Author
Denise Tavares Giannini
Bio: Denise Tavares Giannini is an academic researcher from Rio de Janeiro State University. The author has contributed to research in topics: Metabolic syndrome & Vitamin D and neurology. The author has an hindex of 8, co-authored 25 publications receiving 427 citations.
Papers
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Federal University of Rio de Janeiro1, Oswaldo Cruz Foundation2, Rio de Janeiro State University3, Universidade Federal do Rio Grande do Sul4, Brazilian Institute of Geography and Statistics5, Federal University of Pará6, University of São Paulo7, State University of Feira de Santana8, Universidade Federal de Minas Gerais9, Universidade Federal do Amapá10, Federal University of Amazonas11, Universidade Federal do Espírito Santo12, Universidade Federal de Santa Catarina13, Federal University of Rio Grande do Norte14, Universidade Federal de Mato Grosso15, Federal University of Bahia16, Pontifícia Universidade Católica do Paraná17, Federal University of Pernambuco18, University of Brasília19, Universidade Federal de Rondônia20, State University of Campinas21, Federal University of Piauí22, Universidade Federal de Goiás23, Federal University of Maranhão24, Federal University of Ceará25, Universidade Federal de Sergipe26, Federal University of Paraíba27, Federal University of Alagoas28, Sao Paulo State University29
TL;DR: The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5 and the fractions of hypertension attributable to obesity in the population by 17.8%.
Abstract: 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.
147 citations
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Federal University of Rio de Janeiro1, Rio de Janeiro State University2, Oswaldo Cruz Foundation3, Brazilian Institute of Geography and Statistics4, Sao Paulo State University5, Federal University of Pará6, Universidade Federal de Goiás7, State University of Feira de Santana8, Universidade Federal do Rio Grande do Sul9, Federal University of Amazonas10, Universidade Federal de Minas Gerais11, Universidade Federal do Amapá12, Universidade Federal do Espírito Santo13, University of São Paulo14, Universidade Federal de Santa Catarina15, Federal University of Rio Grande do Norte16, Universidade Federal de Mato Grosso17, State University of Campinas18, Federal University of Bahia19, Pontifícia Universidade Católica do Paraná20, Federal University of Pernambuco21, University of Brasília22, Universidade Federal de Rondônia23, Federal University of Piauí24, Universidade Federal do Acre25, Federal University of Maranhão26, Federal University of Ceará27, Universidade Federal de Sergipe28, Federal University of Paraíba29, Federal University of Alagoas30, Federal University of Roraima31
TL;DR: The 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.
Abstract: The 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.
143 citations
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TL;DR: The diets of Brazilian adolescents were characterized by the intake of traditional Brazilian food, such as rice and beans, as well as by high intake of sugar through sweetened beverages and processed foods, associated with an excessive intake of sodium, saturated fatty acids and free sugar.
Abstract: OBJECTIVE To describe food and macronutrient intake profile and estimate the prevalence of inadequate micronutrient intake of Brazilian adolescents. METHODS Data from 71,791 adolescents aged from 12 to 17 years were evaluated in the 2013-2014 Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). Food intake was estimated using 24-hour dietary recall (24-HDR). A second 24-HDR was collected in a subsample of the adolescents to estimate within-person variability and calculate the usual individual intake. The prevalence of food/food group intake reported by the adolescents was also estimated. For sodium, the prevalence of inadequate intake was estimated based on the Tolerable Upper Intake Level (UL). The Estimated Average Requirement (EAR) method used as cutoff was applied to estimate the prevalence of inadequate nutrient intake. All the analyses were stratified according to sex, age group and Brazilian macro-regions. All statistical analyses accounted for the sample weight and the complex sampling design. RESULTS Rice, beans and other legume, juice and fruit drinks, breads and meat were the most consumed foods among the adolescents. The average energy intake ranged from 2,036 kcal (girls aged from 12 to 13 years) to 2,582 kcal (boy aged from14 to 17 years). Saturated fat and free sugar intake were above the maximum limit recommended ( 50.0%). Sodium intake was above the UL for more than 80.0% of the adolescents. CONCLUSIONS The diets of Brazilian adolescents were characterized by the intake of traditional Brazilian food, such as rice and beans, as well as by high intake of sugar through sweetened beverages and processed foods. This food pattern was associated with an excessive intake of sodium, saturated fatty acids and free sugar.
82 citations
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Rio de Janeiro State University1, Federal University of Rio de Janeiro2, Oswaldo Cruz Foundation3, Universidade Federal do Rio Grande do Sul4, Brazilian Institute of Geography and Statistics5, Federal University of Pará6, University of São Paulo7, State University of Feira de Santana8, Federal University of Amazonas9, Universidade Federal de Minas Gerais10, Universidade Federal do Amapá11, Universidade Federal do Espírito Santo12, Universidade Federal de Santa Catarina13, Federal University of Rio Grande do Norte14, Universidade Federal de Mato Grosso15, Federal University of Bahia16, Pontifícia Universidade Católica do Paraná17, Federal University of Pernambuco18, University of Brasília19, Universidade Federal de Rondônia20, State University of Campinas21, Federal University of Piauí22, Universidade Federal do Acre23, Universidade Federal de Goiás24, Federal University of Maranhão25, Federal University of Ceará26, Universidade Federal de Sergipe27, Federal University of Paraíba28, Federal University of Alagoas29, Federal University of Roraima30, Sao Paulo State University31
TL;DR: 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.
Abstract: 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.
76 citations
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TL;DR: The logistics adopted in ERICA was fairly successful and description of this as well as the difficulties experienced in Brazil can inform and facilitate the planning of future studies, especially in developing countries.
Abstract: The Study of Cardiovascular Risk in Adolescents (ERICA) is a pioneering study that aimed to assess the prevalence of cardiovascular risk factors, including metabolic syndrome components in Brazilian adolescents This study aims to describe the methodological aspects related to blood collection as well as to report pertaining results of the preparation, transport, storage, and exams in ERICA Exams in ERICA were performed in a single laboratory and blood samples were collected in schools in a standardized manner Logistics involved air transportation of samples to the reference laboratory with controlled temperature since sample collection The serum was stored in local biorepositories in four centers to be used in future analyses During the study, 284,247 exams were performed and rate of participation in exams was 562%, thus involving 40,732 adolescents From the total, 926% of the samples reached the reference laboratory maintaining the temperature between 0-10°C No clinical significant changes in results due to temperature changes were identified External quality control recorded satisfactory results in 987% of the evaluations Four biorepositories with samples of 7,785 adolescents were created Thus, we can consider that the logistics adopted in ERICA was fairly successful and description of this as well as the difficulties experienced in Brazil can inform and facilitate the planning of future studies, especially in developing countries
28 citations
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TL;DR: In this large, community-based sample, increased body-mass index was associated with an increased risk of heart failure and strategies to promote optimal body weight may reduce the population burden ofheart failure.
1,388 citations
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TL;DR: Pharmacological treatments are often needed to insure weight loss and weight maintenance as adjuncts to diet and physical activity in people with obesity and overweight patients.
Abstract: This is an overview of the mechanisms of obesity and its relation to cardiovascular risks, describing the available treatment options to manage this condition. The pathogenesis of obesity includes the balance between calories consumed and energy expenditure followed by the maintenance of body weight. Diet, physical activity, environmental, behavioral and physiological factors are part of the complex process of weight loss, since there are several hormones and peptides involved in regulation of appetite, eating behavior and energy expenditure. The cardiovascular complications associated to obesity are also driven by processes involving hormones and peptides and which include inflammation, insulin resistance, endothelial dysfunction, coronary calcification, activation of coagulation, renin angiotensin or the sympathetic nervous systems. Pharmacological treatments are often needed to insure weight loss and weight maintenance as adjuncts to diet and physical activity in people with obesity and overweight patients. To accomplish satisfactory goals, patients and physicians seek for weight loss, weight maintenance and improvement of the risk factors associated to this condition, especially cardiovascular risk.
