ABSTRACT Objective: Herein, we compared ambulatory blood pressure (ABP) between young adults with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase enzyme (21OHase) deficiency and a control group. Additionally, we analyzed correlations between the glucocorticoid dose and androgen levels and ABP parameters. Subjects and methods: This case-control study included 18 patients (6 males and 12 females) and 19 controls (8 males and 11 females) matched by age (18-31 years). ABP monitoring was used to estimate blood pressure (BP) over a 24-h period. Results: No difference was noted between patients and controls in terms of systolic BP (males, 115.5 ± 5.6 vs. 117.0 ± 9.3, P = 0.733; and females, 106.4 ± 7.9 vs. 108.4 ± 7.6, P = 0.556, respectively) and diastolic BP during 24 h (males, 62.8 ± 7.5 vs. 66.2 ± 5.6, P = 0.349; and females, 62.7 ± 4.9 vs. 62.3 ± 4.9, P = 0.818, respectively). Systolic and diastolic BP and pulse pressure during daytime and nocturnal periods were similar between patients and controls. Furthermore, no differences were detected in the percentage of load and impaired nocturnal dipping of systolic and diastolic BP between patients and controls during the 24-h period. Additionally, the glucocorticoid dose (varying between r = −0.24 to 0.13, P > 0.05) and androgens levels (varying between r = 0.01 to 0.14, P > 0.05) were not associated with ABP parameters. Conclusion: No signs of an elevated risk for hypertension were observed based on ABP monitoring in young adults with CAH attributed to 21OHase deficiency undergoing glucocorticoid replacement therapy. Objective Herein (ABP (CAH 21hydroxylase hydroxylase 21 OHase (21OHase group Additionally parameters methods casecontrol case 1 6 ( females 8 1831 31 (18-3 years. years . years) (BP 24h period Results males, (males 1155 115 5 115. 56 5. vs 1170 117 0 117. 93 9 3 9.3 0.733 0733 733 1064 106 4 106. 79 7 7. 1084 108 108. 76 7.6 0556 556 0.556 respectively 2 628 62 62. 75 662 66 66. 0.349 0349 349 627 49 4. 623 0818 818 0.818 respectively. Furthermore varying 024 −0.2 013 13 0.13 0.05 005 05 001 01 0.0 014 14 0.14 Conclusion therapy 183 (18- 9. 0.73 073 73 10 055 55 0.55 0.34 034 34 081 81 0.81 02 −0. 0.1 00 0. (18 0.7 07 0.5 0.3 03 08 0.8 −0 (1 −

Resumo Objetivos: avaliar a massa óssea de pacientes pré-púberes com Síndrome de Turner (ST) de acordo com a idade estatura (IE) e verificar a influência do cariótipo e da adiposidade. Métodos: estudo retrospectivo e analítico de pacientes pré-púberes com ST. As variáveis analisadas foram: cariótipo, idade na realização da densitometria óssea (DO); estatura, índice de massa corporal (IMC) e resultado da DO. Realizou-se a correção do resultado da DO utilizando a IE. O IMC e a DO foram calculados em Z score para idade cronológica (IC) e para IE. Resultados: foram selecionadas 37 pacientes pré-púberes e após critério de exclusão foram incluídas no estudo 13 casos entre 10 e 13 anos de idade. A DO para IE foi significativamente maior que para IC (0,39 ± 1,18 × −1,62 ± 1,32), sem influência do cariótipo (p=0,369) e do IMC (p=0,697). Conclusão: pacientes pré-púberes com ST apresentam DO normal quando corrigida para IE, sem influência do cariótipo e do IMC.

Abstract Objectives: to evaluate the bone mass in prepubertal patients with Turner Syndrome (TS) according to height age (HA) and verify the influence of karyotype and adiposity. Methods: retrospective and analytical study of prepubertal TS patients. The variables analyzed were: karyotype, age at bone densitometry (BD), height, body mass index (BMI) and BD result. The result of the BD was corrected using HA. BMI and BD were calculated on Z score for chronological age (CA) and for HA. Results: thirty-seven prepubertal patients were selected and after exclusion criteria, 13 cases between 10 and 13 years old were included in the study. The BD for HA was significantly higher than for CA (0.39 ± 1.18 x −1.62 ± 1.32), without karyotype (p=0.369) and BMI (p=0.697) influence. Conclusion: prepubertal TS patients present normal BD when corrected for HA, without influence of karyotype and BMI.

