to lifestyle behaviors. Objective: To describe the CVRFs identified in children from a rural and urban population in Colombia. Materials and methods: A cross-sectional study was conducted between March and June 2013 in schoolchildren from an urban and a rural area in Colombia. Weight, height, blood pressure, triglycerides, fasting glucose, and total cholesterol were measured, and a survey covering nutrition, physical activity, and passive smoking was applied. The prevalence of CVRFs was calculated with a 95% CI. Results: A total of 1,055 schoolchildren (833 urban, 222 rural) participated; their mean age was 6.71 years. The prevalence of CVRFs in the rural and the urban study population, respectively, was 68.69%/90.16% for sedentary lifestyle, 97.18%/95.44% for unhealthy diet, 11.16%/14.52% for passive smoking, 0%/5.64% for obesity, 6.31%/11.28% for hypertension, 0%/0% for diabetes, and 18.28%/16.31% for total cholesterol. A total of 99.15% of the study population had at least one CVRF, with an average of 3.14 for the urban area (SD:1.12), and of 2.76 for the rural one (SD: 1.1). Overweight children had a higher prevalence of hypertension (15.21%; 95% CI:11.04%-20.59%) and sedentary lifestyle (90.69%), compared to those without this risk factor (8.98% and 84.32%, respectively). Conclusions: Our results showed a high prevalence of CVRFs in children, especially in the urban area. Public health strategies adapted to the rural and urban populations should be implemented.

Association between arterial hypertension and nutritional status in adolescents from Goiânia, Goiás, Brazil

INTRODUCTION

Adolescents are a population with unique lifestyle challenges, including physical inactivity, inadequate nutrition, and obesity, all of which increase the risk of developing hypertension (HTN). The objective of this study has been to estimate the prevalence of factors associated with hypertension in adolescents in the city of Goiânia City, Central Brazil.

METHODS

Between 2013and2014, a cross-sectional population study on cardiovascular risk in adolescents, was conducted with the participation of 1,586 adolescents in 108 classes at 36 schools (public and private) in Goiânia city. All of the adolescents were interviewed to establish their sociodemographic and behavioral characteristics related to hypertension and nutritional status. Anthropometric and blood pressure data were collected following a protocol. A Poisson regression, stratified by gender, was used to verify the factors associated with HTN.

RESULTS

In this mixed-gender group of 1,586 students, the prevalence of HTN was 6.2% (95% CI: 4.6-8.2%) in girls and 14.0% (95% CI: 10.2-18.8%) in boys-about twice as high in boys as in girls (p <0.001). Obesity was independently associated with HTN in both genders. Being overweight was a risk factor for HTN. In addition, there was a positive correlation between the SBP/SBP percentile and the BMI Z-score/Nutritional status (NS)in both genders. A high prevalence of physical inactivity was also observed in the adolescents investigated, especially in the girls. On the other hand, more boys than girls were found to be obese.

CONCLUSION

The results of this investigation revealed the need for strategies to prevent and control HTN and its risk factors, especially in Brazil's schools. In addition to the constant surveillance of HTN prevalence and risk factors (in particular, being overweight or obese), information should be distributed to promote beneficial health behaviors among adolescents.

Clustered Cardiovascular Risk Factors Are Associated with Inflammatory Markers in Adolescents

BACKGROUND

Clusters of cardiovascular risk (CVR) factors are associated with an increased risk of developing cardiovascular diseases (CVDs). This cross-sectional study assessed the associations between classic CVR factor clusters and inflammatory markers in Brazilian adolescents.

METHODS

Measurements included anthropometric, clinical and biochemical parameters and selected inflammatory markers in 487 adolescents (236 boys/251 girls; 12.06 ± 1.41 years).

RESULTS

After stratifying the population by gender and adjusting for potential confounding variables, principal component analysis was performed and it produced 5 independent components in both genders: adiposity, glucose metabolism, blood pressure, high-density lipoprotein (HDL)/triacylglycerols (TG), and cholesterol/low-density lipoprotein. Glucose metabolism was inversely associated with interleukin-1β (IL-1β) in both genders (r = -0.026; r = -0.021); blood pressure was inversely associated with tumor necrosis factor alpha (TNF-α) in girls (r = -0.046); HDL/TG was positively associated with interleukin-6 in girls (r = 0.012), with IL-1β (r = 0.010) TNF-α (r = 0.045) in boys, and inversely associated with adiponectin in both genders (r = -0.015; r = -0.013).

