Establishing international optimal cut-offs of waist-to-height ratio for predicting cardiometabolic risk in children and adolescents aged 6-18 years

BACKGROUND

Waist-to-height ratio (WHtR) has been proposed as a simple and effective screening tool for assessing central obesity and cardiometabolic risk in both adult and pediatric populations. However, evidence suggests that the use of a uniform WHtR cut-off of 0.50 may not be universally optimal for pediatric populations globally. We aimed to determine the optimal cut-offs of WHtR in children and adolescents with increased cardiometabolic risk across different countries worldwide.

METHODS

We used ten population-based cross-sectional data on 24,605 children and adolescents aged 6-18 years from Brazil, China, Greece, Iran, Italy, Korea, South Africa, Spain, the UK, and the USA for establishing optimal WHtR cut-offs. We performed an external independent test (9,619 children and adolescents aged 6-18 years who came from other six countries) to validate the optimal WHtR cut-offs based on the predicting performance for at least two or three cardiometabolic risk factors.

RESULTS

Based on receiver operator characteristic curve analyses of various WHtR cut-offs to discriminate those with ≥ 2 cardiometabolic risk factors, the relatively optimal percentile cut-offs of WHtR in the normal weight subsample population in each country did not always coincide with a single fixed percentile, but varied from the 75th to 95th percentiles across the ten countries. However, these relatively optimal percentile values tended to cluster irrespective of sex, metabolic syndrome (MetS) criteria used, and WC measurement position. In general, using ≥ 2 cardiometabolic risk factors as the predictive outcome, the relatively optimal WHtR cut-off was around 0.50 in European and the US youths but was lower, around 0.46, in Asian, African, and South American youths. Secondary analyses that directly tested WHtR values ranging from 0.42 to 0.56 at 0.01 increments largely confirmed the results of the main analyses. In addition, the proposed cut-offs of 0.50 and 0.46 for two specific pediatric populations, respectively, showed a good performance in predicting ≥ 2 or ≥ 3 cardiometabolic risk factors in external independent test populations from six countries (Brazil, China, Germany, Italy, Korea, and the USA).

CONCLUSIONS

The proposed international WHtR cut-offs are easy and useful to identify central obesity and cardiometabolic risk in children and adolescents globally, thus allowing international comparison across populations.

Effects of exergaming on the microcirculation of adolescents with overweight or obesity-a clinical trial efficacy

To assess the effect of exergaming on the microcirculation function of adolescents with overweight or obesity, this non-randomized clinical trial efficacy was conducted with 61 adolescents aged between 10 and 16 years. The intervention group (n = 31) performed exergaming three times per week for 8 weeks. Both groups received guidelines for a healthy diet and staying physically active. Microcirculation was assessed using a laser Doppler flowmetry (LDF) at baseline and after intervention. Primary outcomes derived from LDF assessment included resting flow, maximum flow, maximum/resting flow ratio, area under hyperemia, and post-occlusive reactive hyperemia (PORH). Secondary outcomes were body mass index and systemic blood pressure. Unpaired Student's t test compared intergroup analyses, and paired Student's t test compared intragroup analyses. The significance was set at 5%. Statistical analysis intergroup and intragroup was done by fitting a two-way mixed effects model. Microcirculation was similar between groups. Maximum flow (109.0 ± 38.3 versus 124.6 ± 43.0, P = 0.022), area under hyperemia (1614 ± 472 versus. 1755 ± 461, P = 0.023), and PORH (2.18 ± 0.49 versus 2.01 ± 0.52, P = 0.031) were statistically different after intervention. Body mass index decreased in intervention (24.5 ± 3.8-24.1 ± 4.0 kg/m², P = 0.002) and control (25.2 ± 3.2-25.1 ± 3.3 kg/m², P = 0.031) groups. Systolic blood pressure decreased significantly in the intervention group (110 ± 10-106 ± 9 mm Hg; P = 0.041) but not diastolic blood pressure (66.0 ± 7-68.8 ± 8 mm Hg; P = 0.089). Exergaming for 8 weeks led to improvements in the microcirculation function in adolescents with overweighed or obesity. Clinical trials: NTC03532659.

