Fatores associados à dislipidemia em crianças e adolescentes de escolas públicas de Salvador, Bahia

Prevalence of dyslipidemias in the Middle East region: A systematic review & meta-analysis study

BACKGROUND AND AIMS

Dyslipidemia is a known main risk factor for cardiovascular diseases, and it can be controlled to reduce the incidence of cardiovascular diseases. This meta-analysis aimed to estimate the prevalence of dyslipidemias in the Middle East.

METHODS

The relevant published articles between 2000 and 2021 that investigated the prevalence of dyslipidaemias in the Middle East were found through international data sources such as Medline, PubMed, and Google Scholar. The random-effects model was used to estimate the pooled prevalence with 95% confidence intervals.

RESULTS

The pooled prevalence of dyslipidemias, hypertriglyceridemia, hypercholesterolemia, high levels of low-density lipoprotein cholesterol and low levels of high-density lipoprotein cholesterol in the Middle East were 54.08% (95% CI: 43.83-66.71), 32.51% (95% CI: 28.59-36.43), 29.44% (95% CI: 18.74-40.13), 32.09% (95% CI: 22.17-42.01), 44.71% (95% CI: 37.86-51.57), respectively. During the last two decades, an increasing trend in the prevalence of dyslipidemias was observed overall and in both sexes. Also, the age groups over 30 significantly had the highest prevalence of hypercholesterolemia, high levels of low-density lipoprotein cholesterol, and low levels of high-density lipoprotein cholesterol (p < 0.05).

CONCLUSIONS

The increasing trend in the prevalence of dyslipidemias during the last two decades is an alarming and significant concern in the Middle East. Therefore, special measures are needed to deal with dyslipidemias as a health priority in the Middle East.

Impact of Lifestyle Intervention Programs for Children and Adolescents with Overweight or Obesity on Body Weight and Selected Cardiometabolic Factors-A Systematic Review

Excessive body mass is a health problem among children and adolescents that contributes to the occurrence of lipid disorders and abnormal blood pressure. Effective treatment of excessive body mass in children is essential for the health of population in the future. The aim of the study was to identify universal components of lifestyle interventions in children and adolescents with overweight or obesity leading to weight loss and improvement of selected cardiometabolic parameters. The review included studies from the PubMed and Google Scholar databases published in 2010–2019, which were analyzed for eligibility criteria including age of the participants, BMI defined as overweight or obese, nutritional intervention and the assessment of BMI and/or BMI z-score and at least one lipid profile parameter. Eighteen studies were included in the review, presenting the results of 23 intervention programs in which a total of 1587 children and adolescents participated. All interventions, except one, were multi-component. Data analysis suggests a relationship between a decrease in BMI and/or BMI z-score with diet and physical activity, the involvement of a dietician/nutrition specialist and physician in the treatment team and a longer duration of intervention. Moreover, it seems that a decrease in BMI is mostly associated with decreases in total cholesterol, triglycerides, low density lipoprotein cholesterol and blood pressure. No change in BMI and/or BMI z-score is associated with no change in blood pressure. Our data can be used by public health authorities to design effective weight loss programs for children and adolescents.

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

BACKGROUND

The presence of dyslipidemia and behavioral aspects are determinants of cardiovascular risk, especially in childhood and adolescence.

OBJECTIVE

To verify possible relationships between dyslipidemia, cultural factors, and cardiorespiratory fitness (CRF) in schoolchildren.

METHODS

This cross-sectional study evaluated a sample of 1,254 children and adolescents between the ages of 7 and 17 from the South of Brazil, 686 of whom were female. Dyslipidemia was defined as increased levels of at least one of the following lipid profile parameters: triglycerides (TG), total cholesterol (TC) and fractions of high (HDL-c) and low-density lipoprotein (LDL-c). Cultural aspects were evaluated by a self-reported questionnaire. Data were analyzed by logistic regression, considering the odds ratios (OR) and confidence intervals (CI) at 95%.

RESULTS

The results revealed a high prevalence of dyslipidemia (41.9%), which was associated with female sex (OR: 1.56; IC: 1.24-1.96) and overweight/obese status (OR: 1.55; IC: 1.20-2.00). When lipid profile parameters were evaluated separately, high levels of LDL-c were observed to be associated with sedentary school transport (OR: 1.59; IC: 1.20-2.09). Schoolchildren who were overweight/obese had higher chances of elevated levels of TC (OR: 1.40; IC: 1.07-1.84) and TG (OR: 3.21; IC: 1.96-5.26). HDL-c was shown to be related to high television time (OR: 1.59; IC: 1.00-2.54).