Abstract Objective: To indicate neck circumference (NC) cutoff points to identify excess weight at different stages of somatic maturation and evaluate the association between NC and body mass index (BMI). Methods: Cross-sectional study with 1715 adolescents. BMI was classified according to the World Health Organization (WHO) criteria. Somatic maturation was obtained through the peak growth velocity (PGV). To define the cutoff points, curves of the receiver operating characteristic (ROC) model were constructed. The agreement between the anthropometric evaluation instruments was analyzed. The association between the variables was verified. Results: Of the girls, 93 were in the pre-PGV stage, 266 in the PGV stage, and 481 in the post-PGV stage. Of the boys, 264 were in the pre-PGV stage, 334 in the PGV stage, and 277 in the post-PGV stage. For the pre-PGV group, the cutoff point was 28 cm for females and 29 cm for males; for the group during PGV, the cutoff points were 30 cm for females and 33 cm for males; in the post-PGV group the cutoff values were 32 cm in females and 35 cm in males. The prevalence of excess weight was higher in the pre-PGV stage in males and in the PGV stage in females. The correlation coefficients were higher in the pre-PGV and PGV stages. Conclusion: The cutoff points for NC found in this study showed good sensitivity and specificity to identify excess weight in Brazilian adolescents and can be used as a reference in epidemiological studies.

RESUMO Objetivo: Identificar a prevalência de excesso de peso em adolescentes de acordo com diferentes critérios de classificação de obesidade e estágios de maturação somática. Métodos: Estudo transversal em dez escolas de um município da região Sul do Brasil, com 1.715 adolescentes. Dados de estatura, peso, circunferência da cintura e circunferência do pescoço (CP) foram coletados. O índice de massa corpórea (IMC) foi classificado com os critérios da Organização Mundial da Saúde (OMS) e do Centers for Disease Control and Prevention, e a razão cintura-estatura (RCE) foi classificada de acordo com pontos de corte brasileiros e europeus. A maturação somática foi obtida por meio do pico de velocidade do crescimento (PVC). Os dados de prevalência foram comparados entre os sexos e os estágios maturacionais; verificou-se a concordância entre os diferentes critérios. Resultados: A prevalência do excesso de peso foi elevada em ambos os sexos. Com o critério da OMS, a prevalência foi de 34,5% nos meninos e 29,3% nas meninas. Para a RCE, a prevalência foi de 28,4% nos meninos e 23,7% nas meninas. A CP rastreou 13,8% de excesso de peso nos meninos e 15,8% nas meninas. A prevalência de excesso de peso foi mais elevada em adolescentes antes da maturação somática completa. Conclusões: A prevalência do excesso de peso foi elevada entre os adolescentes. Os meninos apresentaram maior percentual de excesso de peso, exceto na variável CP. Adolescentes antes da maturação somática apresentaram maior prevalência de sobrepeso. A CP tem menor capacidade de rastrear adolescentes obesos.

ABSTRACT Objective: To identify the prevalence of overweight in adolescents according to different classification criteria for obesity and somatic maturation stages. Methods: Cross-sectional study in 10 schools in a city from Southern Brazil, with 1715 adolescents. Height, weight, waist circumference, and neck circumference (NC) data were collected. Body Mass Index was classified according to World Health Organization (WHO) and Centers for Disease Control and Prevention criteria, and the waist-to-height ratio (WHtR) was classified according to Brazilian and European cut-off points. Somatic maturation was obtained through the Peak Height Velocity. The prevalence data were compared between sex and stages of somatic maturation; the concordance between different criteria was verified. Results: The prevalence of overweight was high in both sexes; WHO criteria showed that 34.5% of boys and 29.3% of girls were overweight. For the WHtR, the prevalence was 28.4% in boys and 23.7% in girls. NC classified 13.8% of boys and 15.8% of girls as being overweight. The prevalence of overweight was higher in adolescents before complete somatic maturation. Conclusions: The prevalence of overweight was high among adolescents. The boys presented higher frequency of overweight, except if NC was used to classify them. Adolescents before somatic maturation had a higher prevalence of overweight. NC showed a lower ability to track obese adolescents.

