The study of cardiovascular risk in adolescents – ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents
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.
Citations
More filters
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
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
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
TL;DR: The prevalence of leisure-time physical inactivity in Brazilian adolescents is high and is associated with age and low socioeconomic status and should be given to girls and to those who do not engage in any physical activity during the leisure time, so that they can adopt a more active lifestyle.
Abstract: OBJECTIVE To evaluate the prevalence of leisure-time physical inactivity in Brazilian adolescents and their association with geographical and sociodemographic variables. METHODS The sample was composed by 74,589 adolescents participating in the Study of Cardiovascular Risks in Adolescents (ERICA). This cross-sectional study of school basis with national scope involved adolescents aged from 12 to 17 years in Brazilian cities with more than 100 thousand inhabitants. The prevalence of leisure-time physical inactivity was categorized according to the volume of weekly practice (< 300; 0 min). The prevalences were estimated for the total sample and by sex. Poisson regression models were used to assess associated factors. RESULTS The prevalence of leisure-time physical inactivity was 54.3% (95%CI 53.4-55.2), and higher for the female sex (70.7%, 95%CI 69.5-71.9) compared to the male (38.0%, 95%CI 36.7-39.4). More than a quarter of adolescents (26.5%, 95%CI 25.8-27.3) reported not practicing physical activity in the leisure time, a condition more prevalent for girls (39.8%, 95%CI 38.8-40.9) than boys (13.4%, 95%CI 12.4-14.4). For girls, the variables that were associated with physical inactivity were: reside in the Northeast (RP = 1.13, 95%CI 1.08-1.19), Southeast (RP = 1.16, 95%CI 1.11-1.22) and South (RP = 1.12, 95%CI 1.06-1.18); have 16-17 years (RP = 1.06, 95%CI 1.12-1.15); and belong to the lower economic class (RP = 1.33, 95%CI 1.20-1.48). The same factors, except reside in the Southeast and South, were also associated with not practicing physical activity in the leisure time for the same group. In males, as well as the region, being older (p < 0.001) and declaring to be indigenous (RP = 0.37, 95%CI 0.19-0.73) were also associated with not practicing physical activities in the leisure time. CONCLUSIONS The prevalence of leisure-time physical inactivity in Brazilian adolescents is high. It presents regional variations and is associated with age and low socioeconomic status. Special attention should be given to girls and to those who do not engage in any physical activity during the leisure time, so that they can adopt a more active lifestyle.
73 citations
TL;DR: The high prevalence of common mental disorders among adolescents and the fact that the symptoms are often vague mean these disorders are not so easily identified by school administrators or even by health services, can help the proposition of more specific prevention and control measures, focused on highest risk subgroups.
Abstract: OBJECTIVE To describe the prevalence of common mental disorders in Brazilian adolescent students, according to geographical macro-regions, school type, sex, and age. METHODS We evaluated 74,589 adolescents who participated in the Cardiovascular Risk Study in Adolescents (ERICA), a cross-sectional, national, school-based study conducted in 2013-2014 in cities with more than 100,000 inhabitants. A self-administered questionnaire and an electronic data collector were employed. The presence of common mental disorders was assessed using the General Health Questionnaire (GHQ-12). We estimated prevalence and 95% confidence intervals of common mental disorders by sex, age, and school type, in Brazil and in the macro-regions, considering the sample design. RESULTS The prevalence of common mental disorders was of 30.0% (95%CI 29.2-30.8), being higher among girls (38.4%; 95%CI 37.1-39.7) when compared to boys (21.6%; 95%CI 20.5-22.8), and among adolescents who were from 15 to 17 years old (33.6%; 95%CI 32.2-35.0) compared to those aged between 12 and 14 years (26.7%; 95%CI 25.8-27.6). The prevalence of common mental disorders increased with age for both sexes, always higher in girls (ranging from 28.1% at 12 years to 44.1% at 17 years) than in boys (ranging from 18.5% at 12 years to 27.7% at 17 years). We did not observe any significant difference by macro-region or school type. Stratified analyses showed higher prevalence of common mental disorders among girls aged from 15 to 17 years of private schools in the North region (53.1; 95%CI 46.8-59.4). CONCLUSIONS The high prevalence of common mental disorders among adolescents and the fact that the symptoms are often vague mean these disorders are not so easily identified by school administrators or even by health services. The results of this study can help the proposition of more specific prevention and control measures, focused on highest risk subgroups.