CONCLUSION

The results suggest that lipid metabolism alterations, as potential early events in the development of CVDs, have a strong link to the inflammatory process, in contrast to other clusters of risk factors.

Prevalence of hypertension among adolescents: systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of hypertension among adolescent Brazilian students.

METHODS

A systematic review of school-based cross-sectional studies was conducted. The articles were searched in the databases MEDLINE, Embase, Scopus, LILACS, SciELO, Web of Science, CAPES thesis database and Trip Database. In addition, we examined the lists of references of relevant studies to identify potentially eligible articles. No restrictions regarding publication date, language, or status applied. The studies were selected by two independent evaluators, who also extracted the data and assessed the methodological quality following eight criteria related to sampling, measuring blood pressure, and presenting results. The meta-analysis was calculated using a random effects model and analyses were performed to investigate heterogeneity.

RESULTS

We retrieved 1,577 articles from the search and included 22 in the review. The included articles corresponded to 14,115 adolescents, 51.2% (n = 7,230) female. We observed a variety of techniques, equipment, and references used. The prevalence of hypertension was 8.0% (95%CI 5.0-11.0; I2 = 97.6%), 9.3% (95%CI 5.6-13.6; I2 = 96.4%) in males and 6.5% (95%CI 4.2-9.1; I2 = 94.2%) in females. The meta-regression failed to identify the causes of the heterogeneity among studies.

CONCLUSIONS

Despite the differences found in the methodologies of the included studies, the results of this systematic review indicate that hypertension is prevalent in the Brazilian adolescent school population. For future investigations, we suggest the standardization of techniques, equipment, and references, aiming at improving the methodological quality of the studies.

IGF2, LEPR, POMC, PPARG, and PPARGC1 gene variants are associated with obesity-related risk phenotypes in Brazilian children and adolescents

Association studies of genetic variants and obesity and/or obesity-related risk factors have yielded contradictory results. The aim of the present study was to determine the possible association of five single-nucleotide polymorphisms (SNPs) located in the IGF2, LEPR, POMC, PPARG, and PPARGC1 genes with obesity or obesity-related risk phenotypes. This case-control study assessed overweight (n=192) and normal-weight (n=211) children and adolescents. The SNPs were analyzed using minisequencing assays, and variables and genotype distributions between the groups were compared using one-way analysis of variance and Pearson's chi-square or Fisher's exact tests. Logistic regression analysis adjusted for age and gender was used to calculate the odds ratios (ORs) for selected phenotype risks in each group. No difference in SNP distribution was observed between groups. In children, POMC rs28932472(C) was associated with lower diastolic blood pressure (P=0.001), higher low-density lipoprotein (LDL) cholesterol (P=0.014), and higher risk in overweight children of altered total cholesterol (OR=7.35, P=0.006). In adolescents, IGF2 rs680(A) was associated with higher glucose (P=0.012) and higher risk in overweight adolescents for altered insulin (OR=10.08, P=0.005) and homeostasis model of insulin resistance (HOMA-IR) (OR=6.34, P=0.010). PPARG rs1801282(G) conferred a higher risk of altered insulin (OR=12.31, P=0.003), and HOMA-IR (OR=7.47, P=0.005) in overweight adolescents. PARGC1 rs8192678(A) was associated with higher triacylglycerols (P=0.005), and LEPR rs1137101(A) was marginally associated with higher LDL cholesterol (P=0.017). LEPR rs1137101(A) conferred higher risk for altered insulin, and HOMA-IR in overweight adolescents. The associations observed in this population suggested increased risk for cardiovascular diseases and/or type 2 diabetes later in life for individuals carrying these alleles.

