Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 15 nº 2 - Apr/Jun - 2018

Original Article Imprimir 

Páginas 56 a 64


Diet and risk factors for cardiovascular disease in scholar adolescents: cross-sectional study

Dieta y factores de riesgo para enfermedad cardiovascular en escolares adolescentes: estudio transversal

Dieta e fatores de risco para doença cardiovascular em escolares adolescentes: estudo transversal

Autores: Dandara Milena Gomes dos Santos1; Simone Augusta Ribas2

1. Resident Nutritionist of the Gaffrée Guinle University Hospital (UNIRIO). Rio de Janeiro, RJ, Brazil. Graduation in Nutrition by the Castelo Branco University (UCB-RJ). Rio de Janeiro, RJ, Brazil
2. Assistant Professor in the Department of Nutrition in Public Health - Rio de Janeiro Federal University (UNIRIO). Rio de Janeiro, RJ, Brazil

Dandara Milena Gomes dos Santos
Rua Vaz de Toledo, nº 144, apto 404, Engenho Novo
Rio de Janeiro, RJ, Brasil. CEP: 20.780-150
(dandaramilena@hotmail.com)

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Keywords: Adolescent, cardiovascular diseases, risk factors.
Palabra Clave: Adolescente, factores de riesgo, enfermedades cardiovasculares.
Descritores: Adolescente, fatores de risco, doenças cardiovasculares.

Abstract:
OBJECTIVE: Investigate the quality of diet and its relation with risk factors for cardiovascular disease in adolescent students in a public school.
METHODS: A descriptive, prospective and cross - sectional study included 100 students with ages between 14 to 18 years old, of both sexes, enrolled in a public school system located in the city of Rio de Janeiro. The investigated outcomes were: insufficient levels of physical activity, inadequate eating habits, high blood pressure, alcoholism, excess body weight and smoking.
RESULTS: It was found that 31% of the students were overweight, 65% were inactive, 32% had systolic blood pressure and 15% had diastolic alterations. Regarding the dietary profile, there was a high protein intake (19.4% of the total energetic value) and sodium (4917 mg / day). The inverse was observed in relation to cardioprotective nutrients, in which the consumption was below the daily dietary recommendation: calcium (239.4mg), fibers (13.4g) and monounsaturated fats (6.5%). In addition, it was found that overweight adolescents presented the highest percentages of dietary inadequacies regarding lipids intake (p = 0.03) and calcium (p = 0.03) when compared to eutrophic adolescents.
CONCLUSION: These findings reinforce that risk factors are increasingly present in children and adolescents, intensifying the necessity to implement health actions directed at the early ages.

Resumen:
OBJETIVO: Investigar la calidad de la dieta y su relación con factores de riesgo para enfermedad cardiovascular en estudiantes adolescentes en una escuela de la red pública.
MÉTODOS: Participaron en este estudio descriptivo, prospectivo y transversal, 100 escolares, con edades entre 14 y 18 años, de ambos sexos, matriculados en una escuela de la red de enseñanza pública situada en la ciudad de Río de Janeiro. Los resultados investigados fueron: niveles insuficientes de actividad física, hábitos alimenticios inadecuados, presión arterial elevada, etilismo, exceso de peso corporal y tabaquismo.
RESULTADOS: Se constató que del total de la muestra investigada, el 31% de los estudiantes tenía sobrepeso, el 65% era inactivo y el 32% presentó una presión arterial sistólica y un 15% diastólica alterada. En cuanto al perfil dietético, se verificó un elevado consumo de proteína (19,4% del valor energético total) y de sodio (4917mg / día). El inverso fue observado en relación a los nutrientes cardio-protectores, en el cual el consumo estuvo por debajo de la recomendación dietética diaria preconizada: calcio (239,4mg), fibras (13,4 g) y grasas mono-insaturadas (6,5%). Además, se verificó que los adolescentes con sobrepeso fueron los que presentaron mayores porcentajes de alimentación inadecuada en la ingestión de lípidos (p = 0,03) y de calcio (p = 0,03) en comparación con los adolescentes eutróficos.
CONCLUSIÓN: Tales hallazgos refuerzan que los factores de riesgo están cada vez más presentes en niños y adolescentes, intensificando la necesidad de la implantación de acciones de salud dirigidas hacia las edades tempranas.

