Inflamação subclínica na infância: associação com o risco cardiometabólico e consumo alimentar (Estudo PASE)
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2019-02-26
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Universidade Federal de Viçosa
Resumo
Introdução: A concentração sérica da proteína C reativa (PCR) é considerada um importante marcador inflamatório e, quando aumentada, está associada ao maior risco cardiometabólico em adultos. Entretanto, estudos sobre a inflamação subclínica e seus fatores associados com a população infantil ainda são escassos. Objetivo: Avaliar a concentração sérica da PCR ultrassensível (PCR-us) e identificar fatores associados em crianças de Viçosa-MG. Metodologia: Trata-se de um estudo transversal com amostra representativa de crianças com 8 e 9 anos, matriculadas em todas escolas da área urbana do município de Viçosa - MG. Foram excluídas do estudo as crianças com processo inflamatório agudo (PCR ≥ 10mg/L), sendo a amostra constituída por 350 crianças. Os Termos de Consentimento Livre e Esclarecidos (TCLE) foram assinados pelos pais das crianças participantes. Os dados sociodemográficos, dos pais e comportamentais foram coletados por meio de questionário semiestruturado. Medidas antropométricas, de composição corporal, clínica e metabólicas foram aferidas para avaliação do risco cardiometabólico. As crianças com a PCR acima do percentil 90 da amostra (≥ 1,82mg/L) foram classificadas com valores aumentados e potencial inflamação subclínica. Realizou-se avaliação do consumo alimentar por meio de três recordatórios 24 horas (R24H). A análise dos dados dietéticos foi realizada utilizando o software Diet Pro® 5i, versão 5.8. Os alimentos foram classificados de acordo com seu grau de processamento, bem como foram agrupados em subgrupos, visando identificar aqueles que mais contribuir am para o consumo de alimentos in natura e minimamente processados, processados e ultraprocessados (UPF). Os nutrientes foram ajustados pela energia pelo método residual. As análises estatísticas foram realizadas nos softwares Statistical Package for the Social Science® versão 21 (SPSS Inc., Chicago, IC, USA) e Stata versão 13 (StataCorp LP). O nível de significância estatística considerado foi de 5%. Resultados: A média da concentração sérica da PCR foi de 0,62 (±1,44) mg/L. As crianças com a presença de fatores tradicionais de risco cardiometabólico (excesso de peso, gordura ginóide e androide aumentados), componentes da síndrome metabólica (SM) (obesidade abdominal, HDL-c baixa e hiperglicemia) e fatores de risco não tradicionais (concentrações séricas elevadas de ácido úrico, homocisteína e apoB), apresentaram maiores de chances de ter a PCR aumentada. Também foi observada associação positiva entre a PCR e o acúmulo de fatores de risco cardiometabólico e dos componentes da SM. As variáveis sociodemográficas e maternas não se associaram à PCR. Observou-se uma maior frequência de PCR aumentada entre as crianças que realizavam mais de 5 refeições por dia. Sobre o consumo alimentar, as crianças com baixa ingestão de alimentos in natura, bem como aquelas com elevada ingestão de UPF, como guloseimas e carnes processadas, apresentaram maiores chances de terem a PCR aumentada. Além disso, 97,4% das crianças apresentaram baixa ingestão de cálcio, principalmente aquelas com menor renda, não brancas e estudantes de escola pública. As crianças com menor ingestão de cálcio (1o tercil) apresentaram maiores prevalências de PCR aumentada, perímetro da cintura em risco e menor prevalência de LDL aumentada. Conclusão: Neste estudo, as crianças com fatores de risco cardiometabólico (tradicionais, não tradicionais e componentes da SM) apresentaram maiores chances de ter PCR aumentada, indicando a ocorrência precoce de alterações cardiometabólicas e sua relação com a inflamação subclínica já nas fases iniciais da vida. A baixa ingestão de alimentos in natura, elevada de UPF, e baixa de ingestão de cálcio da dieta, também estão associados a maior chance de ter PCR aumentada, demonstrando a importância de hábitos alimentares saudáveis e consumo de alimentos fontes de cálcio para a prevenção da inflamação subclínica desde a infância.
