Influências familiares e determinantes precoces na ocorrência da obesidade e do risco cardiovascular em crianças
Arquivos
Data
2010-06-02
Autores
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Federal de Viçosa
Resumo
Foram realizados estudos analíticos transversais híbridos, com componentes retrospectivos, a fim de verificar o efeito de determinantes precoces e de antecedentes familiares de obesidade e de hipertensão arterial, sobre o desenvolvimento de fatores de risco cardiovascular em crianças. Numa primeira etapa do estudo foi realizada avaliação antropométrica com 90,6% dos escolares de 6 a 10 anos das escolas municipais de Nova Era-MG (n=1025) a partir do indicador: Índice de Massa Corporal (IMC)/Idade, considerando-se o padrão de referência antropométrica da World Health Organization (WHO)(2007). Todas as crianças classificadas como obesas foram convidadas a participar do estudo. Para cada criança obesa, foram selecionadas 2 crianças eutróficas, de mesmo sexo, idade e escola.Os pais e mães biológicas das crianças também foram convidados a participar. Nos estudos que verificaram a influência do estado nutricional e dos níveis pressóricos das mães e dos pais no estado nutricional e Pressão Arterial (PA) das crianças (artigos 1 e 2), participaram das análises, apenas as crianças com informações completas de PA e estado nutricional de seus pais e mães biológicas.No estudo que investigou a influência do Peso ao Nascer e do estado nutricional atual sobre fatores de risco cardiovascular (artigo 3), participaram das análises, apenas as crianças com informações de peso ao nascer. Crianças com peso ao nascer superior a 4000 g também foram excluídas do estudo. As variáveis infantis analisadas foram: peso ao nascer, peso e estatura atual, circunferência da cintura (CC), percentual de gordura corporal (%GC), PA, níveis séricos de colesterol total e frações (HDL, LDL, VLDL, triglicérides), glicose e Proteína C Reativa (PCR). As variáveis maternas e paternas foram: PA, peso, estatura, CC e %GC. A PA das crianças, dos pais e das mães foi aferida e classificada de acordo com as recomendações das V Diretrizes Brasileiras de Hipertensão Arterial (2006). Considerou-se PA aumentada nas crianças, valores em percentis correspondentes à classificação de pré-hipertensão e PA aumentada nos pais e mães, valores de pressão arterial sistólica (PAS) ou pressão arterial diastólica (PAD) correspondentes à classificação de PA limítofre para adultos. O estado nutricional dos filhos esteve significativamente associado ao estado nutricional de suas mães e de seus pais. As médias de IMC, %GC e CC foram estatisticamente superiores entre filhos de mães e pais com excesso de peso, excesso de GC e com obesidade central. Indicadores corporais de adiposidade encontraram-se significativamente correlacionados a níveis mais elevados dePA em crianças: PAD esteve correlacionada com IMC, %GC e CC. A PA das crianças esteve associada à PA dos pais, mas não com a PA das mães. Observou-se fraca associação entre baixo peso ao nascer e risco cardiovascular. O Peso ao nascer correlacionou-se apenas com a PAD. Já o estado nutricional atual correlacionou-se com PAD, CC, % GC, glicose, triglicérides (TGL), LDL, VLDL e PCR. Observou-se médias estatisticamente superiores de IMC, CC, %GC, PAD, TGL, VLDL e PCR no grupo de crianças com BPN e obesidade atual e também naquele com peso ao nascer ≥2500 e >4000g e obesidade atual, sugerindo o maior incremento de peso nos primeiros anos de vida, como importante preditor de risco cardiovascular. Os resultados dos estudos sugerem que a obesidade e a hipertensão arterial em crianças, estão associados com o excesso de peso de mães e de pais e com a PA paterna, respectivamente. Intervenções para a redução de eventos cardiovasculares devem priorizar medidas direcionadas para toda a família, em detrimento de ações voltadas apenas para o indivíduo. Destaca-se a importância da implementação de políticas de saúde materno-infantil e o papel primordial da estratégia da Saúde da Família.