Food habits and risk of cardiovascular disease in schoolchildren from Ouro Preto, Minas Gerais

OBJECTIVE: To investigate the relationship between food habits and risk factors for cardiovascular disease in schoolchildren of the city Ouro Preto, Minas Gerais. METHODS: A cross-sectional study was conducted in a population-based sample of 738 schoolchildren aged 6-14 years. A semi-structured questionnaire was used for collecting demographic, socioeconomic, biochemical, clinical, and anthropometric data. Food intake was determined by a food-frequency questionnaire. Food habits were evaluated according to the adapted Recommended Food Score. Multiple linear regression models were constructed to assess how food consumption was associated with cardiovascular risk factors. RESULTS: The schoolchildren presented a dietary pattern characterized by low consumption of healthy foods. Association of cardiovascular risk factors showed that the consumption of foods according to the adapted Recommended Food Score was negatively and significantly associated with tetrapolar percentage of body fat (p=0.030) and systolic blood pressure (p=0.049) in children aged 6-9 years. CONCLUSION: Children's dietary patterns proved to be an important determinant of some of the cardiovascular risk factors studied. Thus, food intake assessment is a primary tool for the prevention and early intervention on cardiovascular risk factors during childhood.

Prevalence of high blood pressure in 122,053 adolescents: a systematic review and meta-regression

Several studies have reported high prevalence of risk factors for cardiovascular disease in adolescents. To perform: i) systematically review the literature on the prevalence of high blood pressure (HBP) in adolescents; ii) analyze the possible methodological factors associated with HBP; and iii) compare the prevalence between developed and developing countries. We revised 10 electronic databases up to August 11, 2013. Only original articles using international diagnosis of HBP were considered. The pooled prevalence's of HBP were estimated by random effects. Meta-regression analysis was used to identify the sources of heterogeneity across studies. Fifty-five studies met the inclusion criteria and total of 122,053 adolescents included. The pooled-prevalence of HBP was 11.2%, 13% for boys, and 9.6% for girls (P < 0.01). Method of measurement of BP and year in which the survey was conducted were associated with heterogeneity in the estimates of HBP among boys. The data indicate that HBP is higher among boys than girls, and that the method of measurement plays an important role in the overall heterogeneity of HBP value distributions, particularly in boys.

[Cardiovascular risk and associated factors in schoolchildren in Belém, Pará State, Brazil]

This cross-sectional study aimed to identify risk factors for cardiovascular disease in a stratified cluster sample of 557 schoolchildren (6-19 years) in Belém, Pará State, Brazil. Potential risk factors were obesity, hypertension, dyslipidemia, diabetes, smoking, physical inactivity, and atherogenic diet. Socio-demographic and lifestyle variables were tested in a binary logistic regression model. The most prevalent risk factors were overweight (20.4%), dyslipidemia (48.1%), and physical inactivity (66.2%). Children below ten years of age and those from higher-income families and with higher maternal schooling showed greater odds of developing overweight; meanwhile, those with overweight were more prone to developing hypercholesterolemia and hypertriglyceridemia. The findings point to the need to implement strategies to prevent overweight in early childhood, through balanced nutrition and regular physical activity, in order to effectively reduce the prevalence of risk factors in schoolchildren.

[Blood pressure and its association with physical activity and obesity in adolescents: a systematic review]

In the light of the importance of the impacts that obesity and physical activity may have on blood pressure (BP) among adolescents, and the suggestion that abnormal pressure levels at young ages are maintained into more mature stages of these individuals' lives, the scope of this study is to conduct a systematic review of the associations between obesity and BP and between physical activity and BP among adolescents. The PubMed database was consulted to search for scientific articles relating to this topic and, after applying the appropriate inclusion and exclusion criteria, 30 articles were selected and analyzed. To assess the quality of articles Strengthening the Reporting of Observational Studies in Epidemiology was applied. The results suggest that despite the existence of hegemonic thinking to guide these relationships, BP and physical activity do not always have negative associations, and BP and obesity do not always have positive associations. The conclusion reached is that this situation illustrates the need for more in-depth reflection on these relationships before pre-established paradigms are passively accepted.

