Hipertensão arterial, estilo de vida e estado nutricional de participantes do Estudo de Riscos Cardiovasculares em Adolescentes no Distrito Federal

SOUSA, Natália de Oliveira; OKAMURA, Aline Bassetto; CARVALHO, Kênia Mara Baiocchi de; DUTRA, Eliane Said; GONÇALVES, Vivian Siqueira Santos

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Sumário

ORIGINAL • Rev Nutr 34 • 2021 • https://doi.org/10.1590/1678-9865202134e210051 copiar

Hipertensão arterial, estilo de vida e estado nutricional de participantes do Estudo de Riscos Cardiovasculares em Adolescentes no Distrito Federal

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo

Estimar a prevalência de hipertensão arterial em participantes do Estudo de Riscos Cardiovasculares em Adolescentes no Distrito Federal, investigando fatores relacionados ao estilo de vida e ao estado nutricional associados.

Métodos

Variáveis de estilo de vida, econômicas e demográficas foram obtidas por questionário autopreenchido. Os dados antropométricos e a aferição da pressão arterial foram coletados de acordo com protocolo padronizado. Empregou-se estatística descritiva para conhecer a distribuição dos parâmetros investigados em relação ao desfecho. A associação entre hipertensão arterial e as variáveis de interesse foi investigada pela análise multivariada hierárquica por meio da regressão de Poisson.

Resultados

Foram avaliados 2.646 adolescentes, com média de idade de 14,9 anos. A prevalência de hipertensão arterial foi 8,0% (IC95% 6,8-9,3). Estudar em escolas da região rural (RP=2,1; IC95% 1,4-3,3), ter obesidade (RP=4,0; IC95% 2,5-6,3), ser do sexo masculino (RP=2,2; IC95% 1,6-3,0) e ter idade maior ou igual a 15 anos (RP=1,4; IC95% 1,0-1,9) foram fatores associados a maiores prevalências de hipertensão. O consumo de alimentação escolar apresentou-se como um fator de proteção (RP=0,7; IC95% 0,6-0,9).

Conclusão

A prevalência de hipertensão arterial foi 8% e se associou com o sexo masculino, idade maior ou igual a 15 anos, estudar em escolas da zona rural e ter obesidade. O consumo de alimentação ofertada pelas escolas foi identificado como fator de proteção.

Palavras-chave
Adolescentes; Hipertensão; Estilo de vida; Obesidade; Alimentação Escolar

Characteristics		Prevalence of adolescents		Prevalence of hypertension
Characteristics		%	CI95%	%	CI95%
School administrative dependency
	Public	69.3	51.7-82.6	07.7	6.2-9.4
	Private	30.7	17.3-48.2	08.6	6.9-10.5
School location area
	Urban	94.2	77.6-98.6	07.5	6.4-8.7
	Rural	05.8	1.3-22.3	15.2	8.8-24.8
Sex
	Women	50.1	-	04.5	3.3-6.0
	Men	49.9	-	11.4	9.4-13.8
Skin color
	White	36.0	31.3-40.8	08.1	6.1-10.7
	Brown or black	58.6	53.8-63.2	08.0	6.5-9.8
	Asian	02.6	1.9-3.3	04.0	1.5-9.8
	Indigenous	00.4	0.2-0.8	14.8	3.5-44.7
	Did not answer	02.4	1.9-3.0	07.6	2.7-19.1
Age
	< 15 years old	52.0	-	07.2	5.7-8.8
	≥ 15 years old	48.0	-	08.9	7.1-10.9
Sexual maturation¹ 1 Puberal stadiometer classified according to the Tanner’s pubertal stage, with levels 4 and 5 being advanced stages [13].
	Not pubescent	18.6	16.3-21.2	06.8	4.3-10.4
	Pubescent	81.4	78.7-83.6	08.3	6.9-9.7
Physical activity² 2 Insufficiently active/active ≥1 min/wk; No physical activity =0 min/wk;
	Insufficiently active/active	75.1	72.8-77.1	09.0	7.5-10.6
	No physical activity	24.9	22.8-27.1	05.0	3.5-6.9
Consumption of food offered by the school
	No	53.0	45.2-60.7	08.8	7.3-10.4
	Yes	47.0	39.2-54.7	07.1	5.5-9.0
Snack purchase at the school cafeteria
	No	13.4	9.3-18.8	05.6	3.3-9.1
	Yes	86.6	81.1-90.6	08.4	7.1-9.7
Breakfast consumption
	No	19.1	15.9-22.5	08.4	6.2-11.2
	Yes	80.9	77.4-84.0	07.9	6.5-9.4
Lunch consumption in front of the TV
	No	17.9	15.8-20.3	10.5	7.5-14.4
	Yes	82.1	79.6-84.1	07.4	6.1-8.8
Dinner consumption in front of the TV
	No	19.6	16.6-22.9	09.9	7.0-13.8
	Yes	80.4	77.0-83.3	07.5	6.1-9.0
Lunch consumption with parents or guardian
	No	16.6	15.1-18.1	05.9	3.8-9.0
	Yes	83.4	81.8-84.8	08.4	6.9-10.0
Dinner consumption with parents/guardians
	No	11.5	10.0-13.0	04.9	2.5-9.1
	Yes	88.5	86.9-89.9	08.4	7.0-9.9
Snack consumption while watching TV
	No	13.7	11.8-15.6	10.1	6.9-14.3
	Yes	86.3	84.3-88.1	07.7	6.4-9.0
Snack consumption using the computer or playing video game
	No	29.0	26.2-31.8	08.2	6.0-10.9
	Yes	71.0	68.1-73.7	07.9	6.4-9.6
Daily water consumption
	Does not drink water	01.2	0.7-1.8	07.2	1.6-26.9
	1 to 2 glasses a day	18.9	16.5-21.4	06.3	3.8-10.1
	3 to 4 glasses a day	35.0	32.0-38.1	07.6	6.0-9.4
	At least 5 or more glasses a day	44.9	40.9-48.8	09.0	7.1-11.3
Tobacco use in the last 30 days
	No	93.7	92.1-95.0	08.0	6.8-9.4
	Yes	05.3	4.0-6.8	06.7	2.5-16.8
	Does not know/remember	01.0	0.4-2.1	08.1	2.0-27.4
Consumption of alcoholic beverages in the last 30 days
	No	74.6	71.5-77.4	08.1	6.9-9.2
	Yes	22.2	19.7-24.7	07.2	5.0-10.3
	Does not know/remember	03.2	2.2-4.5	11.3	5.4-22.0
Nutritional status³ 3 Nutritional status classified by body mass index by age, based on the Z-score, indicated for children and adolescents according to the WHO recommendations [16].
	Very low/low weight	03.1	2.5-3.7	05.4	1.5-17.3
	Normal	75.6	73.1-77.7	04.4	3.3-5.7
	Overweight	14.5	12.8-16.4	17.8	14.3-21.8
	Obesity	06.8	5.5-8.4	27.8	17.4-41.3
Waist circumference
	≤p90 (82.25cm)	94.5	92.9-95.7	06.7	5.7-8.0
	>p90 (82.25cm)	05.5	4.2-7.0	28.7	18.2-42.1

