Risk factors for overweight among Brazilian adolescents of low-income families: a case-control study

The Interactive Role of Family Functioning among BMI Status, Physical Activity, and High-Fat Food in Adolescents: Evidence from Shanghai, China

Objectives: Family functioning (FF), physical activity (PA), and high-fat food consumption (HF) are associated with adolescents being overweight and obese; however, little is known about their interactions. Therefore, this study aimed to examine how they work jointly on adolescent obesity with BMI as the outcome variable. Methods: A cross-sectional survey utilizing a cluster sampling design was conducted. Multinomial logistic regressions, multiplication interaction (MI), and marginal effects (MEs) were tested. Results: Active PA (non-overweight vs. obesity: OR = 2.260, 95% CI [1.318, 3.874]; overweight vs. obesity: OR = 2.096, 95% CI [1.167, 3.766]), healthy HF (non-overweight vs. obesity: OR = 2.048, 95% CI [1.105, 3.796]) and healthy FF (overweight vs. obesity: OR = 2.084, 95% CI [1.099, 3.952]) reduced obesity risk. Overweight students with healthy FF were less likely to become obese regardless of PA (inactive: OR = 2.181, 95% CI [1.114, 4.272]; active: OR = 3.870, 95% CI [1.719, 8.713]) or HF (unhealthy: OR = 4.615, 95% CI [1.049, 20.306]; healthy: OR = 5.116, 95% CI [1.352, 19.362]). The MEs of inactive PA and unhealthy FF were −0.071, 0.035, and 0.036 for non-overweight, overweight, and obese individuals, respectively (p < 0.05); the MEs of HF and healthy FF individuals were −0.267 and 0.198 for non-overweight and obese individuals, respectively (p < 0.05). Conclusions: Unhealthy FF regulated the influence of inactive PA or unhealthy HF on adolescent obesity, altogether leading to a higher risk of obesity.

Sugar-sweetened beverage consumption and overweight and obesity in adolescents in Ho Chi Minh City, Vietnam: a population-based analysis

BACKGROUND

The aim of this research was to describe the patterns of consumption of multiple sugar-sweetened beverages (including modern and traditional ones) among adolescents in Ho Chi Minh City and to identify a possible relationship between this consumption and overweight, obesity, and other factors.

METHODS

A secondary analysis from a cross-sectional study of 11-15-year-old students from 31 junior high schools across Ho Chi Minh City was used. We measured the students' anthropometric status and assessed beverage consumption using a validated Food Frequency Questionnaire. Multivariate logistic regression models were used to identify the association between the consumption of sugar-sweetened beverages, obesity and other factors.

RESULTS

The sugar-sweetened beverages (SSB) ranged widely from modern soft drinks and powdered drinks to traditional sugar-added fruit and leaf juices, and milk-based drinks. These beverages were very popular among 2,660 participants with 36% consuming at least one variety daily. Factors positively associated with sugar-sweetened beverage consumption included a higher level of physical activity, higher consumption of fast foods, and daily fruit and vegetable consumption. We found a negative association between milk-based SSBs and the overweight and obesity status of the students, i.e. every kcal more of fresh milk with sugar and condensed milk can reduce an obesity odd of 0.005 (95% CI [0.002-0.008], p < 0.001) and 0.004 (95% CI [0.002-0.010], p = 0.044) consecutively. None of the other SSBs was significantly related to adolescent overweight and obesity.

CONCLUSIONS

Milk-based drinks potentially protect adolescents against overweight and obesity. Further research to assess this protection is needed.

