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Chalil VK, Prasad HK, Nassir SAMA, Arulalan KV, Sangaralingam T, Krishnamoorthy N. A Study on New IAP 2015 Growth References in Rural South Indian Children. Indian J Pediatr 2021; 88:645-649. [PMID: 33210206 DOI: 10.1007/s12098-020-03563-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/28/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To ascertain the utility of the new pan Indian 2015 IAP references in rural South Indian children and the ability of new IAP charts to recognise children with abnormal cardiometabolic risk factors in 10 to 16 y age group. METHODS Among school health camps conducted at two centres of Tamil Nadu- rural Vellore and rural Erode- height, weight, waist circumference, blood pressure, triceps skin-fold thickness and body fat percentage were measured by trained pediatricians and Z-scores calculated. The anthropometric measures were studied as per IAP 2015 references and compared to other national and international references. Their utility in identification of malnutrition and cardiometabolic risk ascertained. RESULTS A total of 420 children (210 from Erode and 210 from Vellore) in the age group of 10 to 16 y were included in the study. New IAP references recognized more short stature (4.2 vs. 3%), wasting (11 vs. 1.5%) and overweight (14.2 vs. 13.2%) children compared to old IAP charts. The Z-scores of anthropometric measures as per New IAP 2015 references had significant correlation with old IAP and other international data (p < 0.05). It was noted that new IAP charts could detect 83.3%, old IAP chart 50% and WHO 83.3% of subjects with malnutrition. New IAP charts could detect 70.3% cardiometabolic risk associated with over nutrition compared to old IAP (57.4%) and WHO (51.8%). CONCLUSIONS There is a significant prevalence of both under nutrition and overweight in rural setting. IAP 2015 reference is useful to diagnose children with under nutrition and overweight including abnormal cardiometabolic risk.
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Affiliation(s)
| | - Hemchand Krishna Prasad
- Department of Pediatric Endocrinology, Mehta Multispeciality Hospitals India Pvt Ltd, Chennai, Tamil Nadu, 600031, India.
| | | | - K V Arulalan
- Department of Pediatrics, AA Child Care Centre, Vellore, Tamil Nadu, India
| | - Thangavelu Sangaralingam
- Department of Pediatrics, Mehta Multispeciality Hospitals India Pvt Ltd, Chennai, Tamil Nadu, India
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Amiri P, Vahedi-Notash G, Naseri P, Khalili D, Hashemi Nazari SS, Mehrabi Y, Mahdavi Hazaveh AR, Azizi F, Hadaegh F. National trends of pre-hypertension and hypertension among Iranian adolescents across urban and rural areas (2007-2011). Biol Sex Differ 2019; 10:15. [PMID: 30922399 PMCID: PMC6439987 DOI: 10.1186/s13293-019-0230-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/18/2019] [Indexed: 12/29/2022] Open
Abstract
Background The current nationwide study, for the first time, aimed to assess and compare the trend of pre-hypertension and hypertension among urban and rural adolescents in Iran. Methods This study has been conducted in the framework of the National Surveys of Risk Factors for Non-Communicable Diseases. To estimate pre-hypertension and hypertension prevalence among 9715 adolescents, aged 15–19 years, data collected in four repeated cross-sectional surveys (2007–2011) has been used. The prevalence trends of pre-hypertension and hypertension were examined across urban and rural areas of Iran. To calculate the adjusted prevalence ratios (PRs) of pre-hypertension and hypertension over cycles across area of residence and genders, a complex sample survey and multinomial logistic analysis were performed. Results Using the definition of pre-hypertension and hypertension presented by the seventh Joint National Committee (JNC-VII) for adolescents, after adjusting for confounders, the prevalence of pre-hypertension changed in both urban (boys:28.96% to 29.24% and girls:18.33% to 20.06%) and rural (boys 31.58% to 32.05% and girls 22.25% to 24.13%) areas over the study duration. Non-significant rising prevalence of hypertension was also observed in boys and girls of both regions (urban 12.76% to 15.04% and 8.02% to 9.06%; rural 9.95% to 11.79% and 10.35% to 11.60%, for boys and girls respectively). The adjusted prevalence ratios (PRs) of pre-hypertension (2.16; 95% CI 1.68–2.79 and 1.92, 95% CI 1.57–2.34, in urban and rural, respectively) and hypertension (2.40; 95% CI 1.65–3.51 and 1.82, 95% CI 1.36–2.45, in urban and rural, respectively) were higher in boys than girls. Comparing the adjusted PRs of pre-hypertension and hypertension in urban versus rural areas, in both genders, showed higher PRs of pre-hypertension in rural girls (1.33, 95% CI 1.01–1.75). Conclusion The current results showed high constant trends of pre-hypertension and hypertension in Iranian boys and girls, residing in both urban and rural areas.
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Affiliation(s)
- Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golnaz Vahedi-Notash
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Naseri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Saeed Hashemi Nazari
- Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Reza Mahdavi Hazaveh
- Center for Non-communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Prevalence of cardiovascular risk factors in schoolchildren from a rural and urban area in Colombia. BIOMEDICA 2018; 38:545-554. [PMID: 30653869 DOI: 10.7705/biomedica.v38i4.4223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/25/2018] [Indexed: 01/19/2023]
Abstract
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.
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Regional Variations in Physical Fitness and Activity in Healthy and Overweight Ecuadorian Adolescents. CHILDREN-BASEL 2018; 5:children5080104. [PMID: 30072638 PMCID: PMC6111984 DOI: 10.3390/children5080104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 12/22/2022]
Abstract
Background: Insufficient physical activity (PA) and excessive sedentary behavior (SB) are the main contributors to adolescent obesity. However, it is uncertain whether recent economic growth and urbanization in Ecuador are contributing to an obesogenic environment. This study assessed the relationships among fitness, PA, SB, and perceived social support for PA in adolescents from urban (Quito) and rural (Loja) Ecuador. Methods: Fitness was estimated using 3-min step test and PA and SB participation and social support for PA were self-reported in 407 adolescents. T-tests and analysis of variance assessed differences by sex, obesity status, and region of Ecuador. Pearson correlations assessed relationships among PA, SB, fitness, and social support. Results: Males and rural adolescents (48.3 ± 9.4 and 47.1 ± 9.6 mL/kg/min) were more fit than females and urban adolescents (41.1 ± 7.5 and 39.7 ± 6.1 mL/kg/min). Fitness was negatively correlated with obesity only in rural Ecuador. Few adolescents reported ≥60 min/day of PA (8.4%) or ≤2 h/day of SB (30.2%), with greater SB participation in rural Ecuador. Weak correlations were observed among fitness, PA, SB, and parental/peer support for PA (r = -0.18 to 0.19; p < 0.05). Conclusion: While fitness varied by sex, weight status, and region, SB participation and parent/peer support for PA, not PA participation itself, predicted fitness in rural Ecuadorean adolescents.