CONCLUSION

Alterations in lipid parameters are associated with cultural factors, especially those related to sedentary lifestyle and low levels of CRF.

[Association between excess weight and serum lipid alterations in adolescents]

The study estimated the prevalence of serum lipid alterations among adolescents and investigated its association with excess weight and abdominal obesity. It involved a cross-sectional study with 525 adolescents from Piracicaba (São Paulo state). Anthropometric (body mass index, waist circumference and waist-height ratio) and biochemical information were obtained (total cholesterol and fractions, triglycerides). The relationship between the anthropometric indicators and alterations in lipid profile was tested by logistic regression. The prevalence of dyslipidemia was in the order of 81%. An association was verified between high WHeR and serum lipid alterations in total cholesterol (OR = 2.00; CI 95% = 1.09-3.64) and triglycerides (OR = 4.48; CI 95% = 2.03-9.89) after adjustment for age and sex. No significant associations of alterations in lipid profile were found with excess weight and CC. The high prevalence of dyslipidemia and its association with abdominal obesity indicates that preventive measures should begin in childhood in order to reduce the occurrence of cardiovascular diseases.

[Association between ultra-processed food consumption and lipid parameters among adolescents]

The scope of this study was to analyze the association between ultra-processed food (UPF) consumption and lipid parameters. It was a cross-sectional study performed with high school adolescents. Food consumption was analyzed by means of a 24-hour food recall form, where UPF were identified in line with the NOVA system of food classification. The total cholesterol levels, HDL-c and triglycerides were determined by enzymatic colorimetry and the LDL-c fraction estimated by formula. The Student's t-test or Mann-Whitney was used to compare averages, and linear regression to make associations among the variables. The results show that UPF consumption was more frequent in female adolescents between 17 and 19 years of age, with a family income above two minimum wages and from private schools. It was observed that individuals in the upper third of UPF consumption had a higher energetic, carbohydrate and sodium intake, with a lower intake of proteins and fibers. Moreover, it was found that a higher UPF intake was negatively associated with HDL-c levels and positively associated with triglyceride levels and dyslipidemia. Therefore, UPF is associated with a worsening of the nutritional profile of the diet and contributes to negative changes in the lipid parameters of young individuals.

Effects of polymorphisms in APOB, APOE, HSD11β1, PLIN4, and ADIPOQ genes on lipid profile and anthropometric variables related to obesity in children and adolescents

Genes can influence lipid profile and anthropometric variables related to obesity. The present study aimed to verify if variants of the APOE, APOB, ADIPOQ, HSD11β1, and PLIN4 genes are associated with lipid levels or anthropometric variables in a sample comprised of 393 Euro-Brazilian children and adolescents. DNA was genotyped by TaqMan allelic discrimination assay. The ε4 and ε2 alleles of the APOE gene were associated respectively with lower high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels (p=0.015 and p=0.012, respectively), while the ε3 allele was associated with higher abdominal circumference (p=0.0416) and excess weight (p=0.0001). The G allele (rs846910) of the HSD11β1 gene was also associated with excess weight (p=0.039). No other association was found. Our results indicate that the ε4 and ε2 alleles could contribute to lower HDL-C and LDL-C levels, respectively, furthermore, the ε3 allele and the G allele (rs846910) of HSD11β1 gene may be risk factors for excess of weight.These findings are very important because we observed that some genetic variants influence the lipid profile and anthropometric variables early in life.

Health promotion initiatives at school related to overweight, insulin resistance, hypertension and dyslipidemia in adolescents: a cross-sectional study in Recife, Brazil

Background

The emergence of diseases such as dyslipidemia, systemic arterial hypertension, insulin resistance and metabolic syndrome in children and adolescents has brought about a change in the epidemiologic profile of the pediatric population. As action to promote health in the school environment is a useful tool for changing the pattern of health/disease in the young population, the present study aimed to identify schools that promote healthy eating and physical activity and to study the relationship between these practices and the prevalence of overweight, hypertension, insulin resistance and hypercholesterolemia in adolescents.

Methods

A cross-sectional population-based study was conducted with 2400 adolescents aged from 12 to 17 years old and participating in the “Study of Cardiovascular Risk in Adolescents” (ERICA – Estudo de Riscos Cardiovasculares em Adolescente). The association between dependent (overweight, insulin resistance, hypertension and dyslipidemia) and independent variables (implementation of health promoting initiative in schools) was investigated using the chi-square test and prevalence ratio (PR) with a confidence index (CI) of 95%.