Resumo:
OBJETIVO: Investigar a qualidade da dieta e sua relação com fatores de risco para doença cardiovascular em estudantes adolescentes em uma escola da rede pública.
MÉTODOS: Participaram deste estudo descritivo, prospectivo e transversal, 100 escolares, com idade entre 14 e 18 anos, de ambos os sexos, matriculados em uma escola da rede de ensino pública situada na cidade do Rio de Janeiro. Os desfechos investigados foram: níveis insuficientes de atividade física, hábitos alimentares inadequados, pressão arterial elevada, etilismo, excesso de peso corporal e tabagismo.
RESULTADOS: Constatou-se que do total da amostra investigada, 31% dos estudantes tinham excesso de peso, 65% eram inativos e 32% apresentaram pressão arterial sistólica e 15% diastólica alterada. Quanto ao perfil dietético, verificou-se um elevado consumo de proteína (19,4% do valor energético total) e de sódio (4917mg/dia). O inverso foi observado em relação aos nutrientes cardioprotetores, no qual o consumo esteve abaixo da recomendação dietética diária preconizada: cálcio (239,4mg), fibras (13,4g) e gorduras monoinsaturadas (6,5%). Ademais, verificou-se que os adolescentes com excesso de peso foram os que apresentaram maiores percentuais de inadequações alimentares na ingestão de lipídios (p=0,03) e de cálcio (p=0,03) quando comparado aos adolescentes eutróficos.
CONCLUSÃO: Tais achados reforçam que os fatores de risco estão cada vez mais presentes em crianças e adolescentes, intensificando a necessidade da implantação de ações de saúde direcionadas para as idades precoces.

INTRODUCTION

Cardiovascular diseases (CVD) are considered the main causes of death in Brazil, where 4.2% of the population (6.1 million people) aged 18 years or over were diagnosed with heart disease in 20131. Although most clinical manifestations appear in adulthood, it was found that overweight, sedentary lifestyle, poor diet, alcohol and tobacco use are risk factors (RF) that are manifesting increasingly early in childhood and adolescence2 in our country, due to changes in the lifestyle and eating habits of the population.

The current nutritional scenario contributes to the epidemic of obesity and other chronic diseases that already reach all age groups, including adolescents. Excessive consumption of ultra-processed foods, high in fat, sodium and simple sugars, omission or replacement of (fast foods), low consumption of natural foods (fruits and vegetables) and culinary preparations that value regional aspects are a few examples of this scenario3. Globalization, urbanization and lack of control in commercial food advertising may be contributing to accelerate this process.

In addition to diet, other RF as sedentary lifestyle and inadequate lifestyle are increasingly present in children's public. Data from the National School Health Survey4 (PeNSE) conducted in 2015 revealed that approximately 60.8% of adolescents were classified as insufficiently active and 4.8% as inactive, associated mainly with the increase in passive leisure time (number of hours spent in facing the television and internet). In relation to inappropriate habits, 19.6% have tried cigarettes and 26.1% have made or made use of alcoholic beverages5.

From the above, it is noticed that the pediatric population is already at risk of developing pluri-metabolic syndrome (obesity, hypertension, diabetes mellitus and dyslipidemia) and cardiovascular disease, emphasizing the importance of early diagnosis and prevention strategies2. Thus, this study aimed to evaluate the quality of diet and the prevalence of risk factors for cardiovascular disease in adolescent students.


METHODS

It is a descriptive, cross-sectional and prospective study whose population base consisted of 100 adolescents (14-18 years old), of both sexes, enrolled in a public school located in the city of Rio de Janeiro. Participants in the present study were only those students whose parents or guardians over the age of 18 signed the Informed Consent Form (TCLE) and the Term of Consent. The present study was approved by the Research Ethics Committee of the Oswaldo Cruz Foundation (Opinion no. 1,610,816).

The research was performed through a standardized protocol with open and closed questions in which the following information was collected from the participants: anthropometric, dietary, socioeconomic, social and blood pressure data.

To evaluate the nutritional status of adolescents, weight (kg), height (m) and waist circumference (cm) were measured. From these data the anthropometric indices were calculated: Body Mass Index (BMI = Weight/Height2) by age (BMI/I) and height by age (E/I). The classification of the nutritional status followed the classification recommended by the Food and Nutrition Surveillance System (SISVAN) 5, a reference adopted by the World Health Organization 2007. The cutoff point of the 90th percentile was used to classify waist circumference (WC)6.

