BackgroundThe 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.Methods/DesignParticipants answered a self-administered questionnaire using an electronic device, in order to obtain information on demographic and lifestyle characteristics, including physical activity, smoking, alcohol intake, sleeping hours, common mental disorders and reproductive and oral health. Dietary intake was assessed using a 24-hour dietary recall. Anthropometric measures (weight, height and waist circumference) and blood pressure were also be measured. Blood was collected from a subsample of approximately 44,000 adolescents for measurements of fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin and fasting insulin.DiscussionThe 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.

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.

This article discusses the relationship between both poverty and food insecurity and the COVID-19 pandemic, as well as presenting possible strategies and actions for increasing social protection in the fight against these conditions in the current epidemiological context, especially for low-income countries. This is a narrative review concerning COVID-19, poverty, and food and nutritional insecurity. The COVID-19 pandemic may increase poverty and food insecurity levels, resulting from the absence of or weak political, economic, and social interventions to maintain jobs, as well as compromised food production and distribution chains and reduced access to healthy foods in different countries around the world, especially the poorest ones, where social and economic inequality was already historically high; the pandemic heightens and uncovers the vulnerability of poor populations. Public policies focused on guaranteeing the human right to adequate food must be improved and implemented for populations in contexts of poverty with the aim of providing food security.

Fatty liver is increasingly common in obese adolescents. We determined its association with glucose dysregulation in 118 (37M/81F) obese adolescents of similar age and percent total fat. Fast-magnetic resonance imaging (MRI) and simple MRI were used to quantify hepatic fat content and abdominal fat distribution. All subjects had a standard oral glucose tolerance test. Insulin sensitivity was estimated by the Matsuda Index and homeostasis model assessment of insulin resistance. Baseline total and high molecular weight (HMW)-adiponectin and interleukin (IL)-6 levels were measured. The cohort was stratified according to tertiles of hepatic fat content. Whereas age and %fat were comparable across tertiles, ethnicity differed in that fewer Blacks and more Whites and Hispanics were in the moderate and high category of hepatic fat fraction (HFF). Visceral and the visceral-to-subcutaneous fat ratio increased and insulin sensitivity decreased across tertiles. Two-hour plasma glucose rose with increasing hepatic steatosis (P < 0.008). 73.7% of the subjects in the high HFF had the metabolic syndrome compared to 19.5% and 30.6%, respectively, in the low and moderate categories. Both total and HMWadiponectin decreased, and IL-6 increased with increasing hepatic steatosis. Conclusion: In obese adolescents, independent of total fat, increasing severity of fatty liver is associated with glucose dysregulation, metabolic syndrome, and with a proinflammatory milieu. (HEPATOLOGY 2009;49: 1896-1903 E ctopic fat deposition in insulin-sensitive tissues such as liver and muscle strongly correlates with insulin resistance. 1 Previously, we reported that increased intramyocellular fat in obese adolescents was associated with impaired glucose intolerance and insulin resistance. 2 Furthermore, moderate elevation in alanine aminotransferase (ALT) levels, a poor surrogate of fatty liver, was found to be associated with high-normal glucose levels, 3 whereas abnormal ALT levels were reported in youngsters with type 2 diabetes (T2DM), 4 raising the question of a potential role of fatty liver in the onset of T2DM in obese youth. Fatty liver in obese adolescents is becoming increasingly common. [5][6][7] Nevertheless, its role in the dysregulation of glucose metabolism is unclear. We hypothesize that, independent of overall obesity, the severity of hepatic steatosis will strongly affect the presence of prediabetes and diabetes in obese adolescents. Furthermore, we determined if the balance between antiinflammatory markers such as total and high molecular weight (HMW) adiponectin and proinflammatory markers like interleukin-6 (IL-6) would vary as a function of the degree of hepatic steatosis. Using fast-magnetic resonance imaging (MRI) we quantified intrahepatic fat content in a large multiethnic group of obese adolescents matched for age and overall adiposity. Subjects and MethodsThe Cohort. In all, 118 obese adolescents, 13 to 16 years old with a body mass index (BMI)-z score ranging

RESUMOSobrepeso e obesidade infantil apresentam prevalência elevada e caráter multifatorial. Com o objetivo de determinar a influência de fatores biológicos e ambientais no seu desenvolvimento, foi realizado corte transversal com 699 crianças, de 5 a 9 anos, da rede de ensino público e privado da zona urbana de Feira de Santana, BA. Sobrepeso e obesidade foram definidos como índice de massa corpórea ≥ aos percentis 85 e 95 para idade e sexo, respectivamente. A análise de entrevistas com os responsáveis determinou a influência dos fatores em questão. Observados como de significância estatística para o desenvolvimento de ambas as condições: nível elevado de escolaridade e renda familiar, ser unigênito, freqüentar escola privada, possuir eletrodomésticos e utilizar computador. O grupo étnico branco relacionouse apenas ao sobrepeso. Repetência escolar e realização de atividade física sistemática mostraram associação inversa. O odds ratio mostrou associação preditiva independente com o fato de estudar em escola privada e ser unigênito. Em conclusão, há influência de fatores biológi-cos e ambientais no desenvolvimento de sobrepeso e obesidade infantil, confirmando o caráter multifatorial. Childhood overweight and obesity have a high prevalence and multifactorial character. To determine the influence of biological and environmental factors in their development, a cross-sectional study was performed with 699 children, ranging from 5 to 9 years of age, from the public and private schools in the urban area of Feira de Santana, BA. Overweight and obesity were defined as body-mass index ≥ the 85 th and 95 th percentiles for age and gender, respectively. Interviews with the children's responsible were used to determine the influence of these factors. It was observed as statistic significance for the development of both conditions: high level of parent's education and income, being an only child, studying at private school, having household appliances and using computers. The white ethnic group was related only to overweight. There was an inverse association regarding school flunking and practice of systematic physical activity. The odds ratio showed a predictive and independent association with studying at private school and being an only child. In conclusion there was an influence of biological and environmental factors in the development of childhood overweight and obesity, confirming the multifactorial etiology of these conditions.