BackgroundThe Study of Cardiovascular Risk in Adolescents (Portuguese acronym, “ERICA”) is a multicenter, school-based country-wide cross-sectional study funded by the Brazilian Ministry of Health, which aims at estimating the prevalence of cardiovascular risk factors, including those included in the definition of the metabolic syndrome, in a random sample of adolescents aged 12 to 17 years in Brazilian cities with more than 100,000 inhabitants. Approximately 85,000 students were assessed in public and private schools. Brazil is a continental country with a heterogeneous population of 190 million living in its five main geographic regions (North, Northeast, Midwest, South and Southeast). ERICA is a pioneering study that will assess the prevalence rates of cardiovascular risk factors in Brazilian adolescents using a sample with national and regional representativeness. This paper describes the rationale, design and procedures of ERICA.Methods/DesignParticipants answered a self-administered questionnaire using an electronic device, in order to obtain information on demographic and lifestyle characteristics, including physical activity, smoking, alcohol intake, sleeping hours, common mental disorders and reproductive and oral health. Dietary intake was assessed using a 24-hour dietary recall. Anthropometric measures (weight, height and waist circumference) and blood pressure were also be measured. Blood was collected from a subsample of approximately 44,000 adolescents for measurements of fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin and fasting insulin.DiscussionThe study findings will be instrumental to the development of public policies aiming at the prevention of obesity, atherosclerotic diseases and diabetes in an adolescent population.

OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents.METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population.RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%.CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.

This article discusses the relationship between both poverty and food insecurity and the COVID-19 pandemic, as well as presenting possible strategies and actions for increasing social protection in the fight against these conditions in the current epidemiological context, especially for low-income countries. This is a narrative review concerning COVID-19, poverty, and food and nutritional insecurity. The COVID-19 pandemic may increase poverty and food insecurity levels, resulting from the absence of or weak political, economic, and social interventions to maintain jobs, as well as compromised food production and distribution chains and reduced access to healthy foods in different countries around the world, especially the poorest ones, where social and economic inequality was already historically high; the pandemic heightens and uncovers the vulnerability of poor populations. Public policies focused on guaranteeing the human right to adequate food must be improved and implemented for populations in contexts of poverty with the aim of providing food security.

Fatty liver is increasingly common in obese adolescents. We determined its association with glucose dysregulation in 118 (37M/81F) obese adolescents of similar age and percent total fat. Fast-magnetic resonance imaging (MRI) and simple MRI were used to quantify hepatic fat content and abdominal fat distribution. All subjects had a standard oral glucose tolerance test. Insulin sensitivity was estimated by the Matsuda Index and homeostasis model assessment of insulin resistance. Baseline total and high molecular weight (HMW)-adiponectin and interleukin (IL)-6 levels were measured. The cohort was stratified according to tertiles of hepatic fat content. Whereas age and %fat were comparable across tertiles, ethnicity differed in that fewer Blacks and more Whites and Hispanics were in the moderate and high category of hepatic fat fraction (HFF). Visceral and the visceral-to-subcutaneous fat ratio increased and insulin sensitivity decreased across tertiles. Two-hour plasma glucose rose with increasing hepatic steatosis (P < 0.008). 73.7% of the subjects in the high HFF had the metabolic syndrome compared to 19.5% and 30.6%, respectively, in the low and moderate categories. Both total and HMWadiponectin decreased, and IL-6 increased with increasing hepatic steatosis. Conclusion: In obese adolescents, independent of total fat, increasing severity of fatty liver is associated with glucose dysregulation, metabolic syndrome, and with a proinflammatory milieu. (HEPATOLOGY 2009;49: 1896-1903 E ctopic fat deposition in insulin-sensitive tissues such as liver and muscle strongly correlates with insulin resistance. 1 Previously, we reported that increased intramyocellular fat in obese adolescents was associated with impaired glucose intolerance and insulin resistance. 2 Furthermore, moderate elevation in alanine aminotransferase (ALT) levels, a poor surrogate of fatty liver, was found to be associated with high-normal glucose levels, 3 whereas abnormal ALT levels were reported in youngsters with type 2 diabetes (T2DM), 4 raising the question of a potential role of fatty liver in the onset of T2DM in obese youth. Fatty liver in obese adolescents is becoming increasingly common. [5][6][7] Nevertheless, its role in the dysregulation of glucose metabolism is unclear. We hypothesize that, independent of overall obesity, the severity of hepatic steatosis will strongly affect the presence of prediabetes and diabetes in obese adolescents. Furthermore, we determined if the balance between antiinflammatory markers such as total and high molecular weight (HMW) adiponectin and proinflammatory markers like interleukin-6 (IL-6) would vary as a function of the degree of hepatic steatosis. Using fast-magnetic resonance imaging (MRI) we quantified intrahepatic fat content in a large multiethnic group of obese adolescents matched for age and overall adiposity. Subjects and MethodsThe Cohort. In all, 118 obese adolescents, 13 to 16 years old with a body mass index (BMI)-z score ranging