The qualitative and quantitative data on the adolescent's eating behavior were evaluated through the 24-hour recall, in which the consumption of macronutrients, micronutrients, fractions of total fat and fibers was calculated with the aid of the Avanutri Revolution® program. The assessment of the adequacy of macronutrients and micronutrients were performed according to dietary reference intake (DRI). A food frequency questionnaire with sodium-rich foods (QFARS) based on the study of Manfroi (2009)7 was used to analyze normal sodium intake, in which it is composed of 26 food items and the frequency can be described as 0 a 10 times and with the unit of time varying in day, week, month and year.

The students' lifestyle assessment was based on information obtained regarding physical activity, sedentary habits, family history, smoking and alcohol consumption. It was classified as sufficiently active that exercised physical activity over 300 minutes per week8. In relation to passive leisure habits (hours before TV, computer and video clips), it was considered as sedentary risk behavior when the time was greater or equal to 4 hours/day9. Regarding the cigarette, the students were asked if the smoking habit is present, if it was interrupted or if there was only experimentation. And they were also discussed about alcohol intake, their amount and frequency.

When measuring blood pressure levels, the adolescent had blood pressure below the 90th percentile, borderline when the values were between the 90th and 95th percentiles, and hypertensive when the value was equal to or greater than the 9510th percentile.

All analyzes were performed in SPSS version 22.0. Descriptive analyzes included calculations of ratios, mean and standard deviation (SD). The chi-square test was used to compare the prevalence of cardiovascular risk factors by gender or nutritional status.


RESULTS

The initial sample of the study was 126 adolescent; after recruitment there were dropouts and/or refusals (n=26;3.2%), totaling 100 adolescents with a mean age of 16.9 ± years for final data analysis.

According to Table 1, it can be seen that most of the participants were male, of the brown race, of low socioeconomic status, sedentary and presented at least one FR in the family history (FH) for CVD. It was found that the majority of HF was positive for hypertension (29%), diabetes (20%) and obesity (9%). Regarding lifestyle, it was observed that the experimentation of alcoholic beverages (p=0.04) and tobacco (p=0.04) among adolescents was more prevalent among females.




When evaluating by gender, it was observed that females had a higher percentage of physical inactivity, excess weight and waist circumference when compared to males (Table 2). And although 60% of the investigated population had passive leisure above the recommended (>4 hours per day), there was no difference between the sexes. As for blood pressure, 32% of the adolescents investigated showed changes in systolic pressure levels, being more prevalent in females (p=0.03) (Table 3).






When investigating the risk of developing metabolic syndrome (MS) among the participants, it was observed that 3% of adolescents presented concomitant factors such as: excess abdominal fat and high blood pressure.

As for the eating behavior of the participants, the presence of inappropriate eating habits was observed both qualitatively and quantitatively.

Among the dietary items investigated, the students had a high average protein intake (1.7g/kg/day), a low fiber intake (<20g/day) and calcium intake (<1000mg/day) in both the sexes. In addition, the median habitual consumption of sodium among adolescents was 1730.9 mg. It is important to highlight that adolescents reported weekly frequency of consumption of industrial spices (70%), instant noodles (79%) and refrigerants (95%). It was also observed the low consumption of fruits, vegetables and vegetables, contributing to the presented dietary profile. As for the lipid profile of the diet, it was verified that 27.2% of the adolescents presented dietary cholesterol consumption higher than 300mg / day, and a low consumption of monounsaturated fat (80%), being more prevalent among boys (p=0,01).

When comparing dietary intake among eutrophic and overweight adolescents, it was observed that there was only statistical difference regarding the percentage of carbohydrate obtained from the total caloric value of the diet (p=0.03) (Table 4). When analyzing the consumption among the genders, it was found that boys had higher energy consumption (p = 0.01), lipid (p=0.01), iron (p<0.01) and zinc (p=0,03).




As for micronutrient intake, inadequacies were also observed in the investigated population. The mean daily intake of calcium and potassium was only 335.16 mg and 1369 mg, respectively, demonstrating that almost all (99%) of the adolescents had consumption of these micronutrients below the daily recommendation recommended by age group, with no statistical difference between the sexes. Although the mean evaluation of sodium intake by means of the 24-hour recall is within the recommended range (2300mg), it is worth pointing out that 25% of the participants had their consumption above the RDI, mainly males. In addition, when assessing habitual consumption of sodium by QFARS, it was found that this high intake was even more significant in both sexes, but with a higher prevalence among boys (4917mg/day), practically twice the tolerable level of (2500mg), of which 12% had associated high blood pressure levels.

