Prevalencia y factores asociados a dislipidemia en niños de 6 a 42 meses de edad en una capital brasileña

Abreu, Vanessa Roriz Ferreira de; Lobo, Lina Monteiro de Castro; Schincaglia, Raquel Machado; Costa, Paulo Sérgio Sucasas da; Braudes-Silva, Lana Angélica; Hadler, Maria Claret Costa Monteiro

doi:10.1590/0102-311XEN202123

Brasil

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ARTICLE • Cad. Saúde Pública 40 (9) • 2024 • https://doi.org/10.1590/0102-311XEN202123 linkcopiar

Prevalencia y factores asociados a dislipidemia en niños de 6 a 42 meses de edad en una capital brasileña

Autoría SCIMAGO INSTITUTIONS RANKINGS

El objetivo de este estudio fue evaluar la prevalencia y los factores asociados con las anomalías del perfil lipídico en niños de 6 a 42 meses de edad en una ciudad del Centro-Oeste de Brasil. Este estudio transversal utilizó datos de referencia de un ensayo clínico aleatorizado por grupos realizado en paralelo. Se evaluó el perfil lipídico, la ingesta habitual de nutrientes (pesaje directo de alimentos y recordatorio de alimentación de 24 horas), los parámetros antropométricos y los aspectos socioeconómicos de 169 niños de centros de educación infantil. Se realizó una regresión de Poisson con un análisis robusto de la varianza. Se reveló que el 85% de los participantes tenían dislipidemia; el 72% presentaron niveles de lipoproteínas de alta densidad (HDL-c) por debajo del rango esperado; el 49% tenía aumento de triglicéridos (TG); el 17% de lipoproteínas de baja densidad (LDL-c) elevadas y el 15% tenía colesterol total (CT) elevado. Un aumento en el índice de masa corporal (IMC) para la puntuación z de la edad se asoció con una mayor tendencia a aumento de TG (RP = 1,22; IC95%: 1,05-1,41; p = 0,009). La edad más avanzada de los niños se asoció con una mayor prevalencia de LDL-c alta (RP = 1,037; IC95%: 1,01-1,07; p = 0,022) y CT (RP = 1,036; IC95%: 1,00-1,07; p = 0,037), pero fue un factor de protección contra HDL-c baja (RP = 0,991; IC95%: 0,98-1,00; p = 0,042). La ingesta alta de energía se asoció con HDL-c baja (RP = 1,001; IC95%: 1,00-1,00; p = 0,023). Se encontraron que la mayor tendencia a aumento de LDL-c (RP = 1,005; IC95%: 1,00-1,01; p = 0,006) y disminución de HDL-c (RP = 1,002; IC95%: 1,00-1,00; p < 0,001) estuvieron asociadas con la ingesta de colesterol en la dieta. La mayoría de los niños tuvieron al menos un cambio en los lípidos séricos. Las anomalías del perfil lipídico se asociaron con un mayor IMC, mayor edad y mayor consumo de calorías y colesterol.

Palabras-clave: Dislipidemias; Hipercolesterolemia; Nutrición del Niño; Colesterol; IMC-Edad