Analytical cross hybrid studies with retrospective components were conducted in order to verify the effect of early risk factors and family background of obesity and hypertension on the development of cardiovascular risk factors in children. In the first stage, anthropometric evaluation in 90.6% of students aged 6 -10 from the municipal schools in Nova Era/ Minas Gerais (1.025 total) was conducted using the Body Mass Index (BMI)/age as indicator, considering the anthropometric reference standard of the World Health Organization/2007 (WHO). All children classified as obese were invited to participate. For each obese child, two euthrophic ones of the same sex, age and school were selected. Biological parents were invited to take part as well. In the studies that investigated the influence of the nutritional status and blood pressure levels of mothers and fathers in the nutritional status and blood pressure (BP) of children (Articles 1 and 2), only children with complete information on BP and nutritional status of their biological parents participated in the analysis. In the study that investigated the influence of birth weight and current nutritional status on cardiovascular risk factors (Article 3), only children with information on birth weight participated in the analysis. Children with birth weight higher 4,000 grams were excluded too. The variables analyzed for children were: birth weight, current weight and height, waist circumference (WC), percent body fat (%BF), blood pressure, total and fractions of serum cholesterol levels (HDL, LDL, VLDL, triglycerides) glucose and C-reactive protein (CRP). The mother and father variables were: BP, weight, height, WC and %BF. The BP of children, fathers and mothers were assessed and classified according to the recommendations of the V Brazilian Guidelines on Hypertension (2006). It was noticed increased BP in children, percentile value corresponding to the classification of prehypertension and increased BP in mothers and fathers. Moreover, value of systolic blood pressure (SBP) or diastolic blood pressure (DBP), corresponding to the limitrophe classification of BP for adults. The nutritional status of children was notably related to the nutritional state of their parents. The average BMI, % BF and WC were statistically superior in children of overweight parents, excess in BF and with central obesity. I was found that body fatness indicators were significantly correlated to elevated levels of BP in children: DBP was correlated with BMI, % BF and WC. Furthermore, BP of children was associated with the BP of fathers, but did not establish any relation with the BP of mothers. It was observed a weak relation between low birth weight and cardiovascular risk and the weight at birth was correlated only with the DBP. In addition, it was observed that the current nutritional status correlated with DBP, WC, BF%, glucose, triglycerides, LDL, VLDL and CRP. The study presented statistically higher average in the BMI, WC, BF%, DBP, TG, VLDL and CRP of the group of children with low birth weight and current obesity and also in those with birth weight equals or higher 2,500 and higher 4,000g and current obesity, suggesting a higher increase in weight in the first years of life as an significant predictor of cardiovascular risk. As a result, the studies suggest that obesity and hypertension in children are respectively related to the excess in weight of mothers and fathers and with the fathers BP. Interventions to reduce cardiovascular events had better prioritize measures aiming the whole family, instead of actions focused only on the individual. It draws the attention to the importance of implementing policies for motherly and child health and the vital role of the Family Health strategy.
Analytical cross hybrid studies with retrospective components were conducted in order to verify the effect of early risk factors and family background of obesity and hypertension on the development of cardiovascular risk factors in children. In the first stage, anthropometric evaluation in 90.6% of students aged 6 -10 from the municipal schools in Nova Era/ Minas Gerais (1.025 total) was conducted using the Body Mass Index (BMI)/age as indicator, considering the anthropometric reference standard of the World Health Organization/2007 (WHO). All children classified as obese were invited to participate. For each obese child, two euthrophic ones of the same sex, age and school were selected. Biological parents were invited to take part as well. In the studies that investigated the influence of the nutritional status and blood pressure levels of mothers and fathers in the nutritional status and blood pressure (BP) of children (Articles 1 and 2), only children with complete information on BP and nutritional status of their biological parents participated in the analysis. In the study that investigated the influence of birth weight and current nutritional status on cardiovascular risk factors (Article 3), only children with information on birth weight participated in the analysis. Children with birth weight higher 4,000 grams were excluded too. The variables analyzed for children were: birth weight, current weight and height, waist circumference (WC), percent body fat (%BF), blood pressure, total and fractions of serum cholesterol levels (HDL, LDL, VLDL, triglycerides) glucose and C-reactive protein (CRP). The mother and father variables were: BP, weight, height, WC and %BF. The BP of children, fathers and mothers were assessed and classified according to the recommendations of the V Brazilian Guidelines on Hypertension (2006). It was noticed increased BP in children, percentile value corresponding to the classification of prehypertension and increased BP in mothers and fathers. Moreover, value of systolic blood pressure (SBP) or diastolic blood pressure (DBP), corresponding to the limitrophe classification of BP for adults. The nutritional status of children was notably related to the nutritional state of their parents. The average BMI, % BF and WC were statistically superior in children of overweight parents, excess in BF and with central obesity. I was found that body fatness indicators were significantly correlated to elevated levels of BP in children: DBP was correlated with BMI, % BF and WC. Furthermore, BP of children was associated with the BP of fathers, but did not establish any relation with the BP of mothers. It was observed a weak relation between low birth weight and cardiovascular risk and the weight at birth was correlated only with the DBP. In addition, it was observed that the current nutritional status correlated with DBP, WC, BF%, glucose, triglycerides, LDL, VLDL and CRP. The study presented statistically higher average in the BMI, WC, BF%, DBP, TG, VLDL and CRP of the group of children with low birth weight and current obesity and also in those with birth weight equals or higher 2,500 and higher 4,000g and current obesity, suggesting a higher increase in weight in the first years of life as an significant predictor of cardiovascular risk. As a result, the studies suggest that obesity and hypertension in children are respectively related to the excess in weight of mothers and fathers and with the fathers BP. Interventions to reduce cardiovascular events had better prioritize measures aiming the whole family, instead of actions focused only on the individual. It draws the attention to the importance of implementing policies for motherly and child health and the vital role of the Family Health strategy.
Descrição
Palavras-chave
Risco cardiovascular, Crianças, Obesidade, Antecedentes familiares, Determinantes precoces, Cardiovascular risk, Children, Obesity, Family background, Early determinants
Citação
MOREIRA, Adriana Cotote. Family influences and early determinants in the occurrence of obesity and cardiovascular risk in children. 2010. 165 f. Dissertação (Mestrado em Valor nutricional de alimentos e de dietas; Nutrição nas enfermidades agudas e crônicas não transmis) - Universidade Federal de Viçosa, Viçosa, 2010.