Metabolically Healthy Obesity and High Carotid Intima-Media Thickness in Children and Adolescents: International Childhood Vascular Structure Evaluation Consortium

OBJECTIVE

It has been argued that metabolically healthy obesity (MHO) does not increase cardiovascular disease (CVD) risk. This study examines the association of MHO with carotid intima-media thickness (cIMT), a proxy of CVD risk, in children and adolescents.

RESEARCH DESIGN AND METHODS

Data were available for 3,497 children and adolescents aged 6-17 years from five population-based cross-sectional studies in Brazil, China, Greece, Italy, and Spain. Weight status categories (normal, overweight, and obese) were defined using BMI cutoffs from the International Obesity Task Force. Metabolic status (defined as "healthy" [no risk factors] or "unhealthy" [one or more risk factors]) was based on four CVD risk factors: elevated blood pressure, elevated triglyceride levels, reduced HDL cholesterol, and elevated fasting glucose. High cIMT was defined as cIMT ≥90th percentile for sex, age, and study population. Logistic regression model was used to examine the association of weight and metabolic status with high cIMT, with adjustment for sex, age, race/ethnicity, and study center.

RESULTS

In comparison with metabolically healthy normal weight, odds ratios (ORs) for high cIMT were 2.29 (95% CI 1.58-3.32) for metabolically healthy overweight and 3.91 (2.46-6.21) for MHO. ORs for high cIMT were 1.44 (1.03-2.02) for unhealthy normal weight, 3.49 (2.51-4.85) for unhealthy overweight, and 6.96 (5.05-9.61) for unhealthy obesity.

CONCLUSIONS

Among children and adolescents, cIMT was higher for both MHO and metabolically healthy overweight compared with metabolically healthy normal weight. Our findings reinforce the need for weight control in children and adolescents irrespective of their metabolic status.

Persistent metabolic syndrome and risk of cardiovascular disease in children and adolescents

OBJECTIVE

to verify persistence of metabolic syndrome (MetS) and components in overweight children and adolescents, as well as its relation to socioeconomic and demographic characteristics and to the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score.

METHOD

a two-point longitudinal study: at enrollment and after a 24-month interval, with 133 individuals ages from two to 18 years. The demographic anthropomorphic and blood variables were evaluated. Analysis was carried out by simple and paired association tests, as well as multiple logistic regression.

RESULTS

persistent MetS was observed in 38.3% of the sample, associated cardiovascular risk (ACR) in 79.7%, reduction in arterial pressure and do HDL-c. After adjusting for age and sex, excess weight (ExpB: 0.182; CI: 0.059-0.561), low HDL-c (ExpB: 9.247; CI: 1.157-73.930) and high LDL-c (ExpB:1.915; CI: 0.921-3.979) were associated with persistent MetS.

CONCLUSION

persistent MetS was associated with obesity, HDL-c and LDL-c, but not with the PDAY score.

Nursing care of overweight children: A concept analysis

AIM

To report an analysis of the concept nursing care of overweight children.

BACKGROUND

Patient care is the essence of nursing practice. Nursing professionals must define how to serve specific population groups, including overweight children, presenting real solutions to their problem. A clear conceptual analysis is necessary to unify nursing language and to contribute to nursing practice.

DESIGN

Concept analysis.

DATA SOURCES

The following databases were searched: COCHRANE, SCOPUS, LILACS, CINAHL, MEDLINE/PubMed, and CAPES Theses Library of Brazil.

REVIEW METHODS

Walker and Avant's concept analysis methodology was adopted in this study. Twenty-two articles were analyzed, and the uses, attributes, antecedents, and outcomes of the concept were identified. The nursing care assumptions proposed by Virginia Henderson comprised the theoretical referential.

RESULTS

The attributes of nursing care for overweight children included investigation, guidance, and monitoring of dietary, clinical, academic, and social aspects, along with evaluation of lifestyle and anthropometric data related to the affected children and their families.

CONCLUSION

This study enabled the construction of a defined concept for nursing care of overweight children that may be useful in the construction of a medium-range theory. Further research is recommended to verify the usefulness of the nursing approach.

Serial album validation for promotion of infant body weight control

Objective:

to validate the content and appearance of a serial album for children aged from 7 to 10 years addressing the topic of prevention and control of body weight.