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Ochoa-Avilés A, Verstraeten R, Huybregts L, Andrade S, Van Camp J, Donoso S, Ramírez PL, Lachat C, Maes L, Kolsteren P. A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: a cluster randomized controlled trial. Nutr J 2017; 16:79. [PMID: 29228946 PMCID: PMC5725778 DOI: 10.1186/s12937-017-0299-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 11/23/2017] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND In Ecuador, adolescents' food intake does not comply with guidelines for a healthy diet. Together with abdominal obesity adolescent's inadequate diets are risk factors for non-communicable diseases. We report the effectiveness of a school-based intervention on the dietary intake and waist circumference among Ecuadorian adolescents. METHODS A pair-matched cluster randomized controlled trial including 1430 adolescents (12-14 years old) was conducted. The program aimed at improving the nutritional value of dietary intake, physical activity (primary outcomes), body mass index, waist circumference and blood pressure (secondary outcomes). This paper reports: (i) the effect on fruit and vegetable intake, added sugar intake, unhealthy snacking (consumption of unhealthy food items that are not in line with the dietary guidelines eaten during snack time; i.e. table sugar, sweets, salty snacks, fast food, soft drinks and packaged food), breakfast intake and waist circumference; and, (ii) dose and reach of the intervention. Dietary outcomes were estimated by means of two 24-h recall at baseline, after the first 17-months (stage one) and after the last 11-months (stage two) of implementation. Dose and reach were evaluated using field notes and attendance forms. Educational toolkits and healthy eating workshops with parents and food kiosks staff in the schools were implemented in two different stages. The overall effect was assessed using linear mixed models and regression spline mixed effect models were applied to evaluate the effect after each stage. RESULTS Data from 1046 adolescents in 20 schools were analyzed. Participants from the intervention group consumed lower quantities of unhealthy snacks (-23.32 g; 95% CI: -45.25,-1.37) and less added sugar (-5.66 g; 95% CI: -9.63,-1.65) at the end of the trial. Daily fruit and vegetable intake decreased in both the intervention and control groups compared to baseline, albeit this decrease was 23.88 g (95% CI: 7.36, 40.40) lower in the intervention group. Waist circumference (-0.84 cm; 95% CI: -1.68, 0.28) was lower in the intervention group at the end of the program; the effect was mainly observed at stage one. Dose and reach were also higher at stage one. CONCLUSIONS The trial had positive effects on risk factors for non-communicable diseases, i.e. decreased consumption of unhealthy snacks. The program strategies must be implemented at the national level through collaboration between the academia and policy makers to assure impact at larger scale. TRIAL REGISTRATION ClinicalTrial.gov-NCT01004367 .
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Affiliation(s)
- Angélica Ochoa-Avilés
- Departmento de Biociencias, Grupo Nutrición Alimentación y Salud, Facultad de Ciencias Químicas, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, 0101168, Cuenca, Ecuador.
| | - Roosmarijn Verstraeten
- Independent researcher, Ghent, Belgium.,Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, 2033 K St, NW, Washington, DC, USA
| | - Susana Andrade
- Departmento de Biociencias, Grupo Nutrición Alimentación y Salud, Facultad de Ciencias Químicas, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, 0101168, Cuenca, Ecuador
| | - John Van Camp
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium
| | - Silvana Donoso
- Departmento de Biociencias, Grupo Nutrición Alimentación y Salud, Facultad de Ciencias Químicas, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, 0101168, Cuenca, Ecuador
| | - Patricia Liliana Ramírez
- Departmento de Biociencias, Grupo Nutrición Alimentación y Salud, Facultad de Ciencias Químicas, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, 0101168, Cuenca, Ecuador
| | - Carl Lachat
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium
| | - Lea Maes
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium
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Alexander A, Florez H, Ladera N. Hyperglycemia and dyslipidemia of Isabela, Galápagos, Ecuador: A pilot study of cardiovascular risk factors in an Isolated Island community. Diabetes Res Clin Pract 2017; 130:108-112. [PMID: 28601002 DOI: 10.1016/j.diabres.2017.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 05/03/2017] [Accepted: 05/16/2017] [Indexed: 01/01/2023]
Abstract
AIM To evaluate the prevalence of hyperglycemia and dyslipidemia in the population of Isabela, Galápagos, Ecuador, across gender and age (above or below 50). METHODS In this population-based retrospective cross-sectional study among individuals in Isabela, Galápagos, Ecuador, demographic and metabolic factors were evaluated based on World Health Organization (WHO) Global Guidelines. RESULTS The population overall exceeded the WHO guidelines for cardiovascular health. As to be expected, there was significance in the trend of increasing dyslipidemia and hyperglycemia with age except postprandial glucose. In those individuals below the age of 50, 8.0%, 49% and 26% had hyperglycemia, hypercholesterolemia and hypertriglyceridemia, respectively. However, in those above 50, they measured 24%, 68% and 36% respectively, showing a significant increase. CONCLUSIONS Hyperglycemia and dyslipidemia appear to be prevalent in Isabela, Galápagos, Ecuador and this pilot study supports further research into metabolic syndrome and diabetes. Such data may help in healthcare planning and screening to ensure not only timely diagnosis, but prevention. The limitations of this data illustrate modalities that data collection can be improved, such as having a linked clinical history to the data itself and better patient follow up for such entities as post prandial glucose, for example. However, this pilot study presents a starting point for future directions of research, such as ascertaining prevalence of diabetes type II, metabolic syndrome and cardiovascular disease.
