Hypertension, lifestyle, and nutritional status of participants in the Study of Cardiovascular Risks in Adolescents in the Federal District

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

doi:10.1590/1678-9865202134e210051

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

Hypertension, lifestyle, and nutritional status of participants in the Study of Cardiovascular Risks in Adolescents in the Federal District

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To estimate the prevalence of hypertension in participants of the Study of Cardiovascular Risks in Adolescents in Federal District, Brazil, and to investigate the factors related to lifestyle and nutritional status.

Methods

Lifestyle, economic, and demographic variables were obtained using a self-administered questionnaire. Anthropometric data and blood pressure measurements were collected according to a standardized protocol. Descriptive statistics was used to know the distribution of the investigated parameters in relation to the outcome. The association between hypertension and the variables of interest was investigated by hierarchical multivariate analysis using Poisson regression, considering p<0.05.

Results

We evaluated 2,646 adolescents with a mean age of 14.9 years. The prevalence of hypertension was 8.0% (95%CI 6.8-9.3). Studying in schools in the rural region (PR=2.1; 95%CI 1.4-3.3), having obesity (PR=4.0; 95%CI 2.5-6.3), male sex (PR=2.2; 95%CI 1.6-3.0) and age over 15 years (PR=1.4; 95% CI 1.0-1.9) were factors associated with a higher prevalence of hypertension. School feeding consumption was a protective factor (PR=0.7; 95%CI 0.6-0.9).

Conclusions

The prevalence of arterial hypertension was 8% and was associated with male sex, age at least 15 years, attendance in rural schools, and obesity. The consumption of school feeding was a protective factor.

Keywords
Adolescent; Hypertension; Life Style; Obesity; School Feeding

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.