Method:

methodological study with descriptive nature. The validation process was attended by 33 specialists in educational technologies and/or in excess of infantile weight. The agreement index of 80% was the minimum considered to guarantee the validation of the material.

Results:

most of the specialists had a doctoral degree and a graduate degree in nursing. Regarding content, illustrations, layout and relevance, all items were validated and 69.7% of the experts considered the album as great. The overall agreement validation index for the educational technology was 0.88. Only the script-sheet 3 did not reach the cutoff point of the content validation index. Changes were made to the material, such as title change, inclusion of the school context and insertion of nutritionist and physical educator in the story narrated in the album.

Conclusion:

the proposed serial album was considered valid by experts regarding content and appearance, suggesting that this technology has the potential to contribute in health education by promoting healthy weight in the age group of 7 to 10 years.

Vulnerability associated with sexually transmitted infections in physically disabled people

Objective

to analyze the conditions that enhance the dimensions of individual, social and programmatic vulnerability associated with sexually transmitted infections in physically disabled people.

Methods

this transversal study, with a quantitative approach, was conducted in 2015 in conjunction with an association for disabled people in Campina Grande, PB, Brazil. Ninety-eight individuals participated in the study and answered a questionnaire regarding the dimensions of vulnerability in relation to sexually transmitted infections. The chi-square test, Fisher's test, contingency coefficient test and prevalence ratio test were all performed.

Results

an association was identified between the occurrence of sexually transmitted infections with the number of partners (p = 0.020); the belief that having few partners was a form of prevention (p = 0.044); the belief that poor hygiene was a risk factor; age (p = 0.007); the type of disability (p = 0.007); and having a consultation with a urologist (p = 0.030).

Conclusion

physically disabled people have conditions that enhance their vulnerability to sexually transmitted infections, which are linked to individual, social and programmatic dimensions. By characterizing the conditions of vulnerability it is possible to devise specific prevention linked to the reality of the social and health conditions of individuals.

Adolescentes: comportamento e risco cardiovascular

Contexto

Os benefícios para a saúde decorrentes da prática regular de atividade física estão bem documentados. Entretanto, são raros os estudos associando essa prática ao comportamento sedentário e ao risco cardiovascular em adolescentes.

Objetivos

Pretende-se avaliar a prática de atividade física, o comportamento sedentário e a associação com o risco cardiovascular mensurado pelo escore Pathobiological Determinants of Atherosclerosis in Youth (PDAY).

Métodos

Estudo transversal desenvolvido nas escolas públicas estaduais de Campina Grande, PB, Brasil, com 576 adolescentes de 15 a 19 anos, incluindo variáveis socioeconômicas, demográficas, de estilo de vida e clínicas. Os dados foram coletados através de formulário validado, antropometria, aferição da pressão arterial e exames laboratoriais. Foram utilizadas medidas descritivas, teste do qui-quadrado de Pearson e regressão logística binomial. Trabalhou-se com o SPSS 22.0 se adotou intervalo de confiança de 95%.

Resultados

A idade média foi de 16,8 anos. A maioria dos adolescentes era do sexo feminino (66,8%), não branco (78.7%) e pertencente às classes C, D e (69,1%). Quanto ao sedentarismo e à insuficiência de atividade física, as prevalências foram de 78,1% e 60,2%, respectivamente. De acordo com o escore PDAY, 10,4% dos adolescentes apresentaram alto risco cardiovascular; 31,8% risco intermediário; e 57,8%, risco baixo. Verificou-se que PDAY esteve associado ao sexo e à adiposidade abdominal.

Conclusões

Ficou comprovado que adiposidade abdominal e sexo masculino representam importantes fatores de risco cardiovascular em adolescentes. Considerando-se a presença de um fator de risco modificável, medidas preventivas voltadas ao estilo de vida são essenciais.

Risk factors associated with treatment abandonment by overweight or obese children and adolescents

OBJECTIVE

To evaluate the risk factors associated with treatment abandonment by overweight or obese children and adolescents.

METHODS

A cross-sectional study, conducted in 2011, at the Childhood Obesity Center, in Campina Grande, Brazil, with the records of 208 children and adolescents, between three and 18 years of age, divided into two groups: Group I included those who abandoned treatment, and Group II included those who did not abandon treatment.