When verifying the relationship between dietary items and the nutritional status presented by adolescents, it was observed that the students with the highest BMI Z score were those who had lower caloric intake (r=-0.25, p=0.02) and carbohydrate (r=-0.27, p=0.01). The adolescents who had higher consumption of dietary cholesterol had the highest values of systolic blood pressure (r=0.3, p=0.01).


DISCUSSION

Our results revealed that almost half of the adolescents presented some FR positive for CVD, being the most prevalent in the sample: obesity, physical inactivity, altered diastolic pressure and high dietary sodium intake, a nutritional scenario increasingly present in other regions of Brazil. country11. In a recent editorial, Schieri and Cardoso (2016)12 reported that the increase in cases of hypertension in young people stems mainly from an increase in excess weight, which can be independently associated with physical inactivity, increasing sodium intake, sugar and an inadequate lifestyle.

Among the aforementioned RF, we highlight the prevalence of overweight (31%), fat in the central region (14%) and undesirable pressure levels (32%). Despite this nutritional picture, only 3% of the sample had a MS. Data previously published in the literature reported prevalence rates of MS between 2% and 9% among adolescents13 consistent with our findings. In Brazil, there are still few studies investigating the prevalence of MS in representative samples of adolescents. Most suggest that the etiology of MS in young individuals is linked to overweight and abdominal obesity, usually related to sedentary lifestyle and atherogenic diet14.

As for physical activity, more than half of the participants were sedentary and had passive hours of leisure time above the recommended time, despite the percentage found to be lower than that of other studies4,15. As already mentioned in another publication, although the practice of regular physical activity brings countless benefits such as blood pressure, blood glucose and cholesterol levels, it is still little experienced in this public, especially in females14. The rise of the use of virtual electronic games against active leisure (jumping rope, elastic and cycling) can be pointed out as one of the main factors of physical inactivity in adolescence.

Regarding the eating behavior, the same situation revealed years ago in several epidemiological studies4,16, a preponderant consumption of ultra-processed foods compared to in natura foods, which contribute positively to the development of coronary diseases. The consumption of fried foods, salty snacks and sausages was also frequently reported by the majority of young people, as well as the low consumption of fruits, vegetables and vegetables, which may have contributed to high blood pressure levels, also observed by Schommer et al. (2014)]17, in which he made the same assessment.

The reduced consumption of fiber, fruits and vegetables among Brazilian adolescents is frequently observed in national studies. The PeNSE4 of 2015 revealed that among adolescents only 32.7% consume fresh fruits and 37.7% consume vegetables in five days or more in the week.

While on the one hand our adolescents presented low fiber intake, on the other hand high protein intake was observed, due to the consumption of meat and dairy products, not milk, since 99% of the participants had insufficient calcium intake. It is suggested that this fact may be related to the substitution of foods such as milk and dairy products for soft drinks and sugary drinks in the daily life of adolescents18.

Another highlight in the still diet-related study was the mean of sodium intake being double the recommendation of maximum tolerable intake (UL), a result similar to that found by Peter et al. (2009)19. This excessive intake of sodium may be related to poor eating habits presented by schoolchildren, characterized by high consumption of food source of this mineral as snacks, fast foods, barbecue meats, seasoned spices, soft drinks and instant noodles. A high sodium diet may influence the development of alterations in renal function and arterial hypertension, as observed in this study, in which the association of altered blood pressure levels with excessive sodium intake was observed in 12% of adolescents. The potential of the study is the evaluation of the intake of this micronutrient by two types of dietary inquiries. The QFRAS evaluation revealed that habitual sodium intake was even higher when compared to the 24-hour recall, demonstrating that this dietary survey may underestimate the results, since it only evaluates day-to-day consumption.

The relationship between diet and nutritional status and blood pressure suggests that adolescents who were overweight should be more motivated to change their eating habits and lifestyle in order to reach the appropriate weight for their age group, intake of carbohydrates and calories compared to eutrophic. The consumption of foods with high lipid content and cholesterol may have contributed to a change in systolic blood pressure.

As for lifestyle, the use of alcohol and tobacco usually starts at early ages and can be extended throughout life. This is a worrying picture since the evidence is increasing that the consumption of alcoholic beverages and the use of cigarettes are associated with greater accumulation of visceral and total fat, consequently increasing the risk of MS and type 2 diabetes as an adult20. Results close to the current study was reinforced by PeNSE4 (2015) for cigarette experimentation (18.6%), and approximately three times as many adolescents who consumed alcoholic beverages (55.5%), as seen by Silva (2009)9.

