Potential Conflict of Interest
No potential conflict of interest relevant to this article was reported.
Author contributions
Conception and design of the research: Azevêdo LM, Santos LS, Pardono E, Almeida JA, Menezes AS. Acquisition of data: Azevêdo LM, Santos LS. Analysis and interpretation of the data: Azevêdo LM, Santos LS, Pardono E, Almeida JA, Menezes AS. Statistical analysis: Azevêdo LM, Santos LS, Pardono E, Almeida JA, Menezes AS. Writing of the manuscript: Azevêdo LM, Santos LS, Pardono E, Almeida JA, Menezes AS. Critical revision of the manuscript for intellectual content: Pardono E, Almeida JA, Menezes AS.
Cardiovascular diseases are the leading cause of mortality among adults. Evidence has shown that sedentary behaviors are the main preventable outcome, however, many sedentary children also become sedentary adults. Therefore, identifying potential risk factors as early as possible contributes to therapeutic success.
To achieve an anthropometric and cardiovascular mapping of school-age students from Sergipe State, Brazil.
A school-based cross-sectional study with a representative sample from public schools in the state of Sergipe (n= 4700). Anthropometric and blood pressure measurements were performed, and the Global School-based Student Health Survey was used to assess the physical activity level. An independent samples t-test was performed for all comparisons, and significance was established at 5% (p<0.05).
Despite showing mean blood pressure values within reasonable limits (SBP = 114.1±12.4 mm Hg and DBP = 66.3±8.1 mm Hg), school-age students did not comply with global recommendations for health promotion. It was also observed a high rate of low body weight (42.6%), suggesting dietary compromises, which can interfere with the development of this population. In addition, only 7.3% of students met the minimum physical activity criteria proposed for maintaining their health status.
The findings of the present study emphasize the importance of maintaining Physical Education classes as an essential curricular component, since they provide several health benefits and ensure that this population reaches the minimum daily recommendations, preventing diseases in adult life. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)
Data from the World Health Organization
SAH is a chronic non-communicable disease, in which biological, behavioral, and socioeconomic factors lead to blood pressure values higher than 120 and 80 mmHg for systolic (SBP) and diastolic (DBP) pressures, respectively
These strategies include the promotion of public policies for prevention (primary care), pharmacological interventions (e.g. antihypertensive drugs), and non-pharmacological interventions, which include dietary changes
Therefore, the identification of risk factors associated with hypertension is essential for disease prevention and maintenance of quality of life in this population, reducing the burden on health care resources. In this sense, the present study aimed to identify the physical activity level and to trace the anthropometric and cardiovascular profile of a representative sample of school-age students attending public schools in the state of Sergipe, Brazil.
A cross-sectional epidemiological study including students enrolled in public schools was conducted in the 8 geographic territories of the state of Sergipe, Brazil. The local Research Ethics Committee approved the present study under number 1522.876/2016/CEP/CONEP/CNS.
The state of Sergipe is located in the northeastern region of Brazil and has a territorial area of 21,925,424 km2, with approximately 2,298,696 inhabitants. In addition, the state is composed of 75 counties, being geographically divided into 8 territories. Each territory has similar characteristics for 15 variables and 79 indicators distributed in the following dimensions: economic-productive, social, political-institutional, socio-cultural, and environmental.
Considering the government actions that lead rural school-age students to study in the city (urban zone), as well as the similarity in pedagogical proposals and organization within each territory, there is a reduction in the possibility of selection bias due to the equivalence of some characteristics of the sample. For these reasons, it is believed that the random selection of counties as well as of education units (territories) clearly represents the group of school-age students in the state of Sergipe. In this context, proportionality by territory, education unit size, school grades, and study shift justify the methodology adopted for sample selection (
Territory
n
%
Grande Aracaju
1043
25.1
Sul Sergipano
450
10.8
Agreste Sergipano
491
11.8
Centro Sul Sergipano
303
7.3
Leste Sergipano
300
7.2
Médio Sertão Sergipano
391
9.4
Baixo São Francisco
627
15.1
Alto Sertão Sergipano
546
13.2
Stratified random sampling was used to select the desired sample. First, the primary unit was determined by considering the minimum sample needed for the study and stratified proportionally to the territory and size of the school (1 = up to 199 students, 2 = 200-499 students, 3 = 500+ students). Besides, for all territories to be considered representatively with the 3 school sizes, an amount of 25% of the study units (160 study units) was established as a criterion, totaling 42 schools distributed in 30 counties. After this, the secondary unit consisted of schools selected according to school grade and study shift (day or evening), using a simple random process and considering 20 students per school grade.
It should be pointed out that to maintain sample representativeness, for reasons such as participant refusal, age above or below that established in this study, and/or not answering important questions (i.e., sex and age), 10% was added to the total desired sample.
Participants included students of both sexes, aged 14 to 19 years, who voluntarily joined the study, according to the following criteria: be regularly enrolled in the selected schools; be present at the time of the evaluation; and fill in the questionnaire adequately, reducing non-responses as much as possible. Students whose parents did not sign the negative consent form (Parental Passive Consent Form) and who did not answer questions such as sex and age were excluded.