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Affiliation(s)
- Abigail Alexander
- University of Miami Miller School of Medicine, USA; International Outreach Initiative, Galápagos, Ecuador.
| | | | - Nuria Ladera
- International Outreach Initiative, Galápagos, Ecuador
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Casapulla SL, Howe CA, Mora GR, Berryman D, Grijalva MJ, Rojas EW, Nakazawa M, Shubrook JH. Cardiometabolic risk factors, metabolic syndrome and pre-diabetes in adolescents in the Sierra region of Ecuador. Diabetol Metab Syndr 2017; 9:24. [PMID: 28435445 PMCID: PMC5397823 DOI: 10.1186/s13098-017-0224-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 04/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Excess weight (overweight and obesity) is the major modifiable risk factor for type 2 diabetes mellitus (T2DM) and other non-communicable diseases. However, excess weight may not be as predictive of diabetes risk as once thought. While excess weight and other obesity-related non-communicable diseases are of growing concern in low-middle income countries in Latin America, there is limited research on risk factors associated with T2DM in adolescents. This study investigated prevalence of overweight, obesity, prediabetes, diabetes and metabolic syndrome in adolescents in Ecuador. METHODS A cross-sectional study was conducted with 433 adolescents from two schools in a small urban center in southern Ecuador and two schools in a large urban center in Quito. Risk factors were measured, including: height, weight, BMI, waist-to-hip ratio, fasting glucose, lipid panel, and HbA1c. Multivariate analysis of variance (MANOVA) was separately applied to risk factors and demographic factors as a set of dependent variables with sex, location and their interaction included as predictors. An independent t test was run on the data at 95% confidence intervals for the mean difference. The values for the triglycerides, LDL and VLDL were positively skewed. A Mann-Whitney U test was run on these data. RESULTS Using IOTF standards, 9.8% were overweight and 1.9% were obese. Only 1.6% of the sample met the criteria for prediabetes by fasting glucose but 12.4% of the sample met the criteria for prediabetes by HbA1c. None of the participants met criteria for diabetes. There were 2.3% of the participants that met the IDF criteria for metabolic syndrome. Adolescents from the larger urban center had higher rates of prediabetes, higher mean HbA1c, blood pressure, lipid values, and lower HDL levels. CONCLUSIONS Use of HbA1c identified more adolescents with prediabetes than FBG. The HbA1c measure is an attractive screening tool for prediabetes in developing countries. Although rates of obesity in Ecuadorian adolescents are low there is significant evidence to suggest that prediabetes is permeating the smaller urban centers. Traditional screening tools may underestimate this risk.
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Affiliation(s)
- Sharon L. Casapulla
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, 126 Irvine Hall, Athens, OH 45701 USA
- Office of Rural and Underserved Programs, Ohio University Heritage College of Osteopathic Medicine, Athens, OH USA
- The Diabetes Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, OH USA
- Infectious and Tropical Disease Institute, Department of Biomedical Sciences, Ohio University Heritage College of Osteopathic Medicine, Athens, OH USA
| | - Cheryl A. Howe
- School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH USA
- The Diabetes Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, OH USA
| | - Gabriela Rosero Mora
- Department of Surgery, Medical and Social Sciences, University of Alcalá, Madrid, Spain
| | - Darlene Berryman
- School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH USA
- The Diabetes Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, OH USA
- Antiviral Research Center, University of California, San Diego, Athens, OH USA
| | - Mario J. Grijalva
- The Diabetes Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, OH USA
- Antiviral Research Center, University of California, San Diego, Athens, OH USA
- Infectious and Tropical Disease Institute, Department of Biomedical Sciences, Ohio University Heritage College of Osteopathic Medicine, Athens, OH USA
| | - Edgar W. Rojas
- Nutrition Department, College of Nursing, Pontifical Catholic University of Ecuador, Quito, Ecuador
- Center for Infectious and Chronic Disease Research, School of Biological Sciences, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Masato Nakazawa
- Antiviral Research Center, University of California, San Diego, Athens, OH USA
| | - Jay H. Shubrook
- The Diabetes Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, OH USA
- Department of Primary Care, Touro University College of Osteopathic Medicine, California, Vallejo, CA USA
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PREVALENCIA DE SÍNDROME METABÓLICO EN NIÑOS Y ADOLESCENTES DE AMÉRICA. TIP REVISTA ESPECIALIZADA EN CIENCIAS QUÍMICO-BIOLÓGICAS 2017. [DOI: 10.1016/j.recqb.2016.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Individual and Environmental Factors Influencing Adolescents' Dietary Behavior in Low- and Middle-Income Settings. PLoS One 2016; 11:e0157744. [PMID: 27447169 PMCID: PMC4957796 DOI: 10.1371/journal.pone.0157744] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/04/2016] [Indexed: 12/29/2022] Open
Abstract
Objective Given the public health importance of improving dietary behavior in chronic disease prevention in low- and middle-income countries it is crucial to understand the factors influencing dietary behavior in these settings. This study tested the validity of a conceptual framework linking individual and environmental factors to dietary behavior among Ecuadorian adolescents aged 10–16 years. Methods A cross-sectional survey was conducted in 784 school-going Ecuadorian adolescents in urban and rural Southern Ecuador. Participants provided data on socio-economic status, anthropometry, dietary behavior and its determining factors. The relationships between individual (perceived benefits and barriers, self-efficacy, habit strength, and a better understanding of healthy food) and environmental factors (physical environment: accessibility to healthy food; social environment: parental permissiveness and school support), and their association with key components of dietary behavior (fruit and vegetables, sugary drinks, breakfast, and unhealthy snack intake) were assessed using structural equation modeling. Results The conceptual model performed well for each component of eating behavior, indicating acceptable goodness-of-fit for both the measurement and structural models. Models for vegetable intake and unhealthy snacking showed significant and direct effects of individual factors (perceived benefits). For breakfast and sugary drink consumption, there was a direct and positive association with socio-environmental factors (school support and parental permissiveness). Access to healthy food was associated indirectly with all eating behaviors (except for sugary drink intake) and this effect operated through socio-environmental (parental permissiveness and school support) and individual factors (perceived benefits). Conclusion Our study demonstrated that key components of adolescents’ dietary behaviors are influenced by a complex interplay of individual and environmental factors. The findings indicate that the influence of these factors varied by type of dietary behavior.