62 citations
References
More filters
01 Jan 2000
14,990 citations
"The study of cardiovascular risk in..." refers background in this paper
...The prevalence of overweight and obesity is increasing worldwide, affecting all age groups [3] and these conditions in childhood are predictive of obesity in adults [4]....
[...]
TL;DR: This abridged version of the "Anthropometric Standardisation Reference Manual" contains the heart of the original manual - complete procedures for 45 anthropometric measurements.
Abstract: This edition of "Anthropometric Standardisation Reference Manual" contains 45 anthropometric measurement procedures, and also addresses special issues such as reliability and accuracy and details various applications. It can be used as a supplemental text for courses in fitness assessment and exercise prescription, kinanthropometry, body composition, nutrition, and exercise physiology. The text is also suitable as a reference for exercise scientists.
8,171 citations
TL;DR: The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years.
Abstract: Objective To construct growth curves for school-aged children and adolescents that accord with the WHO Child Growth Standards for preschool children and the body mass index (BMI) cut-offs for adults. Methods Data from the 1977 National Center for Health Statistics (NCHS)/WHO growth reference (1–24 years) were merged with data from the under-fives growth standards’ cross-sectional sample (18–71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0–5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample. Findings The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m² to 0.1 kg/m². At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m² for boys and 25.0 kg/m² for girls. These values are equivalent to the overweight cut-off for adults (> 25.0 kg/m²). Similarly, the +2 SD value (29.7 kg/m² for both sexes) compares closely with the cut-off for obesity (> 30.0 kg/m²). Conclusion The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group. Bulletin of the World Health Organization 2007;85:660–667.
6,037 citations
"The study of cardiovascular risk in..." refers methods in this paper
...To determine the weight categories of adolescents, the WHO (World Health Organization) reference curves [21], using the index BMI/age, according to sex, was used....
[...]
Thomas Jefferson University1, Cincinnati Children's Hospital Medical Center2, Yeshiva University3, Alfred I. duPont Hospital for Children4, University of Michigan5, Harvard University6, University of Iowa7, Mayo Clinic8, University of Texas Health Science Center at Houston9, Wake Forest University10, University of Minnesota11, University of Pennsylvania12, National Institutes of Health13, American Institutes for Research14
5,707 citations
TL;DR: It is increasingly recognized that office measurements correlate poorly with blood pressure measured in other settings, and that they can be supplemented by self-measured readings taken with validated devices at home, which gives a better prediction of risk than office measurements and is useful for diagnosing white-coat hypertension.
Abstract: Accurate measurement of blood pressure is essential to classify individuals, to ascertain blood pressure-related risk, and to guide management. The auscultatory technique with a trained observer and mercury sphygmomanometer continues to be the method of choice for measurement in the office, using the first and fifth phases of the Korotkoff sounds, including in pregnant women. The use of mercury is declining, and alternatives are needed. Aneroid devices are suitable, but they require frequent calibration. Hybrid devices that use electronic transducers instead of mercury have promise. The oscillometric method can be used for office measurement, but only devices independently validated according to standard protocols should be used, and individual calibration is recommended. They have the advantage of being able to take multiple measurements. Proper training of observers, positioning of the patient, and selection of cuff size are all essential. It is increasingly recognized that office measurements correlate poorly with blood pressure measured in other settings, and that they can be supplemented by self-measured readings taken with validated devices at home. There is increasing evidence that home readings predict cardiovascular events and are particularly useful for monitoring the effects of treatment. Twenty-four-hour ambulatory monitoring gives a better prediction of risk than office measurements and is useful for diagnosing white-coat hypertension. There is increasing evidence that a failure of blood pressure to fall during the night may be associated with increased risk. In obese patients and children, the use of an appropriate cuff size is of paramount importance.
4,327 citations
"The study of cardiovascular risk in..." refers methods in this paper
...This model has been validated for adolescents [24] and it has been chosen due to its ease of use and the minimization of observer bias or digit preference (which are the common errors associated with the auscultatory method) [25]....
[...]