RESULTS

Non-adherence was significantly associated with higher income (OR=5.8), high maternal education (OR=2.4), white skin color (OR=2.9), and obesity (OR=3.6).

CONCLUSION

Despite the new academic-care approach, the non-adherence to treatment rate was high, and was associated with sociodemographic and nutritional factors.

Persistence of metabolic syndrome and its impact on glucose metabolism in overweight and obese children and adolescents

OBJECTIVE

To verify the effects of metabolic syndrome (MS) and its relation to insulin resistance (IR) in children and adolescents with overweight or obesity after 24 months of follow-up.

DESIGN

Studies of repeated measures from April 2009 to April 2012. For both measurements, the evaluations performed were anthropometry, MS diagnosis, fasting blood glucose, glucose homeostasis model assessment (HOMA-IR), and insulin level; at a second evaluation, glycated hemoglobin (HbA1c) was used as an additional indicator of glucose metabolism alterations. Logistic regression between syndrome persistence and its components with glucose metabolism alterations was performed for each of its indicators. The SPSS version 17.0 software (95% CI) was used.

LOCATION

Center for Childhood Obesity, Campina Grande, Brazil.

SUBJECTS

Children and adolescents (n=133), aged 2-18 years, with overweight or obesity.

RESULTS

There was a significant decrease in MS during the study period, with persistence of the syndrome in 17.3% of the individuals. The presence of at least one alteration in glucose metabolism occurred in 45.1% of children and adolescents. The systolic and diastolic blood pressure, and the average levels of HOMA-IR showed significant decrease at the end of 24 months (p<0.01), and an elevated waist circumference (WC) remained associated with IR (p<0.01).

CONCLUSION

There was observed no relationship of IR or other indicator of glycemic disorders by persistence of MS. An elevated WC remained associated with IR after controlling for the effects of the following variables: gender, age group, and other MS components.

Nursing Diagnosis of overweight and related factors in adolescents

OBJECTIVE

The objective of the study was to compare the related factors to the nursing diagnosis (ND) of overweight in adolescents with and without overweight.

METHODOLOGY

Transversal study conducted in 2013 with 347 adolescents that attended public schools in Natal, Rio Grande do Norte, Brazil, answered a questionnaire and had anthroprometric evaluation. The subjects were divided into two groups, the group without ND (n=247) and the group with ND (n=100).

RESULTS

The prevalence of adolescents with ND overweight was 28.8%. The groups presented an unsatisfactory frequency of physical activity and a low consumption of healthy foods. The group with the ND overweight showed greater chance of consuming sweets and fried foods. The group with ND overweight had higher frequency of history family of illnesses.

CONCLUSION

The prevalence of the ND overweight among adolescents in the public schools of Natal constitute a relevant nutritional deviance and the associated factors diet and family history disease are an alert for nursing in activities of prevention and follow-up for this population.

Fibrinogen: cardiometabolic risk marker in obese or overweight children and adolescents

OBJECTIVES

To determine the prevalence of increased serum fibrinogen levels and its association with cardiometabolic risk factors in overweight or obese children and adolescents.

METHODS

Cross-sectional study with 138 children and adolescents (overweight or obese) followed at a reference outpatient clinic of the public health care network. Fibrinogen concentration was divided into quartiles, and values above or equal to the third quartile were considered high. The association between high fibrinogen values and cardiometabolic risk factors was assessed using Pearson's chi-squared test or Fisher's exact test, as necessary. Logistic regression was used to adjust variables predictive of fibrinogen levels. Analyses were performed using SPSS version 22.0 and SAS software, considering a confidence interval of 95%.

RESULTS

Serum fibrinogen levels were elevated in 28.3% of individuals, showing association with the presence of high CRP (p=0.003, PR: 2.41, 95% CI: 1.30-4.46) and the presence of four or more risk factors (p=0.042; PR: 1.78, 95% CI: 1.00-3.17). After a logistic regression, only elevated CRP remained associated with altered fibrinogen levels (p=0.024; PR: 1.32; 95% CI: 1.09-5.25).