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Andrade S, Lachat C, Cardon G, Ochoa-Avilés A, Verstraeten R, Van Camp J, Ortiz J, Ramirez P, Donoso S, Kolsteren P. Two years of school-based intervention program could improve the physical fitness among Ecuadorian adolescents at health risk: subgroups analysis from a cluster-randomized trial. BMC Pediatr 2016; 16:51. [PMID: 27102653 PMCID: PMC4840972 DOI: 10.1186/s12887-016-0588-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 04/12/2016] [Indexed: 12/18/2022] Open
Abstract
Background Adolescents with overweight and poor physical fitness have an increased likelihood of developing cardiovascular diseases during adulthood. In Ecuador, a health promotion program improved the muscular strength and speed-agility, and reduced the decline of the moderate-to-vigorous physical activity of adolescents after 28 months. We performed a sub-group analysis to assess the differential effect of this intervention in overweight and low-fit adolescents. Methods We performed a cluster-randomized pair matched trial in schools located in Cuenca–Ecuador. In total 20 schools (clusters) were pair matched, and 1440 adolescents of grade 8 and 9 (mean age of 12.3 and 13.3 years respectively) participated in the trial. For the purposes of the subgroup analysis, the adolescents were classified into groups according to their weight status (body mass index) and aerobic capacity (scores in the 20 m shuttle run and FITNESSGRAM standards) at baseline. Primary outcomes included physical fitness (vertical jump, speed shuttle run) and physical activity (proportion of students achieving over 60 min of moderate–to-vigorous physical activity/day). For these primary outcomes, we stratified analysis by weight (underweight, normal BMI and overweight/obese) and fitness (fit and low fitness) groups. Mixed linear regression models were used to assess the intervention effect. Results The prevalence of overweight/obesity, underweight and poor physical fitness was 20.3 %, 5.8 % and 84.8 % respectively. A higher intervention effect was observed for speed shuttle run in overweight (β = −1.85 s, P = 0.04) adolescents compared to underweight (β = −1.66 s, P = 0.5) or normal weight (β = −0.35 s, P = 0.6) peers. The intervention effect on vertical jump was higher in adolescents with poor physical fitness (β = 3.71 cm, P = 0.005) compared to their fit peers (β = 1.28 cm, P = 0.4). The proportion of students achieving over 60 min of moderate-to-vigorous physical activity/day was not significantly different according to weight or fitness status. Conclusion Comprehensive school-based interventions that aim to improve diet and physical activity could improve speed and strength aspects of physical fitness in low-fit and overweight/obese adolescents. Trial registration Clinicaltrials.gov identifier NCT01004367. Registered October 28, 2009. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0588-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susana Andrade
- Food Nutrition and Health Program, Universidad de Cuenca, Avenida 12 de Abril y Loja, 010202, Cuenca, Ecuador. .,Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000, Ghent, Belgium.
| | - Carl Lachat
- Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000, Ghent, Belgium.,Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Angélica Ochoa-Avilés
- Food Nutrition and Health Program, Universidad de Cuenca, Avenida 12 de Abril y Loja, 010202, Cuenca, Ecuador.,Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000, Ghent, Belgium
| | - Roosmarijn Verstraeten
- Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000, Ghent, Belgium.,Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - John Van Camp
- Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000, Ghent, Belgium
| | - Johana Ortiz
- Food Nutrition and Health Program, Universidad de Cuenca, Avenida 12 de Abril y Loja, 010202, Cuenca, Ecuador.,Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000, Ghent, Belgium
| | - Patricia Ramirez
- Food Nutrition and Health Program, Universidad de Cuenca, Avenida 12 de Abril y Loja, 010202, Cuenca, Ecuador
| | - Silvana Donoso
- Food Nutrition and Health Program, Universidad de Cuenca, Avenida 12 de Abril y Loja, 010202, Cuenca, Ecuador
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000, Ghent, Belgium.,Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
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Quadros TMBD, Gordia AP, Silva LR, Silva DAS, Mota J. [Epidemiological survey in schoolchildren: determinants and prevalence of cardiovascular risk factors]. CAD SAUDE PUBLICA 2016; 32:e00181514. [PMID: 26958824 DOI: 10.1590/0102-311x00181514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 06/26/2015] [Indexed: 11/22/2022] Open
Abstract
This study focused on the prevalence of dyslipidemia, high blood glucose, and high blood pressure in scho-olchildren and the associations with demographic, socioeconomic, biological, and behavior factors using a cross-sectional design with 1,139 schoolchildren from six to 18 years of age in Amargosa, Bahia State, Brazil. Prevalence ratio (PR) was used as the measure of association. Prevalence rates for dyslipidemia, high blood glucose, and high blood pressure were 62.1%, 6.6%, and 27%, respectively. Dyslipidemia was associated with the school's geographic location (PR = 1.52) and child's waist circumference (PR = 1.20), and high blood glucose with the school's geographic location (PR = 3.41) and child's peripheral adiposity (PR = 3.13). High blood pressure was associated with age bracket (PR = 2.34), waist-for-height ratio (PR = 1.62), sexual ma-turation (PR = 2.06), and physical activity (PR = 1.32). Intervention programs are needed to change life habits in schoolchildren.
