Fatores de riscos cardiovasculares em adolescentes da cidade do Natal-RN

Estudos têm demonstrado elevada prevalência de fatores de risco cardiovascular em adolescentes a redor do mundo, entretanto, é possível que esses fatores de risco se comportem de modo diferente em diferentes localidades. Objetivos: Examinar a prevalência do sobrepeso/obesidade e sua associação com outros fatores de risco cardiovasculares, em adolescentes, da cidade do Natal-Brasil. Métodos: Estudo observacional de delineamento transversal, realizado em 626 adolescentes (10 a 19 anos) de ambos os sexos. Foram estudadas as variáveis: peso, idade, gênero, cor, escolaridade, renda familiar, hábitos de vida, história familiar, peso, estatura, índice de massa corporal, relação cintura/quadril, pressão arterial, perfil lipídico, Glicose e Insulina de jejum e pós Dextrosol. Resultados: Foram avaliados 273 (43,6%) adolescentes do sexo masculino e 353 (56,4%) feminino. 26,4% dos adolescentes apresentaram sobrepeso/obesidade. A presença de obesidade familiar foi relatada por mais de 30 % da nossa amostra. Na análise de regressão logística múltipla; Idade, renda familiar, percentil de pressão sistólica, história familiar de hipertensão e obesidade, triglicerídeos, HDL colesterol, e HOMA RI mostraram-se associados com sobrepeso/obesidade. A relação cintura quadril apresentou-se mais elevada nas mulheres, e encontramos 10,9 % dos adolescentes com percentil de pressão sistólica (PAS) 95, e 7,4 % com percentil de pressão diastólica (PAD) 95. As dosagens de triglicerídeos, colesterol HDL e HOMA-RI alterados foram mais prevalentes nos que apresentavam IMC aumentado. As alterações do xi colesterol total, triglicerídios, glicemia pós dextrosol e HOMA teste, tiveram maior prevalência no gênero feminino. Na regressão logística binária, foram observadas associações do sobrepeso / obesidade com idade; OR 0,85, IC de 95% (0,78-0,92); p<0,001, pressão arterial sistólica; OR 2,65, IC de 95% (1,18- 5,94); p< 0,020, renda familiar; OR 2,34, IC de 95% (1,53-3,58); p< 0,001, história familiar de hipertensão arterial; OR 1,76, IC de 95% (1,15-2,71); p< 0,009, história familiar de obesidade; OR 1,50, IC de 95% (1,09-2,27); p< 0,04, aumento dos trigliceridios; OR 2,74, IC de 95% (1,69-4,43); p< 0,001, redução do colesterol; HDL OR 0,58, IC de 95% (0,38-0,87); p< 0,009 e o aumento do HOMA OR 3,16, IC de 95% (1,64 - 6,02); p<0,001. Conclusão: A prevalência de fatores de risco cardiovascular em Natal – Brasil se constitui em grave problema de saúde pública, atingindo níveis que se igualam ou até superam os de outras cidades tanto no Brasil, como em outros países

Prevalência e fatores associados à diminuição da função pulmonar em obesos em pré-operatório de cirurgia bariátrica

Introduction: Obesity shows changes in pulmonary function and respiratory mechanics, however, little is known regarding the prevalence of worsening respiratory function when considering the increase in central or peripheral adiposity or general obesity. Objectives: To analyze the association between anthropometric adiposity and decreased lung function in obese. Materials and Methods: Patients eligible for this study obese individuals (IMC≥30kg/m2) in pre-bariatric surgery and referred for Treatment Clinic of Obesity and Related Diseases, located at the University Hospital Onofre Lopes (HUOL), from October 2005 and July 2014. The evaluation included clinical information and measurement of anthropometric measures (body mass index (BMI), body fat index (BFI) and waist circumference (WC) and neck (NC)) and spirometric. The prevalence and analysis by Poisson regression was performed considering the following outcome variables: forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and Maximum Voluntary Ventilation (MVV) and as predictor variables were considered: BMI, IAC, WC and NC and as control variables: age, gender, smoking history and comorbidities (diabetes mellitus, dyslipidemia and hypertension). Statistical analysis was performed using Statistical Package for Social Sciences software (SPSS - version 20.0). Results: We analyzed 384 individuals, 75% women, mean BMI: 46.6 (± 8.7) kg/m2, IAC: 49.26 (± 9.48)%, WC: 130.84 (± 16.23) cm and NC: 42.3 (± 4.6) cm. The higher prevalence of FVC and FEV1 <80% was observed in individuals with NC above 42 cm, followed those with a BMI above 45 kg/m2. Multivariate analysis using Poisson regression showed as risk factors associated with FVC <80%, the variables: NC above 42 cm (odds ratio (OR) 2.41) and BMI over 45Kg/m2 (OR 1.71 ). As for FEV1 <80% predicted, all predictor variables were associated, with the largest odds presented by the NC (3.40). MVVV was not associated with any studied varaible. Conclusion: Individuals with NC above 42 cm had higher prevalence of reduced lung function and the NC was the measure with the highest association with reduced lung function in obese.

