Introduction: Body measurements are attractive tools, due totheir low cost and easy applicability. The aim of this study isto characterize the anthropometric measures of a diabeticpopulation and to analyze the relationship with hemoglobinA1c (HbA1c).Material and Methods: A prospective, observational study included patients followed in a Diabetology consultation. Statistical analysis was performed using the SPSS program, 23.0.Results: Four hundred and fourteen (414) patients (50% men,mean age 68.77 years) were included. In this sample 76.5%were under insulin therapy. Lipodystrophy was present in21% diabetics, who were older and had higher waist circumference (WC) (p < 0.05). The mean HbA1c was 7.61% and itwas higher in women (p < 0.05). The mean body mass index(BMI) was 30.41 kg/m2. Grade 2 obesity and morbid obesitywas higher in women (p < 0.05). The mean WC was 107.24cm and was lower in patients with HbA1c between 7.1% and7.5% (p < 0.05). The mean waist-to-height ratio (WHtR) was0,67. This value was higher in women, older patients andmore obese (p < 0.05). The patients treated with insulin hadhigher HbA1c, WC and WHtR values.Discussion and Conclusion: In this study women have worseglycemic and metabolic control. WC was associated withpoor control of HbA1c and lipodystrophy. Integrating theseparameters into the assessment and guidance of diabeticsmay be a useful tool.

Introduction: The purpose of this study was to analyze secular trends in anthropometrics and physical fitness of Portuguese children. Material and Methods: A group of 1819 students (881 boys and 938 girls) between 10 and 11 years old was assessed in their 5th and 6th scholar grade throughout a 20 years’ time-frame. ANCOVA models were used to analyze variations in anthropometrics (height, weight and body mass index) and physical fitness (sit and reach, curl-up, horizontal jump and sprint time) across four quinquennials (1993 - 1998; 1998 - 2003; 2003 - 2008; 2008 - 2013). Results: Secular trends showed the presence of heavier boys and girls with higher body mass index in the 5th and 6th grade throughout the last 20 years. There was also a presence of taller girls but just until the 3rd quinquennial. Both boys and girls were able to perform better on the core strength test and sprint time but become less flexible over the years. Mean jumping performance remained unchanged for both genders. Discussion: The present study provides novel data on anthropometrics and physical fitness trends over the last two decades in young Portuguese children, consistent with the results reported in other developed countries. Conclusion: Evidence for the start of a positive secular trend in body mass index and in some physical fitness components over the last two decades among the Portuguese youth.

It is unclear if cardiorespiratory fitness (CRF) can be used as a screening tool for premature changes in carotid intima-media thickness (cIMT) in paediatric populations. The purpose of this cross-sectional study was 3-fold: (i) to determine if CRF can be used to screen increased cIMT; (ii) to determine an optimal CRF cut-off to predict increased cIMT; and (iii) to evaluate its ability to predict increased cIMT among children in comparison with existent CRF cut-offs. cIMT was assessed with high-resolution ultrasonography and CRF was determined using a maximal cycle test. Receiver operating characteristic analyses were conducted in boys (n = 211) and girls (n = 202) aged 11-12 years to define the optimal sex-specific CRF cut-off to classify increased cIMT (≥75th percentile). Logistic regression was used to examine the association between the CRF cut-offs with the risk of having an increased cIMT. The optimal CRF cut-offs to predict increased cIMT were 45.81 and 34.46 mL·kg(-1)·min(-1) for boys and girls, respectively. The odds-ratios for having increased cIMT among children who were unfit was up to 2.8 times the odds among those who were fit (95% confidence interval: 1.40-5.53). Considering current CRF cut-offs, only those suggested by Adegboye et al. 2011. (Br. J. Sports Med. 45(9): 722-728) and Boddy et al. 2012 (PLoS One, 7(9): e45755) were significant in predicting increased cIMT. In conclusion, CRF cut-offs (boys: ≤ 45.8; girls: ≤ 34.5 mL·kg(-1)·min(-1)) are associated with thickening of the arterial wall in 11- to 12-year-old children. Low CRF is an important cardiovascular risk factor in children and our data highlight the importance of obtaining an adequate CRF.

