The 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. Participants 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. The 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.

Biostatistics

Sample (material)

10.1186/s12889-015-1442-x

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Citations (199)

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

Jornal de Pediatria (Versão em Português) (2020)

Thiago Veiga Jardim Bernard Rosner Kátia Vergetti Bloch Maria Cristina Caetano Kuschnir Moysés Szklo

Blood 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. The 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. Among 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. Blood pressure references by sex, age, and height percentiles for Brazilian adolescents are provided. Referências de pressão arterial (PA) para adolescentes brasileiros estão ausentes na literatura. Este estudo tem como objetivo investigar a variação normal da pressão arterial no consultório em uma população brasileira saudável de adolescentes sem sobrepeso. O Estudo dos Riscos Cardiovasculares em Adolescentes (ERICA) é um estudo brasileiro, de âmbito nacional e de base escolar, que incluiu adolescentes (12 a 17 anos) matriculados em escolas públicas e privadas, em cidades com mais de 100.000 habitantes, de todas as cinco macrorregiões brasileiras. A altura e o índice de massa corporal (IMC) dos adolescentes foram classificados em percentis de acordo com a idade e o sexo, sendo adotadas as curvas de referência da Organização Mundial de Saúde. Foram realizadas três medidas consecutivas de PA no consultório com um dispositivo oscilométrico validado, utilizando o manguito de tamanho apropriado. Os valores médios das duas últimas leituras foram utilizados nas análises. Modelos de regressão polinomial relacionando PA, idade e estatura foram aplicados. Entre os 73.999 adolescentes, os indivíduos sem sobrepeso representaram 74,5% (IC95%: 73,3‐75,6) do total, com distribuição similar entre as idades. A maior parte da amostra sem sobrepeso originava‐se das escolas públicas, com 84,2% (IC95%: 79,9‐87,7), e os sedentários 54,8% (IC95%: 53,7‐55,8). Os adolescentes que relataram sua cor de pele como parda (48,8% [IC95%: 47,4‐50,1]) e branca (37,8%: [IC 95% 36,1‐39,5]) foram os mais representados. A PA aumentou tanto com a idade, quanto com o percentil de altura. Os padrões de aumento sistólico da PA foram mais acentuados no sexo masculino quando comparados ao sexo feminino, em todos os percentis de altura. O mesmo padrão não foi observado para a PA diastólica. São fornecidas referências de pressão arterial por sexo, idade e percentil de altura para adolescentes brasileiros.

Screen Time

10.1016/j.jpedp.2018.09.002

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Influência de fatores ambientais na eficiência de hospitais de ensino

Epidemiologia e Serviços de Saúde (2011)

Maria Stella Castro Lobo Angela Cristina M. Silva Marcos Pereira Estellita Lins Roberto Fiszman Kátia Vergetti Bloch

Summary Objective: to measure the performance of teaching hospitals by Data Envelopment Analysis (DEA) and to study the influence of environmental factors on the efficiency. Methodology: A hundred and four teaching hospitals were analyzed and the efficiency score was generated by DEA, VRS model, output oriented, with weight restrictions. The efficiency score criteria were then regressed on non-discretionary variables by logistic linear regression. Results: the efficiency score mean was 49% (SD=26%); five hospitals were efficient. In logistic regression, the main predictors of efficiency were the size of the hospital (p=0.001), high teaching intensity (p=0.027) and low teaching dedication (p=0.006). There was no association between efficiency and ownership form or HDI of the surrounding municipality. Conclusion: hospital efficiency suffers the influence of different environmental factors, not necessarily under the control of the manager, that should be considered when defining administrative goals and financing pacts.