A influência da perda de peso no perfil inflamatório de mulheres com síndrome dos ovários policísticos

The polycystic ovary syndrome (PCOS) is considered the most common endocrine disorder in reproductive age women, with a prevalence ranging from 15 to 20%. In addition to hormonal and reproductive changes, it is common in PCOS the presence of risk factors for developing cardiovascular disease (CVD) and diabetes mellitus, insulin resistance (IR), visceral obesity, chronic low-grade inflammation and dyslipidemia. Due to the high frequency of obesity associated with PCOS, weight loss is considered as the first-line treatment for the syndrome by improving metabolic and normalizes serum androgens, restoring reproductive function of these patients. Objectives: To evaluate the inflammatory markers and IR in women with PCOS and healthy ovulatory with different nutritional status and how these parameters are displayed after weight loss through caloric restriction in with Down syndrome. Methods: Tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) were assessed in serum samples from 40 women of childbearing age. The volunteers were divided into four groups: Group I (not eutrophic with PCOS, n = 12); Group II (not eutrophic without PCOS, n = 10), Group III (eutrophic with PCOS, n = 08) and Group IV (eutrophic without PCOS, n = 10). The categorization of groups was performed by body mass index (BMI), according to the World Health Organization (WHO) does not eutrophic, overweight and obesity (BMI> 25 kg / m²) and normal weight (BMI <24.9 kg / m²). IR was determined by HOMA-IR index. In the second phase of the study a controlled dietary intervention was performed and inflammatory parameters were evaluated in 21 overweight and obese women with PCOS, before and after weight loss. All patients received a low-calorie diet with reduction of 500 kcal / day of regular consumption with standard concentrations of macronutrients. Results: Phase 1: PCOS patients showed increased levels of CRP (p <0.01) and HOMAIR (p <0.01). When divided by BMI, both not eutrophic group with PCOS (I) as eutrophic with PCOS (III) showed increased levels of CRP (I = 2.35 ± 0,55mg / L and 2.63 ± III = 0,65mg / L; p <0.01) and HOMA-IR (I = 2.16 ± 2.54 and III = 1.07 ± 0.55; p <0.01). There were no differences in TNF-α and IL-6 between groups. Step 2: After the weight loss of 5% of the initial weight was reduced in all of the components of serum assessed inflammatory profile, PCR (154.75 ± 19:33) vs (78.06 ± 8.9) TNF α (10.89 ± 5.09) vs (6:39 ± 1:41) and IL6 (154.75 ± 19:33) vs (78.06 ± 08.09) (p <0:00) in association with improvement some hormonal parameters evaluated. Conclusion: PCOS contributed to the development of chronic inflammation and changes in glucose metabolism by increasing CRP, insulin and HOMA-IR, independent of nutritional status. The weight loss, caloric restriction has improved the inflammatory condition and hormonal status of the evaluated patients.