Psychophysiological Regulation and Classroom Climate Influence First and Second Graders' Well-Being: The Role of Body Mass Index

This study examines the associations between physical and emotional well-being and classroom climate, cardiac vagal response, and body mass index (BMI) in a sample of 6- to-8-year-olds. Specifically, we expected a direct link between classroom climate, vagal withdrawal, BMI and children's physical and emotional comfort. Furthermore, we explored whether these individual and environmental characteristics influenced well-being in an interactive fashion. Participants were 142 (63 boys, 44%) first and second graders living in the North of Italy who were interviewed on their emotional and physical comfort. Heart rate and a measure of vagal influence on the heart (cardiac vagal tone) were recorded at rest and during an oral academic test. Height and weight were collected. Classroom climate was positively linked with physical well-being, whereas emotional well-being was negatively related with BMI. In addition, an inverted U-shaped effect of cardiac vagal withdrawal (i.e., cardiac vagal tone during stress minus resting vagal tone) on emotional well-being was found. Two regression models highlighted the role played by BMI when interacting with vagal withdrawal in predicting children's physical and emotional well-being. The interplay between BMI and cardiac vagal withdrawal played an important role in primary school children's well-being. From a clinical perspective, preventive training to improve autonomic regulation in concert with interventions promoting healthy eating attitudes might be critical for supporting primary school children's emotional and physical health.

Midday napping in children: associations between nap frequency and duration across cognitive, positive psychological well-being, behavioral, and metabolic health outcomes

STUDY OBJECTIVES

Poor sleep and daytime sleepiness in children and adolescents have short- and long-term consequences on various aspects of health. Midday napping may be a useful strategy to reduce such negative impacts. The effect of habitual napping on a wide spectrum of cognitive, behavioral, psychological, and metabolic outcomes has not been systematically investigated.

METHODS

This study characterized midday napping habits in 3819 elementary school children from the China Jintan Cohort Study. In 2011, weekly nap frequency and average duration were collected once from students at grades 4-6. Prior to their completion of elementary school at grade 6 (in 2011-2013 respective to each grade), the following outcomes were collected once: behavioral and academic achievement evaluated by teachers, and self-reported positive psychology measures including grit, self-control, and happiness. IQ tests were conducted on a subgroup. Metabolic indices, including body mass index and fasting glucose concentration, were measured through physical exams. For the whole sample, we assessed associations between napping and each outcome, adjusted for sex, grade, school location, parental education, and time in bed at night. We also conducted stratified analyses on grade 6 (cross-sectional), grade 4 (2-year gap), and grade 5 (1-year gap) data.

RESULTS

Overall, napping was significantly associated with higher happiness, grit, and self-control, reduced internalizing behavior problem, higher verbal IQs, and better academic achievement, although specific patterns varied across frequency and duration for different outcomes. More limited significant associations were found for decreased externalizing behavior problems, compared to non-nappers, while no significant associations were found for performance IQ and metabolic outcomes.

CONCLUSIONS

Results indicate benefits of regular napping across a wide range of adolescent outcomes, including better cognition, better psychological wellness, and reduced emotional/behavioral problems. The current study underscores the need for further large-scale intervention studies to establish causal effects.

Psychosocial perspectives and the issue of prevention in childhood obesity

A dramatic increase in childhood overweight/obesity has been recognized globally over the past 50 years. This observed increase may reflect genetic, as well as psychological, environmental, and socio-cultural influences. In the first part of this review, we present an updated summary of the psychosocial factors associated with this change and discuss possible ways in which they operate. Among these factors, lower socio economic status (in both industrialized and non-industrialized countries), being female, belonging to a minority group, and being exposed to adverse life events may all be associated with a greater risk of childhood overweight/obesity. These influences may be mediated via a variety of mechanisms, in particular above-average food intake of low nutritional quality and reduction in physical activity. Other important psychosocial mediators include the influence of the family and peer environment, and exposure to the media. In the second part of the review, we discuss the potential of psychosocial prevention programs to intervene in the processes involved in the rise of childhood overweight/obesity. Two points are emphasized. First, prevention programs should be multidisciplinary, combining the knowledge of experts from different professions, and taking into consideration the important role of the family environment and relevant influential social organizations, particularly school. Second, effective change is unlikely to occur without large-scale programs carried out on a public policy level.

