High Blood Pressure among Students in Public and Private Schools in Maceió, Brazil

Prevalence of the Double Burden of Malnutrition among Adolescents: Associations with Lifestyle Behaviors and Clusters of Social Determinants

The double burden of malnutrition (DBM) is a condition in which malnutrition coexists with overweight, reflecting a new layer of malnutrition. Our objectives were to assess prevalence; test associations between DBM and 24-hour movement behaviors; and investigate whether DBM is associated with clusters of social determinants. Methods: This multicenter cross-sectional study included 1152 adolescents (12 to 17 years old) from four Brazilian cities. Body mass index (BMI, kg/m2) was used to estimate overweight, and the adopted cutoff points took into account the curves established for age and sex: Z-score > 1 and ≤2 (overweight) and Z-score > 2 (obesity). The serum concentration of 25-hydroxyvitamin D [25(OH)D] was stratified into three levels: vitamin D deficiency ≤ 20 ng/mL; vitamin D insufficiency = 21-29 ng/mL; optimal vitamin D ≥ 30 ng/mL. We used multilevel Poisson regression models to estimate prevalence ratios (PRs) and their respective 95% confidence intervals (95%CI) and to analyze the association between DBM and covariates. A significance level of p < 0.05 was considered. Cluster analyses were performed by applying a combination of hierarchical and non-hierarchical methods. Results: A population prevalence of DBM of 7.3% (95% CI: 5.9-8.9) was revealed. A percentage of 19.2% (95% CI: 17.0-21.6) of adolescents were overweight, and 8.3% (95% CI: 6.8-10.1) were obese. A total of 41.5% (95% CI: 38.7-44.4) had vitamin D deficiency, and 25.8% (95% CI: 23.4-28.4) had vitamin D insufficiency. However, 24-hour movement behaviors were not associated with DBM. Adolescents living in the southern region of the country, from public schools whose mothers have higher education, have a 1.94 [PR = 2.94 (95% CI: 1.20-7.23)] times greater chance of developing DBM. These results highlight the importance of specific factors to improve the nutritional health of adolescents, considering the specific social determinants identified in this study.

Prevalence of childhood obesity in Brazil: systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of childhood obesity in Brazil by means of a systematic review of representative studies.

SOURCES

We searched for population-based studies that assessed obesity in Brazilian children aged < 10 years in MEDLINE, EMBASE, Scopus and other sources up to September, 2019. Paired researchers selected studies, extracted data and assessed the quality of these studies. Meta-analysis of prevalence and confidence interval (95% CI) was calculated, weighted by the population sizes using Freeman-Tukey double-arccosine transformation. Heterogeneity (I²) and publication bias were investigated by meta-regression and Egger's test, respectively.

SUMMARY OF THE FINDINGS

53 studies were included (n = 122,395), which were held from 1986 to 2015 and limited mainly due to inadequate response rates. Prevalence of obesity in the three-decade period was of 8.2% ([95% CI]: 8.1-8.4%, I² = 98.5%). Higher prevalence was observed in boys (9.7% [9.4-9.9%], I² = 97.4%) than girls (7.3% [7.1-7.5%], I² = 96.1%). Prevalence increased according to the decade (1990: 6.5% [6.0-7.0 %], I² = 96.8%; 2000: 7.9% [7.7-8.0 %], I² = 98.8%; 2010: 12.0% [11.5-12.6 %], I² = 95.8%), and Brazilian region (Northeast: 6.4% [6.2-6.7%], I² = 98.1%; North: 6.7% [6.3-7.2%], I² = 98.8%; Southeast:10.6% [10.2-11.0%], I² = 98.2%; South: 10.1 [9.7-10.4%], I² = 97.7%). Heterogeneity was affected by age and region (p < 0.05) and publication bias was discarded (p = 0.746).

CONCLUSION

For every 100 Brazilian children, over eight had obesity in the three-decade period and 12 in each 100 had childhood obesity in more recent estimates. Higher prevalence occurred in boys, recent decades and more developed Brazilian regions.