Childhood and adolescent overweight and obesity in Latin America: a systematic review

The number of children and adolescents who are overweight or obese worldwide is alarming. We did a systematic review to estimate the prevalence of overweight and obesity in children aged 0-19 years in Latin America. We searched specialised databases and seven books for relevant studies that were done in Spanish-speaking and Portuguese-speaking Latin American and Caribbean countries and published in peer-reviewed journals between January 2008, and April 2013. Indicators used were BMI (kg/m(2)) in all age groups and weight-for-height in children younger than 5 years. We identified 692 publications and included 42. Estimated prevalence of overweight in children younger than 5 years in Latin America was 7·1% with the weight-for-height WHO 2006 classification method. National combined prevalences of overweight and obesity with the WHO 2007 classification method ranged from 18·9% to 36·9% in school-age children (5-11 years) and from 16·6% to 35·8% in adolescents (12-19 years). We estimated that 3·8 million children younger than 5 years, 22·2-25·9 million school-age children, and 16·5-21·1 million adolescents were overweight or obese. Overall, between 42·5 and 51·8 million children aged 0-19 years were affected-ie, about 20-25% of the population. Although undernutrition and obesity coexist in the region, policies in most countries favour prevention of undernutrition, and only a few countries have implemented national policies to prevent obesity. In view of the number of children who are overweight or obese, the associated detrimental effects on health, and the cost to health-care systems, implementation of programmes to monitor and prevent unhealthy weight gain in children and adolescents are urgently needed throughout Latin America.

Epidemiology of physical inactivity, sedentary behaviors, and unhealthy eating habits among brazilian adolescents

This systematic review analyzed the prevalence of physical inactivity, sedentary behaviors and unhealthy eating habits among Brazilian adolescents. Searches were conducted in five databases (Lilacs, SciELO, Medline, Web of Science, and Google Scholar) and in the references cited in the articles retrieved. The literature search yielded 5,872 potentially relevant titles and a total of 69 studies met all the inclusion criteria. The risk behavior most often evaluated was physical inactivity (48/69; 69.6%), and its prevalence rate ranged from 2.3% to 93.5%. Twenty-eight studies estimated the prevalence of physical inactivity at over 50%. Most studies observed the prevalence of greater physical inactivity among girls. The prevalence of sedentary behaviors (lengthy screen time or TV use) was also frequently over 50%. Several variables were used to identify unhealthy eating habits, and some criteria/studies have indicated unhealthy eating habit estimates at close to 100% among adolescents. In conclusion, the estimates of these risk behaviors among Brazilians adolescents were very close to or even greater than those found in developed countries in several studies analyzed in this review.

Hypertension in children and adolescents attending a lipid clinic

This study aims to investigate prevalence of hypertension and cardiovascular risk factor clustering in children and adolescents attending a lipid clinic as well as the relationship of their hypertensive status with indicators of fat distribution and parental fat distribution and blood pressure (BP). In this cross-sectional primary prevention study, data on indicators of fat distribution (waist, hip, and middle-upper arm circumferences), body mass index (BMI), BP, high-sensitivity C-reactive protein (hsCRP), lipid and glucose profile of 370 children and adolescents (180 M, 190 F, mean age 9.5 years, (range 6-14 years)) were collected. Parents (502, 251 M, 251 F, age range 28-36 years), who gave their informed consent, underwent BMI, fat distribution, and BP measurements. There were 131 (35.4 %) hypercholesterolemic subjects and 72 (19.5 %) hypertensives. Using tests on medians, in comparison with 298 normotensives, the 72 hypertensives had higher levels of insulin (p<0.005) and no differences in cholesterol levels, age, and height. BMI and all the indicators of fat distribution were significantly higher (all p<0.01) in hypertensives than normotensives. BMI and waist circumferences were higher (both p<0.05) in the mothers of hypertensives, but not in the fathers. Hypertensive subjects' BMI was related to mothers' hip and waist circumferences (r=0.28 and 0.21, respectively).

CONCLUSIONS

In this study, children's hypertension was a component of the metabolic syndrome, but uric acid and hsCRP levels were not contributive. This hemodynamic and metabolic disorder was related to maternal fat distribution and BMI suggesting an epigenetic etiology.