Metabolic syndrome in obese adolescents: what is enough?

OBJECTIVE

To study the agreement among three distinct criteria for metabolic syndrome (MS) adapted to adolescents, and to identify associated factors for MS.

METHODS

Cross-sectional study with 65 obese subjects aged 10 to 18 years, attended to at the Outpatient Clinic for Obese Children and Adolescents at the Clinical Hospital of the Universidade Estadual de Campinas (Unicamp). MS was defined using the criteria of the World Health Organization (WHO), the International Diabetes Federation (IDF), and the Adult Treatment Panel III (ATP III). Clinical, anthropometrical, and laboratorial data were associated to MS.

RESULTS

From the 65 subjects, none had MS according to the WHO criteria, while 18 were diagnosed with MS (27.6%) according to the IDF, and 19 (29.2%) according to the ATP III. Agreement between IDF and ATP III was excellent (kappa 81%). In this study, puberty and triglycerides levels showed significant statistical difference when comparing subjects with and without MS, the first for ATP III (p = 0.03), and the second for IDF (p = 0.005) and ATP III (p = 0.001) criteria.

CONCLUSION

The WHO criteria does not seem to be adequate for adolescents. IDF and ATP III criteria had an excellent agreement. Puberty and triglycerides were associated with MS.

Assessing pre-clinical ventricular dysfunction in obese children and adolescents: the value of speckle tracking imaging

AIMS

Obesity has become a major health problem worldwide. Cardiovascular abnormalities have been described not only in obese adults but also in obese children and adolescents. The aim of the present study was to investigate left and right, systolic and diastolic ventricular dysfunction in obese paediatric patients without comorbidities using 2D speckle tracking longitudinal strain.

METHODS AND RESULTS

Doppler echocardiogram was performed on 50 obese children and adolescents with body mass index (BMI) above the 95th percentile (OG) and 46 non-obese sex- and age-matched controls (CG). Systolic and diastolic functions of both ventricles were investigated through conventional Doppler echocardiography. Tissue Doppler imaging (TDI), colour Doppler myocardial imaging (CDMI), and two-dimensional (2D) speckle tracking were also used to analyse ventricular performance in both groups. Left-ventricular (LV) ejection fraction was similar between groups (68.2 ± 6.2 vs. 68.3 ± 5.3, P = 0.931). Left-ventricular diastolic parameters did not differ between groups, except for a lower mitral A wave (61.6 ± 13.0 vs. 51.9 ± 10.0 cm/s, P > 0.001) and higher E/A ratio (1.8 ± 0.5 vs. 2.1 ± 0.4, P = 0.007) in the controls. Left-ventricular global strain was lower in the OG by both methods (CDMI: 22.0 ± 2.8 vs. 24.6 ± 2.7%, P = 0.020; 2D speckle tracking: 18.4 ± 1.6 vs. 20.4 ± 1.7%, P < 0.001). In multivariate analysis, 2D longitudinal global strain correlated negatively with BMI, r = -0.433, p = 0.002.

CONCLUSION

Although EF was not different between the two groups, LV 2D speckle tracking longitudinal strain was lower in the obese group, even in the absence of other comorbidities, indicating that obesity effects on LV function is an early finding in obesity.

[Overweight and obesity in prepubertal schoolchildren: the association with low birth weight and family antecedents of cardiovascular disease. Embu - metropolitan region of São Paulo, 2006]

The aim was to determine the prevalence of overweight and obesity in schoolchildren and the association with birth weight and family antecedents of cardiovascular disease. This cross-sectional study used a probabilistic sample of 929 schoolchildren aged 6 to 10 years. The variables were: body mass index (BMI), birth weight and family antecedents of cardiovascular disease. The statistical analysis consisted of the chi-square test (Pearson) and odds ratio, as association measurements. Of the schoolchildren (54.6% of which were female), 14.4% and 13.3% were overweight and obese, respectively. Low birth weight was reported among 9.4% and family antecedents of cardiovascular disease among 35.2%. Overweight or obesity (BMI e" P85) was associated with the presence of family antecedents of cardiovascular disease (OR = 1.66; 95% CI 1.23-2.23) and male sex (OR = 1.37; 95%CI 1.02-1.83); there was no association with birth weight. The results indicate the need for preventive actions for children with family antecedents of cardiovascular disease.