Resumo Objetivo: Avaliar em uma amostra de pacientes com distúrbios da diferenciação do sexo (DDS), dados relacionados à idade, ao encaminhamento e sua correlação com as queixas iniciais, ao sexo ao encaminhamento e ao sexo final e diagnóstico etiológico. Métodos: Revisão retrospectiva da idade por ocasião da primeira consulta e motivo dela, sexo social inicial e após definição do diagnóstico, cariótipo e diagnóstico etiológico de todos os casos atendidos em um ambulatório especializado em DDS entre 1989 e 2016. Foram excluídos casos que não compreendiam DDS e diagnósticos de DDS que não cursam comumente com ambiguidade genital, não necessitam de acompanhamento especializado. Resultados: Dos 1.793 casos atendidos, 1.139 foram diagnosticados com algum DDS. Excluíram-se 430 (272 síndrome de Turner, 66 síndrome de Klinefelter e 92 disgenesia gonadal pura), totalizando 709. Desses, 82,9% foram encaminhados por ambiguidade genital, somente um quarto ainda no primeiro mês de vida e 6,6% por atraso puberal, a maioria com 10 anos ou mais; 68,6% tiveram diagnóstico de DDS XY; 22,4% DDS XX e 9% de anomalias dos cromossomos sexuais. Conclusões: Este estudo apresenta a maior casuística na literatura de pacientes com DDS atendidos em um único serviço. O momento de encaminhamento da maioria dos pacientes com ambiguidade genital foi aquém do ideal e casos mais leves de ambiguidade e muitos com manifestações puberais foram encaminhados ainda mais tardiamente. Os resultados reforçam a importância do ensino continuado a profissionais que terão o primeiro contato com esses pacientes, principalmente pediatras e neonatologistas.

Abstract Objective: To evaluate, in a sample of patients with disorders of sex development (DSD), data related to the age at referral and their correlation with the initial complaints, gender at referral, defined gender after diagnosis and etiological diagnosis. Methods: Retrospective review of the age at the first consultation and the reason for it, initial social gender and gender after the diagnosis, karyotype and etiological diagnosis of all cases treated at a DSD outpatient clinic between 1989 and 2016. Cases that did not involve DSD and DSD diagnoses that do not usually involve ambiguous genitalia, thus not requiring specialized monitoring, were excluded. Results: Of the 1793 treated cases, 1139 were diagnosed with some type of DSD. This study excluded 430 cases (272 with Turner's syndrome, 66 with Klinefelter syndrome, and 92 with pure gonadal dysgenesis), thus a total 709 individuals were included. Of these, 82.9% were referred due to ambiguous genitalia; only one-quarter were still in the first month of life, and 6.6% were referred due to pubertal delay, with most of them aged 10 years or older. Of these patients, 68.6% had a diagnosis of XY DSD, 22.4% of XX DSD, and 9% of sex chromosome abnormalities. Conclusions: This study presents the largest series in the literature of patients with DSD treated in a single center. The time of referral of the majority of patients with ambiguous genitalia fell short of the ideal, and milder cases of ambiguous genitalia and many with pubertal manifestations were referred even later. The results reinforce the importance of continuing education for professionals who will have the first contact with these patients, mainly pediatricians and neonatologists.