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Dong B, Wang Z, Ma J. Urban-rural disparity in blood pressure among Chinese children: 1985-2010. Eur J Public Health 2015; 26:569-75. [PMID: 26715473 DOI: 10.1093/eurpub/ckv239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Understanding the urban-rural gap in childhood blood pressure (BP) is crucial to alleviate the urban-rural disparity in burden of hypertension in the future. This study investigated trends in urban-rural BP disparity and the influence of body mass index among Chinese children between 1985 and 2010. METHODS Data included 1 010 153 children aged 8-17 years enrolled in the Chinese National Survey on Students' Constitution and Health, a successive national cross-sectional survey. High BP was defined according to age-sex- and height-specific 95th percentile. Multi-variable linear and logistic regression models were used to assess the urban-rural BP differentials. RESULTS Although urban children had greater prevalence of overweight and obesity than rural counterparts, rural children revealed higher levels of BP across the consecutive 25-year periods. The urban-rural disparity in prevalence of high systolic BP decreased from 2.3 (95% confidence interval: 2.3, 2.6) % to 0.2 (-0.1, 0.4) % in boys and 3.7 (3.5, 4.0) % to 0.6 (0.3, 0.8) % in girls between 1985 and 2010 after adjusting for confounding factors. Further adjustment of body mass index did not change the urban-rural disparity and its trend. The similar results were also observed for diastolic BP. CONCLUSIONS Despite the urban-rural disparity in BP decreased between 1985 and 2010, rural children constantly showed higher BP levels than their urban counterparts. Since these differentials in BP cannot be explained by obesity, study of other potential factors could provide further opportunity to bridge this gap.
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Affiliation(s)
- Bin Dong
- 1 Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China 2 Centre for Chronic Disease, School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Zhiqiang Wang
- 1 Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China 2 Centre for Chronic Disease, School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jun Ma
- 1 Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China
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Hovsepian S, Kelishadi R, Djalalinia S, Farzadfar F, Naderimagham S, Qorbani M. Prevalence of dyslipidemia in Iranian children and adolescents: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2015; 20:503-21. [PMID: 26487880 PMCID: PMC4590206 DOI: 10.4103/1735-1995.163979] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/10/2015] [Accepted: 05/13/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dyslipidemia is considered as an important modifiable risk factor for cardiovascular disease (CVD). The link between childhood dyslipidemia and occurrence of atherosclerosis and its sequels in adulthood are well-documented. This study aimed to systematically review the prevalence of dyslipidemia among Iranian children and adolescents. MATERIALS AND METHODS An electronic search was conducted on studies published from January 1990 to January 2014. The main international electronic data sources were PubMed and the NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS. For Persian databases, we used domestic databases with systematic search capability including IranMedex, Irandoc, and Scientific Information Database (SID). We included all available population-based studies and national surveys conducted in the pediatric age group (aged <21 years). RESULTS In this review, 1772 articles were identified (PubMed: 1464; Scopus: 11; ISI: 58; SID: 90; IranMedex: 149; Irandoc: 57). During three refine steps and after removing of duplicates, 182 articles related to the study domain were selected. After quality assessment, 46 studies were selected for text appraisal, of which 26 qualified articles were evaluated at the final step. The prevalence range of hypercholesterolemia, hypertriglyceridemia, elevated low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol (HDL-C) were 3-48%, 3-50%, 5-20% and 5-88%, respectively. Low HDL-C and hypertriglyceridemia were the most prevalent lipid disorders in this group of population. CONCLUSION Dyslipidemia is a common health problem among Iranian children and adolescents. Few data were available in preschool children. This finding provides useful information for health policy makers to implement action-oriented interventions for prevention and early control of this important CVD risk factor.
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Affiliation(s)
- Silva Hovsepian
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirin Djalalinia
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Farshad Farzadfar
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Naderimagham
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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de Moraes ACF, Carvalho HB, Gomez-Martinez S, Androutsos O, Jiménez-Pavón D, Sjöström M, Kafatos A, Widhalm K, Cañada D, Martin-Matillas M, Beghin L, Gottrand F, Moreno LA. Family socioeconomic factors are negatively associated with blood pressure in European boys, but not girls, and Brazilian adolescents: Results from two observational studies. Blood Press 2015; 24:250-7. [PMID: 25880603 DOI: 10.3109/08037051.2015.1033171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We aimed to estimate the attributable fraction of systolic (SBP) and diastolic blood pressure (DBP) that can be explained by family socioeconomic factors (FSFs) in adolescents using two observational studies. METHODS Participants were recruited by multistage random cluster in two cross-sectional studies performed in Europe [Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, n = 3308] and Brazil [Brazilian Cardiovascular Adolescent Health (BRACAH) study, n = 991]. SBP and DBP were measured, and FSFs (socioeconomic status and parental education) were self-reported in both studies. The correlations of SBP and DBP with FSFs were examined by multilevel linear regression through two different models (hierarchical and fully adjusted). The generalized attributable fractions of the FSFs were estimated by comparing the models. RESULTS Our results showed a significant inverse relationship between parental education (father and mother) and SBP in European boys. The higher generalized attributable fraction to SBP was observed in boys (13.2-22.4%). In girls, we found lower generalized attributable fractions to DBP (10.8-12.1% in Brazilian girls and 3.1-3.8% in European girls). CONCLUSIONS Our findings revealed a significant inverse relationship between parental education and SBP in European boys. FSF also significantly influenced blood pressure in adolescents, mainly in Brazilian adolescents.
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Affiliation(s)
- Augusto César Ferreira de Moraes
- YCARE (Youth/Child and cARdiovascular Risk and Environmental) Research Group, Department of Preventive Medicine, School of Medicine of the University of São Paulo , São Paulo, SP , Brazil
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Andrade S, Lachat C, Ochoa-Aviles A, Verstraeten R, Huybregts L, Roberfroid D, Andrade D, Camp JV, Rojas R, Donoso S, Cardon G, Kolsteren P. A school-based intervention improves physical fitness in Ecuadorian adolescents: a cluster-randomized controlled trial. Int J Behav Nutr Phys Act 2014; 11:153. [PMID: 25490946 PMCID: PMC4272792 DOI: 10.1186/s12966-014-0153-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 11/28/2014] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Effective lifestyle interventions are needed to prevent noncommunicable diseases in low- and middle-income countries. We analyzed the effects of a school-based health promotion intervention on physical fitness after 28 months and explored if the effect varied with important school characteristics. We also assessed effects on screen time, physical activity and BMI. METHODS AND RESULTS We performed a cluster-randomized pair matched trial in schools in urban Ecuador. The intervention included an individual and environmental component tailored to the local context and resources. Primary outcomes were physical fitness (EUROFIT battery), screen time (questionnaires) and physical activity (accelerometers). Change in BMI was a secondary outcome. A total of 1440 grade 8 and 9 adolescents (intervention: n = 700, 48.6%) and 20 schools (intervention: n = 10, 50%) participated. Data of 1083 adolescents (intervention: n = 550, 50.8%) from 20 schools were analyzed. CONCLUSIONS A school-based intervention with an individual and environment component can improve physical fitness and can minimize the decline in physical activity levels from childhood into adolescence in urban Ecuador. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT01004367.
