Análise de tendência e fatores associados à circunferência da cintura em escolares de 7 a 14 anos de idade de Florianópolis/SC - estudo de quatro painéis transversais no período 2002 a 2019

Abstract

Introdução: A literatura indica que indivíduos com diabetes mellitus do tipo 2 (DM2) podem apresentar maior declínio cognitivo, quando comparado a indivíduos sem a doença. Os mecanismos envolvidos neste declínio estão relacionados ao quadro de resistência à insulina e inflamação, presentes no DM2. Alterações em testes cognitivos e diminuição do marcador BDNF (Fator Neurotrófico derivado do encéfalo) são alguns dos indicativos de alteração cognitiva. A hipótese do estudo é que o estado nutricional, como consumo alimentar, índice de massa corporal (IMC) e composição corporal, podem desempenhar um importante papel no desenvolvimento de alterações cognitivas. Objetivo: Avaliar a correlação entre marcadores do estado nutricional e marcadores da função cognitiva em indivíduos com DM2 no Município de Florianópolis/SC. Métodos: Estudo exploratório, transversal, realizado no Centro de Ciências da Saúde na Universidade Federal de Santa Catarina. A coleta de dados foi realizada em duas etapas, de forma remota, através de um formulário online, e presencial. Realizou-se a avaliação dos indicadores do estado nutricional: IMC, porcentagem de gordura corporal, porcentagem de massa magra, índices bioquímicos e consumo alimentar. Em relação a cognição, foram utilizados os questionários cognitivos (MEEM e Teste de Trilhas), além dos níveis sanguíneos do BDNF. Ainda, foram coletadas covariáveis, sendo elas: Atividade física, sono, sintomas de depressão e ansiedade. Para a análise estatística e associação das variáveis de cognição e estado nutricional, utilizou-se as correlações de Pearson e Spearman. O nível de significância estatística foi de p<0,05. Resultados: 31 indivíduos foram incluídos no estudo (71% mulheres, média de idade 57.87 ±8.29). A concentração média de hemoglobina glicada (HbA1c) foi de 6,95 (±0,89) e de níveis de BDNF de 2,562 (0,0477 - 6,2120). As principais correlações encontradas foram entre os níveis de BDNF sérico e HbA1c (r= .55, p < 0,05), MEEM (r= -.45, p <0,05), níveis de triglicerídeos (r= .43, p <0,05) e ingestão proteica (r= .49, p<0,05). Conclusão: O estudo sugere uma correlação moderada e positiva entre níveis de BDNF sérico e Hb1Ac, que suporta que alterações no metabolismo glicídico podem impactar os níveis de BDNF.

Abstract: Introduction: Obesity is considered a global epidemic, constituting an important public health problem, which affects different age groups, including children and adolescents, at different economic levels. Body mass index (BMI) is a parameter that only considers total or generalized obesity. Therefore, the use of other anthropometric variables such as waist circumference (WC) is necessary to identify body fat in the central region. Increased adiposity in the central region is more strongly associated with several risk factors, such as the emergence of cardiometabolic complications. In Brazil, in the last two decades, a trend towards central obesity was observed in only three studies with children and adolescents aged between 7 and 18 years, which used two and three crosssectional panels, highlighting how little use of the measure is still of WC to identify central obesity in children and adolescents. Objectives: To analyze the trend and factors associated with central obesity in schoolchildren aged 7-14 years from Florianópolis, SC, in four cross-sectional panels (2002 to 2019). Methods: Cross-sectional panel studies, whose data were extracted from four epidemiological sections designed to investigate obesity-related behaviors in schoolchildren aged 7 to 14 years old in Florianópolis, in 2002, 2007, 2012/2013 and 2018/2019. In all four cross-sectional panels, WC anthropometric data were collected according to a standardized procedure. In the present study, the anthropometric measurement of WC will be considered as an outcome variable, and the exposure variables will be sociodemographic data (gender, age group, type of school, school shift, mother's education, travel to school, family income and maturation sexual), travel to school and sexual maturation. For statistical analysis, the chi-square test was used to evaluate the association of the outcome with the independent variables and binary logistic regression with estimation of odds ratios was used to evaluate the predictors of central obesity. Results: In total, 9,939 students participated in all years of the research. The prevalence of central obesity was 26.4%, 27.1%, 30.0% and 32.9% in 2002, 2007, 2012/2013 and 2018-2019 respectively, with an increase of approximately 25% between 2002 and 2018/2019. Furthermore, in the adjusted logistic regression analysis, possible factors associated with central obesity were identified, including the variable year of research-time, sex, age, school shift, passive commuting to school and sexual maturation. prevalence of central obesity and pre-pubertal sexual maturation stage of children aged 7 to 14 years in 2007 (21.1; 95% CI: 11.8-34.9), 2012/2013 (24.2; 95% CI %: 18.0-31.6) and 2018/2019 (30.0; 95% CI: 24.3 36.2). This same upward trend, but with a drop in the last panel, was also observed in individuals with central obesity and post-pubertal stage of sexual maturation in 2007 (37.7; 95% CI: 17.6-63.1), 2012/ 2013 (43.4; 95% CI: 26.0-62.7) and 2018/2019 (41.9; 95% CI: 26.4-59.2), respectively. Conclusions: There was an increase in the trend in the prevalence of central obesity between 2002 and 2018/2019 in schoolchildren aged 7 to 14 in Florianópolis. The observed trends may be due to changes in the sociodemographic, behavioral and biological environment that have occurred over the years. These findings reinforce the need to strengthen and expand public actions and policies that encourage a healthier, more active lifestyle and reduce sedentary behavior, with the aim of promoting health among this population.