Cardiovascular Risk In Adolescents Research Articles

Maternal Smoking During Pregnancy Induces Persistent Epigenetic Changes Into Adolescence, Independent of Postnatal Smoke Exposure and Is Associated With Cardiometabolic Risk.

Background: Several studies have shown effects of current and maternal smoking during pregnancy on DNA methylation of CpG sites in newborns and later in life. Here, we hypothesized that there are long-term and persistent epigenetic effects following maternal smoking during pregnancy on adolescent offspring DNA methylation, independent of paternal and postnatal smoke exposure. Furthermore, we explored the association between DNA methylation and cardiometabolic risk factors at 17 years of age. Materials and Methods: DNA methylation was measured using the Illumina HumanMethylation450K BeadChip in whole blood from 995 participants attending the 17-year follow-up of the Raine Study. Linear mixed effects models were used to identify differential methylated CpGs, adjusting for parental smoking during pregnancy, and paternal, passive, and adolescent smoke exposure. Additional models examined the association between DNA methylation and paternal, adolescent, and passive smoking over the life course. Offspring CpGs identified were analyzed against cardiometabolic risk factors (blood pressure, triacylglycerols (TG), high-density lipoproteins cholesterol (HDL-C), and body mass index). Results: We identified 23 CpGs (genome-wide p level: 1.06 × 10−7) that were associated with maternal smoking during pregnancy, including associated genes AHRR (cancer development), FTO (obesity), CNTNAP2 (developmental processes), CYP1A1 (detoxification), MYO1G (cell signalling), and FRMD4A (nicotine dependence). A sensitivity analysis showed a dose-dependent relationship between maternal smoking and offspring methylation. These results changed little following adjustment for paternal, passive, or offspring smoking, and there were no CpGs identified that associated with these variables. Two of the 23 identified CpGs [cg00253568 (FTO) and cg00213123 (CYP1A1)] were associated with either TG (male and female), diastolic blood pressure (female only), or HDL-C (male only), after Bonferroni correction. Discussion: This study demonstrates a critical timing of cigarette smoke exposure over the life course for establishing persistent changes in DNA methylation into adolescence in a dose-dependent manner. There were significant associations between offspring CpG methylation and adolescent cardiovascular risk factors, namely, TG, HDL-C, and diastolic blood pressure. Future studies on current smoking habits and DNA methylation should consider the importance of maternal smoking during pregnancy and explore how the persistent DNA methylation effects of in utero smoke exposure increase cardiometabolic risk.

ERICA: smoking is associated with more severe asthma in Brazilian adolescents

ObjectiveTo investigate the association between smoking and asthma, and possible associated factors in Brazilian adolescents. MethodsA cross‐sectional, national, school‐based study with adolescents aged 12–17 years, participants in the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes – ERICA). A total of 66,394 participants answered a self‐administered questionnaire with questions about asthma, smoking, lifestyle and sociodemographic variables. Bivariate analysis between Current Asthma (CA) and Severe Asthma (SA) and the other study variables were performed using Chi‐squared. Then, the crude and adjusted Prevalence Ratios (PR), and respective 95% Confidence Intervals (95% CI) of current asthma/severe asthma and smoking variables, corrected for sociodemographic and lifestyle variables, were estimated using generalized linear models with Poisson regression, logit link, and robust variance. ResultsThe prevalence of current asthma and severe asthma were significantly higher in adolescents who were exposed to: experimentation (current asthma: PR=1.78, 95% CI: 1.51–2.09; severe asthma: PR=2.01; 95% CI: 1.35–2.98); current smoking (current asthma: PR=2.08, 95% CI: 1.65–2.64; severe asthma: PR=2.29; 95% CI: 1.38–3.82); regular smoking (current asthma: PR=2.25, 95% CI: 1.64–3.07; severe asthma: PR: 2.41; 95% CI: 1.23–4.73); and passive smoking (current asthma: PR=1.47, 95% CI: 1.27–1.67; severe asthma: PR=1.66; 95% CI: 1.19–2.32); these associations remained significant after adjustment. ConclusionsAsthma and smoking were significantly associated in Brazilian adolescents, regardless of the sociodemographic and lifestyle factors, notably in those with more severe disease.

Masked hypertension and submaximal exercise blood pressure among adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC).