Quedas em idosos assistidos na estratégia saúde da família: frequência e fatores associados

The growth of the elderly population is a global phenomenon and, in Brazil, this transformation is happening in a very rapid rhythm. With the current population aging, this emerging age group will need more health care and attention. One of the characteristics of the population aging is the progressive accumulation of disabilities, which makes it more vulnerable to falls. This study was developed with the purpose of knowing the episode falls in the scope of an elderly population treated at a Family Health Unit. It is a research with cross-sectional nature, and its sample was composed by 121 elderly. The research was approved by the Ethics Committee of HUOL, with Opinion nº 816.022. We applied a questionnaire to the participants, and the results were statistically analyzed by using Chi-square test and Fisher’s exact test to verify the association between variables. In order to perform a multivariate analysis, we used the method of the Binomial Logistic Regression. For both tests, we accepted significance p<0,05 and CI of 95%. The results prove that the majority belongs to the female gender (76,9%); the age group of elderly reaches 88,4% and 11,6% is over-aged; regarding the marital status, 35,3% are married and 29,4% widowed; 92,1% with family income between one and two minimum wages; and 91,8% live with their partners and/or children. Regarding the frequency of falls, we found that 61,2% of the surveyed elderly suffered one or more falls in 2014. As associated factors, it became clear that 73,8% were due to extrinsic factors, 6,4% to intrinsic factors and 21,4% to both factors. As a consequence of the fall, we found that 89,2% have fear of falling again, 37,3% showed anxiety and 13,3% had their ambulation affected. Concerning the exposure to the risk factors, the most prevalent places were: street/avenue (31,0%), pavement (19,0%), living room (14,3%) and courtyard/backyard (10,7%). The study has proven a statistically significant association among female gender (p=0,001), rubble/objects in the backyard (p=0,015) and furniture that may cause accidents (p=0,005). It was evident among the elderly people surveyed, 72.7% receive little information about falls, being a risk factor for falls. We conclude that there is a high frequency of falls in the surveyed elderly, thereby constituting a worrisome data because this event in the elderly population is a serious matter, which raises the need to ensure them a safe environment in their homes and, above all, outside them. The information provided by the Family Health Strategy team are important to avoid these occurrences, which reinforces the need for developing health education activities together with the population as a way to prevent and reduce the occurrence of falls, thereby improving the quality of life of elderly.

Receptores de citocinas proinflamatórias na pré-eclâmpsia

Preeclampsia is a disease specific of human pregnancy that affects 3-8% of pregnant women, and it is one of the three leading causes of maternal mortality and morbidity. The disease is characterized by hypertension and proteinuria after the 20th week of gestation. The risk factors for this disease are not completely understood but appear to include dysregulation of the immune response arising from defects in placentation, environmental and genetic factors. This study aimed to determine whether the variation in the amount of proinflammatory cytokine receptors IL-1R2, IL-6R and TNF-αR1 would be involved in preeclampsia. They were recruited women with preeclampsia (n=24) and women who evolved during pregnancy without changes in blood pressure (n=12) were recruited. Clinical and laboratory data were collected. The cytokine receptors (IL-1R2, TNF-αR1 and IL-6R) were assessed in mononuclear cells isolated from peripheral blood using flow cytometry (Control = 8; PE = 24). C-reactive protein (CRP) was determined by CRP ultrasensitive method (Control = 7; PE = 18) was performed using sera pregnant women. Women with preeclampsia had higher weight at the beginning of the pregnancy (p=0.0171) and lower gestational age at delivery (0.0008). Classical monocytes were decreased in preeclampsia but not intermediate or non-classical monocytes. The frequency of IL-1R2 pro inflammatory cytokine receptors is decreased in women with PE only in the subpopulation of non-classical monocytes (p = 0.0011). TNF-αR1 receptor and IL-6R, had a decreased frequency in the three subpopulations of monocyte (classic, intermediate and non-classical) when compared to women with normal pregnancy. An increase in IL-1R2 receptor in TCD4+ lymphocytes, but a decrease in TNF-receptor and IL-6R in women with preeclampsia were found. No differences in the frequency of those receptors in CD3+/CD8+ in preeclampsia. There was no difference in C-reactive protein in preeclampsia. The reduction in the amount of IL-1R2, TNF- αR1 and IL-6R monocytes and lymphocytes can be involved in the regulation of inflammation observed in preeclampsia, contributing to disease.