RESUMO Objetivo Verificar a influência dos esportes de combate sobre a massa óssea. Métodos Foi realizada revisão sistemática da literatura de acordo com o método PRISMA, com buscas nas bases de dados Pubmed, Bireme, Embase e Web of Science, referente ao período de 1900 a 2015, com os descritores “martial arts”, “fight”, “combat”, “karate”, “kung fu”, “tae kwon do”, “judo”, “aikido”, “bone”, “bone mass”, “bone health”, “bone tissue”, “bone density”, “bone mineral contents”. A busca e a recuperação dos artigos foram realizadas por meio eletrônico e manual, executadas por dois revisores independentes. Resultados Foram identificados 79 artigos, dos quais, 25 eram duplicados, restando 54 artigos para leitura e avaliação dos títulos; posteriormente, foram excluídos os que tratavam de doenças como lesões ortopédicas e/ou ósseas, maxilofaciais, cirurgias, fraturas, mulheres osteopênicas e osteoporóticas, prevenção de quedas e aptidão física, restando 15 artigos. Dos estudos selecionados e encontrados na íntegra, todos foram publicados entre 2002 e 2015. Apenas um era estudo de caso controle, dois eram estudos longitudinais, dois estudos randomizados e 10 estudos transversais. Verificou-se um total de 1.368 crianças, adolescentes, adultos e idosos envolvidos em esportes de combate e avaliação óssea por imagem. Fatores como ingestão calórica, de cálcio e/ou vitamina D, intensidade e volume do exercício, aspectos hormonais como marcadores ósseos e características da menopausa não são conclusivos com relação à massa óssea e requerem um número maior de estudos. Conclusão A prática de esportes de combate evidencia melhora significativa na massa óssea em todas as idades . Nível de Evidência III, Estudos terapêuticos – Investigação dos resultados do tratamento.

ABSTRACT Objective To determine the influence of combat sports on bone mass. Methods A systematic review was performed according to the PRISMA method, with searches in the Pubmed, Bireme, Embase and Web of Science databases covering the period 1900 to 2015, using the keywords “martial arts”, “fight”, “combat”, “karate”, “kung fu”, “tae kwon do”, “judo”, “aikido”, “bone mass”, “bone health”, “bone tissue”, “bone density”, and “bone mineral contents”. The articles were searched for and retrieved electronically and manually, by two independent reviewers. Results Seventy-nine articles were identified, of which 25 were duplicates, leaving 54 for reading and evaluation of the titles; next, articles about diseases such as bone and/or orthopedic injuries, maxillofacial, surgeries, fractures, osteoporosis and osteopenia in women, prevention of falls, and physical fitness were excluded, leaving 15 articles. Of the articles selected and retrieved in full, all were published between 2002 and 2015. One article was a case control study; two were longitudinal studies, two were randomized studies; and 10 were cross-sectional studies. A total of 1368 children, adolescents, adults and elderly subjects were involved in combat sports and had bone evaluation by imaging. Factors such as calorie intake, calcium and/or vitamin D, intensity and volume of the exercise, hormonal aspects as bone markers, and characteristics of menopause are not conclusive in relation to bone mass, and further studies are needed. Conclusion The practice of combat sports shows a significant improvement in bone mass at all ages. Level of Evidence III, Therapeutic study – Investigation of treatment results.

RESUMEN Objective To determine the influence of combat sports on bone mass. Methods A systematic review was performed according to the PRISMA method, with searches in the Pubmed, Bireme, Embase and Web of Science databases covering the period 1900 to 2015, using the keywords “martial arts”, “fight”, “combat”, “karate”, “kung fu”, “tae kwon do”, “judo”, “aikido”, “bone mass”, “bone health”, “bone tissue”, “bone density”, and “bone mineral contents”. The articles were searched for and retrieved electronically and manually, by two independent reviewers. Results Seventy-nine articles were identified, of which 25 were duplicates, leaving 54 for reading and evaluation of the titles; next, articles about diseases such as bone and/or orthopedic injuries, maxillofacial, surgeries, fractures, osteoporosis and osteopenia in women, prevention of falls, and physical fitness were excluded, leaving 15 articles. Of the articles selected and retrieved in full, all were published between 2002 and 2015. One article was a case control study; two were longitudinal studies, two were randomized studies; and 10 were cross-sectional studies. A total of 1368 children, adolescents, adults and elderly subjects were involved in combat sports and had bone evaluation by imaging. Factors such as calorie intake, calcium and/or vitamin D, intensity and volume of the exercise, hormonal aspects as bone markers, and characteristics of menopause are not conclusive in relation to bone mass, and further studies are needed. Conclusion The practice of combat sports shows a significant improvement in bone mass at all ages. Level of Evidence III, Therapeutic study – Investigation of treatment results.