Masked hypertension is associated with increased cardiovascular risk but is undetectable by clinic blood pressure (BP). Elevated systolic BP responses to submaximal exercise reveal the presence of masked hypertension in adults, but it is unknown whether this is the case during adolescence. We aimed to determine if exercise BP was raised in adolescents with masked hypertension, and its association with cardiovascular risk markers. A total of 657 adolescents (aged 17.7±0.3years; 41.9% male) from the Avon longitudinal study of parents and children (ALSPAC) completed a step-exercise test with pre-, post-, and recovery-exercise BP, clinic BP and 24-hour ambulatory BP. Masked hypertension was defined as clinic BP <140/90mmHg and 24-hour ambulatory BP ≥130/80mmHg. Assessment of left-ventricular (LV) mass index and carotid-femoral pulse wave velocity (aortic PWV) was also undertaken. Thresholds of clinic, pre-, post-, and recovery-exercise systolic BP were explored from ROC analysis to identify masked hypertension. Fifty participants (7.8%) were classified with masked hypertension. Clinic, pre-, post-, and recovery-exercise systolic BP were associated with masked hypertension (AUC≥0.69 for all, respectively), with the clinic systolic BP threshold of 115mmHg having high sensitivity and specificity and exercise BP thresholds of 126, 150, and 130mmHg, respectively, having high specificity and negative predictive value (individually or when combined) for ruling out the presence of masked hypertension. Additionally, this exercise systolic BP above the thresholds was associated with greater left-ventricular mass index and aortic PWV. Submaximal exercise systolic BP is associated with masked hypertension and adverse cardiovascular structure in adolescents. Exercise BP may be useful in addition to clinic BP for screening of high BP and cardiovascular risk in adolescents.

Association of Sleep Duration and Blood Pressure in Adolescents: A Multicenter Study

Evidence suggests that sleep duration is related to blood pressure (BP), but the findings are still inconsistent for adolescents. To analyze the association between sleep duration and BP in Brazilian adolescents between 12 and 17 years of age. This study is part of the Study of Cardiovascular Risk in Adolescents (ERICA), a multicenter, school-based, cross-sectional study in 273 municipalities in Brazil. The sample consisted of 65,643 adolescents. Sleep duration was measured by a subjective method, and BP was measured by the oscillometric method. Multiple linear regression analyses were performed to evaluate the association between sleep duration and BP. The mean sleep duration was 8.14 hours (± 1.40), with significant difference between the groups according to BP levels (P < 0.0001). The mean systolic and diastolic BP were 110.59 (± 11.87) and 65.85 (± 7.94) mm Hg, respectively, in the group of adolescents. Sleep duration was significantly associated with BP. Each increase 1 hour in sleep was associated with BP reduction in both sexes combined (P < 0.0001). Considering the effects of covariates, each increase 1 hour in sleep was associated with systolic BP (SBP) reduction among boys (P = 0.004) and SBP elevation among girls (P = 0.009), after full adjustment. The results suggest that each increase in sleep duration was associated with SBP elevation among girls. Such findings may have important implications for cardiovascular health in adolescence.

Usual intake and dietary sources of Selenium in adolescents: A cross-sectional school-based study

Selenium is a mineral that constitutes selenoproteins and, therefore, has been studied, especially in cardiovascular diseases. Some risk factors for the development of these diseases, such as obesity, hypertension and dyslipidemia, have been observed early in life, including in childhood and adolescence, and food and nutrient intake is an important associated factor for their development. The aim of this study was to assess usual intake of selenium (Se) and dietary inadequacies regarding the consumption of this mineral, and to identify the main dietary sources of Se among 12-17 year-old Brazilian adolescents. Data from the Study of Cardiovascular Risk in Adolescents, performed countrywide in the years 2013 and 2014, were used to estimate inadequate Se dietary intake. The National Cancer Institute's method was used, considering two days of 24h dietary recall (24hR). The contribution of each food group to the total intake of Se was determined using a single 24hR, and was defined as a ratio between the total intake of Se and the percentage of Se in each food group, until reaching 95%. Food mentioned by adolescents were categorized into 39 food groups, according to macronutrient similarities. Data from 76,957 adolescents aged from 12-17 years (49.7% girls) from public and private schools were assessed. Selenium intake was according to recommendation levels. Mean Se intake ranged from 84.3 to 105.9μg among sex and age groups. Considering the whole sample, meat, pasta, poultry, and fish were the food groups that contributed with the greatest amount of Se (representing 57.9% of total Se). Brazil nuts are consumed in bigger quantity only by 14-17 year-old girls, contributing to 1.6% of the Se in their diets. Brazilian adolescents have an adequate Se intake because of the high consumption of meat, pasta, and poultry. Although Brazil nuts are the most important dietary source of Se, adolescents consume them in very small amounts, leading to a small contribution in the total intake.