RESUMOSobrepeso e obesidade infantil apresentam prevalência elevada e caráter multifatorial. Com o objetivo de determinar a influência de fatores biológicos e ambientais no seu desenvolvimento, foi realizado corte transversal com 699 crianças, de 5 a 9 anos, da rede de ensino público e privado da zona urbana de Feira de Santana, BA. Sobrepeso e obesidade foram definidos como índice de massa corpórea ≥ aos percentis 85 e 95 para idade e sexo, respectivamente. A análise de entrevistas com os responsáveis determinou a influência dos fatores em questão. Observados como de significância estatística para o desenvolvimento de ambas as condições: nível elevado de escolaridade e renda familiar, ser unigênito, freqüentar escola privada, possuir eletrodomésticos e utilizar computador. O grupo étnico branco relacionouse apenas ao sobrepeso. Repetência escolar e realização de atividade física sistemática mostraram associação inversa. O odds ratio mostrou associação preditiva independente com o fato de estudar em escola privada e ser unigênito. Em conclusão, há influência de fatores biológi-cos e ambientais no desenvolvimento de sobrepeso e obesidade infantil, confirmando o caráter multifatorial. Childhood overweight and obesity have a high prevalence and multifactorial character. To determine the influence of biological and environmental factors in their development, a cross-sectional study was performed with 699 children, ranging from 5 to 9 years of age, from the public and private schools in the urban area of Feira de Santana, BA. Overweight and obesity were defined as body-mass index ≥ the 85 th and 95 th percentiles for age and gender, respectively. Interviews with the children's responsible were used to determine the influence of these factors. It was observed as statistic significance for the development of both conditions: high level of parent's education and income, being an only child, studying at private school, having household appliances and using computers. The white ethnic group was related only to overweight. There was an inverse association regarding school flunking and practice of systematic physical activity. The odds ratio showed a predictive and independent association with studying at private school and being an only child. In conclusion there was an influence of biological and environmental factors in the development of childhood overweight and obesity, confirming the multifactorial etiology of these conditions.

OBJECTIVE -Among other metabolic consequences, a dyslipidemic profile often accompanies childhood obesity. In adults, type 2 diabetes and hepatic steatosis have been shown to alter lipoprotein subclass distribution and size; however, these alterations have not yet been shown in children or adolescents. Therefore, our objective was to determine the effect of hepatic steatosis on lipoprotein concentration and size in obese adolescents.RESEARCH DESIGN AND METHODS -Using fast magnetic resonance imaging, we measured intrahepatic fat content in 49 obese adolescents with normal glucose tolerance. The presence or absence of hepatic steatosis was determined by a threshold value for hepatic fat fraction (HFF) of 5.5%; therefore, the cohort was divided into two groups (HFF Ͼ or Ͻ5.5%). Fasting lipoprotein subclasses were determined using nuclear magnetic resonance spectroscopy.RESULTS -Overall, the high-HFF group had 88% higher concentrations of large VLDL compared with the low-HFF group (P Ͻ 0.001). Likewise, the high-HFF group had significantly higher concentrations of small dense LDL (P Ͻ 0.007); however, the low-HFF group had significantly higher concentrations of large HDL (P Ͻ 0.001). Stepwise multiple regression analysis revealed that high HFF was the strongest single correlate, accounting for 32.6% of the variance in large VLDL concentrations (P Ͻ 0.002).CONCLUSIONS -The presence of fatty liver was associated with a pronounced dyslipidemic profile characterized by large VLDL, small dense LDL, and decreased large HDL concentrations. This proatherogenic phenotype was strongly related to the intrahepatic lipid content. Diabetes Care 30:3093-3098, 2007S tudies from autopsies on 742 children (aged 2-19 years) reported fatty liver prevalence at 9.6%, and in obese children this rate increased to an alarming 38% (1). An imbalance between fatty acid flux and utilization and VLDL secretion leads to an accumulation of triglycerides within the hepatocytes and ultimately to hepatic steatosis (2). It is becoming increasingly clear that fat accumulation in the liver, per se, is not a benign condition (3). Indeed, it is frequently associated with type 2 diabetes in both adults and children (4,5) and has been labeled as the hepatic component of the metabolic syndrome (2,3).Worsening of the dyslipidemic profile has been described in adults in association with insulin resistance and type 2 diabetes (6 -8). Garvey et al. (7) have shown that subjects with type 2 diabetes have larger VLDL and smaller LDL and HDL particles compared with insulinsensitive subjects. The insulin-resistant and type 2 diabetic groups also had greater concentrations of these atherogenic particles. Further studies by Toledo et al. (8) reported that the presence of hepatic steatosis in obese subjects with type 2 diabetes further altered lipoprotein composition compared with type 2 diabetic subjects without fatty liver. Type 2 diabetic subjects with fatty liver had larger triglyceride-rich VLDL particles, smaller LDL and HDL particles, and reduced concentrations o...

BackgroundStudies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation.MethodsThis study presents cross sectional, baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications.ResultsPatients with ulcer had longer disease duration (17.2 ± 9.9 vs. 13.2 ± 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 ± 2.03 vs. 8.35 ± 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2–3.7), smoking (OR 1.78; 95 % CI 1.09–2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31–44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47–3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08–2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65–13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2–3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01–11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43–112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14–0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1–4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67–19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64–7.33). There was no association between either outcome and ethnicity.ConclusionsUlcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population.

OBJECTIVE To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents. METHODS We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status. RESULTS Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95%CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95%CI 2.4-3.2]), when compared with private schools (1.9% [95%CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides. CONCLUSIONS ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome.