Concentração sérica de vitamina D ao nascer e marcadores de risco Cardiometabólico em adolescentes: um estudo de coorte de nascimento.

Abstract

This these is compound by 3 studies: Frist study approach the question of vitamin D deficiency and cardiometabolic risk factors in adolescents was done a systematic review and meta-analysis were included the studies from Brazil and other countries of the world. The results shown that vitamin D deficiency associated with high systolic pressure (SMD= 0,22; IC95% = 0,10 ;0,34; diastolic pressure (SMD=0.23; IC 95%= 0.10; 0.35); increased glycaemia (SMD=0,13 IC 95% = 0,05; 0,12); insulin (SMD= 0,50; IC95%= 0.15; 0.84) HOMA-IR index (SMD=0,48 IC 95% = 0,36 – 0,60); high values of triglycerides (SMD =0,30 IC95% = 0,11 – 0,49) low levels of HDL cholesterol (SMD = -0.25; IC 95%= -0,46 -0,04). Was not recorded a statistics significant association to glycated hemoglobin (SMD=0,28; IC 95%= -0.15 – 0.73) and total cholesterol (SMD = 0,10; IC 95% = -0,06 – 0,27). The second study approach relation between socioeconomic, environmental and vitamin D insufficiency using a hierarchy approach was used the logistic regression analysis and odds ratio (OR) as association measurement to investigate the association. The prevalence of vitamin D insufficiency (10 – 299 ng/ml) was 54.1% in adolescents was not recorded vitamin D deficiency (<10 ng/ml).in the basic level, was reported a protect effect 52% (OR= 0,48 I.C 95% 0.28-0.82; p =0,003); those from low socioeconomic status were protected of occurrence vitamin D insufficiency when compared with those from high socioeconomic status. adolescents who lived in the rural area, increased 2,35 more time to being vitamin D insufficiency (OR= 2.35; C.I 95% 1.41-3.92; p= 0,001). In the intermediate level, sanitary conditions, at home and surrounding the home, those situated in lowest tertil of wealth after adjusted by socioeconomic conditions in the basic level, showed high odds 1,41% (OR= 2,41 C.I 95% 1.06-5.44; p=0,034) to being vitamin D insufficiency. In the immediate level, after adjusted by variables of basic and intermediate level, the results shown that adolescents aged 14 years had 2,37 times more (OR= 2,35 C.I 95% 1.18-5.02; p= 0,001) to being vitamin D insufficiency when compared with those with 11 to 13 years old. While skin color showed to be a black+ brown (OR=2,00 C.I 95% 1.00-3.97; p=0,047) increased 2,00 more times to be vitamin D insufficiency when compared with white+ indigenous+ yellow skin colors. third study treat mean variation of vitamin D and cardiometabolic risk markers at birth and adolescence a cohort study at birth with longitudinal approach with repeated measures. Was used Generalized Estimating Equation (GEE) adequate to longitudinal data with repeated measures using continuous outcomes Results showed that vitamin D insufficiency was 53.7% in adolescents; the mean of vitamin D 29.98 ng/ml (SD = 8,75ng/ml). Were reported a negative association and statistically significant between vitamin D variation at birth and adolescences with mean variation of cardiometabolic risk markers at birth and adolescence. Were identified negative coefficients (β) to total cholesterol (β= -0,587C.I 95% -1.12—0.05;; p= 0.031); LDL cholesterol ( β= -0,512; C.I 95%-0.93—0.08; p= 0,018), triglycerides (β= -2,105; C.I 95% 0.07-0.18; p= 0,000); increase each unit ng/ml of vitamin D were positively associated with HDL cholesterol (β= 0,190; C.I95% 0.21-0.35; p=0,027); homocysteine (β= 0,094; p= 0,038) to glucose (β=0,236;C.I95% 0.02-0.38; p=0,026) also, was identified a positive relation between vitamin D concentration and variation of body mass index (β=0,054;C.I 95% 0.02-0.08; p=0,001) Conclusion: Hypovitaminosis D (vitamin D insufficiency and deficiency) was associated with socioeconomic and environmental determinants also was recorded an association between insufficiency and deficiency levels of vitamin D and some cardiometabolic risk markers, specially components of the parameters of lipid profile, glucose, blood pressure and homocysteine.