199 citations
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Federal University of Rio de Janeiro1, Oswaldo Cruz Foundation2, Rio de Janeiro State University3, Universidade Federal do Rio Grande do Sul4, Brazilian Institute of Geography and Statistics5, Federal University of Pará6, University of São Paulo7, State University of Feira de Santana8, Universidade Federal de Minas Gerais9, Universidade Federal do Amapá10, Federal University of Amazonas11, Universidade Federal do Espírito Santo12, Universidade Federal de Santa Catarina13, Federal University of Rio Grande do Norte14, Universidade Federal de Mato Grosso15, Federal University of Bahia16, Pontifícia Universidade Católica do Paraná17, Federal University of Pernambuco18, University of Brasília19, Universidade Federal de Rondônia20, State University of Campinas21, Federal University of Piauí22, Universidade Federal de Goiás23, Federal University of Maranhão24, Federal University of Ceará25, Universidade Federal de Sergipe26, Federal University of Paraíba27, Federal University of Alagoas28, Sao Paulo State University29
TL;DR: The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5 and the fractions of hypertension attributable to obesity in the population by 17.8%.
Abstract: 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.
147 citations
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TL;DR: Serum FFA levels correlated with nonalcoholic fatty liver disease and could be used as an indicator for predicting advanced fibrosis in NAFLD patients and stepwise regression showed that serum F FA levels were an independent factor predictingAdvanced fibrosis (FIB-4 ≥ 1.3) in NA FLD patients.
Abstract: High serum free fatty acid (FFA) levels are associated with metabolic syndrome (MS). This study aimed to assess the association of fasting serum FFAs with nonalcoholic fatty liver disease (NAFLD) in a Chinese population. A total of 840 subjects fulfilled the diagnostic criteria of NAFLD and 331 healthy control participants were enrolled in this cross-sectional study. Fasting serum FFA levels and other clinical and laboratory parameters were measured. NAFLD patients had significantly higher serum FFA levels than controls (P < 0.001). Serum FFA levels were significantly and positively correlated with parameters of MS, inflammation indexes, and markers of hepatocellular damage. Elevated serum FFA levels were found in NAFLD subjects with individual components of MS (obesity, hypertriglyceridaemia, and hyperglycaemia). Stepwise regression showed that serum FFA levels were an independent factor predicting advanced fibrosis (FIB-4 ≥ 1.3) in NAFLD patients. Serum FFA levels correlated with NAFLD and could be used as an indicator for predicting advanced fibrosis in NAFLD patients.
132 citations
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TL;DR: The diets of Brazilian adolescents were characterized by the intake of traditional Brazilian food, such as rice and beans, as well as by high intake of sugar through sweetened beverages and processed foods, associated with an excessive intake of sodium, saturated fatty acids and free sugar.
Abstract: OBJECTIVE To describe food and macronutrient intake profile and estimate the prevalence of inadequate micronutrient intake of Brazilian adolescents. METHODS Data from 71,791 adolescents aged from 12 to 17 years were evaluated in the 2013-2014 Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). Food intake was estimated using 24-hour dietary recall (24-HDR). A second 24-HDR was collected in a subsample of the adolescents to estimate within-person variability and calculate the usual individual intake. The prevalence of food/food group intake reported by the adolescents was also estimated. For sodium, the prevalence of inadequate intake was estimated based on the Tolerable Upper Intake Level (UL). The Estimated Average Requirement (EAR) method used as cutoff was applied to estimate the prevalence of inadequate nutrient intake. All the analyses were stratified according to sex, age group and Brazilian macro-regions. All statistical analyses accounted for the sample weight and the complex sampling design. RESULTS Rice, beans and other legume, juice and fruit drinks, breads and meat were the most consumed foods among the adolescents. The average energy intake ranged from 2,036 kcal (girls aged from 12 to 13 years) to 2,582 kcal (boy aged from14 to 17 years). Saturated fat and free sugar intake were above the maximum limit recommended ( 50.0%). Sodium intake was above the UL for more than 80.0% of the adolescents. CONCLUSIONS The diets of Brazilian adolescents were characterized by the intake of traditional Brazilian food, such as rice and beans, as well as by high intake of sugar through sweetened beverages and processed foods. This food pattern was associated with an excessive intake of sodium, saturated fatty acids and free sugar.
82 citations