Obesidade infantil: fatores de risco perinatais, obesidade central, maturação sexual e análises linear e não linear da modulação autonômica da frequência cardíaca
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Data
2016-10-14
Autores
Moraes, Fernanda Regina de [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Há muito tempo sabe-se que o excesso de peso traz grandes riscos para a saúde, e atualmente o mundo assiste a uma epidemia de obesidade com forte impacto sobre as crianças. A obesidade é um clássico exemplo de doença multifatorial complexa, resultante da interação entre fatores comportamentais, ambientais, genéticos, metabólicos, hormonais e psicossociais. Têm sido estudados vários fatores associados à obesidade infantil, tais como o tipo de parto, peso e comprimento ao nascimento, tempo de exposição à amamentação materna, bem como fator socioeconômico familiar e a presença de sobrepeso e/ou obesidade nos pais. Na presença da obesidade, a distribuição de gordura corporal é o maior fator de risco para as doenças crônicas, e os indicadores de adiposidade abdominal devem ser mensurados para avaliação precoce e acompanhamento desta população, com atenção também para avaliação do nível de maturação sexual, pois já está estabelecido que a adolescência representa um marco nas alterações de distribuição de gordura corporal. Outro aspecto que merece atenção é o cardiovascular, e nesse sentido métodos de avaliação da modulação autonômica cardíaca têm sido investigados. A variabilidade da frequência cardíaca é uma medida não invasiva, que pode ser utilizada para identificar fenômenos relacionados ao controle autonômico. Diante disso, os objetivos do trabalho foram: avaliar a modulação autonômica cardíaca em crianças e adolescentes obesos e verificar a associação desta com exame físico, nível de maturação sexual e fatores de risco perinatais. Foram avaliadas 160 crianças, entre 6 e 15 anos, divididas em obesas e eutróficas, as quais foram submetidas às investigações de fatores de risco perinatais, exame físico, avaliação do nível de maturação sexual e captação da frequência cardíaca e intervalos R-R. A variabilidade da frequência cardíaca foi analisada por métodos lineares e não lineares. Os dados sugeriram que a obesidade foi relacionada a uma precocidade da maturação sexual em ambos os sexos, que o excesso de peso alterou a modulação autonômica da FC e a complexidade da mesma, e que tanto o ramo autonômico parassimpático, quanto o simpático estavam alterados. O tempo de exposição à amamentação materna foi um importante fator de risco para o desenvolvimento de obesidade infantil, uma vez que apresentou correlações significativas com todos os indicadores antropométricos de distribuição da gordura corporal. Ainda, o parto cesárea e o menor comprimento ao nascimento também foram associados à presença de obesidade. O excesso de peso na infância não difere da obesidade na idade adulta, quando se trata de complicações e riscos para a saúde, e esforços devem ser empregados na identificação dos fatores de risco perinatais e avaliação precoce, para um futuro mais saudável nesta população.
Since a long while, it is a well-known truth that huge risks to health are being imposed by overweight, and nowadays our civilization faces the epidemics of obesity and its relevant reflexes over childhood. Obesity is a classic example of complex multifactorial disease, resulting from the interactions among behavioral, environmental, genetic, metabolic, hormonal and psychosocial factors. Many of the factors linked with obesity in childhood have been studied, such as the mode of delivery at birth, weight and tally by delivery time, length of time subject to breast feeding, as well as familial standards of social and economic aspects, and parental obesity. Along with obesity, body fat distribution is a major risk factor for other chronic diseases, and the indicators for abdominal fat deposition must be measured for early evaluation and regular follow-up for this population, with due attention to the evaluation of sexual maturation levels, once the trends of body fat distribution by adolescence period is an already well established matter. Another aspect worth of noting is the development of cardiovascular function and, in this sense, consistent investigation on the methods for evaluating heart autonomic modulation is being successfully held. Heart rate variability is a non-invasive measure which enables the identification of autonomic control related phenomena. Having these points in mind, the aims of this study consisted in evaluating the heart autonomic modulation in obese subjects of childhood and adolescence age groups, as well as its associations with physical examination, sexual maturation level, and pre and peri delivery risk factors. A total of 160 individuals have been evaluated, ranging from 6 to 15 years of age, separated in obese and eutrophic groups. All subjects have been submitted to birth risk factors investigation, physical examination, evaluation of sexual maturation level, and data for heart rate and RR intervals has been obtained. Heart rate variability was analyzed by both linear and non-linear methods. Data analysis has suggested that obesity was related to precocity on sexual maturation level for both genders. Heart rate modulation and its complexity were alterated due to weight excess, and both the sympathetic and parasympathetic autonomic branches presented alterations. The length of time subject to breast feeding was an important risk factor for the development of child obesity, as it has presented significave correlations with all the anthropometric indicators of body fat distribution. Last but not least, caesarian delivering and a lesser length at birth have also been associated to a presence of obesity. Weight excess in childhood does not differ from adulthood obesity, as complications and risks to health are considered, and efforts should be employed to its utmost limits in the identification of birth risk factors and in early evaluation for a healthier future for this population.
Since a long while, it is a well-known truth that huge risks to health are being imposed by overweight, and nowadays our civilization faces the epidemics of obesity and its relevant reflexes over childhood. Obesity is a classic example of complex multifactorial disease, resulting from the interactions among behavioral, environmental, genetic, metabolic, hormonal and psychosocial factors. Many of the factors linked with obesity in childhood have been studied, such as the mode of delivery at birth, weight and tally by delivery time, length of time subject to breast feeding, as well as familial standards of social and economic aspects, and parental obesity. Along with obesity, body fat distribution is a major risk factor for other chronic diseases, and the indicators for abdominal fat deposition must be measured for early evaluation and regular follow-up for this population, with due attention to the evaluation of sexual maturation levels, once the trends of body fat distribution by adolescence period is an already well established matter. Another aspect worth of noting is the development of cardiovascular function and, in this sense, consistent investigation on the methods for evaluating heart autonomic modulation is being successfully held. Heart rate variability is a non-invasive measure which enables the identification of autonomic control related phenomena. Having these points in mind, the aims of this study consisted in evaluating the heart autonomic modulation in obese subjects of childhood and adolescence age groups, as well as its associations with physical examination, sexual maturation level, and pre and peri delivery risk factors. A total of 160 individuals have been evaluated, ranging from 6 to 15 years of age, separated in obese and eutrophic groups. All subjects have been submitted to birth risk factors investigation, physical examination, evaluation of sexual maturation level, and data for heart rate and RR intervals has been obtained. Heart rate variability was analyzed by both linear and non-linear methods. Data analysis has suggested that obesity was related to precocity on sexual maturation level for both genders. Heart rate modulation and its complexity were alterated due to weight excess, and both the sympathetic and parasympathetic autonomic branches presented alterations. The length of time subject to breast feeding was an important risk factor for the development of child obesity, as it has presented significave correlations with all the anthropometric indicators of body fat distribution. Last but not least, caesarian delivering and a lesser length at birth have also been associated to a presence of obesity. Weight excess in childhood does not differ from adulthood obesity, as complications and risks to health are considered, and efforts should be employed to its utmost limits in the identification of birth risk factors and in early evaluation for a healthier future for this population.
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Palavras-chave
Obesidade infantil, Variabilidade da frequência cardíaca, Fatores de risco perinatais, Maturação Sexual, Indicadores antropométricos, Heart rate variability, Childhood Obesity, Breast feeding, Birth risk factors, Sexual maturation, Anthropometric references