CONCLUSIONS

Increased fibrinogen was prevalent in the study population and was associated with ultrasensitive C-reactive protein and the presence of four or more cardiovascular risk factors; it should be included in the assessment of individuals at risk.

HÁBITOS ALIMENTARES, DE ATIVIDADE FÍSICA E ESTADO NUTRICIONAL DE CUIDADORES DE CRIANÇAS E ADOLESCENTES COM EXCESSO DE PESO

O objetivo deste estudo foi analisar o estado nutricional e hábitos alimentares e de atividade físicade cuidadores de crianças e adolescentes com excesso de peso em acompanhamento multidisciplinar. Estudoexploratório, descritivo, transversal e abordagem quantitativa com amostra de 109 cuidadores de crianças eadolescentes em atendimento no Centro de Obesidade Infantil, Campina Grande, Paraíba, Brasil. Aplicou-sequestionário estruturado entre fevereiro e abril de 2011. Os resultados evidenciaram 74,3% dos responsáveis comexcesso de peso. A prática de atividade física foi considerada, em sua maioria, de forma imprópria e a alimentaçãoclassificada como regular. O hábito de comer frituras, biscoito e massas foi considerado ruim. Percebeu-se queos hábitos alimentares e de atividade física foram identificados como inadequados. O estado nutricional e aspráticas alimentares e de atividade física podem refletir no estado nutricional das crianças e adolescentes emtratamento, por isso sugere-se que o atendimento de enfermagem envolva cuidadores e familiares.

C-reactive protein and cardiometabolic risk factors in overweight or obese children and adolescents

OBJECTIVE: To investigate the relationship between ultrasensitive C-reactive protein and cardiometabolic risk factors in overweight or obese childrenand adolescents. METHODS: Cross-sectional study conducted at the Center for Childhood Obesity in the period from April 2009 to April 2010, involving 185 overweight children and adolescents aged 2 to 18 years. Measures of ultrasensitive C-reactive protein according to age, nutritional status, gender, race, cardiometabolic risk factors (waist circumference, lipid profile, impaired fasting glucose, high blood pressure and presence of insulin resistance) were compared through the Chi-square test and analysis of variance. All analyses were performed using the Statistical Package for the Social Sciences software version 17.0, adopting a significance level of 5%. RESULTS: Altered high-density lipoprotein was the most frequent cardiometabolic risk factor, and there was a significant association between altered ultrasensitive C-reactive protein values and severe obesity (p=0.005), high waist circumference (p<0.001), hypertriglyceridemia (p=0.037) and insulin resistance (p=0.002), as well as significantly higher body mass index (p=0.000), waist circumference (p=0.001), insulin (p=0.005) and index of glucose homeostasis values(p=0.005). CONCLUSION: High prevalence of altered ultrasensitive C-reactive protein and significant association with severe obesity, waist circumference, hypertriglyceridemia and insulin resistance were observed.

Nursing care in childcare services: Acantose nigricans as a marker for metabolic risk

OBJECTIVE

to analyze the association between the presence of Acantose nigricans and metabolic changes in overweight adolescents, so as to ascertain the relevance of the identification of this marker in the nursing consultation.

METHOD

a cross-sectional study undertaken between April 2009 and April 2010 with 118 adolescents who were service users of the Center for Child Obesity in Campina Grande in the Brazilian State of Paraíba (PB). The presence of Acantose nigricans, and the subjects' anthropometric measurements, were investigated. The following exams were made: insulin, triglycerides, HDL-Cholesterol, Glucose and the homeostatic model of assessment (HOMA-IR).

RESULTS

there was association between the presence of Acantose nigricans and participants with insulin resistance (p=0.008), metabolic syndrome (p=0.031), elevated triglycerides (p=0.045) and altered HDL (p=0.002).

CONCLUSIONS

the suggestion is supported that the detection/identification of Acantose nigricans may be used in the nursing consultation as a tool for identifying overweight adolescents with greater risk of metabolic changes.