Influência de fatores ambientais na Leishmaniose visceral no Rio Grande do Norte

The Visceral Leishmaniose (LV) disease is endemic in some places in Brazil. It is caused by the protozoa Leishmania chagasi, being transmitted for vector, the phlebotomies, Lutzomyia longipalpis. In virtue of the expansion of the illness in Rio Grande do Norte, it is necessary to evaluate the determinative ambient factors in the proliferation of the vector for better control of the illness. The variable rainfall and the social variables had been analyzed using space regression with two models and the ambient variable of ZANE and the variables analyzed in 205 houses in the cities of Natal, Extremoz, Nísia Floresta, São Gonçalo do Amarante, São Jose do Mipibu, Parnamirim and Macaíba the Person and ML Chi-square were used . The analyses had shown that high rainfall, plain relief, the forest, the humid tropical climate the activities of production culture of sugar cane and fruit culture and the presence of bovines increase the risk of the LV. The work showed that it has space aggregation and that ambient factors influence in the LV in the State

Prevalência da infecção por HPV e perfil das mulheres frente ao exame de papanicolau no município de São José de Mipibú/RN.

The Human Papillomavirus (HPV) infection is the major sexually transmitted disease all over the world. There are many factors associated to infection and the virus persistency in the organism. This study aims to evaluate the women's knowledge, attitudes and practice about the Papanicolaou test (Pap), as well as analyze the HPV and Chlamydia trachomatis infections prevalences in sexually active women from the city of São José do Mipibu/RN/Brazil. This research was divided in two steps (step I and step II), using different methodologies and samples each. The samples collected in each step, even socio-demographic or from uterus cervix, are from different patients e were analyzed separated. In step I was evaluated 267 rural and urban zone women s knowledge, attitudes and practices about the Pap by home interview. In the step II were included 605 women with age ranged from 15 to 71 years old, with mean of 33,5 years old and from each one were collected two cervical samples, one for Pap and other for molecular biology, beside the epidemiological interview to investigate the correlation between prevalence of HPV infection and risk factors. To molecular analyses, the samples were processed using a mammal rapid DNA extraction technique protocol. For C. trachomatis DNA detection were used the CP24/27 primers, and GP5+/GP6+ to HPV. PCR products were analyzed by electrophoresis on 8% polyacrylamide gels, followed by silver staining. The results of the step I showed that, in spite of only 46,1% of the interviewed women they have demonstrated to possess appropriate knowledge on the Pap test, the attitude and practice proportions were significantly larger, 63,3% and 64,4% respectively. The largest education degree presented association with adaptation of the knowledge, attitudes and practice, while neglect, lack of solicitation of the exam for the doctor and shame, came as main barriers for the accomplishment of the exam. In the stage II the HPV general prevalence was 28,9%, being 26,7% in the women with normal cytology or benign alterations, 26,7% in the ones that had atypical squamous cells of undetermined significance (ASC-US) and 80% in those with Low grade squamous intraepithelial lesion (LSIL). the HPV infection prevalence was larger in the patients with up to 30 years of age and in the unmarried women, and those that had more than one sexual partner presented larger infection risk. The results show that the sexual relationship with multiple partners increased the infection risk for HPV and consequently the possibility of the occurrence of lesions uterine cervix

Definições para o resultado de enfermagem comportamento de prevenção de quedas: uma revisão integrativa

Devido à necessidade de mensurar o risco de quedas em concordância à linguagem padronizada de enfermagem, foi selecionado o resultado de enfermagem Comportamento para Prevenção de Quedas da Nursing Outcomes Classification (NOC), com objetivo de identificar evidências sobre seus elementos, mensuração, comparação com indicadores existentes e construir definições constitutivas. Foi efetuada revisão integrativa entre abril e novembro de 2009, mediante identificação da questão, estabelecimento de critérios de inclusão/exclusão, extração das informações, avaliação, interpretação e síntese. Destacaram-se pesquisas transversais e perspectivas de especialistas. Os indicadores Uso de recursos de correção da visão e Uso de sapatos amarrados e do tamanho adequado foram considerados insuficientes para avaliar fatores de risco como déficits sensoriais e roupas/calçados inadequados. Percebe-se que algumas definições precisam ser melhor desenvolvidas e que esse resultado de enfermagem merece refinamento sobretudo referente aos indicadores. Foram identificados 22 indicadores e definições foram propostas baseadas nas evidências da literatura