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de Moraes ACF, Lacerda MB, Moreno LA, Horta BL, Carvalho HB. Prevalence of high blood pressure in 122,053 adolescents: a systematic review and meta-regression. Medicine (Baltimore) 2014; 93:e232. [PMID: 25501086 PMCID: PMC4602805 DOI: 10.1097/md.0000000000000232] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
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.
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Affiliation(s)
- Augusto César Ferreira de Moraes
- From the School of Medicine of the University of São Paulo (FMUSP)-Department of Preventive Medicine, São Paulo, Brazil (ACFdeM, MBL, HBC); YCARE (Youth/Child and cARdiovascular Risk and Environmental) Research Group, FMUSP/Brazil (ACFdeM, MBL, HBC); Faculty of Health of the University of Zaragoza, GENUD-Growth, Exercise, Nutrition and Development, Zaragoza, Spain (ACFdeM, LAM); Visiting Professor, School of Medicine of the University of São Paulo-Department of Preventive Medicine, São Paulo, Brazil (LAM); and School of Medicine of the Federal University of Pelotas, Pelotas, Brazil (BLH)
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Ochoa-Avilés A, Verstraeten R, Lachat C, Andrade S, Van Camp J, Donoso S, Kolsteren P. Dietary intake practices associated with cardiovascular risk in urban and rural Ecuadorian adolescents: a cross-sectional study. BMC Public Health 2014; 14:939. [PMID: 25205169 PMCID: PMC4171553 DOI: 10.1186/1471-2458-14-939] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/15/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) are amongst the leading causes of death worldwide. Risk factors of CVD develop during childhood and adolescence, and dietary quality has been linked to the development of CVD itself. This study examines the association between dietary patterns and cardiovascular risk in a group of urban and rural Ecuadorian adolescents from different socioeconomic backgrounds. METHODS A cross-sectional study was conducted from January 2008 to April 2009 among 606 adolescents from the 8th, 9th and 10th grade in an urban area (Cuenca), and 173 adolescents from a rural area (Nabón) in Ecuador. Data collection involved measuring anthropometric data (weight, height and waist circumference), blood pressure, dietary intake (2-day 24 h recall) and socio-demographic characteristics. Fasting blood lipids and glucose were measured in a subsample of 334 adolescents. Factor analysis was used to identify dietary patterns and linear regression models were used to (i) identify differences in food intake practices according to socioeconomic status and place of residence and (ii) establish relationships between dietary patterns and cardiovascular risk factors. RESULTS Median energy intake was 1851 kcal/day. Overall, fiber, fish and fruit and vegetables were scarcely consumed, while added sugar, refined cereals and processed food were important constituents of the diet. Two dietary patterns emerged, one labelled as "rice-rich non-animal fat pattern" and the other one as "wheat-dense animal-fat pattern". The first pattern was correlated with a moderate increase in glucose in urban participants, while the second pattern was associated with higher LDL and cholesterol blood levels in rural participants. CONCLUSIONS This group of adolescents presented various dietary practices conducive to CVD development. Effective strategies are needed to prevent CVD in the Ecuadorian population by encouraging a balanced diet, which contains less refined cereals, added sugar, and processed food, but has more fruits, vegetables and whole grain cereals.
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Affiliation(s)
- Angélica Ochoa-Avilés
- />Food Nutrition and Health Program, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, Cuenca, Ecuador
- />Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Gent, Belgium
| | - Roosmarijn Verstraeten
- />Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Gent, Belgium
- />Nutrition and Child Health Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Carl Lachat
- />Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Gent, Belgium
- />Nutrition and Child Health Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Susana Andrade
- />Food Nutrition and Health Program, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, Cuenca, Ecuador
- />Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Gent, Belgium
| | - John Van Camp
- />Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Gent, Belgium
| | - Silvana Donoso
- />Food Nutrition and Health Program, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, Cuenca, Ecuador
| | - Patrick Kolsteren
- />Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Gent, Belgium
- />Nutrition and Child Health Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Ortiz J, Van Camp J, Wijaya S, Donoso S, Huybregts L. Determinants of child malnutrition in rural and urban Ecuadorian highlands. Public Health Nutr 2014; 17:2122-30. [PMID: 24073991 PMCID: PMC11108716 DOI: 10.1017/s1368980013002528] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 06/21/2013] [Accepted: 07/25/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify and compare the sociodemographic determinants of stunting, wasting and overweight among infants of urban and rural areas in the Ecuadorian highlands. DESIGN Cross-sectional study. SETTING Nabon (rural) and Cuenca (urban) cantons, Azuay Province, Ecuador. SUBJECTS A total of 703 children aged 0-24 months and their caregivers (227 rural and 476 urban) recruited during the period from June to September 2008. RESULTS Stunting prevalence was significantly higher in the rural area (37·4 % v. 17·7 %; P < 0·001) while wasting (7·1 %) and overweight (17·1 %) prevalence were more similar between areas. Determinants of stunting for the pooled sample were male gender (OR = 1·43; 95 % CI 1·06, 1·92; P = 0·02), preterm delivery (OR = 1·65; 95 % CI 1·14, 2·38; P = 0·008), child's age (OR = 1·04; 95 % CI 1·01, 1·07; P = 0·011), maternal education (OR = 0·95; 95 % CI 0·92, 0·99; P = 0·025) and facility-based delivery (OR = 0·57; 95 % CI 0·45, 0·74; P < 0·001). The latter was also a determinant of overweight (OR = 0·39; 95 % CI 0·25, 0·62; P < 0·001). Rural determinants of stunting were maternal height (OR = 0·004; 95 % CI 0·00004, 0·39; P = 0·018), diarrhoea prevalence (OR = 2·18; 95 % CI 1·13, 4·21; P = 0·02), socio-economic status (OR = 0·79; 95 % CI 0·64, 0·98; P = 0·030) and child's age (OR = 1·07; 95 % CI 1·02, 1·11; P = 0·005). Urban determinants were: maternal BMI for stunting (OR = 0·91; 95 % CI 0·84, 0·99; P = 0·027), cough prevalence (OR = 0·57; 95 % CI 0·34, 0·96; P = 0·036) and facility-based delivery (OR = 0·25; 95 % CI 0·09, 0·73; P = 0·011) for overweight, and hygiene for wasting (OR = 0·57; 95 % CI 0·36, 0·89; P = 0·013). CONCLUSIONS Infant malnutrition was associated with different sociodemographic determinants between urban and rural areas in the Ecuadorian highlands, a finding which contributes to prioritize the determinants to be assessed in nutritional interventions.