Results

The unsatisfactory implementation of a “health promoting environment” (PR = 1.02; CI 95%: 1.0; 1.04) and “partnerships with the health sector” (PR = 1.03; CI 95%: 1.01; 1.05) were linked to a high prevalence of overweight in adolescents. Hypercholesterolemia was found to be higher in the schools with unsatisfactory implementation of “healthy eating and health on the scholar curriculum” (PR = 1.71; CI 95%: 1.22; 2.44) and those lacking a “healthy-eating promoting environment” (PR = 1.29; CI 95%: 1.10; 1.54). Schools with unsatisfactory implementation of a “health-eating promoting environment” (PR = 1.36; CI 95%: 1.04; 1.79) and those lacking “partnership with the health sector” (PR = 2.12; CI 95%: 1.38; 3.24) had more adolescents with insulin resistance. There was no association between hypertension and any other component studied.

Conclusion

Schools which have implemented adequate health promotion in their curriculums showed a lower prevalence of overweight, insulin resistance and hypercholesterolemia in adolescents.

Elevated Serum Retinol and Low Beta-Carotene but not Alpha-Tocopherol Concentrations Are Associated with Dyslipidemia in Brazilian Adolescents

The purpose of this study was to investigate the status of retinol, beta-carotene, and alpha-tocopherol serum concentrations in adolescents with dyslipidemia. A case series dyslipidemia study was conducted, with an attached control group, including 104 adolescents of public schools in Recife during the months of March/April 2013. Retinol, beta-carotene and alpha-tocopherol serum concentrations were analysed by high efficiency liquid chromatography. Sociodemographic, anthropometric, clinical and biochemical variables were analysed. Dyslipidemic adolescents had high serum concentrations of both retinol (p=0.007) and beta-carotene/apolipoprotein A-I ratio (p=0.034); they also had low concentrations of beta-carotene/total cholesterol (p<0.0001) and beta-carotene/apolipoprotein B ratios (p=0.033) when compared to the controls. The alpha-tocopherol serum status was not associated with dyslipidemia. Overweight, abdominal obesity, lipid profile markers, and systolic and diastolic blood pressures were more prevalent in dyslipidemic adolescents. The findings show an association between vitamin A and dyslipidemia in adolescents. However, additional investigations of this risk group are necessary to clarify the mechanisms of action of this nutrient in the pathogenesis of this syndrome, aiming at reducing cardiometabolic risks as of earlier ages.

Cardiovascular risk factors in pre-pubertal schoolchildren in Angola

METHODS

The incidence of obesity is increasing worldwide, especially in countries with accelerated economic growth. We determined the prevalence of and associations between overweight/obesity and cardiovascular risk factors in pre-pubertal (seven- to 11-year-old) schoolchildren (both genders, n = 198) in Luanda, Angola. Biochemical (fasting blood) and clinical examinations were obtained in a single visit. Data are reported as prevalence (95% confidence intervals) and association (r, Pearson).

RESULTS

Prevalence of overweight/obesity was 17.7% (12.4- 23.0%), high blood pressure (BP > 90% percentile) was 14.6% (9.7-19.5%), elevated glucose level was 16.7% (11.5-21.9%) and total cholesterol level > 170 mg/dl (4.4 mmol/l) was 69.2% (62.8-75.6%). Significant associations between body mass index (BMI) and systolic and diastolic BP (r = 0.46 and 0.40, respectively; p < 0.05) were found. No association between BMI and elevated glucose or cholesterol levels was found.

CONCLUSION

The prevalence of cardiovascular risk factors was high in pre-pubertal schoolchildren in Angola and fat accumulation was directly associated with blood pressure increase but not with other cardiovascular risk factors.

Lipid profiles of children and adolescents with inflammatory response in a paediatric emergency department

BACKGROUND

To compare the lipid profile between patients with and without inflammatory process in according nutritional status, gender and age.

METHODS

One hundred and twenty-four children and adolescents in the emergency department were separated into two groups according to the levels of C-reactive protein (CRP). Total cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL), triglycerides (TG) and albumin in patients with CRP < 5 mg/L were compared with patients with CRP ≥ 5 mg/L. Nutritional status was assessed by anthropometric measurements.