Introduction: The serum C-reactive protein (CRP) concentration is considered an important inflammatory marker and it is associated with increased cardiometabolic risk in adults. However, studies investigating the subclinical inflammation and its associated factors with the infant population are still scarce. Objective: To evaluate the serum high sensitive CRP (hs-CRP) and identify its associated factors in children of Viçosa-MG. Methods: This is a cross-sectional study with a representative sample of children with 8 and 9 years old, enrolled in all schools in the urban area of Viçosa-MG. Children with acute inflammatory process (CRP ≥ 10 mg/L) were excluded from the study, resulting in a total sample of 350 children. The Written Informed Consent was signed by the parents of the children. The sociodemographic, parents, and behavioral data were collected through a semi-structured questionnaire. Anthropometric, body composition, metabolic and clinical measurements were evaluated for cardiometabolic risk assessment. Children with CRP above 90 percentile of the sample (≥ 1.82mg/L) were classified with increased values and potential subclinical inflammation. Food consumption was assessed through three 24 h dietary recalls. The dietary data analysis was performed using the Diet Pro ® 5i software, version 5.8. The foods items were classified according to its degree of processing, as well as were grouped into subgroups, in order to identify those who contributed the most to the consumption of fresh, processed and ultra-processed food (UPF). Nutrients were energy-adjusted by the residual method. Statistical analysis was carried out using the software Statistical Package for the Social Science ® version 21 (SPSS Inc., Chicago, USA) and Stata version 13 (StataCorp LP). The statistical significance level of 5% was adopted. At the end of the data collection, all the children received the results of their exams and evaluations with the appropriate nutritional orientations aiming to improve health and the quality of life. Results: The average of serum CRP concentration was 0.62 (± 1.44) mg/L. Children with the presence of traditional cardiometabolic risk factors (excess of weight, increased gynoid and android fat), components of the metabolic syndrome (MetS) (abdominal obesity, low HDL-c and hyperglycemia) and nontraditional cardiometabolic risk factors (high serum uric acid, homocysteine and apoB), showed higher chances of having increased CRP. Also, a positive association was observed between the CRP and the accumulation of cardiometabolic risk factors, as well as with MetS components. Sociodemographic and maternal variables were not associated to CRP. There was a higher prevalence of increased CRP among the children who ate more than 5 meals per day. About the food consumption, children with low intake of fresh foods, as well as those with increased intake of UPF, like sweets and processed meats, presented higher chances of having increased CRP. In addition, 97.4% of the children presented low calcium intake, especially those with lower income, non-white children and public-school students. Children with the lowest calcium intake (1 st tertile) showed higher prevalence of increased waist circumference, elevated CRP, and lower prevalence of increased LDL. Conclusion: In this study, children with cardiometabolic risk factors (traditional, non-traditional and components of MetS) were more likely to have increased CRP, indicating the early occurrence of cardiometabolic alterations and their relation to subclinical inflammation already in the early stages of life. Low intake of fresh foods, elevated UPF, and low calcium intake, are also associated with a higher chances of having increased CRP, demonstrating the importance of having healthy eating habits and the consumption of calcium food sources for the prevention of subclinical inflammation since childhood.
Introduction: The serum C-reactive protein (CRP) concentration is considered an important inflammatory marker and it is associated with increased cardiometabolic risk in adults. However, studies investigating the subclinical inflammation and its associated factors with the infant population are still scarce. Objective: To evaluate the serum high sensitive CRP (hs-CRP) and identify its associated factors in children of Viçosa-MG. Methods: This is a cross-sectional study with a representative sample of children with 8 and 9 years old, enrolled in all schools in the urban area of Viçosa-MG. Children with acute inflammatory process (CRP ≥ 10 mg/L) were excluded from the study, resulting in a total sample of 350 children. The Written Informed Consent was signed by the parents of the children. The sociodemographic, parents, and behavioral data were collected through a semi-structured questionnaire. Anthropometric, body composition, metabolic and clinical measurements were evaluated for cardiometabolic risk assessment. Children with CRP above 90 percentile of the sample (≥ 1.82mg/L) were classified with increased values and potential subclinical inflammation. Food consumption was assessed through three 24 h dietary recalls. The dietary data analysis was performed using the Diet Pro ® 5i software, version 5.8. The foods items were classified according to its degree of processing, as well as were grouped into subgroups, in order to identify those who contributed the most to the consumption of fresh, processed and ultra-processed food (UPF). Nutrients were energy-adjusted by the residual method. Statistical analysis was carried out using the software Statistical Package for the Social Science ® version 21 (SPSS Inc., Chicago, USA) and Stata version 13 (StataCorp LP). The statistical significance level of 5% was adopted. At the end of the data collection, all the children received the results of their exams and evaluations with the appropriate nutritional orientations aiming to improve health and the quality of life. Results: The average of serum CRP concentration was 0.62 (± 1.44) mg/L. Children with the presence of traditional cardiometabolic risk factors (excess of weight, increased gynoid and android fat), components of the metabolic syndrome (MetS) (abdominal obesity, low HDL-c and hyperglycemia) and nontraditional cardiometabolic risk factors (high serum uric acid, homocysteine and apoB), showed higher chances of having increased CRP. Also, a positive association was observed between the CRP and the accumulation of cardiometabolic risk factors, as well as with MetS components. Sociodemographic and maternal variables were not associated to CRP. There was a higher prevalence of increased CRP among the children who ate more than 5 meals per day. About the food consumption, children with low intake of fresh foods, as well as those with increased intake of UPF, like sweets and processed meats, presented higher chances of having increased CRP. In addition, 97.4% of the children presented low calcium intake, especially those with lower income, non-white children and public-school students. Children with the lowest calcium intake (1 st tertile) showed higher prevalence of increased waist circumference, elevated CRP, and lower prevalence of increased LDL. Conclusion: In this study, children with cardiometabolic risk factors (traditional, non-traditional and components of MetS) were more likely to have increased CRP, indicating the early occurrence of cardiometabolic alterations and their relation to subclinical inflammation already in the early stages of life. Low intake of fresh foods, elevated UPF, and low calcium intake, are also associated with a higher chances of having increased CRP, demonstrating the importance of having healthy eating habits and the consumption of calcium food sources for the prevention of subclinical inflammation since childhood.
Descrição
Palavras-chave
Crianças - Nutrição, Inflamação, Alimentos - Consumo, Síndrome metabólica, Proteína C-Reativa, Sistema cardiovascular - Doenças - Fatores de risco
Citação
SUHETT, Lara Gomes. Inflamação subclínica na infância: associação com o risco cardiometabólico e consumo alimentar (Estudo PASE). 2019. 111 f. Dissertação (Mestrado em Ciência da Nutrição) - Universidade Federal de Viçosa, Viçosa. 2019.