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Affiliation(s)
- Johana Ortiz
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium
- Faculty of Chemical Sciences, Cuenca University, Cuenca, Ecuador
| | - John Van Camp
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium
| | - Sylviana Wijaya
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium
| | - Silvana Donoso
- Faculty of Chemical Sciences, Cuenca University, Cuenca, Ecuador
| | - Lieven Huybregts
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium
- Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Andrade S, Ochoa-Avilés A, Lachat C, Escobar P, Verstraeten R, Van Camp J, Donoso S, Rojas R, Cardon G, Kolsteren P. Physical fitness among urban and rural Ecuadorian adolescents and its association with blood lipids: a cross sectional study. BMC Pediatr 2014; 14:106. [PMID: 24745348 PMCID: PMC3997748 DOI: 10.1186/1471-2431-14-106] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 04/11/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Physical fitness has been proposed as a marker for health during adolescence. Currently, little is known about physical fitness and its association with blood lipid profile in adolescents from low and middle-income countries. The aim of this study is therefore to assess physical fitness among urban and rural adolescents and its associations with blood lipid profile in a middle-income country. METHODS A cross-sectional study was conducted between January 2008 and April 2009 in 648 Ecuadorian adolescents (52.3% boys), aged 11 to 15 years, attending secondary schools in Cuenca (urban n = 490) and Nabón (rural n = 158). Data collection included anthropometric measures, application of the EUROFIT battery, dietary intake (2-day 24 h recall), socio-demographic characteristics, and blood samples from a subsample (n = 301). The FITNESGRAM standards were used to evaluate fitness. The associations of fitness and residential location with blood lipid profile were assessed by linear and logistic regression after adjusting for confounding factors. RESULTS The majority (59%) of the adolescents exhibited low levels of aerobic capacity as defined by the FITNESSGRAM standards. Urban adolescents had significantly higher mean scores in five EUROFIT tests (20 m shuttle, speed shuttle run, plate tapping, sit-up and vertical jump) and significantly most favorable improved plasma lipid profile (triglycerides and HDL) as compared to rural adolescents. There was a weak association between blood lipid profile and physical fitness in both urban and rural adolescents, even after adjustment for confounding factors. CONCLUSIONS Physical fitness, in our sample of Ecuadorian adolescents, was generally poor. Urban adolescents had better physical fitness and blood lipid profiles than rural adolescents. The differences in fitness did not explain those in blood lipid profile between urban and rural adolescents.
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Affiliation(s)
- Susana Andrade
- Food Nutrition and Health Program, Universidad de Cuenca, Avenida 12 de Abril s/n Ciudadela Universitaria, Cuenca, Ecuador EC010107.
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Abril V, Manuel-y-keenoy B, Solà R, García JL, Nessier C, Rojas R, Donoso S, Arija V. Prevalence of overweight and obesity among 6-to 9-year-old school children in Cuenca, Ecuador: relationship with physical activity, poverty, and eating habits. Food Nutr Bull 2014; 34:388-401. [PMID: 24605689 DOI: 10.1177/156482651303400404] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The high prevalence of childhood overweight and obesity is a health problem worldwide. In developing countries, we lack information on the extent of the problem and the risk factors involved. OBJECTIVE To determine the prevalence rates of overweight and obesity and of abdominal obesity, and their relationship with physical activity, poverty, and eating habits in schoolchildren in Cuenca, Ecuador. METHODS A cross-sectional survey in a representative sample (n = 743) schoolchildren aged 6 to 9 years was conducted. Overweight and obesity were detected using the International Obesity Task Force cutoffs according to body mass index (BMI), and abdominal obesity was detected according to waist circumference. Poverty, physical activity, and eating habits were assessed with validated questionnaires. RESULTS The prevalence rates of overweight and obesity and of abdominal obesity were 26.0% and 10.6%, respectively. There were no differences between the sexes, but the prevalence of overweight and obesity was 1.5- to 2-fold higher in 9-year-old than in 6-year-old children (p < .05). Multivariate models demonstrated that higher BMI and waist circumference were significantly related to low physical activity and nonpoverty. Insufficient physical activity (in 75% of children) was associated with a 13% to 18% increased risk of overweight and obesity and abdominal obesity. Eating breakfast and eating more than three meals per day (in 96.7% and 85.9% of children, respectively) were not related to the prevalence of overweight and obesity. Eating fruits during school break was associated with a lower BMI.L CONCLUSIONS: The high prevalence of overweight and obesity observed in schoolchildren increased from the ages of 6 to 9 years and was associated with insufficient physical activity and nonpoverty. Promoting physical activity and fruit consumption in school snacks should be explored as intervention measures to prevent and reduce overweight and obesity in Cuenca schoolchildren.