Acidentes por quedas em um grupo específico de idosos

Este estudo objetivou conhecer a incidência do evento queda e identificar a presença de seus principais fatores de risco. Estudo exploratório, realizado de março a novembro/2009, com aplicação de um formulário sobre quedas em um grupo de idosos. Os dados foram analisados por cálculo de frequências, média e desvio-padrão. Participaram 62 idosos, 41,9% relataram queda nos últimos seis meses, a maioria mulheres. Identificou-se ocorrência de agravos concomitantes: visão regular, audição boa, polifarmácia, IMC normal, forte força de preensão palmar e condições dos pés adequadas. Na maioria dos que caiu, o desequilíbrio foi apontado como principal motivo. A queda ocorreu mais no período da manhã, em local de piso áspero e seco, sem degraus, rampas ou tapetes, iluminação adequada e o tipo de calçado mais utilizado foi chinelo de borracha. Percebe-se a alta ocorrência das quedas na população idosa, fato que fundamenta a necessidade de avaliação das condições de risco envolvidas

Avaliação do retinol em parturientes com diabetes mellitus gestacional no pós parto imediato

Micronutrient deficiencies affect individuals mainly in developing countries, where vitamin A deficiency is a public health problem worldwide more worrying, especially in groups with increased physiological needs such as children and women of reproductive age. Vitamin A is supplied to the body through diet and has an important role in the visual process, cell differentiation, maintenance of epithelial tissue, reproductive and resistance to infection. The literature has demonstrated the relationship between vitamin A and diabetes, including gestational, leading to a risk to both mother and child. Gestational diabetes is any decrease in glucose tolerance of variable magnitude diagnosed each the first time during pregnancy, and may or may not persist after delivery. Insulin resistance during pregnancy is associated with placental hormones, as well as excess fat. Studies have shown that retinol transport protein produced in adipose tissue in high concentrations, this would be associated with resistance by interfering with insulin signaling. Therefore, this study aimed to evaluate the concentration of retinol in serum and colostrum from healthy and diabetic mothers in the immediate postpartum period. One hundred and nine parturient women were recruited, representing seventy-three healthy and thirty-six diabetic. Retinol was extracted and subsequently analyzed by High Performance Liquid Chromatography. Among the results highlights the mothers with gestational diabetes were older than mothers healthy, had more children and a higher prevalence of cases of cesarean section. Fetal macrosomia was present in 1.4% of healthy parturient women and in 22.2% of diabetic mothers. The maternal serum retinol showed an average of 39.7 ± 12.5 mg/dL for healthy parturients 35.12 ± 15 mg/dL for diabetic and showed no statistical difference. It was observed that in the group of diabetic had 17% vitamin A deficiency, whereas in the healthy group, only 4% of the women were deficentes. Colostrum, the concentration of retinol in healthy was 131.3 ± 56.2 mg/dL and 125.3 ± 41.9 mg/dL in diabetic did not differ statistically. This concentration of retinol found in colostrum provides approximately 656.5 mg/day for infants born to healthy mothers and 626.5 mg/day for infants of diabetic mothers, based on a daily consumption of 500 mL of breast milk and need Vitamin A 400 mg/day, thus reaching the requirement of the infant. The diabetic mothers showed significant risk factors and complications related to gestational diabetes. Although no 11 difference was found in serum retinol concentration and colostrum among women with and without gestational diabetes, the individual analysis shows that parturients women with diabetes are 4.9 times more likely to develop vitamin A deficiency than healthy parturients. However, the supply of vitamin A to the newborn was not committed in the presence of gestational diabetes

Prevalência da infecção genital pelo vírus herpes simples tipo 1 e 2 em mulheres grávidas e não grávidas de Natal/RN