RESUMO Objetivo: Verificar a efetividade de intervenções educacionais baseadas na orientação sobre atividade física e nutrição em escolares. Fonte de dados: Foi realizada busca sistemática em quatro bancos e bases de dados eletrônicos, com artigos publicados entre outubro de 2007 e janeiro de 2017 que abordaram a realização de intervenções educacionais com ênfase em educação nutricional e atividade física ou exercício físico em escolares com idades entre 10 e 19 anos. Síntese dos dados: Foram selecionados 12 artigos para esta revisão. Desses estudos, quatro incluíram a intervenção educacional; quatro associaram intervenções educacionais à inclusão de alimentos saudáveis e atividade física; dois estudos relacionaram as orientações e a atividade física; e, por fim, dois ligaram as orientações com o consumo de alimentos saudáveis. Conclusões: As intervenções baseadas na orientação de atividade física e/ou nutrição foram eficientes, com resultados superiores nos estudos que associaram a prática de atividade física à orientação. Entretanto, observou-se a necessidade da realização de novos estudos que abordem as intervenções educacionais em escolares.

ABSTRACT Objective: To verify the effectiveness of educational interventions based on guidance on physical activity and nutrition in schoolchildren. Data sources: A systematic search was carried out in four electronic databases containing articles published between October 2007 and January 2017 and addressing educational interventions with emphasis on both nutritional education and physical activity in schoolchildren and adolescents aged 10 to 19 years. Data synthesis: Twelve articles were selected for this review, of which four included only educational interventions; four made and association between educational interventions, inclusion of healthy foods and physical activity; two made a relation between guidelines and physical activity; and finally, two associated guidelines with consumption of healthy foods. Conclusions: Interventions based on physical activity and/or nutrition counseling were efficient and showed superior results in studies that associated the practice of physical activity with counseling. However, the need for new studies on educational interventions among schoolchildren and adolescents was made evident.

SUMMARY A gonadal tumor was diagnosed in the first months of life in a patient with genital ambiguity, a 45,X/46,XY karyotype, and mixed gonadal dysgenesis. Gonadal biopsies at the age of 3 months revealed dysgenetic testes and a gonadoblastoma on the right testis. Even though gonadal tumors are rare in childhood, this case indicates that prophylactic removal of dysgenetic gonads should be performed as early as possible, especially when the female sex is assigned to a patient with a Y-chromosome sequence.

RESUMO Objetivo: Avaliar a massa óssea pela ultrassonografia quantitativa de falanges em jovens praticantes de karatê em relação a um grupo controle. Métodos: Amostra constituída por 162 praticantes de karatê (52 meninas) e 326 controles escolares (110 meninas) saudáveis, de 6 a 16 anos de idade, do oeste do Paraná. Foram avaliados peso, estatura, índice de massa corporal (IMC), Amplitude Dependent Speed of Sound (AD-SoS) e Bone Time Transmission (BTT), e os valores de IMC, AD-SoS e BTT transformados em escore Z. Aplicaram-se testes de Mann-Whitney, qui-quadrado ou Exato de Fisher e regressão linear múltipla, sendo significante p≤0,05. Resultados: Para ambos os sexos, os praticantes de karatê apresentaram valores superiores do escore Z do BTT comparados aos controles. Quanto à AD-SoS, as meninas do grupo de controle apresentaram valor absoluto e de escore Z superiores aos apresentados pelas praticantes de karatê do mesmo sexo. Ao avaliar a frequência relativa e absoluta de acordo com o escore Z do BTT em ambos os grupos, os meninos praticantes de karatê apresentaram maior frequência de massa óssea adequada. Nas meninas praticantes de karatê, a idade apresentou poder de explicação de 42% na variação da AD-SoS e o peso de 45% na variação do BTT. Nos meninos praticantes de karatê, a idade apresentou poder de explicação de 26% na variação da AD-SoS e a estatura 36% na variação do BTT. Conclusões: Nesse grupo de crianças e adolescentes, independentemente do sexo, os praticantes de karatê apresentaram maior massa óssea em relação ao grupo controle, sendo o BTT mais sensível para essa avaliação.

