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 4 - Oct/Dec - 2018

Original Article Imprimir 

Páginas 16 a 26


Sexual maturation, physical activity and food consumption: association with the components of metabolic syndrome in adolescents

Maderez sexual, actividad física y consumo alimenticio: asociación con los componentes del síndrome metabólico en adolescentes

Maturação sexual, atividade física e consumo alimentar: associação com os componentes da síndrome metabólica em adolescentes

Autores: Rafael V. Martins1; Priscila Iumi Watanabe2; Michael Pereira da Silva3; Oldemar Mazzardo4; Roseane F. Guimarães5; Rodrigo Bozza6; Wagner de Campos7

1. Master in Physical Education. Member of the Center of Studies in Physical Activity and Health of the Department of Physical Education at the Federal University of Paraná (UFPR). Curitiba, PR, Brazil
2. Master in Physical Education. Member of the Center of Studies in Physical Activity and Health of the Department of Physical Education at the Federal University of Paraná (UFPR). Curitiba, PR, Brazil
3. Doctor in Physical Education. Member of the Center of Studies in Physical Activity and Health at the Federal University of Paraná (UFPR). Professor in the Department of Physical Education at the State University of the Center-West - (UNICENTRO). Guarapuava, PR, Brazil
4. Doctor in Motor Development. Professor in the Department of Physical at the State University of West Paraná (UNIOESTE). Marechal Cândido Rondon, PR, Brazil
5. Doctor in Child and Adolescent Health. Post-doctoral Student. Laboratory of Physical activity and Health. Department of Kinesiology and Physical sciences activity. University of Montreal. Montreal, Québec, Canada
6. Doctor in Physical Education. Professor in the Department of Physical Education at the Positivo University. Curitiba, PR, Brazil
7. Doctor in Motor Development. Headline Professor in the Department of Physical Education at the Federal University of Paraná (UFPR). Curitiba, PR, Brasil

Rafael Vieira Martins
Rua Coração de Maria, 92, Jardim Botânico
Curitiba, PR, Brasil. CEP: 802015-370
(rafa_rvm@yahoo.com.br)

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Keywords: Motor activity, puberty, risk factors, adolescent health.
Palabra Clave: Actividad motriz, pubertad, factores de riesgo, salud del adolescente.
Descritores: Atividade motora, puberdade, fatores de risco, saúde do adolescente.

Abstract:
OBJECTIVE: Investigate the association between sexual maturation, level of physical activity and food intake with the components of metabolic syndrome (SM) in adolescents in the city of Curitiba, Paraná.
METHODS: The study included 960 participants (548 girls) enrolled in the public-school system of Curitiba, Paraná, ages between 12 to 17.9 years. We evaluated the level of physical activity, weight, height, waist circumference (CC), blood pressure (PA) and sexual maturation, as well as blood glucose levels, high density lipoprotein (HDL-C) and triglycerides. The sample analysis was carried out by descriptive statistics, comparisons were evaluated by Fisher's exact test and chi-square test and the odds ratio was obtained by binary logistic regression.
RESULTS: The prevalence of inadequate food intake and insufficient physical activity were 56.1% and 45.4%, respectively. When compared to components of SM, it was observed that 52.3% of participants showed low HDL-C and 15% had high PA values. It was found that the CC was associated with maturation in boys, where post-pubescent showed a protective factor for the altered CC.
CONCLUSION: We observed high prevalence of inappropriate behavior and alteration in the components of SM. In addition, there was an association between CC and sexual maturation in boys.

Resumen:
OBJETIVO: Verificar la asociación entre la madurez sexual, el nivel de actividad física y el consumo alimenticio con los componentes del Síndrome Metabólico (SM) en adolescentes de la ciudad de Curitiba, Paraná.
MÉTODOS: Participaron del estudio 960 estudiantes (548 niñas) matriculados en el sistema público de enseñanza de Curitiba, Paraná, con edades entre 12 y 17,9 años. Se evaluó el nivel de actividad física, peso, estatura, circunferencia de cintura (CC), presión arterial (PA) y la madurez sexual, así como los valores de glucemia, lipoproteína de alta densidad (HDL-c) y triglicéridos. El análisis de la muestra se realizó mediante estadísticas descriptivas, las comparaciones se evaluaron mediante el Test Exacto de Fisher y Test Chi-Cuadrado y la razón de probabilidades se obtuvo por regresión logística binaria.
RESULTADOS: Las prevalencias de consumo alimenticio inadecuado y de práctica insuficiente de actividad física fueron 56,1% y 45,4%, respectivamente. En relación a los componentes de la SM, se observó que el 52,3% de los participantes presentó bajo nivel de HDL-C y el 15% estaban con altos valores de PA. Se verificó que la CC estuvo asociada a la madurez en los niños, donde los post-púberes presentaron un factor de protección para la CC alterada.
CONCLUSIÓN: Se observaron altas prevalencias de comportamientos inadecuados y de alteraciones en los componentes de la SM. Además, hubo una asociación entre la CC y la madurez sexual en los niños.

Resumo:
OBJETIVO: Verificar a associação entre a maturação sexual, o nível de atividade física e o consumo alimentar com os componentes da Síndrome Metabólica (SM) em adolescentes da cidade de Curitiba, Paraná.
MÉTODOS: Participaram do estudo 960 estudantes (548 meninas) matriculados no sistema público de ensino de Curitiba, Paraná, com idades entre 12 e 17,9 anos. Foram avaliados o nível de atividade física, peso, estatura, circunferência de cintura (CC), pressão arterial (PA) e a maturação sexual, bem como foram obtidos valores de glicemia, lipoproteína de alta densidade (HDL-c) e triglicerídeos. A análise da amostra foi realizada pela estatística descritiva, as comparações foram avaliadas pelo Teste Exato de Fisher e Teste do Qui-quadrado e a razão de chance foi obtida pela regressão logística binária.
RESULTADOS: As prevalências de consumo alimentar inadequado e de prática insuficiente de atividade física foram 56,1% e 45,4%, respectivamente. Em relação aos componentes da SM, observou-se que 52,3% dos participantes apresentaram baixo nível de HDL-C e 15% estavam com altos valores de PA. Verificou-se que a CC esteve associada à maturação nos meninos, onde os pós-púberes apresentaram um fator de proteção para a CC alterada.
CONCLUSÃO: Observaram-se altas prevalências de comportamentos inadequados e de alterações nos componentes da SM. Além disto, houve uma associação entre a CC e a maturação sexual nos meninos.

INTRODUCTION

Adolescence is characterized by various physiological and psychosocial transformations. In addition, the behaviors acquired in this phase tend to extend to adulthood, which increases the importance of research on the factors related to health in this population1.

The metabolic syndrome (MS) is defined as the aggregation of metabolic risk factors for developing cardiovascular disease and is commonly diagnostic of the existence of at least three of the following factors: high distribution of abdominal fat, hypertriglyceridemia, low concentrations of plasma high density lipoprotein (HDL-C), hypertension and glucose or fasted high2 However, in children and adolescents, S M is not completely understood, as there is a lack of consensus regarding the factors associated with the etiology of this group3. This inconsistency is explained in the literature by several hormonal changes that occur in this stage derived from the maturity process, and that lead to changes in body composition. This change in body composition is mainly characterized by an increase in body fat in girls and an increase in muscle mass in children4. By On the other hand, there is evidence that there are behaviors that help in the prevention of cardiovascular diseases, such as regular physical activity and maintaining adequate eating habits5.

Despite the above information, there are few studies that investigate at the same time the relationship between the maturity and behavioral conditions, including the level of physical activity (LPA) and eating habits with changes in the components of MS in adolescents.

The objective of this study was to investigate the association between sexual maturity, level of physical activity and dietary intake with the components of MS in adolescents, of both sexes, belonging to the public education network of the city of Curitiba-Paraná.


MATERIAL AND METHODS

Sample

The present study has a design of correlation transversal and descriptive. The sample was constituted by adolescents of both sexes with ages between 12 and 17.9 years, enrolled in public schools located in the central region of Curitiba, Paraná. To participate in the study the adolescent should be enrolled in a public institution of education in Curitiba, be between 12 and 17.9 years old, obtain consent from the parents / guardians, sign the term of With free and enlightened feeling, not be a diabetic of the type 1 or any other recognized pathology that affects lipid profile results. They were excluded from the sample with a wide variation in blood pressure and school values who refused to participate or who submitted questionnaires filled out incorrectly.

