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.

CONTEXT: Diabetes mellitus prevalence has been increasing worldwide due to factors like lifestyle changes and higher life expectancy. The Brazilian Multicenter Study performed between 1986 and 1988 evaluated the prevalence of diabetes and impaired glucose tolerance. OBJECTIVE:To assess the prevalence of diabetes and impaired glucose tolerance in the urban population aged 30-69 years of the city of Ribeirão Preto, SP, Brazil. TYPE OF STUDY:A two-stage, cross-sectional home survey. SETTING:Ribeirão Preto, São Paulo, Brazil. PARTICIPANTS:A random sample of 1,473 individuals. METHODS:The sample plan was drawn up using a sampling scheme of stage conglomerates according to sex, age and family head income. Subjects were first screened by fasting capillary glycemia (FCG). Those that screened positive (FCG 100 mg/dl) and every seventh consecutive person who screened negative (FCG < 100 mg/dl) was submitted to a 75 g oral glucose tolerance test. The diagnosis of diabetes and impaired glucose tolerance were based on World Health Organization criteria. RESULTS:The overall rates of diabetes and impaired glucose tolerance were 12.1 and 7.7%, respectively. Men and women had similar rates of diabetes (12.0 vs. 12.1%) and impaired glucose tolerance (7.9 vs. 7.3%). Differences in the rates for whites (11.6%) and nonwhites (13.3%) for diabetes were not significant, while impaired glucose tolerance was more prevalent among whites. The prevalences of diabetes and impaired glucose tolerance ranged from 3.3% and 2.6% in the 30-39 year age group to 21.7% and 11.3% in the 60-69 year age group, respectively. Obese subjects (BMI 30 kg/m 2 ) and those with a family history of diabetes (first-degree relatives) presented higher prevalences of diabetes (22.6% and 19.7%, respectively). CONCLUSIONS:The prevalence of diabetes in Ribeirão Preto was found to be comparable to that occurring in developed countries. With respect to the Brazilian Multicenter Study we verified an increased prevalence of diabetes but a similar prevalence of impaired glucose tolerance. These findings may reflect modifications in environmental factors and lifestyle that have been occurring in Brazilian cities like Ribeirão Preto, especially regarding increasing rates of sedentary living and obesity .

OBJECTIVE -To investigate the presence of restless legs syndrome (RLS) and the quality of sleep in a population of type 2 diabetic patients.RESEARCH DESIGN AND METHODS -The study population was composed of 100 consecutive patients regularly attending a diabetes clinic at the University Hospital of the Federal University of Ceará. The subjects' quality of sleep was assessed by the Pittsburgh Sleep Quality Index, and excessive daytime sleepiness (EDS) was measured by the Epworth Sleepiness Scale. The RLS was diagnosed using the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Other relevant clinical and laboratory parameters were obtained by interview and chart review.RESULTS -RLS was found in 27% of patients. Poor sleep quality was present in 45% of cases and was associated with age (P ϭ 0.04), peripheral neuropathy (P ϭ 0.001), and RLS (P ϭ 0.000). EDS was found in 26% of patients. Logistic regression analysis revealed an association between RLS and peripheral neuropathy (odds ratio 12.85 [95% CI 2.83-58.40], P ϭ 0.001).CONCLUSIONS -RLS is common in type 2 diabetic patients and can be a major cause of sleep disruption in these patients. Diabetes Care 28:2633-2636, 2005 Diabetes is a lifelong disease of increasing incidence in the Western world and is frequently comorbid with other disorders such as retinopathy, peripheral neuropathy, and nephropathy (1,2). Most patients develop diabetes after age 40 years, and, although much progress has been made in therapy, the majority of diabetic patients continue to die from macrovascular complications (i.e., cardiovascular disease) (3).Recently it has become clear that sleep disturbances (e.g., chronic insomnia, sleep apnea) have a major impact on health and quality of life; this adverse impact can usually be reversed by adequate diagnosis and treatment (4). Neuropathy may also contribute to the significant reduction in quality of life for patients (5).These problems are frequently overlooked on routine medical interviews; furthermore, in some cases, short-term disturbances of sleep may evolve into chronic conditions (6). The indiscriminate use of sleeping pills may further disrupt the sleep-wake cycle and contribute to stress in patients with sleep disorders (7). In type 2 diabetes, sleep disturbances are believed to be common (8) and have been attributed to impaired glucose metabolism and general physical distress (9).Restless legs syndrome (RLS) is a common neurological condition characterized by unpleasant sensations deep inside the legs that occur at rest, especially at bedtime (10,11). The paresthesias are accompanied by an irresistible urge to move the limbs, with movement temporarily relieving the symptoms (12,13). RLS patients experience discomfort and complain of disturbances in initiating and maintaining sleep, sleepiness, and lessrefreshing sleep (14). The intensity of sensory and motor symptoms can vary throughout a patient's lifetime but generally tends to increase with advancing age. RLS has been reported in association ...

The majority of patients did not meet metabolic control goals and a substantial proportion was not screened for diabetic complications. These issues may increase the risk of chronic complications and negatively impact public health.

Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.

Prolactinomas, drug induced hyperprolactinemia, and macroprolactinemia were the 3 most common causes of hyperprolactinemia. Although PRL levels could not reliably define the etiology of hyperprolactinemia, PRL values >500 ng/ml were exclusively seen in patients with prolactinomas. CAB was significantly more effective than BCR in terms of prolactin normalization, tumor shrinkage, and tolerability.

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.