Esta investigação teve como objectivo geral conceber e implementar um programa de intervenção na Escola Secundária com 3º Ciclo do Ensino Básico de Gama Barros (situada no Concelho de Sintra) e, consequentemente, conhecer a aptidão física associada à saúde de todos os alunos que frequentam o 3º Ciclo (7º, 8º e 9º Anos), e avaliar os efeitos do exercício físico no controlo do excesso de peso/composição corporal e na melhoria da aptidão física dos adolescentes. Para concretizar o objectivo referido realizou-se uma avaliação da composição corporal (peso/altura, índice de massa corporal, perímetro da cintura e % massa gorda) de todos os alunos do 3º Ciclo (465). Os alunos realizaram, também, alguns dos testes de aptidão física da bateria de testes do Fitnessgram, em particular os testes de resistência (vaivém) e de força e resistência abdominal. Todos os alunos que se encontravam com o índice de massa corporal maior ou igual a 24 Kg/m 2 foram referenciados com excesso de peso e encaminhados para o programa de intervenção de exercício físico, denominado PEPA. Este consistiu no acréscimo de uma aula de 45 minutos semanais às duas aulas de Educação Física já existentes no currículo Nacional, perfazendo assim um total de 180 minutos de exercício por semana. Dos 72 alunos referenciados (15,5% da amostra) apenas 14 integraram o programa PEPA de forma regular. Os resultados foram considerados bastante relevantes na melhoria da aptidão física e na diminuição da massa gorda dos alunos em geral. No entanto, no que concerne à variável índice de massa corporal, as alterações não foram tão significativas, uma vez que alguns alunos aumentaram. Os trabalhos práticos desenvolvidos em contexto escolar são bastante úteis e fundamentais para uma maior sensibilização, consciencialização e prevenção da problemática do excesso de peso entre os jovens.

Esta tese é composta por três artigos que veiculam os resultados da realização e análise de uma intervenção de base escolar com o objetivo de reduzir o ganho de peso excessivo em adolescentes. O ensaio, denominado PAPPAS (Pais, Alunos e Professores Pela Alimentação Saudável), foi conduzido com alunos do 5º ano de vinte escolas públicas do município de Duque de Caxias, Rio de Janeiro. As atividades desenvolvidas durante o ano letivo de 2010 desencorajaram o consumo de bebidas adoçadas e biscoitos e estimularam o consumo de feijão e frutas. Pais/ responsáveis e professores receberam informação e material de divulgação sobre os mesmos temas abordados em sala de aula. O consumo de alimentos foi avaliado por meio de um questionário de frequência alimentar aplicado ao início e ao final do estudo. A aferição do peso e da estatura se deu em três momentos: na linha de base, na metade do ano letivo e ao fim do estudo. Para as análises longitudinais, empregou-se modelos generalizados lineares mistos, que levam em conta tanto os dados faltantes quanto o efeito de conglomerado. No primeiro artigo é apresentado o efeito da intervenção no Índice de Massa Corporal (IMC) dos estudantes. Análise por intenção de tratamento revelou que a alteração no IMC dos adolescentes ao longo do tempo não foi estatisticamente diferente entre os grupos intervenção e controle. Observou-se redução estatisticamente significativa no consumo de bebidas adoçadas e biscoitos e aumento no consumo de frutas nos participantes do grupo intervenção quando comparados aos do grupo controle. Pôde-se concluir que estratégias baseadas exclusivamente na qualidade da dieta podem não levar à alterações no peso corporal de adolescentes. No segundo artigo verificou-se a influência do estágio de prontidão para modificação dos hábitos alimentares dos adolescentes na alteração do consumo de refrigerantes, biscoitos e frutas. Observou-se maior alteração no consumo dentre os participantes do grupo intervenção que se encontravam nos estágios de ação na linha de base (relataram já ter alterado seus hábitos alimentares), sugerindo que essa estratégia pode auxiliar em estudos de intervenção visando à alteração do comportamento. O terceiro artigo revisou evidências do ajuste inadequado para características da linha de base, em análises de ensaios randomizados de base escolar que objetivaram alteração no estado nutricional de adolescentes. Foram avaliados 37 estudos e 35% apresentaram desbalanceamento estatisticamente significativo para o IMC na linha de base. Concluiu-se que o ajuste para o IMC na linha de base é frequente em ensaios comunitários randomizados, porém, esta prática força um balanço, que pode levar à resultados espúrios sobre o efeito do tratamento. Os resultados dos artigos 2 e 3 permitem explicar, ao menos em parte, as inconsistências nos resultados de estudos de intervenções voltadas para alteração de hábitos alimentares em escolares.