Characteristics		Adolescents with hypertension		Adolescents without hypertension
Characteristics		%	CI95%	%	CI95%
Consumption of food offered by the school		41.7	31.5-52.6	47.4	39.7-55.1
Snack purchase at the school cafeteria		90.6	84.1-94.6	86.2	80.5-90.4
Breakfast consumption		79.9	73.1-85.3	81.0	77.3-84.2
Lunch consumption in front of the TV		76.4	69.3-82.2	82.5	79.9-84.8
Dinner consumption in front of the TV		75.5	67.2-82.2	80.8	77.2-83.8
Lunch consumption with parents or guardian		87.7	80.2-92.5	83.0	81.5-84.3
Dinner consumption with parents/guardians		93.0	86.8-96.3	88.1	86.3-89.6
Snack consumption while watching TV		82.8	75.9-87.9	86.6	84.5-88.4
Snack consumption using the computer or video game		70.2	61.7-77.5	71.1	68.0-73.9
Daily water consumption
Does not drink water		01.1	0.2-4.8	01.2	0.7-1.9
1 to 2 glasses a day		14.9	9.5-22.5	19.2	16.6-22.1
3 to 4 glasses a day		33.3	26.6-40.7	35.2	32.1-38.3
At least 5 or more glasses a day		50.7	41.6-59.6	44.4	40.3-48.4
Tobacco use in the last 30 days		04.4	1.5-11.6	05.3	4.0-6.8
Alcoholic beverage consumption		20.1	15.1-26.1	22.4	19.8-25.0
Physical inactivity¹ 1 No physical activity =0 min/wk;		15.5	11.3-20.9	25.7	23.5-28.0
Nutritional status² 2 Nutritional status classified by body mass index by age, based on the Z-score, indicated for children and adolescents according to the WHO recommendations [18].
	Very low/low weight	02.1	0.5-7.0	03.2	2.5-3.8
	Normal	41.7	32.0-51.9	78.5	76.3-80.5
	Overweight	32.5	25.4-40.3	13.0	11.3-14.7
	Obesity	23.8	14.8-35.9	05.3	4.1-6.8
	Waist circumference	19.7	11.7-31.2	04.2	3.2-5.5

