Fatores de risco cardiovascular em crianças : estudo de prevalência e intervenção multidisciplinar em contexto escolar envolvendo atividade física e nutrição
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2018
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Diversas variáveis contribuem para o desenvolvimento precoce de fatores de risco
cardiovascular e metabólico (FRCM) a partir da infância, sendo esse desenvolvimento mais
frequente em crianças com obesidade. Mantendo a tendência, o número de crianças com
excesso de peso ou obesidade irá aumentar para 70 milhões em 2025. A atividade física
(AF) e a ingestão alimentar são fatores comportamentais modificáveis que influenciam a
aptidão física e o peso corporal, ambos relacionados com FRCM potenciadores das doenças
cardiovasculares e diabetes. O objetivo deste trabalho foi analisar em contexto escolar a
associação entre medidas antropométricas (MA), pressão arterial (PA), aptidão
cardiorespiratória (ACR), AF e comportamentos sedentários (CS), procurando também fazer
a predição das MA (n=245). Foram analisados os efeitos de uma intervenção
multidisciplinar (através de um RCT), durante seis meses, em diversos FRCM (n=77). Foi
encontrada uma elevada proporção de crianças com excesso de peso (29.8%) e obesidade
(20.0%), 41.2% apresentou uma relação cintura-estatura (RCE) superior a 0.5 e mais de 50%
não atingiu as recomendações internacionais de AF. A ACR e a AF vigorosa (AFV) foram
inversamente correlacionadas com as MA. A AF moderada (AFM) e a AFV foram
positivamente relacionadas com a ACR e esta foi inversamente com a PA. A ACR e a AF
explicaram a variância do índice de massa corporal (IMC). A variância do perímetro de
cintura (PC) e da RCE foi predita pela ACR. As associações positivas na avaliação inicial
entre o z-score do IMC, o PC, a RCE com os triglicéridos (TGC), entre o z-score do IMC, a
RCE com a glicose, entre a AF leve (AFL) e o HDL-colesterol (HDL-C), entre a AF
moderada a vigorosa (AFMV) e a AFV com a ACR, entre a ingestão calórica e de lípidos
com o LDL-colesterol (LDL–C), o z-score do IMC, o PC e a RCE, bem como a relação
inversa entre a ACR e os TGC, demonstraram a importância da implementação de
programas escolares interdisciplinares inseridos na comunidade escolar, nos projetos e
planos de atividades, que envolvam profissionais treinados e os pais. No RCT, o grupo
experimental (GE) aumentou a AFM, a AFV, os passos e os períodos de AFMV de 1-5
minutos, a ACR, para além das alterações clinicamente relevantes no HDL-C e TGC. A
ACR foi a variável que mais explicou a variação das MA. Parece pertinente começar mais
precocemente a avaliação da prevalência e inter-relação entre os diversos FRCM e é
determinante a implementação de programas multidisciplinares cada vez mais centrados na
componente fitness e não somente na componente fatness
Several variables contribute to the early development of cardiovascular and metabolic risk factors in youth and this development occur more frequently in children with obesity. If current trends continue the number of overweight or obese infants and young children globally will increase to 70 million by 2025. The physical activity (PA) and eating behaviour are considered modifiable behavioural risk factors influencing physical fitness (PF) and body weight that are related to cardiovascular and metabolic risk factors (CMRF), potentially leading to cardiovascular diseases and diabetes. Thus, the objective of this study was to analyse the association between anthropometric measures (AM) and blood pressure (BP) with cardiorespiratory fitness (CRF), PA and sedentary behaviour (SB), and predicted body mass index (BMI) z-score, waist circumference (WC) and waist height to ratio (WHtR) variance (n=245). The effects of a 6-month multidisciplinary school-based intervention (through a RCT) in several CMRF were analysed (n=77). It was found a large proportion of overweight children (29.8%) or with obesity (20.0%), 41.2% of the participants had a WHtR larger than 0.5 and more than 50% did not meet the PA international recommendations. The CRF and vigorous PA (VPA) were inversely correlated with all AM. Moderate PA (MPA) and VPA were both positively associated with CRF and this was inversely correlated with BP. The CRF and PA explained the BMI z-score variance. The WC and WHtR variance was predicted by CRF. The positive associations founded at baseline between the BMI z-score, WC, and WHtR with triglycerides (TGC), the BMI z-score and WHtR with glucose; the light PA (LPA) time and HDL-cholesterol (HDL-C); the vigorous and moderate-to-vigorous PA (MVPA) with CRF; the caloric intake and lipids with LDL-cholesterol, BMI z-score, WC, and WHtR, as well as, the inverse association between CRF and TGC, stress the importance of multidisciplinary school-based interventions integrated in school communities and their educational project and annual activity plan, involving trained experts and the parents. In the RCT, the experimental group (EG) participants increased the MPA, the VPA, the steps, the MVPA 1-5 minutes periods, the CRF, in addition to the clinically relevant changes in HDL-C and TGC. The CRF was the variable that most strongly explained the AM variance. It is relevant to start earlier the assessement of the prevalence and relationship between the several CMRF, it is important to develop multidisciplinary school-based programs, and it is critical place their approaches focused on the fitness component and not only in the fatness component.