Herpes simplex is a virus that can be transmitted sexually and is potentially associated with vertical transmission. This study evaluated the prevalence of genital infection by herpes simplex virus (HSV) types 1 and 2 in pregnant and nonpregnant care in the city of Natal / RN, including a total of 222 women, 92 pregnant and 130 nonpregnant. The participants answered a questionnaire to obtain data and socio-demographic characteristics, as well as potential risk factors for sexually transmitted diseases. After the interview, we collected two cervical specimens, one for the Pap test and the other for DNA extraction and analyzed by polymerase chain reaction (PCR) to detect both virus serotypes. Then the women underwent a clinical examination by colposcopy. For statistical analysis, we used the chi-square and logistic regression by SSPS 17.0 Statistic. Most women were up to 30 years of age, nonwhite ethnicity, married, elementary education, family income below the poverty level; initiated sexual activity with age up to 18 years; had more than one sexual partner lifelong and was not pregnant, but has had at least one child. The HSV-1 showed a prevalence of 26.1% among pregnant women and 30.0% in non-pregnant women. While HSV-2 prevalence was found with 10.9% and 19.2% in pregnant and nonpregnant women, respectively. The largest proportion of morphological changes of the uterine cervix was detected among nonpregnant women, both in cytology and in colposcopy. The women were nonwhite ethnicity, married, became pregnant aged less than or equal to 18 years and who had one to two pregnancies had a lower risk of acquiring genital HSV infection. There was a high prevalence of genital HSV infection, HSV-1 is more prevalent than HSV-2. No association was found between morphological changes of the uterine cervix and the presence of the virus in pregnant and nonpregnant women, nor between genital HSV infection and the classic risk factors for sexually transmitted diseases

Sintomatologia depressiva e avaliação de níveis de TNFα IL-2 em indivíduos idosos e com doença pulmonar obstrutiva crônica

The aim of the present study was to assess the presence of depressive symptomatology among elderly residents in long-stay institutions (LSI) and in the community of Recife, Brazil. In total, 81 long-stay elderly patients (mean age of 75.55 ± 9.18 years) and 132 elderly (mean age of 73.14 ± 8.27 years) individuals from the community were evaluated. Depressive symptomatology was assessed by the Geriatric Depression Scale (GDS-15), cognitive status by the Mini Mental State Examination (MMSE) and capacity to perform the activities of daily living (ADL) by the Katz Index. Comorbities and the use of medication were recorded. The LSI elderly exhibited more depressive symptoms (p < 0.001) and more dependency (p< 0.001). We observed no differences in MMSE (p = 0.058). The elderly in the community displayed more comorbidities and the LSI elderly consumed more medication (p < 0.001 and p < 0.001, respectively). According to multivariate analysis (logistic regression), being male, having no spouse and having a low schooling level are risk factors for depressive symptoms. In conclusion, most elderly with depressive symptoms received no medication fordepression.

Desmame em recém-nascidos de muito baixo peso ao nascer no primeiro retorno ambulatorial após a alta hospitalar

Investigate intrahospital and neonatal determinants associated to the weaning of very low birth weight (VLBW) infants. Methods: 119 VLBW (<1500g) infants 81 were monitored from July 2005 through August 2006, from birth to the first ambulatory visit after maternity discharge. This maternity unit uses the Kangaroo Method and the Baby Friendly Hospital Initiative. Results: Out of 119 VLBW infants monitored until discharge, 88 (75%) returned to the facility, 22 (25%) were on exclusive breastfeeding (EB) and 66 (75%) were weaned (partial breastfeeding or formula feeding). Univariate analysis found an association between weaning and lower birth weight, longer stays in the NICU and longer hospitalization times, in addition to more prolonged enteral feeding and birth weight recovery period. Logistic regression showed length of NICU stay as being the main determinant of weaning. Conclusion: The negative repercussion on EB of an extended stay in the NICU is a significant challenge for health professionals to provide more adequate nutrition to VLBW infants