Higher adiponectin concentrations are associated with reduced metabolic syndrome risk independently of weight status in Brazilian adolescents

ObjectiveTo evaluate the association between adiponectin concentrations and metabolic syndrome (MetS) risk and to investigate if this association is independent of weight status in adolescents.MethodsAdiponectin concentrations and MetS risk were assessed in 4546 Brazilian adolescents (12–17 years old) enrolled in The Study of Cardiovascular Risks in Adolescents (“ERICA”), a cross-sectional multicenter study in Brazil. For analyses, adiponectin was categorized in sex and age-specific quartiles and MetS risk was expressed as a continuous score, calculated as the average of the standardized values (z-score) of the five MetS components. Multiple linear regression models were used to investigate the association between the quartiles of adiponectin and MetS risk.ResultsAdiponectin was inversely associated with waist circumference and log-transformed triglycerides, and positively associated with HDL-c. We also observed an inverse association between adiponectin concentrations and MetS risk. After adjustment for sociodemographic variables, physical activity, skipping breakfast and body mass index (BMI), higher quartiles of adiponectin remained inversely associated with waist circumference and MetS risk. A direct association between adiponectin and HDL-c was also observed. In further analysis, the sample was stratified by weight status and an inverse association between quartiles of adiponectin and MetS risk was observed in both normal weight and overweight/obese adolescents.ConclusionHigher adiponectin concentrations were independently and inverse associated with MetS risk in Brazilian adolescents, even after adjusting for BMI. These results were similar in normal weight and overweight/obese adolescents, suggesting that adiponectin may play a role in early development of MetS.

Characteristics of the school food environment associated with hypertension and obesity in Brazilian adolescents: a multilevel analysis of the Study of Cardiovascular Risks in Adolescents (ERICA).

To characterize the food environment in schools that participated in the Study of Cardiovascular Risks in Adolescents (ERICA) and to identify individual and contextual factors associated with hypertension and obesity. National school-based survey. Blood pressure, weight and height were measured, and characteristics of the schools were obtained in interviews with the principals. For each outcome, multilevel models of mixed effects were applied by logistic regression. School-going adolescents aged 12-17 years. A total of 73 399 adolescents were evaluated. The prevalence of hypertension was 9·6 (95 % CI 9·0, 10·3) % and that of obesity was 8·4 (95 % CI 7·9, 8·9) %. Approximately 50 % of the adolescents were able to purchase food at school and in its immediate vicinity and 82 % had access to no-charge meals through Brazil's National School Feeding Program. In the adjusted analysis, hypertension was associated (OR; 95 % CI) with the consumption of meals prepared on the school premises (0·79; 0·69, 0·92), the sale of food in the school's immediate vicinity (0·67; 0·48, 0·95) and the purchase of food in the school cafeteria (1·29; 1·11, 1·49). It was observed that there were lower odds of obesity among students who were offered meals prepared on the school premises (0·68; 0·54, 0·87). High frequency of sales of ultra-processed foods in schools was identified. Contextual and individual characteristics in the school food environment were associated with hypertension and obesity, pointing to the need for regulation and supervision of these spaces.

OR20-1 Increasing Values of Cardiometabolic Risk Markers Are Associated with Severity of Obesity in Adolescents: Findings from the ERICA Study

Overweight and obesity in adolescents have exponentially increased in the last decades and are considered a primary driver of other chronic diseases, such as diabetes and hypertension. Cardiometabolic risk factors, if not early managed, tend to persist in adult life, and some studies suggest different prevalences according to obesity category. This association among young people, however, is still unclear. The aim of this study was to evaluate the association of severity of obesity and known cardiometabolic risk factors in a representative sample of Brazilian adolescents from ERICA (Study of Cardiovascular Risk in Adolescents), a multicenter, school-based cross-sectional study composed of 75,000 students. For this analysis, we used data from students with overweight or obesity according to the IOTF reference values for body mass index: overweight ≥ 25kg/m²; class I obesity ≥ 30kg/m²; class II ≥ 35kg/m²; class III ≥ 40kg/m². Prevalences of abnormal cardiometabolic risk factors according to the severity of obesity were calculated for overall sample and stratified by sex and age groups (12-14 or 15-17 years). Adjusted Wald’s test for trends and Poisson regression models were used. From the 8,708 adolescents with excess weight, 71.6% were classified with overweight, 23.2% with class I obesity, 4.1% with class II and 1.2% with class III. As severity of obesity increased, there was an increase in the prevalence of higher levels of blood pressure, total and LDL-cholesterol, triglycerides, glycated hemoglobin, fasting glucose, insulin and metabolic syndrome (p≤0.05). Prevalence of low HDL-cholesterol levels was inversely proportional to increase in severity of obesity (p≤0.01). Increasing severity of obesity was associated with higher prevalence of all cardiometabolic risk factors in both age groups, except for fasting glucose in 15-17 years adolescents. After adjustment for sex, age, skin color and socioeconomic status, individuals with class III obesity had the highest prevalence of all the evaluated cardiometabolic variables, such as high levels of blood pressure [odds ratio (OR) compared to overweight = 2.4; 95%CI 1.5 - 3.8), triglyceride (OR = 2.99; 95%CI 1.8 - 4.9), LDL-cholesterol (OR = 2.5; 95%CI 1.2 – 5.3), glycated hemoglobin (OR = 2.0; 95%CI 1.3 - 3.2) and insulin (OR = 8.3; 95%CI 6.3 – 10.8). Metabolic syndrome in class III obese adolescents, when compared to overweight and class I obese, was 2 and 9 times more frequent, respectively. Our study involving Brazilian youth shows a positive association between severity of obesity and prevalence of cardiometabolic risk factors, indicating the need to further stratify them in this population. Investigating the association between severity of obesity and cardiometabolic risk factors can help us to identify the individuals at higher risk groups and develop public health strategies against obesity related outcomes early in life. Support: CAPES