For anthropometric measurements, body mass and height measurements were used to estimate body mass index (BMI), and waist circumference (WC) and hip circumference (HR) were used to estimate the waist-to-hip ratio (WHR), following the WHO criteria and cut-off points
The physical activity level was estimated from the Global School-based Student Health Survey (GSHS/WHO), using recommendations for each age group as criteria for analysis
Data were expressed using descriptive statistics, such as absolute and relative frequency for categorical variables and mean and standard deviation for continuous variables. Normality and heterogeneity were assessed by the Shapiro-Wilk and Levene tests, respectively. In order to verify differences between the sexes, Student t-test for independent samples was applied. Also, the criteria proposed by Cole et al.,
A total of 4700 school-age students, of both sexes, were evaluated. However, due to non-compliance with some of the inclusion criteria, 549 of these were excluded from the sample, accounting for a final sample of 4151 individuals. The general characteristics of the study sample are shown in
Mean
±SD
95% CI
Body Mass (kg)
59.5
12.4
59.1 – 59.9
Height (m)
1.6
0.1
1.63 – 1.64
Body Mass Index (kg/m2)
22.1
4.0
22.0 – 22.2
WC (cm)
72.3
8.8
72.0 – 72.5
HC (cm)
92.4
9.5
92.1 – 92.7
WHR
0.8
0.1
0.78 – 0.79
SBP (mmHg)
114.1
12.4
113.7 – 114.5
DBP (mmHg)
66.3
8.1
66.0 – 66.5
HR (bpm)
82.2
12.9
81.8 – 82.6
In general, students presented BMI in the "normal weight" category (22.1 ±4.0 kg/m2), WHR in the "low risk" category (0.8 ±0.1), and values within the reference range for both SBP (114.1 ±12.4 mmHg) and DBP (66.3 ±8.1 mmHg).
n
%
0 day
226
5.5
1 to 2 days
287
7.0
3 to 4 days
125
3.1
5 to 6 days
63
1.5
7 days
47
1.1
0 day
693
16.9
1 to 2 days
798
19.5
3 to 4 days
334
8.2
5 to 6 days
206
5.0
7 days
160
3.9
0 day
339
8.3
1 to 2 days
460
11.2
3 to 4 days
160
3.9
5 to 6 days
104
2.5
7 days
96
2.3
The same pattern was observed for both boys (42.9%) and girls (42.3%), with age ranging from 16 to 17 years, and compared to the BMI categories of the same age group, as well as among the other age groups (
Male
Female
n
%
N
%
Low Weight
354
14.8
224
12.8
Normal Weight
90
3.8
44
2.5
Overweight
32
1.3
10
0.6
Low Weight
1024
42.9
743
42.3
Normal Weight
205
8.6
115
6.6
Overweight
79
3.3
47
2.7
Low Weight
450
18.9
451
25.7
Normal Weight
105
4.4
90
5.1
Overweight
47
2.0
31
1.8
Boys
Girls
p
Mean
±SD
Mean
±SD
≤ 15 years
108.9
10.8
116.2
12.1
0.001*
16 - 17 years
109.2
10.1
120.2
12.4
0.001*
18 - 19 years
111.0
10.9
122.3
11.4
0.001*
≤ 15 years
65.6
8.1
63.7
7.6
0.001*
16 - 17 years
66.1
7.6
65.9
8.2
0.663
18 - 19 years
67.7
8.1
67.5
8.4
0.634
≤ 15 years
87.3
12.0
80.8
13.0
0.001*
16 - 17 years
85.5
11.7
78.5
13.2
0.001*
18 - 19 years
83.9
11.6
74.7
12.0
0.001*
After the BMI stratification, it was evidenced that the individuals with lower body mass had lower blood pressure values, 112.8 ±12.0 and 65.5 ±7.8 mmHg, respectively, for SBP and DBP, compared to normal weight (118.1 ±12.6 and 68.2 ±8.2 mmHg) and overweight (112.2 ±12.8 and 71.2 ±8.9 mmHg) individuals.
Mean
±SD
95% CI
Low Weight
112.8
12.0
112.3 – 113.2
Normal Weight
118.1†
12.6
117.1 – 119.0
Overweight
122.2††
12.8
120.6 – 123.8
Low Weight
65.5
7.8
65.2 – 65.8
Normal Weight
68.2†
8.2
67.6 – 68.8
Overweight
71.2††
8.9
70.2 – 72.2
Low Weight
82.1
13.0
81.7 – 82.6
Normal Weight
81.9
12.6
80.9 – 82.9
Overweight
83.5
11.6
81.8 – 85.1
Several studies demonstrate the importance of physical activity, especially in the early stages of life, since it can promote increased academic performance
These indices reveal that Brazilian public policies appear to be ineffective in promoting health at the primary care level, addressing it only when issues reach a permanent status, which in turn leads to an excessive burden on the Brazilian public health system
The “16 to 17 years” age group presented high rates of low body weight, both when compared to the other age categories, as well as between the sexes of the same age category. The results of the present study differed partially from those obtained by Reuter et al.,
The study conducted by de Almeida Silva et al.,
Based on this premise, a study conducted in Belo Horizonte, state of Minas Gerais
In the present study, the cardiovascular variables differed between the sexes and the BMI categories. Besides, low levels of physical activity associated with an inadequate diet can trigger chronic diseases, such as obesity and hypertension, which can persist into adulthood
This study has some limitations, such as not using direct methods for measuring physical activity levels, although the instrument used presents high reliability in obtaining this variable in epidemiological studies, and the measurement of blood pressure in the classroom. However, the results obtained for this variable have high ecological validity, since they were obtained under real conditions of analysis.
Although no significant manifestations of obesity were revealed, students from the state of Sergipe showed insufficient levels of physical activity, despite the high levels of low body weight. Thus, after this epidemiological mapping, we suggest the development of strategies to increase physical activity in Physical Education classes, as well as health education policies for students in Sergipe State attending public schools to raise awareness of healthy habits that can contribute to the prevention of chronic diseases.
Study Association
This study is not associated with any thesis or dissertation work.
Ethics Approval and Consent to Participate
This study was approved by the Ethics Committee of the
Sources of Funding.There were no external funding sources for this study.