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BackgroundChildren who have unhealthy lifestyles are predisposed to develop hypertension, dyslipidemia and other complications. The epidemic of obesity is also affecting children with congenital heart disease. The aim of this study is to estimate the prevalence of obesity and describe associated risk factors, including family history in children with congenital heart disease.MethodsA cross-sectional study with 316 children and adolescents with congenital heart disease seen in an outpatient clinic of a reference hospital. Collected sociodemographic data included family history of chronic disease, dietary habits, laboratory tests (total cholesterol, HDL and LDL/cholesterol, triglycerides, fasting glucose, CRP, hematocrit and hemoglobin), and anthropometric assessment. Anthropometric data of the caregivers was self-reported.ResultsThe prevalence of excess weight was 26.9%. Altered levels of total cholesterol were observed in 46.9%, of HDL in 32.7%, LDL in 23.6% and of triglycerides levels in 20.0%. A higher frequency of family history of obesity (42.6%; p = 0.001), dyslipidemia (48.1%; p = <0.001), diabetes (47.4%; p = 0.002), hypertension (39.2%; p = 0.006) and ischemic disease (43.7%; p = 0.023), as well as significantly higher values of triglycerides (p = 0.017), glycemia (p = 0.004) and C-reactive protein (p = 0.002) were observed among patients with excess weight.ConclusionThe presence of modifiable risk factors and the variables associated to excess weight in this population was similar to that described in the literature for children without congenital disease. As these children already present the risks associated to heart disease, it is particularly important to promote a healthy lifestyle in this group.

Objective: To estimate the prevalence of overweight, obesity and nutritional habits in schoolchildren aged 10-18 years. Methods: Contemporary, cross-sectional, population-based study, with a stratified probabilistic sample of secondary schools in Porto Alegre comprising a total of 511 schoolchildren. Data on family risk factors, anthropometrics and eating habits were collected. Results: The prevalence of excess weight was 27?6 % among the schoolchildren, with 17?8 % being overweight (BMI $ 85th and ,95th percentile) and 9?8 % obese (BMI $ 95th percentile). Overweight was more prevalent in females (19?9 %) and obesity in males (11?8 %). Children who ate fewer meals per day tend to be more obese (mean: 3?51 (SD 1?14) v. 4?22 (SD 1?01) meals/d for students with normal weight). The mean weekly intake of unhealthy foods was 3?25 times for soft drinks, 2?91 for fried foods and 4?01 for sweets. The intake of skimmed milk (38?9 %) and diet soft drinks (20?9 %) was greater among obese children. Conclusion: Overweight and obesity are increasing even in developing countries such as Brazil. Although many families are already taking measures towards healthier health habits, preventive actions must be considered a priority, with an emphasis on education, in order to avoid the need to treat obesity and its significant burden in the near future. Keywords Schoolchildren Overweight Obesity Risk factors Eating habitsAccording to data from the WHO, about one-third of deaths worldwide are due to circulatory diseases such as coronary artery disease and cerebrovascular disease (1) . Approximately 80 % of deaths from CVD occur in developing countries and it is estimated that by 2010 these diseases will be the main cause of death in those countries (2) . Atherosclerotic disease is the result of a combination of genetic, socio-economic and environmental factors. Pathological alterations due to atherosclerosis may be identified long before the onset of clinical signs of the disease. By the end of adolescence, about 61 % of individuals present some type of atherosclerotic lesion in the coronary arteries. After the age of 40 years, such lesions are present in almost 95 % of the population.Lifestyles causing atherosclerosis may begin in early childhood and the prevalence of risk factors such as overweight and obesity, hypertension, dyslipidaemia, sedentarism and diabetes mellitus in this age group has been rising. If these conditions persist, it is likely that diseases that were formerly seen only in much older adults will become a cause of morbidity in young adults and adolescents as well. It is therefore necessary to institute early preventive management at all levels of health care.Considering the evidence that the prevalence of overweight and obesity has been increasing in developing countries, including Brazil (3) , the purpose of the current study was to investigate the presence of these risk factors in a population-based sample of schoolchildren aged 10 to 18 years in Porto Alegre, southern Brazil. In addition, we sought to ex...

BackgroundThe prevalence of hypertension among children and adolescents is estimated to range between 1% and 13%. Excess weight and central obesity are related to blood pressure levels in adults, and may be important in the early pathogenesis of SH when present in childhood. ObjectivesTo study the association between anthropometric variables and blood pressure levels in schoolchildren from the 5th and 8th grades, and to identify which parameter was more strongly correlated with blood pressure levels. MethodsContemporary cross-sectional study with probabilistic population-based cluster sampling of schoolchildren enrolled from the 5th to the 8th grades in public elementary schools of Porto Alegre. Data on familial risk factors and anthropometry were collected. Statistical analysis included correlations and cluster-adjusted confidence intervals. ResultsThe mean age of participants was 12.57 (± 1.64) years, and 55.2% of them were females. Abnormal blood pressure levels were found in 11.3% of the sample and borderline values, in 16.2%. Among the anthropometric variables analyzed, hip circumference was the one with the strongest correlation with increased blood pressure (r = 0.462, p < 0.001), followed by waist circumference (r = 0.404, p < 0.001) and abdominal skinfold (r = 0.291, p < 0.001). ConclusionWe observed an association of waist circumference and skinfolds with increased blood pressure levels in the schoolchildren of the sample. Therefore, it is of the utmost importance that early measurements of blood pressure, and waist and hip circumferences become a routine in health services in order to prevent this condition.