Phthalate exposure linked to high blood pressure in Chinese children

BACKGROUND

Exposure to phthalate esters may be linked to the risk of high blood pressure (HBP), but limited evidence is available in Chinese children.

OBJECTIVE

To investigate the associations between nine phthalate metabolites (mPAEs) and systolic/diastolic BP, pulse pressure (PP), mean arterial pressure (MAP), and the risk of HBP.

METHODS

In this cross-sectional study, a total of 1044 primary school children (6-8 years old) were enrolled from Shenzhen, China, between 2016 and 2017. Nine mPAEs were analyzed from urine using ultra-performance liquid chromatography and tandem mass spectrometry. A multivariable linear regression model was used to explore the associations between phthalate exposure and systolic/diastolic BP, PP, and MAP. A binary logistic regression model was used to examine the associations between phthalate exposure and the risk of HBP.

RESULTS

Monomethyl phthalate (MMP) concentrations were significantly higher in HBP children than normal BP children. MMP, monoisobutyl phthalate (MiBP), monobutyl phthalate (MnBP), mono(5-carboxy-2-ethylpentyl) phthalate, mono-[(2-carboxy methyl)hexyl] phthalate (MCMHP), the sum of four short-chain mPAEs (∑LMW), and the sum of all nine mPAEs (∑₉mPAEs) were significantly positively associated with increases in systolic BP z-score, while only MMP was significantly positively associated with diastolic BP z-score. MMP, MiBP, MnBP, MCMHP, ∑LMW, and ∑₉mPAEs were significantly associated with increases in PP, while MMP and MnBP were significantly associated with increases in MAP. MMP was significantly associated with the risk of HBP, with an odds ratio of 1.87 (95% CI: 1.23, 2.85).

CONCLUSIONS

The present study suggests that dimethyl phthalate exposure increases the risk of HBP. And some types of phthalates are associated with elevations in systolic/diastolic BP z scores, PP, and MAP in Chinese children.

Stunting and overweight among children in Northeast Brazil: prevalence, trends (1992-2005-2015) and associated risk factors from repeated cross-sectional surveys

Background

A study involving children from Alagoas (Northeast Brazil) revealed that, as a consequence of a drastic reduction in the prevalence of stunting between 1992 to 2005, (22.5 to 11.4%) combined with an increase in overweight prevalence (6.7 to 9.3%), the prevalence of these two conditions in 2005 was very close. If these trends were maintained, it is very likely that, at this time, the childhood overweight prevalence has already exceeded that of the stunting. However, no study is available to confirm this hypothesis. The identification of these changes is relevant to the planning and evaluation of public policies. This study aimed to investigate the prevalence, time trends and associated factors with stunting and overweight in children from Alagoas.

Methods

Independent cross-sectional household surveys were conducted in 1992 (n = 1231), 2005 (n = 1381) and 2015 (n = 988). Data were collected from probabilistic samples of children aged 0–60 months. Stunting was defined by stature-for-age < − 2 sd and overweight by weight-for-stature > 2 sd.

Results

Between 1992, 2005 and 2015, the stunting prevalence was 22.6, 11.2 and 3.2% (reduction of 85.8%), while the overweight prevalence was 6.9, 7.5 and 14.9% (increase of 115.9%), respectively. After multivariate analysis, the following positive associations with stunting were observed in 1992: age group > 24 months (28.3% vs 14.5%), mother with ≥2 children (28.8% vs 12.8%), low birth weight (28.3% vs 15.7%) and mother with low schooling (29.3% vs 7.2%). In 2015 there was a higher prevalence of stunting in males (4.2% vs 2.2%), in children < 24 months (4.6% vs 2.2%), with low birth weight (8.6% vs 3.0%) and in those who had mothers with low schooling (7.0% vs 2.6%). Regarding overweight, in 1992 there was higher prevalence for male (9.1% vs 4.7%) and in children whose mothers had ≤2 children (8.9% vs 5.8%), while in 2015 only birth weight >  4 kg was associated to overweight (27.3% vs 14.2%).

Conclusions

During the analyzed period, there was a significant decrease in stunting prevalence. At the same time, a substantial increase was observed in the overweight prevalence. Currently, stunting is a problem of low magnitude, while overweight has become a worrying public health problem.