One limitation presented in this study is related to the small sample size. However, this research is important since it evaluated the various risk factors commonly seen among adolescents and related to CVD.


CONCLUSION

It can be concluded that our adolescents are increasingly exposed to cardiovascular diseases, reinforcing the importance of public health policies in primary care that promote changes in eating habits and lifestyle before the development of chronic diseases in adult life.


REFERENCES

1. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde 2013. Percepção do estado de saúde, estilos de vida e doenças crônicas. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2014.

2. Ribas AS, Silva LCS. Dislipidemia e fatores de risco cardiovascular na população pediátrica brasileira. Salud Ciencia 2014; 20:404-412.

3. Ministério da saúde. Departamento de Atenção Básica. Guia alimentar para a população brasileira - 2. ed. Brasília: Ministério da saúde; 2014.

4. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde do Escolar 2015. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2016.

5. Ministério da saúde. Orientações para a coleta e análise de dados antropométricos em serviços de saúde. Norma Técnica do Sistema de Vigilância Alimentar e Nutricional (SISVAN). Brasília: Ministério da saúde; 2011.

6. Freedman DS, Serdula MK, Srinivasan SR, Berenson GS. Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa heart study. Am J Clin Nutr. 1999; 69 (2):308-17.

7. Manfroi GF, Santos RS, Teixeira AS, Feoli AMP, Silva VL. Consumo de sódio em usuários com Síndrome Metabólica de uma Unidade de Saúde. Revista da Graduação 2009; 2(2):1983-1374.

8. WORLD HEALTH ORGANIZATION (OMS). Physical activity. Acesso em 2015, novembro. Disponível em: http://www.who.int/mediacentre/factsheets/fs385/en/

9. Silva KS, Nahas MV, Peres KG, Lopes AS. Fatores associados à atividade física, comportamento sedentário e participação na Educação Física em estudantes do Ensino Médio em Santa Catarina, Brasil. Cad. Saúde Pública 2009; 25(10): 2187-2200.

10. V Diretrizes Brasileiras de Hipertensão Arterial. Arq Bras Cardiol 2007; 89(3): e24-e79.

11. Pereira PF, Serrano HMS, Carvalho GQ, Lamounier JA, Peluzio MCG, Franceschini SCC et al. Circunferência da cintura como indicador de gordura corporal e alterações metabólicas em adolescentes: comparação entre quatro referências. RevAssocMedBras 2010; 56(6): 665-669.

12. Schieri R, Cardoso MA. ERICA: Estudo dos Riscos Cardiovasculares em Adolescentes. Rev Saúde Pública 2016; 50(supl 1):1s.

13. Neto AS, Bozza R, Ulbrich A, Mascarenhas LPG, Boguszewski MCS, Campos W. Síndrome metabólica em adolescentes de diferentes estados nutricionais. Arq Bras Endocrinol Metab 2012; 56(2): 104-109

14. Ribas AS, Silva LCS. Fatores de risco cardiovascular e fatores associados em escolares do Município de Belém, Pará, Brasil. Cad. Saúde Pública 2014;30(3): 577-586.

15. Fermino RC, Rech CR, Hino AAF, Rodriguez ACR, Reis RS. Atividade física e fatores associados em adolescentes do ensino médio de Curitiba, Brasil. Rev Saúde Pública 2010; 44(6): 986-995.

16. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde do escolar - PENSE 2012. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2013.

17. Schommer VA, Barbiero SM, Cesa CC, Oliveira R, Silva AD, Pellanda LC. Excesso de Peso, Variáveis Antropométricas e Pressão Arterial em Escolares de 10 a 18 Anos. Arq Bras Cardiol 2014; 102(4): 312-318.

18. Veiga GV, Costa RS, Araújo MC, Souza AM, Bezerra IN, Barbosa FS et al . Inadequação do consumo de nutrientes entre adolescentes brasileiros. Rev Saúde Pública 2013; 47(Suppl 1): 212s-221s.

19. Peters BSE, Roque JP, Fisberg M, Martini LA. Metabólitos séricos da vitamina D não se correlacionam com pressão arterial em adolescentes. Arq Bras Endocrinol Metab 2009; 53(4): 416-424.

20. Batista ES, Campos TN, Valente FX, Priore SE, Franceschini SCC, Sabarense CM, Peluzio MCG. Revista Brasileira de Cancerologia 2011; 57(3): 355-363.
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