OR21-5 Unhealthy Snack Intake Modifies the Association Between Screen-Based Sedentary Time and Metabolic Syndrome in Brazilian Adolescents: Findings from a Country-Wide Survey

Metabolic syndrome (MetS) in adolescence represents a higher risk for the development of subclinical atherosclerosis and type 2 diabetes mellitus during adulthood. Excessive screen time, has been associated with MetS; however, the findings are inconsistent due to the methodological differences among studies. Moreover, unhealthy food intake in front of screens could modify this association, an issue that is not completely clear. Therefore, our objective was to investigate the association between screen-based sedentary times and MetS and whether this association is modified by unhealthy snack intake in front of screens. This research is part of the Study on Cardiovascular Risks in Adolescents (ERICA), a nationwide, cross-sectional, school-based survey in Brazil. Adolescents aged 12 to 17 years were included. Measurements of waist circumference, blood pressure and fasting blood samples were collected for the measurement of blood glucose, HDL-cholesterol, and triglycerides. Metabolic syndrome was defined based on the International Diabetes Federation criteria. Screen time was self-reported (i.e. time in front of TV, computers, and videogames) and it was categorized as ≤ 2 hours, 3 to 5 hours, and ≥ 6 hours a day. Snack intake in front of screens was self-reported and the answers were dichotomized into no (if the subject reported no habit of eating in front of a screen) or yes (if they reported eating sometimes, almost every day or every day). For this analysis, we used data from 33,900 students. Associations between screen time and MetS were investigated using logistic regression to estimate the odds ratio. In further analyses, we stratified the sample based on snack intake in front of screens. The majority of the sample was composed of females (59.4%) and the mean age was 14.6 years (CI95%: 14.6-14.7). Half of the sample was classified as physically active, and the majority of them declared that they usually eat snacks in front of TV (85.1%) and computer/videogame (64%). The adjusted model, which included sociodemographic data, physical activity, and energy intake, showed that adolescents who spent ≥ 6 hours/day in front of screens had a higher odds ratio (OR) for MetS (OR = 1.71, 95%CI: 1.04-2.79) when compared with the reference group. However, the increase in the OR for MetS by screen time categories is observed only among those who reported habitual consumption of snacks while in front of the TV (3-5 hours/day: OR = 1.96, 95%CI: 1.37-2.80; ≥ 6 hours/day: OR = 2.63, 95%CI: 1.68-4.11) or computers/videogames (3-5 hours/day: OR = 1.77, 95%CI: 1.15-2.72; ≥ 6 hours/day: OR = 2.05, 95%CI: 1.24-3.38). We concluded that higher screen-based sedentary times were positively associated with MetS. However, this association is modified by snack intake. Interventions should address simultaneously the reduction of screen time and snack consumption in order to improve metabolic health among adolescents.

Diet quality index for Brazilian adolescents: the ERICA study.