Characteristics	Sample	At least one altered parameter	Increased TG	Increased TC	Decreased HDL-c	Increased LDL-c
n (%)	169 (100)	144 (85)	83 (49)	26 (15)	122(72)	29 (17)
Child age (months) [median (IQR]	24 (15-35)	24 (13-35)	24 (13-34)	30 (24-34)	24 (13-34)	31 (24-35)
p-value		0.720	0.059	0.088	0.119	0.032
Sex [n (%)]
Female	89 (53)	74 (51)	43 (52)	14 (54)	63 (52)	14 (48)
Male	80 (47)	70 (49)	40 (48)	12 (46)	62 (48)	15 (52)
p-value		0.426 *	0.827 *	0.895 *	0.668 *	0.603 *
Race or skin color [n (%)]
White	76 (45)	62 (43)	35 (42)	10 (38)	52 (43)	10 (34)
Non-white	93 (55)	82 (57)	48 (58)	16 (62)	70 (57)	19 (66)
p-value		0.230 *	0.472 *	0.468 *	0.323 *	0.212 *
Maternal age (years) [mean (SD)]	30 (6)	30 (6)	30 (6)	30 (6)	30 (6)	30 (4)
p-value		0.106 **	0.827 **	0.853 **	0.281 **	0.934 **
Maternal education (years) [median (IQR)]	12 (12-16)	12 (12-16)	12 (12-16)	12 (11-16)	12 (12-15)	12 (11-16)
p-value		0.902	0.569	0.731	0.990	0.821
Monthly income per capita (USD) ^# [median (IQR)]	206 (132-278)	204 (131-278)	208 (125-278)	208 (139-312)	206 (132-278)	208 (139-278)
p-value		0.860	0.864	0.727	0.774	0.702
Current breastfeeding practice [n (%)]	45 (31)	41 (32)	23 (32)	9 (39)	31 (29)	8 (32)
p-value		0.429 ***	0.815 *	0.334 *	0.403 *	0.869 *
Duration of exclusive breastfeeding (days) [median (IQR)]	122 (61-183)	122 (45-182)	122 (61-152)	122 (61-182)	106 (61-182)	122 (61-182)
p-value		0.052	0.279	0.998	0.195	0.420
BMI-for-age (z-score) [mean (SD)]	0.8 (1.0)	0.8 (1.0)	1.0 (1.1)	0.8 (1.1)	0.8 (1.1)	0.8 (1.1)
p-value		0.917 **	0.007 **	0.807 **	0.513 **	0.882 **
Height (z-score) [median (IQR)]	-0.2 (-0.9-0.8)	-0.2 (-0.9-0.8)	-0.2 (-0.9-0.7)	-0.2 (-1.0-0.5)	-0.2 (-0.9-0.8)	-0.1 (-0.1-0.6)
p-value		0.280	0.454	0.672	0.431	0.920
Energy (kcal) [median (IQR)]	1,256 (1,149-1,353)	1,258 (1,146-1,358)	1,250 (1,133-1,355)	1,254 (1,151-1,377)	1,256 (1,143-1,362)	1,257 (1,146-1,377)
p-value		0.769	0.667	0.956	0.967	0.956
Carbohydrates (g) [mean (SD)]	179 (14)	179 (15)	177 (15)	176 (15)	179 (14)	176 (15)
p-value		0.804 **	0.346 **	0.348 **	0.918 **	0.317 **
Protein (g) [median (IQR)]	48 (39-58)	49 (39-59)	49 (39-59)	50 (40-62)	48 (38-59)	52 (37-62)
p-value		0.489	0.877	0.622	0.643	0.425
Fat (g) [mean (SD)]	39 (6)	38 (6)	38 (6)	38 (6)	38 (6)	38 (6)
p-value		0.411 **	0.529 **	0.382 **	0.274 **	0.411 **
Saturated fat (g) [median (IQR)]	14 (11-17)	14 (11-17)	15 (12-17)	14 (12-17)	14 (11-17)	14 (11-17)
p-value		0.154	0.986	0.716	0.070	0.610
Trans fatty acids (g) [median (IQR)]	1.0 (0.6-1.5)	0.9 (0.6-1.5)	0.9 (0.6-1.4)	1.1 (0.7-1.3)	0.9 (0.6-1.5)	1.1 (0.7-1.4)
p-value		0.087	0.050	0.978	0.063	0.914
Monounsaturated fat (g) [median (IQR)]	9 (8-12)	10 (8-12)	9 (7-12)	10 (8-12)	10 (7-12)	10 (8-13)
p-value		0.472	0.164	0.879	0.203	0.713
Polyunsaturated fat (g) [median (IQR)]	6 (5-7)	6 (5-7)	6 (5-7)	6 (5-7)	6 (5-7)	6 (5-8)
p-value		0.828	0.336	0.699	0.487	0.961
Omega-6 (g) [median (IQR)]	5 (4-6)	5 (4-6)	5 (4-6)	4 (4-6)	5 (4-6)	5 (4-6)
p-value		0.885	0.259	0.203	0.533	0.318
Omega-3 (g) [median (IQR)]	0.8 (0.6-0.9)	0.8 (0.6-0.9)	0.8 (0.6-0.9)	0.8 (0.5-0.9)	0.8 (0.6-0.9)	0.8 (0.5-1.1)
p-value		0.524	0.456	0.725	0.212	0.915
ω-6/ω-3 ratio [median (IQR)]	6 (6-7)	7 (6-8)	7 (6-8)	6 (6-7)	7 (6-8)	7 (6-7)
p-value		0.539	0.870	0.569	0.459	0.795
Cholesterol (mg) [median (IQR)]	131 (100-180)	132 (102-182)	134 (103-185)	132 (101-204)	132 (105-181)	137 (120-209)
p-value		0.409	0.367	0.569	0.318	0.162
Fiber total (g) [median (IQR)]	11 (8-13)	11 (9-14)	11 (9-13)	11 (9-12)	12 (9-14)	11 (9-13)
p-value		0.107	0.438	0.257	0.144	0.474