Aptidão física relacionada à saúde de escolares Norte- Rio-Grandenses

O sedentarismo é cada vez mais acentuado entre os adolescentes em todo o mundo. Objetivou-se neste estudo analisar o estado nutricional e a aptidão física de escolares norte-rio-grandenses. Participaram 2065 sujeitos, selecionados aleatoriamente (Masc = 1066, Fem = 999) (Natal n=1158; Mossoró n= 312; Lajes n= 231), divididos em três grupos etários pelos estágios maturacionais: 10 a 12 anos, 13 a 14 anos e _ 15 anos. Foi avaliada a composição corporal (IMC, dobras cutâneas tríceps e subescapular); o hábito alimentar (questionário de prevalência do consumo por grupo alimentar); o índice de atividade física (questionário Baeck) e o nível de aptidão física (testes do salto em distância, flexibilidade, resistência abdominal e cardiovascular). Utilizando-se a estatística descritiva, testes de médias pela análise dos intervalos de confiança, o teste de Kruskall-Wallis, teste t, o Qui2 e o coeficiente de contingência. Encontraram-se diferenças significativas com p < 0001 na distribuição do índice de massa corporal (n = 1701); Região Leste Potiguar (RLP) com excesso de peso e obesidade de 16,8 % e 15,2 %, a Região Oeste 16,3% e 9,6 % e a Região Central 10,4 % e 3,9 %, com as escolas privadas contribuindo significativamente na prevalência dessas variáveis nas RLP e ROP com p < 0,003 e p < 0,001 respectivamente. O hábito alimentar demonstrou que 98,3% dos sujeitos consomem alimentos do grupo das massas 98,3%; cereais 97,7%; laticínios 94,7%; frutas 92,3%; gorduras 88,3% e as hortaliças 61,6%, não havendo diferenças significativas no consumo alimentar entre o tipo de escolas e gênero (n = 300). No índice de atividade física habitual há diferenças entre esses respectivos extratos: 2,65±0,78 e 2,81±0,80 (p < 0,014) e 2,89±0,82 e 2,57±0,78 (p < 0,001), com as práticas de atividades esportivas, programas de exercícios físicos e lazer ativo mais significativo em escolas privadas 2,85 ± 1,06 e 3,37±1,26 (p < 0,001) em prol do sexo masculino com 3,47±1,24 e 2,75±1,03 (p <0,001). Resistência abdominal ( =19) e força de membros inferiores ( =128,5 cm) foram classificadas como muito fraco , a flexibilidade ( =26,9 cm) razoável e resistência geral ( =1439 m) como bom . Conclui-se que o hábito alimentar e o baixo índice de atividade física habitual influenciam negativamente os índices da aptidão física relacionada à saúde dos escolares, com menor incidência em instituições privadas em função das práticas esportivas. Este estudo apresenta relação de interface multidisciplinar, tendo o seu conteúdo uma aplicação nos campos da Medicina, Nutrição e Educação Física

Estado nutricional antropométrico, composição corporal e pressão arterial em adolescentes