This study aimed to assess the dietary patterns of adolescents using a food-based diet quality index and their compliance with a healthy dietary guideline METHODS: Participants included 71,553 Brazilian adolescents (12-17years old) from the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional school-based multicenter study.. Dietary intake was measured by one 24-h recall. A second recall was collected in a random subsample (~ 10%) to correct within-person variability. The Diet Quality Index for Adolescents adapted for Brazilians (DQIA-BR) was used to measure the overall quality of the dietary intake. The National Cancer Institute method was applied to estimate usual dietary intake. The DQIA-BR and the distribution of its components (quality, diversity, and equilibrium) were analyzed according to sex, geographical area, and type of school RESULTS: The mean (SD) DQIA-BR scores were 14.8% (6.1%) for females and 19.0% (6.3%) for males. All analyzed strata revealed low scores of DQIA-BR and its components. The median usual intake was five to sevenfold below the recommendations for vegetables and fruits and approximately twofold below the recommendations for dairy. The highest DQIA-BR mean scores were found in the northern region [17.0% (6.4%), females; 20.7% (6.3%), males]. Adolescents in both types of schools had relatively similar median intakes of snacks (~ 85g) and sugared drinks (~ 600ml) CONCLUSIONS: The overall diet quality of Brazilian adolescents is inadequate based on evaluated parameters in all regions and socioeconomic backgrounds.

Prevalence of type 2 diabetes among adolescents in Brazil: Findings from Study of Cardiovascular Risk in Adolescents (ERICA)

Type 2 diabetes mellitus (T2DM) in adolescents represents a clinical challenge related to lifestyle and obesity; however, only a few data are available in developing countries. Therefore, our aim was to investigate the prevalence of T2DM and prediabetes among Brazilian adolescents, as well as to describe the cardio-metabolic profile according to the diagnosis. This is a cross-sectional school-based multicenter study including youth aged 12 to 17 years from cities with more than 100 000 inhabitants in Brazil (n = 37 854 students). Fasting glucose, hemoglobin A1c (HbA1c) and other cardio-metabolic risk factors were measured. Prediabetes was defined by glucose levels 100 to 125 mg/dL or HbA1c 5.7% to 6.4%. T2DM was defined by self-report, glucose ≥126 mg/dL or HbA1c ≥ 6.5%. Multinomial logistic regression was used to estimate the odds ratio (OR) of prediabetes or T2DM according to covariates. Prevalences of prediabetes and T2DM were 22.0% (95% confidence interval [CI] 20.6%-23.4%) and 3.3% (95% CI 2.9%-3.7%), respectively. This estimates represented 213 830 adolescents living with T2DM and 1.46 million adolescents with prediabetes in Brazil. Prevalences of cardio-metabolic risk factors were higher in adolescents with prediabetes and T2DM. In the multinomial logistic model, obesity (OR 1.59, 95% CI 1.20-2.11), high waist circumference (OR 1.51, 95% CI 1.13-2.01), and skipping breakfast (OR 1.48, 95% CI 1.21-1.81) were associated with an increased OR for T2DM, while studying at rural area (OR 0.56, 95% CI 0.41-0.78) was associated with a decreased OR for T2DM. The prevalence of T2DM and prediabetes was high among Brazilian adolescents, which highlights that this disease became a public health challenge not only among adults in Brazil.

Association between dietary patterns and overweight/obesity: a Brazilian national school-based research (ERICA 2013–2014)

The aim of this study was to identify dietary patterns and verify their association with overweight/obesity. This was a cross-sectional study conducted with a probabilistic sample of 71,298 Brazilian adolescents aged between 12 and 17 years, who participated in the Study of Cardiovascular Risk in Adolescents (ERICA). ERICA is a multicenter school-based countrywide cross-sectional study, conducted in 2013–2014. Food consumption was estimated with a single 24-h dietary recall, and factor analysis was conducted to identify dietary patterns. To test the association between dietary patterns and overweight/obesity, we performed logistic regression analyses. The prevalence of overweight/obesity was 25.4% (95% CI 24.3–26.6). Three dietary patterns were identified: “traditional Brazilian” (beans, rice and meat), “unhealthy” (sugar sweetened beverages, processed foods, desserts and cakes, and milk and cheese), and “coffee and bread” (bread, oils and fat, coffee, and processed meat). Adolescents in the highest tertile of the “traditional Brazilian” pattern had lower odds of overweight/obesity (OR 0.85; 95% CI 0.74–0.98; p = 0.033) compared with adolescents in the first tertile. “Coffee and bread” and “unhealthy” dietary patterns were not associated with overweight/obesity. Brazilian adolescents with higher scores on the “traditional Brazilian” pattern had lower odds of being overweight/obese. To promote and enhance the consumption of traditional Brazilian foods may help prevent overweight/obesity in this population.