ABSTRACT Objective: To evaluate bone mass by quantitative ultrasound of the phalanges in young karate practitioners compared to a control group. Methods: Sample composed of 162 karate practitioners (52 females) and 326 healthy controls (110 females) aged 6 to 16 years old, in Western Paraná (Southern Brazil). Weight, height, BMI, amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT) were evaluated. BMI, AD-SoS and BTT values were converted to Z scores. Mann-Whitney, chi-square or Fisher Exact tests and multiple linear regression were applied, with significance level set at p≤0.05. Results: Both genders showed higher values of BTT as Z scores when compared to control group. Females from the control group had higher AD-SoS values (m/s and Z score) compared to female karate practitioners. When relative and absolute frequencies were assessed according to BTT Z score in both groups, male karate practitioners’ bone mass was shown to be adequate more frequently. In female practitioners, age and weight were independent predictors of AD-SoS (R2=0.42) and BTT (R2=0.45), respectively. Among male karate practitioners, age was related to 26% of AD-SoS variances and height was responsible for 36% of BTT variances. Conclusions: Children and adolescents who practice karate were shown to have more bone mass in comparison to the control group, regardless of gender. BTT was more sensitive for this evaluation.

Resumo O objetivo deste estudo foi verificar a prevalência e a concordância de excesso de peso (IMC) e de gordura corporal (% gordura) em adolescentes de ambos os sexos das cidades de Rio Branco-AC e Porto Velho-RO. Participaram do estudo 4.310 adolescentes, sendo 2.167 de Rio Branco e 2.143 de Porto Velho. Não houve diferença (p=0,46) entre o excesso de peso nos adolescentes de Rio Branco (34.8%) e de Porto Velho (33.8%). O % gordura foi significativamente maior (p=<0,01) nos adolescentes de Porto Velho (59,8%) em relação aos de Rio Branco (44,3%). Nos estágios intra-púbere e púbere foram identificadas moderadas concordâncias (p=0,01) e no estádio pré-púbere foi observado substancial concordância (p=0,01). Assim, os achados do presente estudo apontam para a necessidade da adequação do rastreamento da obesidade e sobrepeso que possibilitará identificação mais precoce e tratamento dos adolescentes.

Abstract The aim of this study was to identify the prevalence and concordance of excess weight (BMI) and body fat (fat %) in adolescents of both sexes from cities of Rio Branco-AC and Porto Velho-RO. This study evaluated 4,310 adolescents, 2,167 from Rio Branco and 2,143 from Porto Velho. No difference (p=0.46) for excess weight between adolescents from Rio Branco (34.8%) and Porto Velho (33.8%) was observed. Fat percentage was significantly higher (p<0.01) in adolescents from Porto Velho (59.8%) compared to those from Rio Branco (44.3%). In intra-pubertal and pubertal stages, moderate concordance was identified (p<0.01) and in pre-pubertal stage, substantial concordance was observed (p<0.01). Thus, the findings of this study point out the adequacy of screening and diagnosis of obesity and overweight, which will enable earlier approach and treatment of adolescents.

Resumo: Objetivo: Desenvolver curvas específicas de índice de massa corporal (IMC-para-idade) para população brasileira com síndrome de Down (SD). O objetivo secundário foi comparar os valores de IMC-para-idade com os valores normativos dos Centros de Controle e Prevenção de Doenças dos Estados Unidos (CDC). Métodos: Estudo do tipo retrospectivo e transversal. A amostra foi constituída de 706 jovens com SD (56,7%, meninos) recrutados em 51 instituições no Estado de São Paulo, Brasil. Peso e estatura foram obtidos e empregados para o cálculo de IMC (Kg/m2). O método LMS foi usado para a construção das curvas. Escores Z foram calculados com base na referência do CDC 2000. Resultados: As curvas de referência de IMC-para-idade para meninos e meninas com SD na faixa entre 2-18 anos apresentaram excelente ajuste estatístico. Aos 2 anos, o escore Z médio IMC de crianças com SD apresentou-se menor quando comparado com o CDC (escore Z = -0,2). Em contraste, os escores Z médios de IMC de jovens com SD foram superiores entre 3-18 anos (escores Z = +0,2 a +1,3). Conclusões: A população brasileira com SD apresentou diferentes padrões de IMC quando comparada com as referências do CDC. As curvas desenvolvidas neste estudo representam a primeira referência nacional de IMC-para-idade para jovens com SD. Espera-se, portanto, que essas curvas possam guiar pais e profissionais na avaliação do estado nutricional de crianças e adolescentes com SD no território brasileiro.