Prevalence of high blood pressure in Brazilian adolescents and quality of the employed methodological procedures: systematic review

OBJECTIVE: To review the literature on studies that estimated the prevalence of high blood pressure (HBP) or systemic arterial hypertension (SAH) in Brazilian adolescents, considering the employed methodological procedures. METHODS: Bibliographical research of prevalence studies of HBP/SAH in adolescents from 1995 to 2010. The search was conducted in the electronic databases PubMed/Medline, Lilacs, SciELO, and Isi Adolec. The descriptors "hypertension", "BP", "teen", "students", "cross-sectional", "prevalence" and "Brazil" were used in Portuguese and English. Furthermore, a score ranging from 0 to 18 based on Recommendations for Blood Pressure Measurement in Humans and Experimental Animals and the VI Brazilian Guidelines of Hypertension was elaborated, in order to analyze the procedures used to measure BP in studies. RESULTS: Twenty-one articles were identified, mostly published in the last 10 years, and 90.5% were performed in school-based and regions of the Southeast, Northeast and South. The prevalence of HBP/SAH ranged from 2.5 to 30.9%. The score of the studies ranged from 0 to 16. A significant negative correlation (rho = -0.504; p = 0.020) was observed between the prevalence of HBP/SAH and the score of BP measurement quality. CONCLUSION: The great variability of PAE/SAH estimates appears to be influenced by methodological procedures used in the studies.

Prevalence of arterial hypertension among Brazilian adolescents: systematic review and meta-analysis

Background

Cardiovascular diseases are the leading cause of death in the world and are responsible for a high number of disability-adjusted life years. Elevated blood pressure is an independent, linear and continuous risk factor for cardiovascular disease and has also been reported in the young population. Brazil is a country of continental dimensions, and is very heterogeneous with respect to socioeconomic and cultural aspects. Brazilian studies on the subject of hypertension in adolescence are not nationally representative, and this provides a rationale for the conduction of a meta-analysis to assess the magnitude of the problem in the country.

Methods

Hypertension studies in adolescents published from 1990 to September 2010 were searched in six electronic databases. Forest plots of the prevalence of hypertension were built for the overall population and by gender. Heterogeneity was assessed using I² statistics. Meta-regression models were adjusted in order to identify possible sources of heterogeneity.

Results

Of 3,631 articles initially identified, 17 were considered eligible for systematic review. The pooled prevalence of hypertension, estimated through random effects models, was 8.12% (95% CI 6.24 - 10.52) for the total population. Overall, prevalence was higher in males, 8.75% (95% CI 5.81 - 12.96) than females, 6.31%, (95% CI 4.41 - 8.96). Several variables were investigated in the heterogeneity analysis: region of the study, sample size, age and method of blood pressure measurement. The only variables that partially and inconsistently explained the observed heterogeneity (I² = 95.3%) were the region of the country where the study was conducted and sample.

Conclusions

There was a large variation in hypertension prevalence and in the methods used for its evaluation throughout studies with Brazilian adolescents, indicating the need for standardized procedures and validated methods for hypertension measurement. Despite the large observed heterogeneity, and the small number of studies in some regions of Brazil, the pooled prevalence found in both males and females shows that systemic arterial hypertension should be monitored in the population aged 10–20 years and that specific measures are required to prevent and control the disease, as well as its risk factors. Studies that compare regional heterogeneities may contribute to the knowledge of factors associated with increased blood pressure among adolescents.

Risk factors for high blood pressure in low income children aged 3-4 years

This study aimed to evaluate the effect of dietary sodium intake on blood pressure among low income children aged 3-4 years. Data were collected during a randomized trial conducted in São Leopoldo, Brazil, with 500 mother-child pairs recruited from the maternity ward of a local hospital. Breastfeeding data were obtained during the children's first year of life. At 3 to 4 years of age, children's anthropometric, dietary, and blood pressure assessments were obtained. Sodium intake was estimated from two multiple-pass 24-h dietary recalls. Systolic blood pressure > 90th percentile for age, sex, and height was classified as high systolic blood pressure, according to the population-based percentiles provided by the Task Force on Hypertension Control in Children and Adolescents. Blood pressure data were obtained from 331 children at 3 to 4 years. The mean value of systolic blood pressure was 91.31 mmHg (SD = 8.30 mmHg) and 5.2% (n = 17) presented high systolic blood pressure. The results of the multivariable analyses showed that children who consumed more than 1,200 mg of sodium/day and with waist-to-height ratio higher than 0.5 presented, respectively, 3.32 (95%CI 0.98-11.22) and 8.81 (95%CI 2.13-36.31) greater risk of having high systolic blood pressure. Exclusive breastfeeding, child overweight and change in body mass index z score during the first year of life were not associated with the outcome.