233. Characteristics of Adolescents With PCOS As Diagnosed By The Rotterdam Criteria

Polycystic ovarian syndrome (PCOS) is challenging to diagnose during adolescence. Diagnostic criteria for adults are difficult to apply to adolescents in part because ultrasound criteria are based on adult data. This retrospective study aimed to assess and compare clinical, metabolic, and hormonal characteristics of adolescents diagnosed with PCOS who required ultrasound for diagnosis according to Rotterdam criteria to those of adolescents who did not. Two hundred forty-two females presenting to an outpatient adolescent medicine practice with complaints of irregular menses, hirsutism, or hyperandrogenism from June 2012-June 2016 were evaluated as a part of a quality improvement project. Inclusion criteria for the current study included age 13-25 years, physician diagnosis of PCOS, and availability of at least one laboratory result (n=176). Patients were divided into 3 groups: those diagnosed by clinical or biochemical hyperandrogenism and irregular menstruation (HA/IM, n=148); by hyperandrogenism and polycystic ovary morphology (PCOM) on ultrasound (HA/PCOM, n=10); or by irregular menstruation and PCOM (IM/PCOM, n=18). Data included clinical characteristics (age at evaluation, age at menarche, body mass index (BMI), blood pressure, acne score (range: 0-5), Ferriman-Gallwey (FG) score (range: 0-36), and hormonal measures (FSH, LH, prolactin, TSH, total testosterone, free testosterone, DHEAS, 17-hydroxyprogesterone). Metabolic measures obtained included non-fasting total cholesterol and HDL for those classified as low-risk and HbA1c with fasting total cholesterol, HDL, LDL, triglycerides, insulin, and glucose for those classified as high-risk (BMI > 30 kg/m2 and/or personal/family history of diabetes). Given the non-normal distribution of most measures, statistical comparisons between groups were performed using the non-parametric Wilcoxon rank sum test, with significance adjusted for multiple comparisons at p=0.017. Median age at evaluation was 16.0 years [inter-quartile range (IQR) = 2 years]. Median age at menarche was 12 years (IQR = 2 years). Median BMI for the entire cohort was 28.9 kg/m2; BMI was not significantly different between groups (HA/IM=29.3 kg/m2, HA/PCOM=25 kg/m2, and IM/PCOM=24 kg/m2). Significant differences were found between groups HA/IM and IM/PCOM for median acne scores (2 vs 1, p<0.01), FG scores (6 vs 3, p=0.01), median total testosterone (43 ng/dL vs 30 ng/dL, p<0.01) and free testosterone (7.9 pg/mL vs 5.2 pg/mL, p<0.01). There was a significant difference in median HbA1c for group HA/IM versus IM/PCOM (5.3% vs 5.1%, p=0.01) and a marginally significant difference in median HbA1c for group HA/PCOM versus HA/IM (5.9% vs 5.3%; p=0.04). The majority of adolescents (84%) evaluated did not require ultrasound for diagnosis of PCOS as they had already met 2 of the 3 Rotterdam criteria. Limited differences were found between diagnostic groups. Acne scores, FG scores, and testosterone concentrations were elevated in those with HA as expected. Additionally, those with HA had significantly higher HbA1c and trended towards greater BMIs, suggesting elevated cardiovascular risk in adolescents with HA. Further longitudinal studies looking into future cardiovascular health by PCOS diagnosis type in adolescence should be considered.

Dietary patterns of Brazilian adolescents according to geographic region: an analysis of the Study of Cardiovascular Risk in Adolescents (ERICA).

The study aimed to identify the dietary patterns of Brazilian adolescents in each of Brazil's five major geographic regions and verify possible differences in adherence to dietary patterns according to age, sex, and type of school. Data were analyzed from 71,298 adolescents 12 to 17 years of age that participated in the Study of Cardiovascular Risk in Adolescents (ERICA), a cross-sectional nationwide, multicenter, school-based survey. Food consumption data were obtained using a 24-hour food recall, and identification of dietary patterns used factor analysis. Associations between the adolescents' sociodemographic characteristics and dietary patterns were verified by linear regression analyses, stratified by age and adjusted for nutritional status, total energy intake, and physical activity. In the five geographic regions, three dietary patterns with similar characteristics were identified: traditional pattern, bread-and-coffee pattern, and unhealthy pattern. The North of Brazil showed a fourth dietary pattern characterized by typical regional foods, called the traditional-North pattern. In all five regions, male adolescents showed the highest adherence to the traditional pattern and the lowest adherence to the unhealthy pattern. Private school students showed higher adherence to the unhealthy pattern and lower adherence to the traditional pattern. The results suggest that in this sample of adolescents, males were associated with traditional Brazilian foods such as rice and beans, while higher socioeconomic status was associated with the consumption of unhealthy foods like sugary beverages and snacks.