Characteristics	At least one altered parameter	Increased TC	Decreased HDL-c	Increased LDL-c	Increased TG
Characteristics	PR (95%CI)	PR (95%CI)	PR (95%CI)	PR (95%CI)	PR (95%CI)
Child age (months)	1.00 (0.99-1.00)	1.03 (1.00-1.07)	0.99 (0.98-1.00)	1.04 (1.01-1.07)	1.00 (0.99-1.01)
p-value	0.694	0.047	0.093	0.017	0.572
Sex	1.05 (0.93-1.19)	0.95 (0.47-1.94)	1.04 (0.86-1.26)	1.19 (0.61-2.32)	1.03 (0.76-1.41)
p-value	0.425	0.896	0.668	0.605	0.827
Race or skin color	1.08 (0.95-1.23)	1.31 (0.63-2.72)	1.10 (0.91-1.33)	1.55 (0.77-3.14)	1.12 (0.82-1.53)
p-value	0.243	0.473	0.332	0.221	0.477
Maternal age (years)	0.99 (0.98-1.00)	1.01 (0.95-1.07)	0.99 (0.97-1.01)	1.00 (0.96-1.05)	1.00 (0.97-1.02)
p-value	0.162	0.844	0.318	0.913	0.826
Maternal education (years)	1.01 (0.98-1.03)	1.00 (0.89-1.12)	1.00 (0.97-1.04)	1.00 (0.90-1.11)	1.02 (0.97-1.08)
p-value	0.640	0.971	0.864	0.969	0.449
Monthly income per capita (USD)	1.00 (1.00-1.00)	1.00 (1.00-1.00)	1.00 (1.00-1.00)	1.00 (1.00-1.00)	1.00 (1.00-1.00)
p-value	0.306	0.305	0.445	0.556	0.753
Current breastfeeding practice	0.94 (0.83-1.06)	0.69 (0.32-1.47)	1.10 (0.87-1.37)	0.94 (0.44-2.02)	0.96 (0.68-1.36)
p-value	0.290	0.333	0.428	0.869	0.814
Duration of exclusive breastfeeding (days)	1.00 (1.00-1.00)	1.00 (0.99-1.01)	1.00 (1.00-1.00)	1.00 (1.00-1.01)	1.00 (1.00-1.00)
p-value	0.063	0.904	0.225	0.339	0.370
BMI-for-age (z-score)	1.00 (0.94-1.06)	1.04 (0.73-1.48)	1.03 (0.94-1.12)	0.98 (0.70-1.36)	1.22 (1.05-1.41)
p-value	0.922	0.814	0.503	0.887	0.009
Height-for-age (z-score)	0.96 (0.92-1.00)	0.95 (0.73-1.25)	0.97 (0.90-1.05)	1.03 (0.78-1.36)	0.93 (0.82-1.05)
p-value	0.110	0.732	0.419	0.832	0.216
Energy (kcal)	1.00 (1.00-1.00)	1.00 (1.00-1.00)	1.00 (1.00-1.00)	1.00 (1.00-1.00)	1.00 (1.00-1.00)
p-value	0.695	0.705	0.863	0.719	0.574
Carbohydrates (g)	1.00 (1.00-1.00)	0.99 (0.96-1.01)	1.00 (0.99-1.01)	0.99 (0.96-1.01)	0.99 (0.98-1.01)
p-value	0.768	0.357	0.918	0.336	0.351
Protein (g)	1.00 (1.00-1.00)	1.00 (0.98-1.02)	1.00 (1.00-1.01)	1.01 (0.99-1.03)	1.00 (0.99-1.01)
p-value	0.421	0.821	0.369	0.526	0.872
Fat (g)	1.00 (0.99-1.00)	0.97 (0.91-1.04)	0.99 (0.98-1.01)	0.98 (0.92-1.04)	0.99 (0.96-1.02)
p-value	0.337	0.383	0.278	0.439	0.531
Saturated fat (g)	0.99 (0.98-1.00)	0.97 (0.89-1.05)	0.98 (0.96-1.01)	0.97 (0.89-1.05)	1.00 (0.97-1.04)
p-value	0.205	0.462	0.146	0.472	0.890
Trans fatty acids (g)	0.95 (0.88-1.04)	0.95 (0.60-1.49)	0.90 (0.77-1.04)	0.98 (0.65-1.49)	0.84 (0.65-1.10)
p-value	0.252	0.824	0.155	0.938	0.202
Monounsaturated fat (g)	0.99 (0.98-1.01)	1.01 (0.90-1.13)	0.98 (0.95-1.01)	1.02 (0.91-1.13)	0.97 (0.93-1.02)
p-value	0.537	0.919	0.149	0.750	0.295
Polyunsaturated fat (g)	1.00 (0.97-1.03)	0.98 (0.77-1.25)	0.98 (0.93-1.04)	1.02 (0.82-1.27)	0.95 (0.87-1.04)
p-value	0.952	0.875	0.481	0.863	0.302
Omega-6 (g)	1.00 (0.97-1.03)	0.90 (0.67-1.21)	0.98 (0.92-1.04)	0.95 (0.73-1.22)	0.94 (0.85-1.04)
p-value	0.992	0.491	0.461	0.671	0.233
Omega-3 (g)	0.97 (0.82-1.16)	0.57 (0.14-2.32)	0.86 (0.62-1.21)	0.76 (0.20-2.90)	0.76 (0.42-1.36)
p-value	0.770	0.435	0.388	0.686	0.356
ω-6/ω-3 ratio	1.02 (0.99-1.04)	0.93 (0.74-1.17)	1.03 (0.99-1.07)	0.95 (0.77-1.17)	0.96 (0.86-1.07)
p-value	0.290	0.546	0.179	0.616	0.468
Cholesterol (mg)	1.00 (1.00-1.00)	1.00 (1.00-1.01)	1.00 (1.00-1.00)	1.00 (1.00-1.01)	1.00 (1.00-1.00)
p-value	0.156	0.282	0.081	0.033	0.222
Fiber total (g)	1.01 (0.99-1.03)	0.93 (0.85-1.02)	1.01 (0.98-1.04)	0.97 (0.88-1.06)	0.98 (0.94-1.03)
p-value	0.239	0.111	0.561	0.473	0.481