Characteristics		Crude analysis		p-value
Characteristics		PR	CI95%	p-value
School administrative dependency
	Public	Ref
	Private	1.1	0.8-1.4	0.461
School location area
	Urban	Ref
	Rural	2.0	1.1-3.4	0.011
Sex
	Women	Ref
	Men	2.5	1.7-3.6	<0.0010
Skin color
	White	Ref
	Brown or black	0.9	0.6-1.4	0.930
	Asian	0.4	0.1-1.3	0.147
	Indigenous	1.8	0.4-6.8	0.371
	Did not answer	0.9	0.3-2.6	0.883
Age
	<15 years old	Ref
	≥15 years old	1.2	0.9-1.6	0.133
Consumption of food offered by the school
	No	Ref
	Yes	0.8	0.6-1.0	0.123
Snack purchase at the school cafeteria
	No	Ref
	Yes	1.5	0.9-2.4	0.109
Breakfast consumption
	No	Ref
	Yes	0.9	06-1.3	0.722
Lunch consumption in front of the TV
	No	Ref
	Yes	0.7	0.4-1.0	0.073
Dinner consumption in front of the TV
	No	Ref
	Yes	0.7	0.4-1.1	0.178
Lunch consumption with parents or guardian
	No	Ref
	Yes	1.4	0.8-2.3	0.181
Dinner consumption with parents/guardians
	No	Ref
	Yes	1.7	0.8-3.4	0.123
Snack consumption while watching TV
	No	Ref
	Yes	0.8	0.5-1.1	0.170
Snack consumption using the computer or playing video game
	No	Ref
	Yes	0.9	0.6-1.3	0.841
Daily water consumption
	Does not drink water	Ref
	1 to 2 glasses a day	0.9	0.1-3.9	0.856
	3 to 4 glasses a day	1.0	0.2-4.7	0.948
	At least 5 or more glasses a day	1.2	0.2-5.5	0.766
Tobacco use in the last 30 days
	No	Ref
	Yes	1.0	0.9-1.0	0.989
Alcoholic beverage consumption
	No	Ref
	Yes	1.0	0.9-1.1	0.406
Physical inactivity¹ 1 Insufficiently active/active ≥1 min/wk; no physical activity =0 min/wk;
	No	Ref
	No physical activity (yes)	0.6	0.3-0.7	0.002
Obesity² 2 Nutritional status classified by body mass index by age, based on the Z-score, indicated for children and adolescents according to the WHO recommendations [16];
	No	Ref
	Yes	4.3	2.5-7.1	<0.0010.
Sexual maturation³ 3 Puberal stadiometer classified according to the Tanner’s pubertal stage, with levels 4 and 5 being advanced stages [13]. PR: Prevalence Ratio; Ref: Reference category.
	Not pubescent	Ref
	Pubescent	1.2	0.7-1.9	0.414

Characteristics		Model 1		Model 2		Model 3		Final Model
Characteristics		PR	CI95%	PR	CI95%	PR	CI95%	PR	CI95%
Distal level
School location area
	Urban	Ref		Ref		Ref		Ref
	Rural	2.0^* * p<0.05,	1.1-3.4	2.1^* * p<0.05,	1.1-3.9	2.2^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	1.4-3.2	2.2^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	1.4-3.3
Intermediate level
Consumption of food offered by the school
	No			Ref		Ref		Ref
	Yes			0.7^* * p<0.05,	0.5-0.9	0.7^* * p<0.05,	0.6-0.9	0.7^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	0.6-0.9
Snack purchase at the school cafeteria
	No			Ref
	Yes			1.4^* * p<0.05,	0.8-2.2
Lunch consumption in front of the TV
	No			Ref
	Yes			0.8^* * p<0.05,	0.5-1.2
Dinner consumption in front of the TV
	No			Ref
	Yes			0.7^* * p<0.05,	0.5-1.4
Lunch consumption with parents/guardians
	No			Ref
	Yes			1.2^* * p<0.05,	0.7-2.0
Dinner consumption with parents/guardians
	No			Ref
	Yes			1.5^* * p<0.05,	0.7-3.0
Snack consumption while watching TV
	No			Ref
	Yes			0.7^* * p<0.05,	0.5-1.2
Physical inactivity¹ 1 Insufficiently active/active ≥1 min/wk; no physical activity = 0 min/wk;
	No			Ref		Ref		Ref
	No physical activity (yes)			0.6^* * p<0.05,	0.4-0.8	0.7^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	0.5-1.0	0.7^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	0.5-1.0
Proximal level
Obesity² 2 Obesity classified by body mass index by age, based on Z-scores WHO, 2007 [16]; PR: Prevalence Ratio; Ref: Reference category.
	No					Ref		Ref
	Yes					4.0^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	2.5-6.3	4.0^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	2.5-6.3
Sex
	Women					Ref		Ref
	Men					2.2^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	1.6-3.0	2.2^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	1.6-3.0
Skin color
	White					Ref
	Brown or black					1.0^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	0.7-1.3
	Asian					0.6^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	0.1-1.4
	Indigenous					1.6^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	0.4-0.5
	Did not answer					0.8^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	0.2-2.3
Age
	<15 years old					Ref		Ref
	≥15 years old					1.4^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	1.1-1.9	1.5^ p<0.001; Model 1: Characteristic of distal level x hypertension; Model 2: Characteristic of distal level retained by statistical significance characteristic of the intermediate level x hypertension; Model 3: Characteristics of distal and intermediate levels retained by statistical significance characteristic of the proximal x hypertension level; Final Model: Characteristics of all levels retained x hypertension;	1.1-1.9

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[1] Correspondence to: K.M.B.CARVALHO. E-mail: kenia@unb.br.