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.

In the Geneva adult population, compliance with the Swiss dietary guidelines improved little. Issuing of dietary guidelines did not impact trends.

Adherence to dietary guidelines is associated with significantly better health outcomes. Studies across the world shows that compliance with the guidelines was low, but data in Switzerland are lacking. Hence, we aimed to assess the 5-year trends in dietary compliance regarding food guidelines in Switzerland in a prospective, population-based observational study. Data from 2882 participants (1591 women, 35-75 years), from the first (2009-2012) and second (2014-2017) follow-up. Dietary intake was assessed using a validated food frequency questionnaire. Compliance with the guidelines of the Swiss society of nutrition was assessed at baseline and 5.5 years afterwards. Prevalence rates for compliance were calculated using the exact Poisson method. Factors associated with changes in compliance (never, shifter or maintainer) were assessed by multinomial logistic regression using "Never compliers" as reference. Overall, improvements in compliance to fruits (42.4% to 45.1%) vegetables (6.9% to 8.6%) and fish (66.6% to 60.5%) were found, while compliance to meat decreased (61.1% to 58.5%). The prevalence of participants complying with at least three dietary recommendations did not change (24.1% to 25.2%). During follow-up, only 11.6% of participants maintained compliance to at least three dietary recommendations, and 62.4% never managed to comply. Female gender and older age were associated with maintaining compliance during the two study periods. In conclusion, compliance with dietary guidelines is a dynamic status, and only a small fraction of the population achieves sustained compliance with at least three guidelines. Almost two thirds of the population never achieve compliance with three guidelines.

Background:Schools have become a key figure for the promotion of health and obesity interventions, bringing the development of critical awareness to the construction and promotion of a healthy diet, physical activity, and the monitoring of the nutritional status in childhood and adolescence.Objectives:To describe a study protocol to evaluate the effectiveness of an intervention designed to improve knowledge of food choices in the school environment.Methods:This is a cluster-randomized, parallel, two-arm study conducted in public elementary and middle schools in Brazil. Participants will be children and adolescents between the ages of 5 and 15 years, from both genders. The interventions will be focusing on changes in lifestyle, physical activities and nutritional education. Intervention activities will occur monthly in the school’s multimedia room or sports court. The control group arm will receive usual recommendations by the school. The primary outcome variable will be anthropometric measures, such as body mass index percentiles and levels of physical activity by the International Physical Activity Questionnaire.Results:We expect that after the study children will increase the ingestion of fresh food, reduce excessive consumption of sugary and processed foods, and reduce the hours of sedentary activities.Conclusion:The purpose of starting the dietary intervention at this stage of life is to develop a knowledge that will enable for healthy choices, providing opportunities for a better future for this population.

Objective: To estimate the burden of weight excess in Brazilian adolescents. Design: Systematic review with meta-analysis. Setting: We searched the literature in four databases (MEDLINE/PubMed, EMBASE, SciELO and LILACS). Studies were included if they had cross-sectional or cohort design and enrolled Brazilian adolescents. Studies based on self-reported measures were excluded. Random effect models were used to calculate prevalence estimate and its 95% confidence interval (95%CI). Participants: Brazilian adolescents (10 to 19 years old). Results: One hundred and fifty-one studies were included. Trend analyses showed a significant increase in the prevalence of excess weight in the last decades: 8.2% (95%CI:7.7-8.7) until year 2000, 18.9 (95%CI:14.7-23.2) from 2000 to 2009, and 25.1% (95%CI:23.4-26.8) in 2010 and after. A similar temporal pattern was observed in the prevalence of overweight and obesity separately. In sensitivity analyses, lower prevalence of excess weight was found in older adolescents and those defined using IOTF cutoff points. The Southeast and South regions had the highest prevalence of excess weight, overweight and obesity. No significant difference in prevalence by sex was found, except for studies before the year 2000. Conclusions: The prevalence of overweight and obesity in Brazilian adolescents is high and continues to rise. Public policies on an individual level and targeting modifications in the obesogenic environment are necessary.

The correlation between body mass index percentile and C-reactive protein was confirmed in this population. The prevention of overweight is paramount to avoid overlapping modifiable risk factors to those already inherent to the CHD.

Introduction: Breast milk is nutritionally adequate and is related to the reduction of various health problems in childhood. Its offer is widely recommended in health guidelines. Objective: To estimate the prevalence and obstacles to breastfeeding in patients with CHD in southern Brazil. Methods: Cross-sectional study of patients with CHD between 2 and 18 years of age. Patients with genetic syndromes and patients whose mothers had died were excluded from the analysis. The variables on breastfeeding in the first 2 years of life were collected through a phone call to the mothers, which was conducted by trained evaluators. Prevalence was described in proportions and the continuous variables as means and standard deviation. Bivariate analyses were evaluated using a chi-square test to measure the association between the variables and the outcome. Results: A total of 351 patients with CHD were analysed. There was a predominance of males (53%) and a mean age of 9.54 ± 4.52 years. Breastfeeding up to the sixth month was present in 40% of the cases. Conclusion: The mothers of babies with CHD face great challenges to maintain the supply of breast milk, whether inherent to the practice of breastfeeding or related to CHD.

Background:The ocular effects of obesity and hypertension need to be established and can be used as prognostic markers.Objective:To estimate the prevalence of ophthalmological alterations in children and adolescents who are overweight and/or have SAH.Methods:The database for this study included all observational studies (CS, cohort, case-control and “baseline” description of randomized clinical trials) with children and/or adolescents who were overweight, obese or had SAH and that measured ophthalmological alterations.Results:Comparative studies with healthy children demonstrated positive association between body adiposity with retinal venular dilation, and SAH with retinal arteriolar narrowing. Different retinal fundus cameras and computer-assisted programs to evaluate the retinal vessels, variations in the methods of analysis, adjustments, populations, were the main arguments against formal meta-analysis. The heterogeneity was too high (I2 >90%, in fixed or randomized effects), and the lack of linearity, normal distribution and homoscedasticity did not recommend meta-regression.Conclusion:Obesity and SAH show associations with ophthalmological alterations, especially with retinal vessel diameter. Lack of standardization does not allow a quantitative evaluation.