Title:	Estudo de Riscos Cardiovasculares em Adolescentes (ERICA) : análise da acurácia da hipertensão autorreferida e de fatores do ambiente alimentar escolar associados à hipertensão e obesidade
Authors:	Gonçalves, Vivian Siqueira Santos
Orientador(es)::	Carvalho, Kênia Mara Baiocchi de
Assunto::	Hipertensão Obesidade Alimentação escolar Adolescentes - nutrição
Issue Date:	3-Dec-2020
Data de defesa::	6-Apr-2018
Citation:	GONÇALVES, Vivian Siqueira Santos. Estudo de Riscos Cardiovasculares em Adolescentes (ERICA): análise da acurácia da hipertensão autorreferida e de fatores do ambiente alimentar escolar associados à hipertensão e obesidade. 2018. 137 f., il. Tese (Doutorado em Nutrição Humana)—Universidade de Brasília, Brasília, 2018.
Abstract:	Introduction: Hypertension and obesity are emerging multifactorial diseases in the adolescent population around the world. Studies about diagnosis and associated factors are needed in order to subsidize early interventions. Objective: To investigate the accuracy of self-reported hypertension and school food environment factors associated with hypertension and obesity in adolescence. Methods: Two systematic reviews were accomplished (1) on the accuracy of selfreported hypertension, with meta-analysis; and (2) on the relationship between the school food environment and overweight, through a qualitative analysis. Two original studies were also done with the data from The Study of Cardiovascular Risk in Adolescents (Portuguese acronym “ERICA”). In the first, we investigated the prevalence of self-reported and measured hypertension and calculated sensitivity, specificity, predictive positive (PPV) and negative (NPV) values of the self-reported diagnosis. The association between self-report hypertension and socioeconomic factors was investigated through Poisson regression. In the second, we studied the association between the school food environment characteristics and hypertension as well as obesity prevalence through a multilevel Poisson regression. Results: Systematic Review 1: Twenty-two studies were included and there was great sensitivity and specificity variation among countries and age groups. In most of the studies, self-report underestimated hypertension prevalence. Sensitivity was 42.1% (CI95% 30.9-54.2) and specificity 89.5% (IC95% 84.0-93.3), with high heterogeneity (I2 > 99%). Systematic Review 2: The qualitative analysis consisted of 13 articles. The results were consistent regarding the influence of foods and meals quality in schools on the adolescents’ nutritional status. Deep fried foods for lunch, sodas available in the cafeteria and vending machines in school were some of the factors associated with body mass increase. The results on foods sold in school surroundings were controversial. Original article 1: The sample comprised 73,399 adolescents from 1,247 schools and 122 Brazilian municipalities. Mean age was 14.4 years and 52.7% were male. Measured hypertension prevalence, also considering those who declared they were using medication for hypertension, was 10.2% (IC95% 9.6-10.9) and self-reported prevalence was 3.8% (CI95% 3.4-4.2). Regarding self-report accuracy evaluation parameters, it was observed 7.5% (CI95% 6.9-8.2) sensitivity, 96.6% (CI95% 96.5- 96.7) specificity, 18.9% (CI95% 17.4-20.5) PPV and 90.8% (CI95% 90.6-91.0) NPV. Studying in private schools was associated to lower prevalence of inconsistent reports in girls (PR= 0.68; IC95% 0.55-0.83). Original article 2: Approximately 50% of the adolescents had access to buying foods in school or its surroundings and 82% had access to free meals from the National School Feeding Program (Portuguese acronym “PNAE”). In the adjusted analysis, hypertension was associated with the consumption of meals offered in school (PR= 0.83; CI95% 0.74-0.93), with foods sold in the surroundings (PR= 0.71; 0.53-0.95) and with buying foods in the cafeteria (PR= 1.23; CI95% 1.09-1.39). For obesity, lower prevalence was associated with meals offered in school (PR= 0.68; CI95% 0.54-0.87). Conclusions: Hypertension self-report presented lower sensitivity values in the population aged 18 years or older in the systematic review and did not represent a good strategy to investigate the prevalence of hypertensive adolescents in ERICA data. The use of hypertension self-reports in surveys or to plan actions must be assessed with caution regarding regional, socioeconomic and cultural differences that play a direct role in the population’s access to health services. It was verified that the adoption of measures to improve the school food environment in several parts of the world has been causing a positive effect in the nutritional status of adolescents. In Brazil, contextual and individual characteristics were associated with hypertension and obesity. We also observed high frequency of foods commercialization in schools, suggesting the necessity of regulation and monitoring of such spaces.
metadata.dc.description.unidade:	Faculdade de Ciências da Saúde (FS) Departamento de Nutrição (FS NUT)
Description:	Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós Graduação em Nutrição Humana, 2018.
metadata.dc.description.ppg:	Programa de Pós-Graduação em Nutrição Humana
Licença::	A concessão da licença deste item refere-se ao termo de autorização impresso assinado pelo autor com as seguintes condições: Na qualidade de titular dos direitos de autor da publicação, autorizo a Universidade de Brasília e o IBICT a disponibilizar por meio dos sites www.bce.unb.br, www.ibict.br, http://hercules.vtls.com/cgi-bin/ndltd/chameleon?lng=pt&skin=ndltd sem ressarcimento dos direitos autorais, de acordo com a Lei nº 9610/98, o texto integral da obra disponibilizada, conforme permissões assinaladas, para fins de leitura, impressão e/ou download, a título de divulgação da produção científica brasileira, a partir desta data.
Agência financiadora:	Financiadora de Estudos e Projetos (Finep) e Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).
Appears in Collections:	Teses, dissertações e produtos pós-doutorado

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