Calculation of the statistical power of the sample was made after the logistic regression, using the GPower program.

Instruments and procedures

Height was measured with a portable stadiometer, and body mass (MC) with a digital scale. From the values of height and body mass the body mass index (BMI) was calculated, following the classification of Conde and Monteiro6. Circumference of the waist ( CC ) was obtained by a flexible tape of anthropometric values and the values of CC ≥ 90 percentile for each age and sex, were classified as abdominal obesity7. All measurements were conducted twice and in case of divergence of more than 0.1 cm or 0.1 kg, including the procedure was repeated8.

The Blood Pressure (BP) measurements were performed by auscultation using a blood pressure cuff aneroid and a stethoscope. The measurement of BP was made in the right arm, with the schoolchild sitting, after at least 5 minutes at rest. These measurements were made by a single examiner in order to avoid disagreement among the qualifiers. In the case of elevated BP, another evaluation was made the following week, for confirmation of the value. It was considered normotensive the BPS and/or BPD<90th percentile and as BP high values of BPS and/or BPD ≥ 90th percentile for each age, sex and height percentile9.

The physical activity level (PAL) was obtained using the International Physical Activity Questionnaire (IPAQ) version-8 in its short form10. The participants were classified as insufficiently active (<300 min of moderate-vigorous intensity physical activity per week) and active enough (≥ 300 min of moderate-vigorous intensity physical activity per week)11.

The consumption of foods associated with the risk of coronary heart disease was assessed through the Simplified Questionnaire for the evaluation of cardiovascular risk12 From the frequency of consumption or It was carried out the sum of the scores corresponding to the food consumed in that values ≤ 100 were considered adequate and the values > 10012 consider altered.

Sexual maturity is assessed by self-evaluation of development of pubic hair, according to the criteria proposed by Tanner13. The stages of maturity they are divided into five, being the first stage corresponding to childhood (pre-puberty), the last stage to the adult stage (post-puberty) and the intermediaries to a puberty14,15. In the present study, only puberty (stages 2, 3 and 4) and post-puberty adolescents (stage 5) were considered.

The economic situation was evaluated according to the Economic Classification Criteria proposed by the Brazilian Association of Research - ABEP16. In this study, the economic levels were grouped into three categories: high (A1, A2, B1 and B2), middle (C and D) and low (E)17.

Biochemical Analyses

For blood collection participants were instructed to maintain fasting for at least 12 hours, prevent overeating and practice of vigorous physical activity and one day before the collection18. The enzymatic colorimetric automated method was used for the analysis of HDL-C and TG concentrations, and 80 automated methods Humanstar for glycemia.

The MS was defined by the proposal adapted to children and adolescents NCEP-ATP III/19 characterized by the presence of three or more of the following criteria: glycemia in fasting or ≥ 110 mg/dl; ≥ triglycerides 110 mg/dl; ≤ HDL-C40 mg/dl; circumference of the waist ≥ 90th percentile for age and sex; systolic and/or diastolic ³ 90th percentile for age, sex and height percentile19.

Statistic analysis

The data was described by the simple and relative frequency distribution. Comparisons between proportions were made using the Fisher's Exact test and the Chi-Square test. The binary logistic regression was used to verify the reason of opportunity of the adolescents post-puberty, insufficiently active, and with the inadequate nutritional consumption present changes in the components of the MS, adjusted by the economic level and BMI. The analyze were performed using the Statistical Package for the Social Sciences (SPSS), version 20.0, adopting a level of significance of 5%.

Ethical considerations

The present study received the approval of the ethics committee of the Federal University of Paraná under number 433.568 CAAE: 03934712.9.0000.0102.


RESULTS

In the study participated 960 school children, which 548 were female. For children, the sample of 412 participants had power of 0.89 to identify reasons of possibilities equal to or less than 0.36 and 0.82 to verify reasons of possibilities equal to or greater than 2.0 with a confidence level of 95 %. For girls, the sample of 412 participants had power of 0.81 to identify odds ratios equal to or less than 0.48 and 0.80 to verify odds ratios equal to or greater than 1.8 with 95 % confidence level .Table 1 shows the frequency distributions for each sex, according to the classification of the components of the MS, food consumption, PAL and BMI.