A novel indicator, childhood lipid accumulation product, is associated with hypertension in Chinese children and adolescents

Childhood hypertension has become an important public health issue. This study explored a novel indicator, namely, childhood lipid accumulation product (CLAP), which is associated with hypertension among children and adolescents. A total of 683 children and adolescents aged 8-15 years were measured for body weight, height, waist circumference (WC), abdominal skinfold thickness (AST), triacylglycerol (TG), blood pressure, dietary behaviors, and physical activity time. The novel childhood lipid accumulation product (CLAP) was the product of WC, AST, and TG (CLAP = WC (cm) × AST (mm) × TG (mmol/L)). The logarithmic CLAP (LnCLAP), height, weight, WC, WHtR, BMI, AST, and TG were standardized for sex and age using the z-score method (standardized variables: SLnCLAP, Sheight, Sweight, SWC, SWHtR, SBMI, SAST, and STG). The results showed that the overall prevalence of hypertension was 11.6% (13.1% in boys and 9.7% in girls). SLnCLAP ≥ 1, Sweight ≥ 1, SWC ≥ 1, SWHtR ≥ 1, SBMI ≥ 1, SAST ≥ 1, and STG ≥ 1 increased the statistical risk of childhood hypertension (odds ratio values (95% CI) were 3.70 (2.22-6.16), 2.58 (1.50-4.43), 3.08 (1.84-5.15), 2.33 (1.38-3.93), 2.96 (1.72-5.29), 2.38 (1.41-4.70), and 2.40 (1.38-4.19), respectively). The area under the ROC curve (AUC) for CLAP was higher than that for weight, WC, WHtR, BMI, AST, and TG in the prediction of hypertension. In conclusion, this study showed that CLAP is a novel indicator associated with hypertension in children and adolescents and can more effectively predict childhood hypertension than weight, WC, WHtR, BMI, AST, and TG can.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Prevalence of hypertension and prehypertension in children and adolescents with intellectual disability in southeastern Poland

BACKGROUND

There is insufficient information on the prevalence of hypertension (HPT) among children and adolescents with ID.

AIM

The aim of this study was to determine the prevalence of HPT in children and adolescents with ID in comparison with the control group, which accounted for children and adolescents without ID.

METHODS

The study included 568 students with ID, aged from 7 to 18, attending special education institutions in southeastern Poland. The control group consisted of 568 students (matched to the study group for age and gender) without ID, attending randomly selected elementary and secondary schools located in the same area. Blood pressure was measured in compliance with the European Society of Hypertension recommendations.

RESULTS

The overall prevalence of HPT and pre-HPT in children and adolescents with ID were 18.5 and 20.6% respectively. Prevalence of HPT and pre-HPT in children and adolescents without ID were 5.8 and 18.5% respectively. Children and adolescents with a higher level of ID were found to be at a greater risk of HPT. An excessive body mass and older age were predisposing factors to a significantly higher prevalence of HPT in children and adolescents with ID.

CONCLUSION

The prevalence of HPT among students with ID was more than three times higher than in the general population. The level of ID, age, sex and body mass significantly correlated with HPT in the study group.

Relation of body mass index (BMI) to the prevalence of hypertension in children: A 3years' school-based prospective study in Suzhou, China

BACKGROUND

The prevalence of hypertension has been increasing in children and adolescents in China, which is considered to be accompanied with the epidemic of childhood overweight and obesity, but limited prospective studies have investigated the effect of body mass index (BMI) change on blood pressure among children, especially in China.

METHODS

This school-based prospective study compared the blood pressure and prevalence of hypertension in students with different patterns of change in BMI between two periods (childhood and adolescence). 5465 children were followed-up since 2011(childhood) in Suzhou, China and had weight, height and blood pressure measured in 2011(childhood) and 2014(adolescence).

RESULTS

Those who changed from being overweight in childhood to having normal BMI in adolescence had similar mean blood pressures to those who had a normal BMI at both two periods. In contrast, those who were overweight at both two periods or who had a normal BMI in childhood and were overweight in adolescence had higher blood pressure in adolescence than those who had a normal BMI at both two periods. Compared with students who had a normal BMI at both periods, those with combination of abnormal BMI in childhood and adolescence have higher ORs of hypertension (4.83 in boys, 3.44 in girls and 3.73 in total).