Several variables contribute to the early development of cardiovascular and metabolic risk factors in youth and this development occur more frequently in children with obesity. If current trends continue the number of overweight or obese infants and young children globally will increase to 70 million by 2025. The physical activity (PA) and eating behaviour are considered modifiable behavioural risk factors influencing physical fitness (PF) and body weight that are related to cardiovascular and metabolic risk factors (CMRF), potentially leading to cardiovascular diseases and diabetes. Thus, the objective of this study was to analyse the association between anthropometric measures (AM) and blood pressure (BP) with cardiorespiratory fitness (CRF), PA and sedentary behaviour (SB), and predicted body mass index (BMI) z-score, waist circumference (WC) and waist height to ratio (WHtR) variance (n=245). The effects of a 6-month multidisciplinary school-based intervention (through a RCT) in several CMRF were analysed (n=77). It was found a large proportion of overweight children (29.8%) or with obesity (20.0%), 41.2% of the participants had a WHtR larger than 0.5 and more than 50% did not meet the PA international recommendations. The CRF and vigorous PA (VPA) were inversely correlated with all AM. Moderate PA (MPA) and VPA were both positively associated with CRF and this was inversely correlated with BP. The CRF and PA explained the BMI z-score variance. The WC and WHtR variance was predicted by CRF. The positive associations founded at baseline between the BMI z-score, WC, and WHtR with triglycerides (TGC), the BMI z-score and WHtR with glucose; the light PA (LPA) time and HDL-cholesterol (HDL-C); the vigorous and moderate-to-vigorous PA (MVPA) with CRF; the caloric intake and lipids with LDL-cholesterol, BMI z-score, WC, and WHtR, as well as, the inverse association between CRF and TGC, stress the importance of multidisciplinary school-based interventions integrated in school communities and their educational project and annual activity plan, involving trained experts and the parents. In the RCT, the experimental group (EG) participants increased the MPA, the VPA, the steps, the MVPA 1-5 minutes periods, the CRF, in addition to the clinically relevant changes in HDL-C and TGC. The CRF was the variable that most strongly explained the AM variance. It is relevant to start earlier the assessement of the prevalence and relationship between the several CMRF, it is important to develop multidisciplinary school-based programs, and it is critical place their approaches focused on the fitness component and not only in the fatness component.
Descrição
Orientação: António Labisa Palmeira
Palavras-chave
DOUTORAMENTO EM EDUCAÇÃO FÍSICA E DESPORTO, DESPORTO, EDUCAÇÃO FÍSICA, FATORES DE RISCO, OBESIDADE, APTIDÃO FÍSICA, ATIVIDADE FÍSICA, NUTRIÇÃO, CRIANÇAS, DOENÇAS CARDIOVASCULARES, PHYSICAL EDUCATION, SPORT, PHYSICAL EDUCATION, RISK FACTORS, OBESITY, PHYSICAL FITNESS, PHYSICAL ACTIVITY , NUTRITION, CHILDREN, CARDIOVASCULAR DISEASES