10.5123/s1679-49742011000100005

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Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

WOS (2021)

Bin Zhou Rodrigo M. Carrillo‐Larco Goodarz Danaei Leanne M Riley Christopher Paciorek

Pooled analysis

Source

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Prevalence of Combined Lipid Abnormalities in Brazilian Adolescents and Its Association with Nutritional Status: Data from the Erica Study

Global Heart (2020)

Tatiana Lorena da Luz Kaestner Jamylle A. D. Santos Daiane Cristina Pazin Cristina Pellegrino Baena Márcia Olandoski

Background: Cardiovascular diseases are the leading cause of death in Brazil and worldwide. The growing incidence of obesity in children and adolescents and its association with lipid abnormalities may worsen this scenario, mainly in developing countries where obesity has reached epidemic levels. Dyslipidemias have several patterns, and the combination of some lipid abnormalities may have higher atherogenic potential. Objectives: To evaluate the prevalence of single or multiple combined lipid abnormalities in adolescents and its association with nutritional status assessed by body mass index. Methods: Data were obtained from the Study of Cardiovascular Risks in Adolescents (ERICA), a school-based, national representative study with Brazilian adolescents between 12 and 17 years of age. Adolescents whose lipid profiles were available were included, and lipid abnormalities were defined as LDL-C ≥ 100 mg/dL, HDL-C < 45 mg/dL, and tryglicerides (TG) ≥ 100 mg/dL. We assessed the prevalence of single or combined lipid abnormalities and correlated this nutritional status with body mass index of low weight, normal, overweight, and obesity. Results: A total of 38,069 adolescents were included, with more than 24,000 of them presenting at least one lipid abnormality (64.7%), and 3.7% showing alterations in all of them. The most prevalent combination was high TG with low HDL-C levels. The higher the BMI, the more lipid abnormalities were found. Conclusions: In this large and representative sample of Brazilian adolescents, the majority had at least one lipid abnormality. Higher BMI was associated with a higher prevalence of combined lipid abnormalities. Highlights:
– There is a high prevalence of Brazilian adolescents with dyslipidemias.
– BMI was associated with a higher prevalence of combined lipid abnormalities.
– BMI can be considered as an indicator of the diagnosis of dyslipidemia in adolescents.

Lipid Profile

Abnormality

10.5334/gh.769

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Association Between Sleep Time and Pro- and Anti-Inflammatory Biomarkers Is Mediated by Abdominal Obesity Among Adolescents

Journal of Physical Activity and Health (2023)

Augusto César Ferreira de Moraes Vanessa Cassia Medeiros-Oliveira Katie Burford Beatriz D. Schaan Kátia Vergetti Bloch

Movement behaviors and abdominal obesity are associated with higher inflammatory biomarkers. However, the role of waist circumference as a mediating factor is still unknown. Thus, our aims were to (1) test the associations between 24-hour movement behavior variables (physical activity, sedentary behavior, and sleep), abdominal obesity, and pro- and anti-inflammatory biomarkers; and (2) investigate whether abdominal obesity had a mediating effect between the investigated associations.This multicenter cross-sectional study included 3591 adolescents (aged 12-17 y) from 4 Brazilian cities. Waist circumference (in centimeters; at half the distance between the iliac crest and at the lower costal margin), 24-hour movement behaviors (validated questionnaire), high-sensitive C-reactive protein, and adiponectin (serum plasma) were evaluated. We used multiple mediation regression models (95% confidence interval) to determine if waist circumference mediated the association between 24-hour movement behaviors and pro- and anti-inflammatory biomarkers.The results revealed that screen time and moderate to vigorous physical activity were not associated with pro- or anti-inflammatory biomarkers. However, sleep duration (in hours per day) was negatively associated with pro- (C-reactive protein, β = -0.08; 95% confidence interval, -0.38 to -0.02) and anti- (adiponectin, β = -0.31; 95% confidence interval, -2.13 to -0.12) inflammatory biomarkers. Our results also showed that waist circumference mediated the association between sleep duration and high-sensitive C-reactive protein (2.7%), and adiponectin (2.8%).Sleep duration was inversely associated with pro- and anti-inflammatory biomarkers, and these relations were mediated by abdominal obesity. Therefore, adolescents having healthy sleep can have implications for reducing waist circumference and inflammatory indicators.

Abdominal obesity

10.1123/jpah.2022-0468

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P-27 OBESITY AND LIVER STEATOSIS IN ADOLESCENTS AND YOUNG ADULTS - RELATED FACTORS AND THE IMPACT OF LIFESTYLE

Annals of Hepatology (2024)

F. Basilio Ana Carolina Cardoso Kátia Vergetti Bloch Nathalie C. Leite Cristiane Alves Villela‐Nogueira

Steatosis

Liver steatosis

10.1016/j.aohep.2024.101641

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