Socioeconomic status as determinant of risk factors for overweight in adolescents

OBJECTIVES

To analyze risk factors for overweight among adolescents grouped in three different socioeconomic levels.

METHODS

This cross-sectional study included 1779 adolescents aged 11 to 17 years, grouped according to socioeconomic status (low, middle, and high). Parents reported their own anthropometric data and the adolescents had their anthropometric data taken by trained researchers, and completed three questionnaires.

RESULTS

The prevalence of overweight was 16.7%, 23.8%, and 26.3% in low, middle and high socioeconomic status, respectively (P= 0.001). In all socioeconomic status, parent's overweight was associated with adolescent overweight (all P< 0.05). The students in both high (PR= 1.90) and middle socioeconomic status (PR= 2.00) from private schools were associated with overweight, and the students from low socioeconomic level to sedentary behavior (PR= 2.25) and high ingestion of fried food (PR= 2.35).

CONCLUSION

In each socioeconomic status the overweight was associated with different risk factors in different ways, except for parents overweight.

Risk factors for low birth weight in Botucatu city, SP state, Brazil: a study conducted in the public health system from 2004 to 2008

BACKGROUND

Low birth weight (LBW), defined as birth weight less than 2500 g, has a complex etiology and may be a result of premature interruption of pregnancy or intrauterine growth restriction. The objective of this study was to provide information on determinants of LBW and contribute to the understanding of the problem in Brazil.

METHODS

A case-control study was conducted in Botucatu city, SP state, Brazil. The study population consisted of 2 groups with 860 newborns in each group as follows: low weight newborns (LWNB) and a control group (weight ≥ 2500 g). Secondary data from 2004 to 2008 were collected using the Live Birth Certificate (LBC) and records from medical charts of pregnant women in Basic Health Units (BHU) and in the Public University Hospital (UH). Variables were as follows: maternal socio-demographic characteristics, pregnancy and birth conditions including quality of prenatal care according to 3 criteria. They were based on parameters established by the Ministry of Health (MH), one of them, the modified Kessner Index. The multivariable analysis by logistic regression was used to evaluate the association between variables and LBW.

RESULTS

According to the analysis, the factors associated with LBW were as follows: prematurity (OR = 56.98, 95% CI 29.52-109.95), twin pregnancy (OR = 20.00, 95% CI 6.25-100.00), maternal smoking (OR = 2.12, 95% CI 1.33-3.45), maternal malnourishment (OR = 2.30, 95% CI 1.08-5.00), maternal obesity (OR = 2.30, 95% IC 1.18-4.48), weight gain during pregnancy less than 5 kg (OR = 2.63, 95% CI 1.35-5.00) and weight gain during pregnancy more than 15 kg (OR = 2.26, 95% CI 1.16-4.41). Adequacy of prenatal care visits adjusted to gestational age was less frequent in the LBW group than in the control group (68.7% vs. 80.5%, x2 p < 0.001). According to the modified Kessner Index, 64.4% of prenatal visits in the LWNB group were adequate.

CONCLUSION

LWNB are a quite heterogeneous group of infants concerning their determinants and prevention actions against LBW and the follow-up of these infants have also been very complex. Therefore, improvement in the quality of care provided should be given priority through concrete actions for prevention of LBW.