RESULTS

Patients were mostly classified as well-nourished (76.5%) and had low levels of HDL (70%). There was no significant difference in lipid profile between the two groups of CRP. Linear regression analysis, however, it became clear that for each increase of 1 mg/L in the values of CRP expected an average reduction of 0.072 mg/dL of HDL, the 0.083 mg/dL of LDL, the 0.002 g/dL albumin and an average increase of 0.564 mg/dL of TG.

CONCLUSIONS

Patients with an inflammatory process exhibit changes in the serum levels of the lipids HDL, LDL and TG that are related to the degree of inflammation. These changes occurred regardless of nutritional status. Key Messages Lipoproteins are structures composed of lipids and proteins that transport fats in the circulation: HDL, LDL, IDL, VLDL and chylomicrons. Lipoproteins, especially HDL, undergo changes during the systemic inflammatory response and play an important role as a modulator of the inflammatory response. We believe this is a first study to show that inflammatory process modifies the serum levels of the lipoproteins and triglycerides independent of nutritional status, in paediatric patients.

Body Mass Index Is Better than Other Anthropometric Indices for Identifying Dyslipidemia in Chinese Children with Obesity

BACKGROUND

Body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) are used in screening and predicting obesity in adults. However, the best identifier of metabolic complications in children with obesity remains unclear. This study evaluated lipid profile distribution and investigated the best anthropometric parameter in association with lipid disorders in children with obesity.

METHODS

A total of 2243 school children aged 7-17 years were enrolled in Guangzhou, China, in 2014. The anthropometric indices and lipid profiles were measured. Dyslipidemia was defined according to the US Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. The association between anthropometry (BMI, WC, and WHR) and lipid profile values was examined using chi-square analysis and discriminant function analysis. Information about demography, physical activity, and dietary intake was provided by the participant children and their parents.

RESULTS

Children aged 10-14 and 15-17 years old generally had higher triglyceride values but lower median concentration of total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol compared with children aged 7-9 years old (all P < 0.001). These lipid parameters fluctuated in children aged 10-14 years old. The combination of age groups, BMI, WC and WHR achieved 65.1% accuracy in determining dyslipidemic disorders. BMI correctly identified 77% of the total dyslipidemic disorders in obese children, which was higher than that by WHR (70.8%) (P< 0.05).

CONCLUSION

The distribution of lipid profiles in Chinese children differed between younger and older age groups, and the tendency of these lipid levels remarkably fluctuated during 10 to 14 years old. BMI had better practical utility in identifying dyslipidemia among school-aged children with obesity compared with other anthropometric measures.

Plasma concentrations of retinol in obese children and adolescents: relationship to metabolic syndrome components

Objective:

To evaluate obese children and adolescents' retinol plasma levels and to correlate them with metabolic syndrome components.

Methods:

Cross-sectional study with 61 obese children and adolescents (body mass index Z score - ZBMI>+2). Pubertal development, arterial blood pressure, body weight and height for nutritional classification and waist circumference were obtained. A 15mL blood sample was collected (after a 12-hour fasting in a low luminosity room) for retinol determination (cut-off inadequate if <30µg/dL), lipid profile (HDL-c, LDL-c, and triglycerides), oral glucose tolerance test (fasting and 120 minutes) and for high sensitivity C-reactive protein. Spearman correlation and multiple linear regression were used in the statistical analysis.

Results:

Mean age was 10.7±2.7 years. There was a predominance of male gender 38/61 (62%) and pre-pubertal 35/61 (57%) subjects. The average plasmatic retinol was 48.5±18.6ug/dL. Retinol deficiency and severe obesity were observed in 6/61 (10%) and 36/61 (59%), respectively. Glucose level at 120 minutes was the independent and predictive variable of plasma retinol levels [β=-0.286 (95%CI -0.013 - -0.001)].

Conclusions:

An independent and inverse association between plasma retinol levels and glucose tolerance was observed, suggesting an important contribution of this vitamin in the morbidities associated to obesity in children and adolescents.

Prevalence of dyslipidemia in Iranian children and adolescents: A systematic review

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.

Serum lipid levels and dyslipidaemia prevalence among 2-10 year-old Northern Mexican children

Background and Aims

The increase in overweight and obese children may be linked to increased rates of dyslipidaemia. The aim was to assess the prevalence of dyslipidaemia and associated risk factors among the Northern Mexican child population.