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Affiliation(s)
| | | | | | | | - Celeste Nessier
- Instituto de la Salud "Juan Lazarte" Universidad Nacional de Rosario, Argentina
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Rivera JÁ, de Cossío TG, Pedraza LS, Aburto TC, Sánchez TG, Martorell R. Childhood and adolescent overweight and obesity in Latin America: a systematic review. Lancet Diabetes Endocrinol 2014; 2:321-332. [PMID: 24703050 DOI: 10.1016/s2213-8587(13)70173-6] [Citation(s) in RCA: 275] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Juan Ángel Rivera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | | | - Lilia Susana Pedraza
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Tania Cony Aburto
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Tania Georgina Sánchez
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Verstraeten R, Van Royen K, Ochoa-Avilés A, Penafiel D, Holdsworth M, Donoso S, Maes L, Kolsteren P. A conceptual framework for healthy eating behavior in ecuadorian adolescents: a qualitative study. PLoS One 2014; 9:e87183. [PMID: 24489865 PMCID: PMC3906122 DOI: 10.1371/journal.pone.0087183] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 12/23/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify factors influencing eating behavior of Ecuadorian adolescents - from the perspective of parents, school staff and adolescents - to develop a conceptual framework for adolescents' eating behavior. STUDY DESIGN Twenty focus groups (N=144 participants) were conducted separately with adolescents aged 11-15 y (n (focus groups)=12, N (participants)=80), parents (n=4, N=32) and school staff (n=4, N=32) in rural and urban Ecuador. A semi-structured questioning route was developed based on the 'Attitude, Social influences and Self-efficacy' model and the socio-ecological model to assess the relevance of behavioral and environmental factors in low- and middle-income countries. Two researchers independently analyzed verbatim transcripts for emerging themes, using deductive thematic content analysis. Data were analyzed using NVivo 8. RESULTS All groups recognized the importance of eating healthily and key individual factors in Ecuadorian adolescents' food choices were: financial autonomy, food safety perceptions, lack of self-control, habit strength, taste preferences and perceived peer norms. Environmental factors included the poor nutritional quality of food and its easy access at school. In their home and family environment, time and convenience completed the picture as barriers to eating healthily. Participants acknowledged the impact of the changing socio-cultural environment on adolescents' eating patterns. Availability of healthy food at home and financial constraints differed between settings and socio-economic groups. CONCLUSION Our findings endorse the importance of investigating behavioral and environmental factors that influence and mediate healthy dietary behavior prior to intervention development. Several culture-specific factors emerged that were incorporated into a conceptual framework for developing health promotion interventions in Ecuador.
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Affiliation(s)
- Roosmarijn Verstraeten
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
- * E-mail:
| | - Kathleen Van Royen
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
| | - Angélica Ochoa-Avilés
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
- Food, Nutrition and Health program, Universidad de Cuenca, Cuenca, Ecuador
| | - Daniela Penafiel
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
- Rural Research Centre, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Michelle Holdsworth
- Public Health Section, School of Health and Related Research (ScHARR) - The University of Sheffield, Sheffield, United Kingdom
| | - Silvana Donoso
- Food, Nutrition and Health program, Universidad de Cuenca, Cuenca, Ecuador
| | - Lea Maes
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
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Reuter CP, Burgos LT, Camargo MD, Possuelo LG, Reckziegel MB, Reuter ÉM, Meinhardt FP, Burgos MS. Prevalence of obesity and cardiovascular risk among children and adolescents in the municipality of Santa Cruz do Sul, Rio Grande do Sul. SAO PAULO MED J 2013; 131:323-30. [PMID: 24310801 PMCID: PMC10876324 DOI: 10.1590/1516-3180.2013.1315518] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 01/07/2013] [Indexed: 01/07/2023] Open
Abstract
CONTEXT AND OBJECTIVE Studies have demonstrated that metabolic complications from child obesity, although silent, increase the risk of development of cardiovascular diseases in adulthood. The present paper sought to describe the prevalence of overweight/obesity and analyze the possible relationship between obesity and other cardiovascular risk factors among children and adolescents. DESIGN AND SETTING Cross-sectional study, conducted in a university. METHODS The study included 564 children and adolescents, aged 8 to 17 years. Body mass index and waist circumference were used to evaluate obesity. Other cardiovascular risk factors were evaluated, like systolic and diastolic blood pressure, glycemia, triglycerides and total cholesterol. Descriptive analysis was used for sample characterization, the chi-square test for categorical variables and Pearson's linear correlation for evaluating the relationship between obesity indicators and other cardiovascular risk factors. RESULTS High prevalence of overweight/obesity was found among the schoolchildren (25.3% among the boys and 25.6% among the girls), along with abdominal obesity (19.0%). The overweight/obese schoolchildren presented higher percentages for the pressure and biochemical indicators, compared with underweight and normal-weight schoolchildren. Body mass index and waist circumference showed a weak correlation with the variables of age and systolic and diastolic blood pressure (P < 0.001), but there was no correlation between these obesity indices and biochemical variables. CONCLUSION The high prevalence of overweight/obesity and its relationship with other cardiovascular risk factors demonstrate that it is necessary to develop intervention and prevention strategies from childhood onwards, in order to avoid development of chronic-degenerative diseases in adulthood.
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Affiliation(s)
- Cézane Priscila Reuter
- BSc. Pharmacist. Master Degree in Health Promotion, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul.
| | - Leandro Tibiriçá Burgos
- Doctoral studentin Human Movement Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Marcelo Dias Camargo
- MSc. Professor, Department of Physical Education and Health, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Rio Grande do Sul, Brazil.
| | - Lia Gonçalves Possuelo
- MSc. Doctoral Student in Health Sciences, Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre (UFRGS/HCPA).
| | - Miriam Beatris Reckziegel
- Doctoral studentin Human Movement Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Éboni Marília Reuter
- Physical Educator, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Francielle Pasqualotti Meinhardt
- PhD. Professor, Department of Biology and Pharmacy and Postgraduate Course (Stricto Sensu) on Health Promotion, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Rio Grande do Sul, Brazil.
| | - Miria Suzana Burgos
- BSc. Physiotherapist. Master's Student in Health Promotion, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Rio Grande do Sul, Brazil.
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