CONCLUSIONS

The results of this study suggest that at preschool age sodium intake and high waist-to-height ratio are risk factors for high systolic blood pressure.

Retinol-binding protein 4 and insulin resistance are related to body fat in primary and secondary schoolchildren: the Ouro Preto study

PURPOSE

Evidence suggests that plasma retinol-binding protein 4 (RBP4) and insulin resistance are related to body fat (BF). We aimed to assess the relationship between RBP4 and insulin resistance with obesity in a mixed (skin color) cohort of the Brazilian population.

METHODS

A nested case-control study was conducted in 227 schoolchildren aged 7-14 years. Schoolchildren with a high BF percentage (% BF, ≥ 30 for girls and ≥ 25 for boys) were identified as the obese group (n = 137), and those with lower values were identified as the non-obese group (n = 90). Percentage of body fat (% BF) was determined by tetrapolar bioimpedance (Quantum II, RJL System), RBP4 by enzyme-linked immunosorbent assay (Immunology Consultants Laboratory), plasma fasting insulin by chemiluminescent immunoassay (Access(®) Immunoassay System) and insulin resistance by the homeostasis model insulin resistance (IR(HOMA)) index. Serum lipid profile and arterial blood pressure were evaluated.

RESULTS

The significant independent risk factors associated with obesity were as follows: male sex, increased serum LDL-C, RBP4 and IR(HOMA). Among children with higher RBP4, the association with obesity increased significantly (from 3.1 to 8.5) in the presence of insulin resistance, when compared to higher RBP4 and non-insulin resistance.

CONCLUSION

IR(HOMA) and RBP4 showed significant associations with obesity and traditional CVD risk factors. They might therefore be used as a marker for CVD risk and have clinical implications in the development of comorbidities associated with obesity.

Does the body mass index reflect cardiovascular risk factors in Brazilian children?

This cross-sectional study aimed to: (i) investigate whether obesity and overweight defined according to body mass index (BMI) are good predictors of body fat excess, abdominal adiposity and hypertension in 769 Brazilian children aged 6-11 years, (ii) assess the relationship between overweight/obesity and cardiovascular risk factors. Overweight and obesity were estimated using cut-off points corresponding to World Health Organization 1 and 2 SD (standard deviation) scores. Based on the results of a multiple logistic regression analysis, overweight and obesity were significantly associated with body fat excess, abdominal adiposity and hypertension. The prevalence of obesity (10.7%), overweight (18.7%), abdominal adiposity (17.6%) and systolic (10.1%) and diastolic hypertension (9.3%) was high in this population of Brazilian children. The cardiovascular risk factors increased significantly according to the BMI SD scores, indicating that in epidemiologic studies, BMI may be a good indicator of risk for cardiovascular diseases.

Genetic and environmental influences on blood pressure and physical activity: a study of nuclear families from Muzambinho, Brazil

Blood pressure (BP) and physical activity (PA) levels are inversely associated. Since genetic factors account for the observed variation in each of these traits, it is possible that part of their association may be related to common genetic and/or environmental influences. Thus, this study was designed to estimate the genetic and environmental correlations of BP and PA phenotypes in nuclear families from Muzambinho, Brazil. Families including 236 offspring (6 to 24 years) and their 82 fathers and 122 mothers (24 to 65 years) were evaluated. BP was measured, and total PA (TPA) was assessed by an interview (commuting, occupational, leisure time, and school time PA). Quantitative genetic modeling was used to estimate maximal heritability (h²), and genetic and environmental correlations. Heritability was significant for all phenotypes (systolic BP: h² = 0.37 ± 0.10, P < 0.05; diastolic BP: h² = 0.39 ± 0.09, P < 0.05; TPA: h² = 0.24 ± 0.09, P < 0.05). Significant genetic (r g) and environmental (r e) correlations were detected between systolic and diastolic BP (r g = 0.67 ± 0.12 and r e = 0.48 ± 0.08, P < 0.05). Genetic correlations between BP and TPA were not significant, while a tendency to an environmental cross-trait correlation was found between diastolic BP and TPA (r e = -0.18 ± 0.09, P = 0.057). In conclusion, BP and PA are under genetic influences. Systolic and diastolic BP share common genes and environmental influences. Diastolic BP and TPA are probably under similar environmental influences.