Characteristics	At least one altered parameter *		Increased TC **		Decreased HDL-c ***		Increased LDL-c ^#
Characteristics	PR (95%CI)	p-value	PR (95%CI)	p-value	PR (95%CI)	p-value	PR (95%CI)	p-value
Child age (months)			1.036 (1.00-1.07)	0.037	0.991 (0.98-1.00)	0.042	1.037 (1.01-1.07)	0.022
Maternal age (years)	0.993 (0.98-1.01)	0.278
Duration of exclusive breastfeeding (days)	0.999 (1.00-1.00)	0.059
Height-for-age (z-score)	0.970 (0.93-1.01)	0.184
Energy (kcal)	1.000 (1.00-1.00)	0.928	1.000 (1.00-1.00)	0.757	1.001 (1.00-1.00)	0.023	0.998 (1.00-1.00)	0.121
Saturated fat (g)					0.974 (0.94-1.00)	0.090
Trans fatty acids (g)					0.954 (0.80-1.14)	0.598
Monounsaturated fat (g)					0.973 (0.93-1.02)	0.274
ω-6/ω-3 ratio					1.023 (0.97-1.08)	0.393
Cholesterol (mg)	1.001 (1.00-1.00)	0.069			1.002 (1.00-1.00)	< 0.001	1.005 (1.00-1.01)	0.006
Fiber total (g)			0.897 (0.79-1.02)	0.096

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[TFN1] BMI: body mass index; IQR: interquartile range; HDL-c: high-density lipoproteins; LDL-c: low-density lipoproteins; SD: standard deviation; TC: total cholesterol; TG: triglycerides.

[TFN2] Note: p-value obtained using the Mann-Whitney U test, except for: * Pearson’s chi-square test; ** t-test; *** Fisher’s exact test. Bold values: p < 0.05.

[TFN3] ^# Converted form BRL 3.60 to USD 1.00.