A presente dissertação aborda a tendência do sobrepeso e obesidade no Brasil e sua relação com a escolaridade entre os anos de 2002 e 2013. Para tal, foram utilizadas três bases de dados oriundas de inquéritos nacionais: Pesquisas de Orçamento Familiar 2002/2003 e 2008/2009 e Pesquisa Nacional de Saúde 2013, totalizando 240.051 adultos de 20-59 anos, após exclusão das gestantes. Esta dissertação foi estruturada em cinco seções: Revisão da literatura, material e métodos, justificativa, objetivos e resultados preliminares, no qual é apresentado, como proposta de produto final, o manuscrito: Trends in obesity prevalence among Brazilian adults according to educational level, 2002 2013. As prevalências de sobrepeso e obesidade foram estimadas por sexo, idade e escolaridade. A idade foi categorizada em dois grupos (20 a 39 anos e 40 a 59 anos) e a escolaridade em quatro: pré-primário, primário, secundário e terciário, seguindo a International Standard Classification of Education. Modelos de regressão logística foram desenvolvidos para avaliar a tendência da prevalência de obesidade e sobrepeso de acordo com o nível de escolaridade, ajustados por sexo e idade. Nas análises, foram levados em conta os pesos amostrais e o desenho de estudo. A prevalência de obesidade passou de 7,5% para 17,0% no período de 2002 a 2013 nos adultos com 20-39 anos e de 14,7% para 25,7% nos de 40-59 anos. Em todos os inquéritos a escolaridade associou-se positivamente com a prevalência de obesidade nos homens, entretanto a associação foi negativa nas mulheres. A maior prevalência de obesidade foi de 35,3% nas mulheres de nível secundário (ensino médio completo ou superior incompleto) e elas foram as que apresentaram o maior incremento na prevalência de obesidade no período de 2008 a 2013 (24,4% para 35,3%). Para ambos os sexos, a chance de se tornar obeso dobrou de 2002 para 2013, para mulheres de 20-39 anos a chance foi de duas vezes e meia. Dessa forma, observou-se que diferenças quanto ao nível de escolaridade e o sexo impactam na prevalência de obesidade no Brasil. Dessa forma, políticas públicas de enfrentamento da obesidade devem levar em conta características sociodemográficas da população.

OBJECTIVE: In an attempt to simplify the screening process for detecting obesity in adolescence, the performance of different cutoff values for body mass index (BMI) was assessed in a population-based cohort in Southern Brazil. METHODS: A total of 493 adolescents aged 15-16 years who lived in the city of Pelotas, Brazil, were studied. Obesity was defined according to the WHO criteria taking into account age and sex (a BMI equal to or greater than the 85th percentile of the NHANES I reference, plus subscapular and triceps skinfold equal to or greater than the 90th percentile of the same reference). Different BMI cutoff values were used to assess their specificity and sensitivity. RESULTS: For boys, BMI >; or = 25 kg/m² showed the best performance for detecting obesity, with a sensitivity of 90% and only 5% of false positives. The Brazilian proposed criteria that was used had 100% sensitivity but up to 23% of false positives. Higher cutoff values were also tested, but there was a slight increase in specificity, accompanied by a marked reduction in sensitivity. CONCLUSIONS: The BMI cutoff of 25 kg/m² presented the best performance for screening obesity in the studied sample, and it is recommended for adolescents aged 15 and more in populations with similar characteristics. It provides a single cutoff value to be used in primary health services, eliminating the need for age and sex-specific values and skinfold measurements, and it is also consistent with the cutoff value proposed to identifying overweight adults.