BackgroundChildren with familial hypercholesterolemia may develop early endothelial damage leading to a high risk for the development of cardiovascular disease (CVD). Statins have been shown to be effective in lowering LDL cholesterol levels and cardiovascular events in adults. The effect of statin treatment in the pediatric population is not clearly demonstrated.ObjectiveTo systematically review the literature to evaluate the effects of different statins and dosages in total cholesterol levels in children and adolescents with familial hypercholesterolemia. We also aimed to evaluate statin safety in this group.MethodsPubMed, EMBASE, Bireme, Web of Science, Cochrane Library, SciELO and LILACS databases, were searched for articles published from inception until February 2016. Two independent reviewers performed the quality assessment of the included studies. We performed a meta-analysis with random effects and inverse variance, and subgroup analyses were performed.ResultsTen trials involving a total of 1543 patients met the inclusion criteria. Our study showed reductions in cholesterol levels according to the intensity of statin doses (high, intermediate and low): (-104.61 mg/dl, -67.60 mg/dl, -56.96 mg/dl) and in the low-density lipoprotein cholesterol level: [-105.03 mg/dl (95% CI -115.76, -94.30), I2 19.2%], [-67.85 mg/dl (95% CI -83.36, -52.35), I2 99.8%], [-58.97 mg/dl (95% CI -67.83, -50.11), I2 93.8%. The duration of statin therapy in the studies ranged from 8 to 104 weeks, precluding conclusions about long-term effects.ConclusionStatin treatment is efficient in lowering lipids in children with FH. There is need of large, long-term and randomized controlled trials to establish the long-term safety of statins.

BackgroundThe aim of the current study was to test the effectiveness of a physical activity and exercise-based program in a clinical context to reduce cardiovascular risk factors in children and adolescents.MethodsA randomized clinical trial was conducted in a pediatric preventive outpatient clinic. Intervention was 14 weeks of exercise for the intervention group or general health advice for the control group. The primary and the secondary outcomes were reduction of cardiovascular risk factors and the feasibility and the effectiveness of clinical advice plan to practice physical exercises at home.ResultsA total of 134 children were screened; 26 met eligibility criteria. Of these, 10 were allocated in the exercise intervention group and nine were included in the control group until the end of the intervention. Those patients who discontinued the intervention had the lowest scores of z-BMI (P = 0.033) and subscapular skin fold (P = 0.048). After 14 weeks of intervention, no statistical differences were found between the groups. High-density lipoprotein cholesterol (HDL-C) was higher in the exercise group, with a mild tendency to be significant (P = 0.066). Patients who adhere to treatment had diastolic blood pressure decreased from baseline to the end of the follow-up period in the control group (P = 0.013). Regardless of this result, the other comparisons within the group were not statistically different between T0 and T14.ConclusionA low-cost physical activity advice intervention presented many barriers for implementation in routine clinical care, limiting its feasibility and evaluation of effectiveness to reduce cardiovascular risk factors.

BackgroundLong-term safety, effectiveness and criteria for treatment with statins in children are still unclear in clinical practice. There is very limited evidence for the use of medication to treat children with dyslipidemia secondary to obesity who do not respond well to lifestyle modification.ObjectiveSystematic review of randomized clinical trials of statin use to treat children and adolescents with dyslipidemia secondary to obesity.MethodsWe performed a search in PubMed, EMBASE, Bireme, Web of Science, Cochrane Library, SciELO, and LILACS for data to evaluate the effect of statins on: improvement of surrogate markers of coronary artery disease in clinical outcomes of adulthood; increased serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and apolipropotein B (APOB); and decreased serum levels of high-density lipoprotein cholesterol (HDL-C) from inception to February 2016. Participants were children and adolescents.ResultsOf the 16793 potentially relevant citations recovered from the electronic databases, no randomized clinical trials fulfilled the inclusion criteria for children with dyslipidemia secondary to obesity.ConclusionsWe found no specific evidence to consider statins in the treatment of hypercholesterolemia secondary to obesity in children. The usual practice of extrapolating findings from studies in genetic dyslipidemia ignores the differences in long-term cardiovascular risks and the long-term drug treatment risks, when compared to recommendation of lifestyle changes. Randomized clinical trials are needed to understand drug treatment in dyslipidemia secondary to obesity.