Padrões alimentares de adolescentes na cidade de São Paulo

OBJETIVO: Identificar os padrões alimentares de adolescentes eutróficos e com excesso de peso. MÉTODOS: Estudo transversal envolvendo 239 adolescentes de ambos os sexos, na faixa etária de 14 a 19 anos, alunos de uma escola pública da cidade de São Paulo, Brasil. Foram coletados dados antropométricos e registro alimentar de 4 dias. O estado nutricional foi avaliado pelo índice de massa corporal de acordo com os critérios de Must et al., e foi aplicada análise fatorial para a identificação dos padrões alimentares. RESULTADOS: Foram identificados quatro padrões alimentares: tradicional, urbano, saudável e junk food. O estado nutricional de eutrofia teve associação positiva com os padrões tradicional e urbano, o sobrepeso com os padrões saudável e junk food, e a obesidade associou-se negativamente com os padrões urbano, saudável e junk food. CONCLUSÃO: O padrão saudável foi encontrado entre os adolescentes com sobrepeso, evidenciando preocupação com o controle do peso e tentativa de mudança do hábito alimentar. Entre os obesos, a ocorrência do sub-relato provavelmente tenha influenciado o resultado das associações.

Sedentarismo e variáveis clínico-metabólicas associadas à obesidade em adolescentes

OBJETIVO: Estudar a associação da obesidade com variáveis metabólicas, variáveis clínicas e sedentarismo, em adolescentes pós-púberes de escolas públicas de São Paulo. MÉTODOS: Estudo caso-controle com 128 adolescentes obesos (índice de massa corporal > percentil 95) e 151 adolescentes eutróficos (índice de massa corporal entre percentis 5 e 85). Foram realizados exame físico, avaliação bioquímica e de composição corporal. Foi aplicado questionário previamente testado, que gerou um escore de sedentarismo. Na análise estatística, foi realizada a análise de variância com testes de comparações múltiplas de Bonferroni e qui-quadrado (Pearson). O modelo logístico múltiplo foi utilizado para verificar as associações entre variáveis clínicas, variáveis metabólicas, escore de sedentarismo e estado nutricional. RESULTADOS Por meio da análise de variância, foi identificado um gradiente nos valores médios das variáveis metabólicas e clínicas com piora dessas variáveis em paralelo ao aumento do grau de sedentarismo, o que foi confirmado pelo teste qui-quadrado. Na análise bivariada de riscos para obesidade, os adolescentes obesos apresentaram maiores frequências de sedentarismo, de alterações nos níveis de lipoproteína de alta densidade e triglicérides, de hiperinsulinemia e homeostasis model assessment for insulin resistence alterado, e de pressão arterial alterada (p<0,05). O modelo logístico múltiplo mostrou associações entre obesidade e variáveis de sedentarismo (OR=2,23), lipoproteína de alta densidade reduzida (OR=3,05), pressão arterial alterada (OR=3,57), triglicerídeos aumentados (OR=4,13) e homeostasis model assessment for insulin resistence aumentado (OR=11,65). CONCLUSÃO: Sedentarismo, lipoproteína de alta densidade reduzida, hipertrigliceridemia, resistência insulínica e hipertensão estão fortemente associados com a obesidade em adolescentes. Estratégias para redução do peso corporal por meio de mudanças nos hábitos de vida devem fazer parte das políticas e programas de saúde pública, especialmente para essa faixa etária.

Influence of body mass index, gender, and Hispanic ethnicity on physical activity in urban children

PURPOSE

This community-based participatory research study examined the association between overweight status and activity among Hispanic urban, school-age children.

DESIGN AND METHODS

In a sample of 140 children, activities were assessed using the Youth Risk Behavior Survey's questions about physical activity (PA) and team sports.

RESULTS

Thirty-nine percent were overweight (body mass index [BMI] >85%). Normal-weight children had higher levels of PA and team sports. Females had lower levels of PA and team sports. Significant associations included BMI and sports team participation, and BMI and Hispanic ethnicity.

PRACTICE IMPLICATIONS

Nurses should be aware that Hispanic urban children are at risk for lower activity.