Prevalence and socioeconomic differences of risk factors of cardiovascular disease in Ecuadorian adolescents

PURPOSE

The aim of this paper is to report the prevalence of cardiovascular risk factors and socioeconomic differences in school-going Ecuadorian adolescents.

METHODS

A cross-sectional study was performed from January 2008 until April 2009 in 770 adolescents aged 10 to 16 years old, who attend secondary schools in an urban (Cuenca), and rural area (Nabón) in Ecuador. Data collected for the overall sample included anthropometric variables (weight, height and waist circumference), blood pressure and socio-demographic characteristics. Fasting blood glucose and lipid profile determinations were collected in a subsample of 334 adolescents.

RESULTS

The most prevalent cardiovascular risk factors were dyslipidemia (34.2%), abdominal obesity (19.7%) and overweight (18.0%). The prevalence of the remaining cardiovascular risk factors were high levels of blood pressure (6.2%) and obesity (2.1%). Boys were 3.3 times (P < 0.001) more likely to have risk levels of blood pressure. Compared to their peers from lower socioeconomic groups, children from better off socioeconomic strata were 1.5 times (P = 0.048) more likely to be overweight/obese and 1.5 times (P = 0.046) more likely to have abdominal obesity. Overweight and obese children were 4.4 times more likely to have dyslipidemia (P < 0.001). Children living in the rural area were 2.8 times (P = 0.002) more likely to have dyslipidemia than those from the urban area.

CONCLUSIONS

Our results demonstrate the advanced levels of the nutrition transition in this Ecuadorian adolescent population. Primary health care should monitor and take actions to address this public health problem in adolescents.

Risco cardiovascular e prática de atividade física em crianças e adolescentes de Muzambinho/MG: influência do gênero e da idade

INTRODUÇÃO E OBJETIVO: A doença cardiovascular inicia na infância e está atrelada à presença de fatores de risco cardiovascular (FRC). A prevalência desses fatores varia em diferentes populações brasileiras, tendo sido estudada principalmente em cidades de médio e grande porte. Este estudo avaliou a prevalência dos FRC e da prática de atividade física (AF) em crianças e adolescentes de Muzambinho, uma cidade de pequeno porte. MÉTODO: Foram avaliados 205 sujeitos (entre sete e 18 anos - 108 do gênero masculino). Foram medidos: peso, estatura, glicemia, colesterolemia, pressão arterial (PA) e prática de AF. As comparações foram realizadas pelo teste do Qui-quadrado. RESULTADOS: A prevalência de sobrepeso foi de 19% e de valores alterados de PA, glicemia e colesterolemia foram de, respectivamente, 11, 5 e 15%. Não houve diferença na prevalência dos FRC entre os sexos. O tabagismo, o alcoolismo, a PA alterada e a insuficiência de AF aumentaram com a idade. Setenta e nove por cento dos sujeitos praticavam AF de locomoção, 10% ocupacional, 97% nas aulas de educação física, 72% no recreio e 90% de lazer. Noventa e dois por cento foram considerados ativos. A prática de AF ocupacional foi maior nas meninas e aumentou nos meninos com a idade. A prevalência de AF de lazer e recreio diminuiu com a idade nos dois sexos. CONCLUSÃO: A prevalência de FRC, exceto do sedentarismo, foi expressiva, não diferiu entre os sexos e aumentou com a idade. A prática de AF de todos os tipos foi alta, diferenciou-se entre os sexos e diminuiu com a idade.