Methods and Results

Four hundred and fifty-one subjects aged between 2 and 10 (47.5% girls) took part in the Nuevo León State Survey of Nutrition and Health 2011–2012. According to the 2011 Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, serum lipid levels (mg/dL) were categorized into three subgroups (acceptable, borderline-high/low or high/low) as follows: TChol: acceptable <170, borderline-high 170–199, high ≥200; LDL-chol: acceptable <110, borderline-high 110–129, high ≥130; non-HDL-chol: acceptable <120, borderline-high 120–144, high ≥145; HDL-chol: acceptable >45, borderline-low 40–45, low <40; and TG: acceptable <75, borderline-high 75–99, high ≥100 in ≤9 year-old children, and acceptable <90, borderline-high 90–129, and high ≥130 in 10 year-old children. The overall prevalence of borderline-high + high TG, non-HDL-chol, TChol, and LDL-chol was 63.0%, 44.1%, 43.5%, and 29.9%, respectively. The overall prevalence of borderline-low + low HDL-chol was 46.3%. The overall frequency of dyslipidaemia was 54.3%. Thirteen children (2.9%) had all five symptoms of dyslipidaemia. The most common dyslipidaemia was high TG in combination (26.2%) and in isolation (10.6%).

Conclusions

Half of the children had at least one abnormal lipid concentration. A high TG level was the most frequent dyslipidaemia. Obesity was associated with the occurrence of at least one abnormal lipid level. These findings emphasize the need to pay further attention to the prevention of cardiovascular disease and obesity from an early age.

Sociodemographic, anthropometric and dietary determinants of dyslipidemia in preschoolers

OBJECTIVE

To investigate the determinants of dyslipidemia in preschoolers.

METHODS

A total of 227 preschoolers residing in an urban area of the city of Diamantina, Minas Gerais, Brazil were evaluated at age 5 years, using a cross-sectional design. Dietary intake from a food frequency questionnaire, anthropometric/biochemical parameters, and socioeconomic/behavioral information from a questionnaire were evaluated. 'Mixed diet', 'snack', and 'unhealthy' dietary patterns were identified using principal component analysis. The determinants of dyslipidemia were examined using Poisson regression analysis.

RESULTS

The prevalence of dyslipidemia in this study was 65.19%. Preschoolers who less frequently consumed foods in the 'mixed diet' dietary pattern had a higher risk of high concentrations of low-density lipoprotein cholesterol (PR=2.30; p=0.004) when compared with those with more frequent consumption of the 'mixed diet' dietary pattern. Preschoolers whose mothers had lower levels of education presented a lower risk of high concentrations of low-density lipoprotein cholesterol (PR=0.43; p=0.003), and preschoolers who were overweight/obese presented with greater risk of high concentrations of low-density lipoprotein cholesterol (PR=2.23; p=0.003).

CONCLUSION

The determinants of dyslipidemia identified in this study were less frequent consumption of foods in the 'mixed diet' dietary pattern, higher body mass index, and lower level of maternal education. This study shows that despite the young age of the group under study, they already present a high prevalence of dyslipidemia, which is an important risk factor for cardiovascular disease.

Dietary intake and blood lipid profile in overweight and obese schoolchildren

Background

The high blood lipid levels and obesity are one of the main risk factors for cardiovascular diseases, and the atherosclerotic process begins in childhood. Some environmental factors are supposed to be involved in this relationship, such as dietary factors. This study aimed to investigate the relationship between dietary intake and blood lipids levels in overweight and obese schoolchildren.

Methods

This is a cross-sectional study with 147 overweight and obese schoolchildren in Botucatu city, Brazil. The anthropometric measurements (body weight, height, body mass index, waist circumference and skinfolds), pubertal staging evaluation and biochemical tests were taken in all children. Three 24h-recall were applied in order to estimate the dietary intake and its relationship with blood lipid levels. The Student t test and multiple linear regression analysis were used for statistical analysis. Statistical significance was assessed at the level of 0.05. The data were processed in SAS software (version 9.1.3; SAS Institute).

Results

At this study, 63% of children were obese (body mass index higher than 95^th percentile) and 80% showed high body fat percentage. The percentage of children with abnormal total cholesterol and triglycerides was 12% and 10%, respectively, and 28% presented at least one abnormal lipid levels. The average values of anthropometric measurements were higher in children with elevated lipid levels. Total cholesterol levels were positively related to full-fat dairy products and triglycerides levels to saturated fat percentage.

Conclusions

Saturated fat was positively associated with elevated lipid levels in overweight and obese schoolchildren. These results reinforce the importance of healthy dietary habits since childhood in order to reduce the risks of cardiovascular diseases in adulthood.