Sintomas de internalização e externalização em crianças e adolescentes com excesso de peso

OBJETIVO: Comparar sintomas de internalização e externalização em crianças e adolescentes com e sem excesso de peso. MÉTODO: 88 indivíduos (53 com excesso de peso e 35 eutróficos), entre 6 e 18 anos, foram avaliados por meio do Inventário de Comportamentos da Infância e Adolescência (CBCL-6/18) e de medidas antropométricas. Foram considerados com excesso de peso os indivíduos com índice de massa corporal (IMC) > 1 desvio-padrão. Os indivíduos com T-score > 70 no CBCL-6/18 foram considerados como tendo sintomas emocionais. O teste de Mann-Whitney foi utilizado para verificar se houve diferença entre as médias do IMC, as médias de idade e os T-scores médios obtidos nas subescalas de internalização e externalização, de acordo com os grupos pesquisados. Foi utilizado o índice de correlação de Spearman para verificar correlação entre o IMC e os T-scores médios obtidos nas subescalas de internalização e externalização. RESULTADOS: Sintomas de internalização ocorreram em 14 indivíduos com excesso de peso e em 4 eutróficos (médias de T-score: 59,09 e 49,40, respectivamente, p-valor = 0,003). Sintomas de externalização ocorreram em 9 indivíduos com excesso de peso e em 2 eutróficos (médias de T-score: 53,71 e 47,91, respectivamente, p-valor = 0,019). Foi encontrada uma correlação positiva entre o IMC dos indivíduos pesquisados e a presença de sintomas de internalização e externalização. O mesmo ocorreu, quando se correlacionou os T-scores médios dos sintomas de internalização e externalização. CONCLUSÃO: Sintomas psiquiátricos prevaleceram nos indivíduos com excesso de peso. Quanto maior é o IMC, maior o risco do desenvolvimento de sintomas emocionais.

Fatores familiares associados à obesidade abdominal entre adolescentes

OBJETIVOS: analisar a associação entre fatores de risco familiares e a presença de obesidade abdominal entre adolescentes. MÉTODOS: a amostra foi composta por 691 jovens de ambos os gêneros (11 a 17 anos), residentes em Presidente Prudente-SP no ano de 2007. A identificação da obesidade abdominal foi baseada no valor da circunferência de cintura, e os fatores de risco familiares (escolaridade e excesso de peso dos pais, condição socioeconômica, número de irmãos e quantidade de televisores na residência) foram analisados por meio de questionários. A análise estatística utilizou o teste qui-quadrado e regressão logística (razão de chance [RC] e intervalos de confiança [IC95%]). RESULTADOS: a prevalência de obesidade abdominal foi igual a 14,8% na amostra avaliada e não foi diferente entre os gêneros (masculino: 17,7% e feminino: 12,9%; p=0,111). A obesidade abdominal associou-se com a rede privada de ensino (3,75 [1,27-11,00]), sobrepeso/obesidade da mãe (3,82 [1,14-12,73]) e de ambos os pais (6,21 [2,07-18,63]). CONCLUSÕES: os achados do presente estudo indicam que estudar na rede privada de ensino e o excesso de peso dos pais caracterizam importantes fatores de risco associados à presença da obesidade abdominal entre adolescentes.

Fatores socioeconômicos, demográficos, ambientais e comportamentais associados ao excesso de peso em adolescentes: uma revisão sistemática da literatura