Abstract: Objective: To develop Brazilian growth charts for body mass index (BMI-for-age) for individuals with Down syndrome (DS). The secondary objective was to compare the BMI-for-age with the Centers for Disease Control and Prevention standards (CDC). Methods: A retrospective and cross-sectional growth study of 706 youth with DS (56.7% males) was performed in 51 centers in São Paulo state, Brazil. Weight and height were used to calculate the BMI (kg/m2). The LMS method was applied to construct the growth charts. Z-scores were based on the CDC 2000 growth standards. Results: The BMI-for-age reference charts showed excellent goodness of fit statistics for boys and girls with DS aged 2-18 years. At 2 years of age, the mean BMI Z-scores of boys and girls with DS were lower compared to those of the CDC (Z-score = −0.2). In contrast, children with DS aged 3-18 years had higher mean Z-scores for BMI-for-age when compared to those of the CDC (Z-scores = +0.2 to +1.3). Conclusions: The BMI of Brazilian youth with DS differs from those references established by CDC. These are the first Brazilian BMI-for-age charts for individuals with DS and will hopefully guide clinicians and parents in the evaluation and management of the nutritional status in children and adolescents with DS in Brazil.

Abstract Aim: To ascertain the effects of an after-school intervention on physical activity levels and cardiovascular risk factors in adolescents from Campinas, Brazil. Methods: This was an intervention study with 71 adolescents that was carried out in two schools, randomly assigned to a control group (CG:n=45) or an intervention group (IG:n=26). We performed evaluations of body composition, sexual maturation, blood pressure, level of physical activity, sedentary time (ST), and eating habits, as well as biochemical variables by a portable analyzer. The IG participated in two weekly sessions of physical activities and controlled physical exercises for 14 weeks. The sessions lasted 60’, and were divided into warm-up (5-10’), main part (40-50’), and recovery (5-10’). Results: 30.8% of the IG and 24.4% of the CG were classified as overweight/obese. Additionally, the IG showed significantly lower ST (total: p=0.037; daily: p=0.009) after the intervention, as well as in the post-period (total ST: p=0.043; daily ST: p=0.007). The IG showed a reduction in glycemia (p=0.025). Conclusion: The intervention program generated positive changes in glycemia levels and ST. These results suggest that interventions involving physical exercise should be promoted in the school environment, as physical activity is an important component of a healthy lifestyle.

Introduction: Adolescents with Down syndrome (DS) show high rate of overweight and tend to accumulate high amount of fat compared to the same people without the syndrome. Objective: To estimate the cutoff point of the Body Mass Index (BMI) for the diagnosis of obesity in adolescents with DS according to different references for BMI in relation to the percentage of body fat (%BF) measured by dual-energy X-ray absorptiometry (DXA). Methods: The sample was composed of 34 adolescents with DS (aged: 10 to 17 years old). BMI was evaluated according to the references of the International Obesity Task Force (IOTF), the World Health Organization (WHO) for the general population, and Myrelid et al. and Styles et al. for people with DS. The %BF was assessed by whole body DXA and classified according to National Health And Nutrition Examination Survey (NHANES, 2011). Results: The boys were significantly taller than the girls and this %BF higher than boys. All references who have used BMI to assess obesity was positively associated with %BF measured by DXA in the diagnosis of obesity. Using the ROC curve in relation to %BF by DXA, all references showed high sensitivity, but the z-score of BMI by WHO showed better specificity, with the value of the accuracy of 0.82 for the cutoff point above 2.14. Conclusions: All the references used for the diagnosis of obesity were associated with %BF measured by DXA, and the cutoff point of z-scores above 2.14 by WHO showed better specificity.