Os objetivos deste trabalho foram: (1) estimar as prevalências de excesso de peso e de gordura corporal, obesidade central e pressão arterial elevada (PAE) em adolescentes beneficiários do Programa Nacional de Alimentação Escolar (PNAE) da rede municipal de ensino de Natal-RN; (2) verificar a associação entre variáveis antropométricas e de composição corporal com a pressão arterial, a maturação sexual e a história familiar positiva de fatores de risco para doença cardiovascular (FRDCV); (3) comparar dois padrões de referência para classificação do excesso de peso em adolescentes; e (4) propor equações preditivas de massa gorda (MG) e massa livre de gordura (MLG) baseadas nos perímetros corporais. Trata-se de um estudo transversal, com 526 adolescentes beneficiários do PNAE, em Natal, Brasil. O tamanho da população de estudo foi definido por amostragem aleatória, em dois estágios, e ponderada segundo número de alunos de cada escola. No primeiro estudo, o excesso de peso foi determinado por Índice de Massa Corporal (IMC), a gordura corporal estimada por dobras cutâneas e a obesidade central por perímetro abdominal. A pressão arterial elevada foi classificada conforme a American Academy of Pediatrics. As prevalências foram apresentadas em valores relativos e efeito do desenho. Realizou-se uma análise fatorial para sintetizar o conjunto de variáveis antropométricas visando identificar fatores comuns. Extraíram-se dois fatores: (1) padrão excesso de adiposidade e (2) padrão adiposidade central elevada. Para avaliar a associação entre os padrões de adiposidade corporal com pressão arterial elevada, faixa etária, maturação sexual e história familiar de FRDCV utilizou-se a Razão de Chances e respectivo intervalo de confiança de 95% e regressão logística. No segundo estudo, calculou-se a sensibilidade e a especificidade do excesso de peso classificado segundo o IOTF e a World Health Organization WHO em relação ao excesso de adiposidade corporal; e a estatística Kappa para medir a concordância entre os dois padrões de referência. No terceiro estudo, foram elaborados modelos preditivos de MG e MLG com base em nove perímetros corporais, utilizando a bioimpedância Byodinamics 450 como padrão de referência. Para tanto foram selecionados 218 adolescentes eutróficos, segundo o IMC a partir do estudo transversal. As equações foram estimadas por regressão linear múltipla, considerando a idade e os perímetros corporais. Os resultados apontaram que 14,1% dos meninos e 15,7% das meninas tinham excesso de peso; 15,3% dos meninos e 11,6% das meninas tinham excesso de gordura corporal e dentre os meninos 14,3% tinham pressão arterial elevada e as meninas, 21,4%. Todos os efeitos do desenho foram inferiores a 2,5%. Nos meninos, o padrão excesso de adiposidade foi associado à história familiar positiva de FRDCV (ORajust=2,60; 1,09-6,22), maturação sexual (ORajust=2,92; 1,04-8,22) e PAE (ORajust=3,66; 1,34-9,94). Os meninos com 12 anos e mais apresentaram 6,1 vezes mais chance de apresentar padrão adiposidade central elevada do que os adolescentes com 10 a 11 anos (IC95% 2,32-16,04), assim como os púberes apresentaram 3,2 vezes este mesmo padrão em relação aos pré-púberes (IC95%1,14-8,85). A partir da comparação entre os dois padrões de referencia de classificação do excesso de peso por meio do IMC, observou-se que a sensibilidade foi de 79,3% para o critério IOTF e de 88,9% para WHO e a especificidade foi de 94,7% e 89,9%, respectivamente. O nível de concordância foi maior para o critério IOTF (Kappa=0,70 x Kappa=0,64). Em relação à construção das equações preditivas de gordura corporal, do total de 106 meninos e 112 meninas, foram desenvolvidas duas equações para estimar MG e duas para MLG, considerando o sexo. No sexo masculino, a equação para estimar a MG incluiu as variáveis idade, punho, quadril e perímetro abdominal (R2=0,552; AIC=416,04) e MLG, idade, punho e antebraço (R2=0,869; AIC=578,24). Enquanto que no feminino, MG foi estimada pelas variáveis punho, perímetro do abdômen, do quadril, da coxa proximal e da panturrilha (R2=0,838; AIC=415,36); e a MLG por idade, punho, perímetro do abdômen, do quadril e da panturrilha (R2=0,878; AIC=512,48). Conclui-se que os adolescentes tinham elevada prevalência de excesso de adiposidade corporal e de pressão arterial elevada. Tanto o padrão excesso de adiposidade quanto adiposidade central elevada constituem-se em padrões de risco. O padrão excesso de adiposidade foi associado à pressão arterial, história familiar positiva de FRDCV e maturação sexual em meninos. O critério IOTF mostrou-se menos sensível, mais específico, com maior nível de concordância e maior probabilidade de identificar corretamente o excesso de gordura corporal nos adolescentes avaliados. Quatro equações foram desenvolvidas para a estimativa da MG e MLG em adolescentes. As equações desenvolvidas para estimar a MG no sexo feminino e MLG para ambos os sexos apresentaram valores elevados de coeficiente de determinação ajustados e, portanto, são as preferenciais. Este estudo foi realizado com a participação de equipe multidisciplinar composta por professores da área de Nutrição, Endocrinologia Pediátrica, Estatística, Educação Física, discentes do Curso de Graduação em Nutrição e residentes em Pediatria