OBJETIVO: Identificar fatores socioeconômicos, ambientais e comportamentais associados ao excesso de peso (EP) em adolescentes por meio de uma revisão sistemática da literatura. MÉTODOS: Foram consultadas seis bases de dados (Lilacs, Adolec, SciELO, Medline via Pubmed, ISI Web of Knowlwdge e Cochrane Library) entre os dias 3 e 13 de janeiro de 2008. Os descritores e respectivos termos MeSH utilizados foram: "sobrepeso", "obesidade", "adolescência", "adolescentes", "fatores de risco", "fatores associados". Foram avaliados artigos em inglês, espanhol e português publicados entre 1997 e 2007, e incluídos estudos observacionais que estudaram adolescentes com idades entre 10 e 19 anos, cujo desfecho era o EP diagnosticado por critérios internacionalmente utilizados. Foram excluídos estudos com base em amostras de conveniência ou que não investigavam fatores sociais, ambientais e psicocomportamentais entre as variáveis independentes. RESULTADOS: Da leitura dos títulos e resumos, e da aplicação inicial dos critérios de elegibilidade, resultaram 202 artigos. A revisão das publicações completas permitiu a inclusão e análise de 56 artigos. Observou-se que o nível socioeconômico associou-se inversamente com o EP em países desenvolvidos e de forma direta em países em desenvolvimento. Dieta para emagrecer, número de horas alocadas em TV/vídeo por dia, mãe e/ou pais obesos e ocorrência de EP na infância associaram-se diretamente com o EP. Foram identificados como fatores protetores o hábito de consumir desjejum e a prática de atividade física. CONCLUSÃO: Variáveis socioeconômicas, comportamentais, familiares e do início da vida associaram-se com EP e estas devem ser consideradas nas intervenções dirigidas para este agravo entre adolescentes.

Fatores de risco para sobrepeso entre adolescentes: análise de três cidades brasileiras

OBJETIVO: Realizar análise comparativa de fatores de risco para sobrepeso em adolescentes de três cidades brasileiras, Pelotas, São Paulo e Goiânia. MÉTODOS: Os três bancos de dados são provenientes de estudos com delineamento do tipo caso-controle, que investigaram fatores de risco para sobrepeso/obesidade entre adolescentes das três cidades. Classificaram-se os adolescentes como sobrepeso quando o Índice de Massa Corporal estava acima do percentil 85 em relação ao padrão de referência do National Center for Health Statistcs. Procedeu-se à análise multivariada com modelo hierárquico de regressão logística. RESULTADOS: Foram estudados 903 adolescentes pós-púberes (443 casos e 460 controles). A análise não-ajustada dos três bancos de dados combinados aumentou o poder das associações quando meninos e meninas foram considerados separadamente. Educação materna menor ou igual a 8 anos duplicou o risco de sobrepeso entre meninas; obesidade dos pais esteve fortemente associada ao sobrepeso dos adolescentes; tempo de televisão maior ou igual a 4 horas associou-se ao sobrepeso apenas entre meninas; consumo de gordura visível da carne aumentou o risco de sobrepeso entre os meninos em 70% e consumo de frituras apresentou associação inversa entre as meninas. Finalmente, o consumo de álcool esteve significante e inversamente associado ao sobrepeso entre meninos. CONCLUSÃO: Meninas pós-púberes, provenientes de famílias com baixa escolaridade, devem receber atenção especial durante o planejamento e a execução de estratégias de prevenção e controle do sobrepeso.

Sugar-sweetened soft drinks and obesity: a systematic review of the evidence from observational studies and interventions

Sugar-sweetened soft drinks (SSD) are a special target of many obesity-prevention strategies, yet critical reviews tend to be more cautious regarding the aetiological role of SSD in promoting excess body weight. Since ongoing evaluation of this issue is important, the present systematic review re-examined the evidence from epidemiological studies and interventions, up to July 2008. Database searches of Medline, Cochrane reviews, Google scholar and a hand search of cross-references identified forty-four original studies (twenty-three cross-sectional, seventeen prospective and four intervention) in adults and children, as well as six reviews. These were critically examined for methodology, results and interpretation. Approximately half the cross-sectional and prospective studies found a statistically significant association between SSD consumption and BMI, weight, adiposity or weight gain in at least one subgroup. The totality of evidence is dominated by American studies where SSD consumption tends to be higher and formulations different. Most studies suggest that the effect of SSD is small except in susceptible individuals or at high levels of intake. Methodological weaknesses mean that many studies cannot detect whether soft drinks or other aspects of diet and lifestyle have contributed to excess body weight. Progress in reaching a definitive conclusion on the role of SSD in obesity is hampered by the paucity of good-quality interventions which reliably monitor diet and lifestyle and adequately report effect sizes. Of the three long-term (>6 months) interventions, one reported a decrease in obesity prevalence but no change in mean BMI and two found a significant impact only among children already overweight at baseline. Of the six reviews, two concluded that the evidence was strong, one that an association was probable, while three described it as inconclusive, equivocal or near zero. Reasons for some discrepancies are presented.