OBJECTIVE: To evaluate the performance of the ratio between the waist circumference and the height in the identification of health risk compared with the correlation matrix between the anthropometric parameters body mass index and waist circumference. METHODS: A population-based study presenting a transversal cut in a representative sample of the Brazilian adult and older population. The combination of the body mass index with the waist circumference resulted in health risk categories, and the cutoff points of the ratio between the waist circumference and the height as anthropometric indicator were used for classification of low and increased risk. Poisson regression was used to verify the association of systemic arterial hypertension with the health risk categories. RESULTS: The results showed 26% of adult men, 10.4% of adult women and more than 30% of the older adults of both genders classified as without risk by the combination matrix between body mass index and waist circumference presented a ratio between the waist circumference and height that showed increased risk. All risk categories continued to be associated with hypertension after control for confounding factors, being almost two times higher for adults with moderate and high risk according to both methods. When the waist-to-height ratio was used as a risk indicator, the prevalence of hypertension ratios for the older adults was 1.37 (95%CI 1.16–1.63) and 1.35 (95%CI 1.12–1.62) for men and women, respectively, being these values close to the combination matrix body mass index and waist circumference. CONCLUSIONS: The waist-to-height ratio identified more individuals at early health risk than the combination matrix between the body mass index and the waist circumference and showed comparable ability to identify health risk, regardless of gender and age, regarding the prevalence ratios for systemic arterial hypertension.

OBJECTIVE: To generate a new body mass index curve of reference values and ranges for body mass index and weight gain during pregnancy and to compare the new curve and weight gain ranges with the currently used references. METHODS: A prospective observational study was conducted with a total of 5,656 weight and body mass index measurements in 641 women with single pregnancy who attended their first prenatal visit before 12 weeks. All the women were over 18 years old and had no medical conditions that would influence body mass index. Data were collected using prenatal charts and medical records during hospitalization for childbirth. A linear regression method was used for standard curve smoothing in the general population and for specific curves according to the baseline body mass index classification. Curves were obtained for the 5th, 10th, 50th, 85th, 90th and 95th percentiles. Concordance between the classification of women using the newly generated and currently used curves was evaluated by percentages and kappa coefficients. The weight gain was compared with the reference values of the Institute of Medicine using Student’s T test. The data were analyzed using SAS software version 9.2, and the significance level was set at 5%. RESULTS: A general reference curve of percentiles of body mass index by gestational age was established. Additionally, four specific curves were generated according to the four baseline body mass index categories. The new general curve offered percentile limits for women according to their initial body mass index and according to the Centers for Disease Control and Prevention limits, showing poor agreement with the currently used curve (48.3%). Women who were overweight or obese when starting prenatal care had higher weight gain than the Institute of Medicine recommendation. CONCLUSIONS: The new proposed curve for body mass index during pregnancy showed weak agreement with the currently used curve. The new curve provided more information regarding body mass index increase using percentiles for general and specific groups of body mass index. Overweight pregnant women showed an upward body mass index trend throughout pregnancy that increased more dramatically than those of other groups of pregnant women, and they also presented a major mean difference between weight gain and the Institute of Medicine recommendation.

OBJECTIVE Investigate the effect of exposure to smoking during pregnancy and early childhood on changes in the body mass index (BMI) from birth to adolescence.METHODS A population-based cohort of children (0-5 years old) from Cuiabá, Midwest Brazil, was assessed in 1999-2000 (n = 2,405). Between 2009 and 2011, the cohort was re-evaluated. Information about birth weight was obtained from medical records, and exposure to smoking during pregnancy and childhood was assessed at the first interview. Linear mixed effects models were used to estimate the association between exposure to maternal smoking during pregnancy and preschool age, and the body mass index of children at birth, childhood and adolescence.RESULTS Only 11.3% of the mothers reported smoking during pregnancy, but most of them (78.2%) also smoked during early childhood. Among mothers who smoked only during pregnancy (n = 59), 97.7% had smoked only in the first trimester. The changes in body mass index at birth and in childhood were similar for children exposed and those not exposed to maternal smoking. However, from childhood to adolescence the rate of change in the body mass index was higher among those exposed only during pregnancy than among those who were not exposed.CONCLUSIONS Exposure to smoking only during pregnancy, especially in the first trimester, seems to affect changes in the body mass index until adolescence, supporting guidelines that recommend women of childbearing age to stop smoking.