Changes in the frequency of food intake among children and teenagers: monitoring in a reference service

PURPOSE: to identify changes in the food intake patterns among overweight children and teenagers, treated at a reference medical centre. METHOD: the method used is that of a cohort study, between April 2010 and April 2011. A total of 109 children and teenagers, either obese or overweight, took part in the study. The population was divided into two subgroups depending on the permanence period (more than 6 months, and less than 6 months off the treatment). The chi-square test and logistic regression were carried out. RESULTS: the group which had been longer off the treatment tended to consume more soft drinks, pasta and fried foods, and less fruit and vegetables. The group with less time showed an improvement, with a reduction of consumption of soft drinks and other goodies. There was confirmation of an increased risk for consumption of soft drinks, pasta and goodies in general, as also detachment from the treatment in adolescence. CONCLUSIONS: The group with a longer period of monitoring has had a positive change in food intake frequency. The main contribution made by this study is that of showing that multiprofissional treatment, including some nursing care, is efficient in progressively changing the food intake of children and adolescents who are overweight.

Acanthosis nigricans and insulin resistance in overweight children and adolescents

BACKGROUND

Studies have suggested an association between the presence of acanthosis nigricans (AN) and the development of diabetes.

OBJECTIVE

To investigate the association between AN and insulin resistance (IR) in overweight children and adolescents receiving care at the Center for Childhood Obesity, Campina Grande, PB.

METHODS

This cross-sectional study was conducted between April 2009 and April 2010 including 194 individuals of 2 to 18 years of age receiving care within the Brazilian national health network. The presence of acanthosis nigricans was verified and anthropometric measurements were taken. The following tests were performed: insulin, triglycerides, HDL-cholesterol, glucose and homeostasis model of assessment - insulin resistance (HOMA-IR). Statistical analyses were performed using the SPSS software program, version 17.0.

RESULTS

There was a greater prevalence of females (66%), brown-skinned individuals (63.4%), adolescents (61.3%) and severely obese individuals (66.5%). Acanthosis nigricans was identified in 58.2% and IR in 42.7% of the participants. Acanthosis nigricans was associated with being non-white (p = 0.003), with being an adolescent (p = 0.003) and with IR (p = 0.001). Non-white individuals, adolescents and those with insulin resistance were 5.4, 2.47 and 2.66 times more likely to have acanthosis nigricans, respectively.

CONCLUSION

The results of this study indicate a need to train healthcare professionals to identify acanthosis nigricans, since this condition is associated with IR. Identifying acanthosis nigricans in childhood permits the safe and timely treatment of cardiometabolic disorders through careful monitoring and appropriate treatment.

CENTRO DE OBESIDADE INFANTIL: RELATO DE EXPERIÊNCIA

Este estudo objetiva relatar a experiência de acadêmicos, mestrandos e professores de enfermagem no Centro de Obesidade Infantil quanto ao processo de acompanhamento e tratamento de crianças com sobrepeso e obesidade, entre agosto de 2008 a janeiro de 2012. O Centro conta com equipe multiprofissional para o acompanhamento de 349 crianças; essas têm a oportunidade de serem acompanhadas pelos profissionais, os quais interagem na discussão sobre o estado clínico e avaliam a sua evolução. A vivência no Centro propiciou perceber a real possibilidade de reunir uma equipe multidisciplinar focada em um mesmo objetivo com vistas a realizar um trabalho contínuo que possibilite meios para o alcance de resultados satisfatórios à saúde de crianças obesas ou com sobrepeso.

A PRÁTICA DE ENFERMAGEM: UMA REFLEXÃO À LUZ DA TEORIA KANTIANA E DO CÓDIGO DE ÉTICA

Trata-se de um estudo qualitativo reflexivo baseado em uma história de vida descrita no livro Re(socialização) da pessoa com deficiência adquirida: o processo, os personagens e as máscaras, o qual trata do processo de reabilitação da pessoa com lesão medular. Neste estudo buscou-se refletir sobre a atuação da equipe de enfermagem ao longo dessa (re)construção social e pessoal à luz da Teoria Kantiana e do Código de Ética Profissional de Enfermagem brasileiro. O processo de reação adaptativa à nova situação da pessoa, como lesado medular, permite refletir a necessidade de melhor qualificação e humanização da assistência prestada pelos profissionais de saúde que lidam com tal clientela, especialmente a equipe de enfermagem devido às ações no cuidado oferecido e ao vínculo em tempo integral, tornando-os mais propensos a cometer iatrogenias.