ERICA: age at menarche and its association with nutritional status

ObjectiveTo estimate the mean age at menarche and its association with nutritional status in Brazilian adolescents. MethodsThe study sample included female adolescents aged 12–17 who participated in a multicenter, school‐based, country‐wide, cross‐sectional study entitled The Study of Cardiovascular Risk in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes [ERICA]). Mean and median ages at menarche in Brazil were estimated. The association of age at menarche with sociodemographic data and nutritional status were described as means and their respective 95% confidence intervals. Survival analysis was used to assess the age at menarche according to nutritional status categories and the log‐rank test was used to compare the medians. Bivariate and multivariate analyses were performed using Cox regression to verify the association between menarche and other variables. ResultsA total of 73,624 students were evaluated, comprising 40,803 girls, of whom 37,390 reported menarche at a mean age of 11.71 years and a median of 12.41 years. Median age at menarche was lower in overweight and obese girls (p<0.001). The multivariate analysis showed that excess weight (HR=1.28; 95% CI 1.21–1.36; p<0.001) and studying in a private school (HR=1.06; 95% CI 1.02–1.10; p=0.003) were associated with menarche. ConclusionsThis is a pioneering study in Brazil with national and regional representativeness to estimate the mean and the median age of occurrence of menarche. Adolescents with excess weight had an earlier menarche than their peers, even after adjustment for confounding factors.

Exposure to breastfeeding and common mental disorders in adolescence

This article sought to evaluate the effect of exposure, and exposure time, to breastfeeding on the occurrence of common mental disorders (CMD) among Brazilian adolescents enrolled in school. This study analyzed data from the Study of Cardiovascular Risk in Adolescents (ERICA), evaluating those whose questionnaire regarding breastfeeding had been filled out by parents or guardians. The presence of CMD was identified using the General Health Questionnaire, version 12 items (GHQ-12), and we considered two cutoff points (scores ≥ 3 and ≥ 5). We tested the associations in bivariate analyses and through multiple logistical regression models, adjusting for potential confounding variables. Of the 41,723 adolescents we evaluated, most were students of the female sex (54.6%), aged between 12 and 15 years (71%), attended public schools (83.1%), resided in the Southeastern region (51.9%) and belonged to the economic classes B (53.8%) and C (34.1%). Around half of the adolescents' mothers had not completed their secondary education (51.7%). The group of adolescents who were breastfed for more than six months (51.8%) had a lower CMD prevalence for both GHQ-12 cutoff points, when compared with the group who were not breastfed or who were breastfed for ≤ 1 month (IR = 0.82; 95%CI: 0.69-0.97 and IR = 0.74; 95%CI: 0.59-0.91 for 3 and 5 points, respectively). Prolonged breastfeeding seems to play a protective role on the occurrence of CMD in adolescence.

Blood pressure reference values for Brazilian adolescents: data from the Study of Cardiovascular Risk in Adolescents (ERICA Study)

ObjectiveBlood pressure (BP) references for Brazilian adolescents are lacking in the literature. This study aims to investigate the normal range of office BP in a healthy, non-overweight Brazilian population of adolescents. MethodThe Brazilian Study of Cardiovascular Risks in Adolescents (Portuguese acronym “ERICA”) is a national school-based study that included adolescents (aged 12 through 17 years), enrolled in public and private schools, in cities with over 100,000 inhabitants, from all five Brazilian macro-regions. Adolescents’ height and body mass index (BMI) were classified in percentiles according to age and gender, and reference curves from the World Health Organization were adopted. Three consecutive office BP measurements were taken with a validated oscillometric device using the appropriate cuff size. The mean values of the last two readings were used for analysis. Polynomial regression models relating BP, age, and height were applied. ResultsAmong 73,999 adolescents, non-overweight individuals represented 74.5% (95% CI: 73.3–75.6) of the total, with similar distribution across ages. The majority of the non-overweight sample was from public schools 84.2% (95% CI: 79.9–87.7) and sedentary 54.8% (95% CI: 53.7–55.8). Adolescents reporting their skin color as brown (48.8% [95% CI: 47.4–50.1]) or white (37.8% [95% CI: 36.1–39.5]) were most frequently represented. BP increased by both age and height percentile. Systolic BP growth patterns were more marked in males when compared to females, along all height percentiles. The same pattern was not observed for diastolic BP. ConclusionsBlood pressure references by sex, age, and height percentiles for Brazilian adolescents are provided.