CONCLUSION

These results suggest that obesity is a key determinant of blood pressure during childhood, and weight reduction may have important beneficial effects on blood pressure.

Hypertension Prevalence, Awareness and Blood Pressure Control in Matao, Brazil: A Pilot Study in Partnership With the Brazilian Family Health Strategy Program

Background

Around 30% of Brazilian population is hypertensive. Brazilian’s Family Health Strategy (FHS) is a community-based approach to provide primary health care and control chronic disease as hypertension. The aims of this pilot study were to study hypertension prevalence and awareness and to analyze the feasibility of FHS program with community healthy agents (CHA) to collect data about hypertensive subjects in Matao, Brazil.

Methods

A cross-sectional study was conducted in subjects equal or older than 40 years old in a neighborhood belonging to FHS program. CHA were trained to collect data and to assess blood pressure (BP) with an automated device. Hypertension diagnosis was defined if systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg or subject had previous use of hypertensive drug. Chi-square test and univariate logistic regression analysis were applied with significance level of 5% and a confidence interval of 95%.

Results

In 625 subjects, hypertension prevalence was 68.8% and women (71.9%) were more hypertensive than men (63.2%) (P = 0.02). Prevalence of hypertension increased with age group, from 46.3% (40 - 49 years) to 82.5% (70 - 79 years) (P < 0.001). The overall prevalence of pre-hypertension was 40.1%: stage 1, 25.7% and stage 2, 17.0%. Hypertension awareness was 81.8% and 79.8% reported use of anti-hypertensive drugs. BP was not controlled in 61.8% and 67.7% of them was using anti-hypertensive drugs. CHA reported no difficulties to collect data and BP assessment with the automated device.

Conclusion

We observed a high hypertension prevalence rate, awareness, and subjects with uncontrolled hypertension even with use of anti-hypertensive drugs. CHA from FHS program are a feasible option to BP control in future studies involving larger populations.

Prevalence of and factors associated with anemia in school children from Maceió, northeastern Brazil

Background

Anemia is a major public health problem in preschool children in Alagoas, Brazil, especially in the younger population, because of a positive correlation between hemoglobin level and age. However, due to the lack of studies, it is not known how widespread this condition is among older children or how it is associated with socioeconomic status. The aim of this study was to investigate the prevalence of and factors associated with anemia in school children from the city of Maceió, Alagoas state, Brazil. The analysis was stratified to identify any effect modification according to whether they attend public or private schools.

Methods

A cross-sectional study was conducted using probability sampling of 1518 children (9.8 ± 0.5 years of age) attending public (n = 931) and private (n = 587) elementary schools in the municipality. Semi-structured questionnaires were used to obtain socioeconomic, demographic, anthropomorphic, hemoglobin (Hb), and dietary data. Anemia (Hb <11.5 g/dL) was the dependent variable. The measure of association used was prevalence ratio (PR) and respective CI95 %, calculated by Poisson regression with robust variance adjustment, for the crude and adjusted analyses.

Results

The prevalence of anemia was found to be higher amongst the public school children than the private school children (10.8 % vs. 7.0 %; PR = 1.54; CI95 %: 1.1; 2.2). At the public schools, the variables that remained significantly associated with anemia after the multivariate analysis were “consumption of fruits/fruit juices < 2 portions/day” (PR = 2.19; CI95 %: 1.18; 4.06) and “male” (PR = 1.51; CI95 %: 1.001; 2.30). At the private schools, these variables were “working mother” (PR = 2.83; CI95 %: 1.23; 6.52) and “monthly school fees < R$ 188.00” (PR = 3.20; CI95 %: 1.46; 7.03).

Conclusions

In the population under study, anemia constitutes a major health problem, especially among children from public schools. Considering the associated factors and the fact that these children are in a school environment, the promotion of healthy eating habits could constitute an important approach for reducing the prevalence of anemia.