Introducción: adolescentes con síndrome de Down (SD) muestran alta tasa de sobrepeso y tienden a acumular gran cantidad de grasa en comparación con los adolescentes sin el síndrome. Objetivo: estimar el punto de corte del índice de masa corporal (IMC) para el diagnóstico de obesidad en adolescentes con SD de acuerdo con las diferentes referencias para el IMC en relación con el porcentaje de grasa corporal (%GC) obtenido por el absorciometría con rayos X de doble energía (DXA). Métodos: la muestra se compone de 34 adolescentes con SD (10 a 17 años). El IMC se evaluó de acuerdo con las referencias de la International Obesity Task Force (IOTF), Organización Mundial de la Salud (OMS) para la población general, y Myrelid et al. y Estyles et al. para personas con SD. El %GC fue evaluado por DXA y clasificado según NHANES (2011). Resultados: los niños fueron significativamente más altos que las niñas, y estas con mayor %GC que los niños. Todas las referencias que han utilizado el IMC se asociaron positivamente con el %GC medido por DXA en el diagnóstico de la obesidad. Utilizando la curva ROC en relación con %GC por DXA todas las referencias mostraron alta sensibilidad, pero el score-z del IMC por la OMS mostró mejor especificidad, con el valor de exactitud de 0,82 para el punto de corte por encima de 2,14. Conclusiones: todas las referencias utilizadas para el diagnóstico de obesidad se asociaron con el %GC medido por DXA, y el punto de corte del score-z por encima de 2,14 por la OMS mostró mejor especificidad.

ABSTRACT Clinical and laboratory diagnosis and treatment of central precocious puberty (CPP) remain challenging due to lack of standardization. The aim of this revision was to address the diagnostic and therapeutic features of CPP in Brazil based on relevant international literature and availability of the existing therapies in the country. The diagnosis of CPP is based mainly on clinical and biochemical parameters, and a period of follow-up is desirable to define the “progressive” form of sexual precocity. This occurs due to the broad spectrum of pubertal development, including isolated premature thelarche, constitutional growth and puberty acceleration, progressive and nonprogressive CPP, and early puberty. Measurement of basal and stimulated LH levels remains challenging, considering that the levels are not always in the pubertal range at baseline, short-acting GnRH is not readily available in Brazil, and the cutoff values differ according to the laboratory assay. When CPP is suspected but basal LH values are at prepubertal range, a stimulation test with short-acting or long-acting monthly GnRH is a diagnostic option. In Brazil, the treatment of choice for progressive CPP and early puberty is a long-acting GnRH analog (GnRHa) administered once a month or every 3 months. In Brazil, formulations of GnRHa (leuprorelin and triptorelin) are available and commonly administered, including 1-month depot leuprorelin 3.75 mg and 7.5 mg, 1-month depot triptorelin 3.75 mg, and 3-month depot leuprorelin 11.25 mg. Monthly or 3-month depot GnRHa are effective and safe to treat CPP. Arch Endocrinol Metab. 2016;60(2):163-72

Resumo O objetivo do estudo foi realizar uma revisão sistemática sobre os programas de intervenção, com ações de atividades físicas e/ou educação nutricional, na redução de fatores de risco à saúde (sobrepeso/obesidade e alterações no perfil metabólico), em adolescentes escolares brasileiros. Foi realizada busca nas bases de dados eletrônicas Medline (PubMed), Lilacs, Embase, Scielo e Banco de Teses da Capes. Identificaram-se 1.568 estudos e 21 textos completos foram analisados, dos quais, cinco foram incluídos na revisão. A maioria dos estudos envolveu a prática de atividades físicas combinada à educação nutricional em diferentes regiões do país e todas as intervenções mostraram efeitos positivos na redução de fatores de risco à saúde. Conclui-se que todos os estudos nesta revisão demonstraram alterações positivas após as intervenções, mesmo que não significativas estatisticamente, reforçando a importância de programas de intervenção para a promoção de uma vida mais saudável e para reduzir os fatores de risco à saúde, em adolescentes.

Abstract The aim of this study was to systematically review studies on intervention programs involving physical activity promotion and/or nutritional education to reduce health-related risk factors (overweight/obesity and metabolic profilealterations) in Brazilian adolescent students. A search was performed in the following electronic databases: Medline (PubMed), Lilacs, Embase, Scielo and Capes Thesis Database. A total of 1,568 studies were identified, of which 21 full papers were analyzed and 5 were included in the systematic review. The majority of the studies involved physical activity practice combined with nutritional education in Brazilian adolescent students and all interventions showed positive effect on reducing health-related risk factors among Brazilian adolescents.It was concluded that all studies included in this review showed positive alterations in health-related risk factors after interventions, reinforcing the importance of intervention programs to promote a healthier lifestyle and reduce health-related risk factors in adolescents.