Smoking, alcohol consumption and mental health: Data from the Brazilian study of Cardiovascular Risks in Adolescents (ERICA)

IntroductionPrevious researches have indicated a strong association of alcohol and tobacco use with psychiatric disorders, but the relationship with depression and anxiety symptoms is still uncertain. We investigated the association of psychological distress and alcohol consumption, tobacco use and exposure to secondhand smoke (SHS) among adolescents in a developing country. MethodsThe authors evaluated 73,399 individuals (12–17 years) who participated in the Cardiovascular Risks Study in Adolescents (ERICA), a cross-sectional, national and school-based study, carried out in 124 Brazilian municipalities. The variables considered were alcoholic beverages (experimentation, consumption in the previous month and frequency of use) and smoking (experimentation, current smoking habits, frequent smoking and SHS exposure). Psychological distress was defined as a score ≥ 3 points in GHQ-12. Analyses included multiple logistic regression modeling. ResultsThe frequency of individuals with psychological distress was higher in the group who smoked for at least 7 consecutive days (53.3% vs 31.2%; OR: 2.17; 95%CI: 1.65–2.86), were exposed to SHS indoors (37.8% vs 29.8%; OR:1.30; 95%CI: 1.14–1.48), and outdoors (37.7% vs 26.6%; OR: 1.49; 95%CI: 1.28–1.74), and among young people who consumed at least 1 drink of alcohol in the previous 30 days (42.4% vs 28.6%; OR: 1.70; 95%CI: 1.46–1.97), when compared to adolescents not exposed. ConclusionsSmoking (passively and actively) and the consumption of alcoholic beverages are associated to psychological distress in the adolescent population. Avoiding smoking and the use of alcohol may have beneficial effects on the mental health. Our data reinforce the urgent necessity to prevent effectively underage access to legal drugs in Brazil.

Self-perceived body image, dissatisfaction with body weight and nutritional status of Brazilian adolescents: a nationwide study

ObjectivesThe purpose of this study was to evaluate the agreement and risk factors for underestimation and overestimation between nutritional status and self-perceived body image and to assess the prevalence and associated factors for dissatisfaction with body weight among Brazilian adolescents. MethodsStudents aged 12–17 years participating in the Study of Cardiovascular Risk in Adolescents (“ERICA”), a multicenter, cross-sectional, school-based country-wide study, were included (n=71,740). Variables assessed as covariates were sex, age, skin color, socioeconomic status, and common mental disorders (screened by the General Health Questionnaire, GHQ-12). Multinomial logistic regression was used to explore the association between covariates and combinations between self-perceived body image and body mass index (agreement, underestimation and overestimation). The associations between dissatisfaction with body weight and exposure variables were investigated using multivariable Poisson regression models. ResultsApproximately 66% students rightly matched their body mass index with self-perceived weight (kappa coefficient was 0.38 for boys and 0.35 for girls). Agreement was higher among younger students and adolescents from low income households. Male sex, older age, and GHQ-12 score ≥3 were associated with weight overestimation. Prevalence of dissatisfaction with body weight was 45.0% (95% CI: 44.0–46.0), and higher among girls, older adolescents, those with underweight or overweight/obesity, as well as those who were physically inactive and with GHQ-12 ≥3. ConclusionsMost of the sample rightly self-perceived their body image according to body mass index. Students with body image misperception and those dissatisfied with their weight were more likely to present a positive screening for common mental disorders.

ERICA: smoking is associated with more severe asthma in Brazilian adolescents

ObjectiveTo investigate the association between smoking and asthma, and possible associated factors in Brazilian adolescents. MethodsA cross-sectional, national, school-based study with adolescents aged 12–17 years, participants in the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes – ERICA). A total of 66,394 participants answered a self-administered questionnaire with questions about asthma, smoking, lifestyle and sociodemographic variables. Bivariate analysis between Current Asthma (CA) and Severe Asthma (SA) and the other study variables were performed using Chi-squared. Then, the crude and adjusted Prevalence Ratios (PR), and respective 95% Confidence Intervals (95% CI) of current asthma/severe asthma and smoking variables, corrected for sociodemographic and lifestyle variables, were estimated using generalized linear models with Poisson regression, logit link, and robust variance. ResultsThe prevalence of current asthma and severe asthma were significantly higher in adolescents who were exposed to: experimentation (current asthma: PR=1.78, 95% CI: 1.51–2.09; severe asthma: PR=2.01; 95% CI: 1.35–2.98); current smoking (current asthma: PR=2.08, 95% CI: 1.65–2.64; severe asthma: PR=2.29; 95% CI: 1.38–3.82); regular smoking (current asthma: PR=2.25, 95% CI: 1.64–3.07; severe asthma: PR: 2.41; 95% CI: 1.23–4.73); and passive smoking (current asthma: PR=1.47, 95% CI: 1.27–1.67; severe asthma: PR=1.66; 95% CI: 1.19–2.32); these associations remained significant after adjustment. ConclusionsAsthma and smoking were significantly associated in Brazilian adolescents, regardless of the sociodemographic and lifestyle factors, notably in those with more severe disease.