Table 2 shows the comparison between the levels of physical activity, eating behavior and sexual maturity with the components of MS in the male sex. The results indicate that sufficiently active children showed a higher proportion of altered CC compared to insufficiently active children (p <0.05). In the same way, the group with adequate nutritional behavior obtained a higher proportion of elevated BP compared to those who maintained an inadequate diet (p <0.05). Comparisons between the proportions of puberty and post-puberty children didn´t show significant differences in any of the components of the MS.




Regarding the girls (table 3) no statistically significant differences were observed in terms of the comparison of the level of physical activity, food consumption and sexual maturity with the components of the MS.




Table 4 shows the results of the multivariate regression analysis for both sexes. In children, a factor of protection for altered CC was verified among those classified as post-puberty. The results of the girls did not point to significant associations. It is worth mentioning that the withdrawal of the glycemia data from these analyzes was due to the lack of occurrence of this alteration in the sample of the present study.




DISCUSSION

In the present study the prevalence of MS was 2.8%, a result that resembles some findings of national and international studies in which the prevalence was 3.4%20 and 2.6%21 ( Viçosa, Brazil, Kuala Lumpur and Malaysia, respectively), but deviates from others that have a higher prevalence of 6.7% 3 ( Paraná, Brazil )22 and 19.6% ( Cuernava and Toluca in Mexico). These variations can occur due to the lack of consensus in the definition of SM23. However, it is clear that it is extremely important investigate this pathology due to the risks that it entails for the health of the people24.

In addition to this, the prevalence of insufficiently active individuals (45.4%), with inadequate food consumption (56.1%) and com alterations in the levels of HDL-c (52.3%) and BP (15.4%) found in the sample, given that such factors carry risks for the development of cardiovascular diseases25.

The young people in the sufficiently active group of the present study had CC values more altered than the others. This result contrasts with other studies in which physical activity was inversely associated with CC, both for boys and girls26 and that each additional hour of daily physical activity of moderate to vigorous intensity was associated with a reduction of 5.49 % in CC26. This can be explained by the possible fact that the sufficiently active group with altered CC has started the practice of exercise recently, so there was no working time for the reduction of waist measurements.

In a similar way, BP was associated with feeding behavior, being that the proportion of children classified with high BP was greater in those who maintained an adequate diet. This result contrasts with the study by Hoffmann et al.27 that an inverse relationship was observed between the BP and the frequency of consumption of certain foods (eggs, margarine, sausages, prepared sauce and instant noodles) in adolescents from Caxias do Sul-RS. In this sense, it should be noted that the instrument used in the present study to evaluate the nutritional behavior includes foods with a high content of fat and not specifically the consumption of sodium in the diet. This limitation may have interfered with the results seen evidence s point out that this ethical dietary component is associated with the increase in PA28

According to the result of the regression (adjusted for socioeconomic status and BMI), there was an association between maturity and CC in children, with post-puberty presenting a protective factor for alteration in CC. This protection factor can be explained by the increase in muscle mass and the decrease in subcutaneous fat due to the progress of the stages of maturity in the male sex29.

Among the limitations of this study are the use of a self-reported questionnaire to obtain the PAL, since such an instrument depends on the recall capacity of the participants, as well as the use of a nutritional questionnaire based on foods with a high content of fat and, not sodium, which may have made it difficult to verify the relationship between food consumption and BP. Another important limitation present in this study refers to a low power sample displayed for both sexes, limiting the identification of more significant associations.

However, the present study stands out for simultaneously investigating the relationship of behavioral and biological aspects with MS in adolescence, an aspect that has not been observed in the literature. In addition, the severity of BP collection is highlighted, where a second visit was made to confirm the values of altered BP.


CONCLUSION

In general, the present study found high prevalence of inadequate feeding behaviors, practice of AF and alterations in the components of MS (BP, TG and HDL-c and CC). In addition, a protective factor for alterations in CC was found in post-puberty children.

Given these findings, it is concluded that interventions are needed to encourage the regular practice of BP and healthy diet, in order to prevent the development of MS in adolescents, as well as the implementation of longitudinal studies on the subject for a better understanding of the effects of maturity and behaviors on the components of MS in this population .


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