Pediatric nephrology patients are overweight: 20 years' experience in a single Canadian tertiary pediatric nephrology clinic

BACKGROUND

Obesity is an independent risk factor for chronic kidney disease (CKD). We compared the body composition of pediatric nephrology patients with that of the general child population over 2 decades.

METHODS

About 4,959 patients above 2 years of age (mean: 9.6 +/- 4.5) were referred to a tertiary pediatric nephrology clinic from 1985 to 2006. In 3,422 patients (69.0% with the same mean age) there were sufficient data to analyze body composition, expressed as body mass index (BMI) Z-score and calculated on the basis of normal data taken from the National (USA) Center for Health Statistics (2000).

RESULTS

Hematuria (21.68%), recurrent urinary tract infections (16.09%), proteinuria (13.95%) and hypertension (8.27%) were the most common referral diagnoses. Mean BMI Z-score of the pediatric nephrology patients increased significantly from 0.29 +/- 1.07 during the years 1985-1991 to 0.44 +/- 1.27 in 1992-1999 and 0.87 +/- 1.70 in 2000-2006 (P < 0.0001, ANOVA). Whereas the rate of the increase in BMI Z-score was not statistically different from that seen in the normal population, the young nephrology patients had over the entire time consistently significantly higher BMI Z-scores (average +0.72) than the comparable normal USA data. Several disease groups with potential for development of CKD had higher BMI Z-scores than found in the age- and sex-adjusted control data.

CONCLUSIONS

The increased rate of obesity in our studied population suggests that pediatric nephrology patients are at even greater risk for developing CKD later in life than could be predicted from their renal disease only. We recommend therapeutic intervention to address this potentially modifiable risk factor.

Influence of the family nucleus on obesity in children from northeastern Brazil: a cross-sectional study

BACKGROUND

Obesity is considered to be caused by a combination of heredity and environmental factors with typical onset during childhood. The aim of this study was to identify family risk factors for the development of obesity in children from Brazil.

METHODS

Cross-sectional study with 699 children, randomly and proportionally selected, ranging from 5 to 9 years of age, from public and private schools in Feira de Santana-BA. Overweight and obesity were defined using IOTF standards. Analyses of the interviews with the children's guardians were used to determine the influence of the family nucleus on obesity.

RESULTS

The children were classified into four groups based on weight percentiles (underweight, normal, overweight and obese). Significant differences between the groups in relation to ethnicity, social and economical status (rho = 000.0 for all) were found. The following variables were associated with the development of childhood obesity: fathers' obesity (rho = 0.001), mothers' (rho = 0.021) and both parents' (rho = 0.000). There was no significant statistical difference between fathers and mothers who did (rho = 0.81) or did not work out (rho = 0.15). Obesity (rho = 0.07) tended to be less prevalent in the child whose parents were separated. Family history of obesity (OR = 3.3; IC = 2.0 - 5.5; rho = 0.000) and high social class (OR = 3.0; IC = 1.1 - 7.7; rho = 0.020) were predictive and independent associated factors.

CONCLUSION

This study confirms the influence of genetic and/or behavioral factors on the origin of childhood obesity. Thus, effective intervention strategies must be focused not only on the children but on the entire family nucleus.