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INTRODUCTION: The identification of risk or protective behavioral patterns associated with abdominal adiposity may aid in prevention and health promotion measures. OBJECTIVE: To identify and to associate behavioral patterns of risk and protection to abdominal adiposity in adults in a Brazilian city. MATERIAL AND METHODS: A population-based cross-sectional study was carried out in Viçosa, Brazil, with 1,226 adults of both sexes. Information on social-demographic characteristics, food intake, level of physical activity, alcohol consumption and smoking were collected by using a questionnaire. The anthropometric measurement of waist circumference and anthropometric indices waist/hip ratio and waist/height ratio were indicators of abdominal adiposity. To identify behavioral patterns, exploratory factor analysis was applied for the variables considered as risk or protective factors. The association of the identified patterns with abdominal adiposity was estimated by multiple linear regression, adjusted for gender, age and social economical class. RESULTS: Two patterns were obtained, "healthy" and "risk". The "healthy" pattern, comprised of the clustering of the variables food consumption, fruits, fresh fruit juices, raw and cooked vegetables and the appropriate level of physical activity, was negatively associated with abdominal adiposity identified by waist circumference (p = 0.048), waist/hip (p = 0.013) and waist/height (p = 0.018) indices. The "risk" pattern, composed of smoking, alcohol beverage abuse and habit of consuming visible fat in fat-rich red meat or poultry skin, was positively associated with abdominal adiposity identified by waist circumference (p = 0.002) and waist/hip (p = 0.007) and waist/height indices (p = 0.006). CONCLUSIONS: Two behavioral patterns were identified, a risk pattern and a protective pattern for abdominal adiposity in the assessed population. The study shows the importance of conducting clustering of multiple risk and protective factors to better explain the health conditions of a group.

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Introduction: The identification of risk or protective behavioral patterns associated with abdominal adiposity may aid in prevention and health promotion measures. Objective: To identify and to associate behavioral patterns of risk and protection to abdominal adiposity in adults in a Brazilian city. Material and methods: A population-based cross-sectional study was carried out in Viçosa, Brazil, with 1,226 adults of both sexes. Information on social-demographic characteristics, food intake, level of physical activity, alcohol consumption and smoking were collected by using a questionnaire. The anthropometric measurement of waist circumference and anthropometric indices waist/hip ratio and waist/height ratio were indicators of abdominal adiposity. To identify behavioral patterns, exploratory factor analysis was applied for the variables considered as risk or protective factors. The association of the identified patterns with abdominal adiposity was estimated by multiple linear regression, adjusted for gender, age and social economical class. Results: Two patterns were obtained, "healthy" and "risk". The "healthy" pattern, comprised of the clustering of the variables food consumption, fruits, fresh fruit juices, raw and cooked vegetables and the appropriate level of physical activity, was negatively associated with abdominal adiposity identified by waist circumference (p = 0.048), waist/hip (p = 0.013) and waist/height (p = 0.018) indices. The "risk" pattern, composed of smoking, alcohol beverage abuse and habit of consuming visible fat in fat-rich red meat or poultry skin, was positively associated with abdominal adiposity identified by waist circumference (p = 0.002) and waist/hip (p = 0.007) and waist/height indices (p = 0.006). Conclusions: Two behavioral patterns were identified, a risk pattern and a protective pattern for abdominal adiposity in the assessed population. The study shows the importance of conducting clustering of multiple risk and protective factors to better explain the health conditions of a group (AU)

Introducción: la identificación de los riesgos o los patrones de comportamiento de protección asociados con la adiposidad abdominal puede ayudar en las medidas de prevención y promoción de la salud. Objetivo: identificar y establecer la asociación entre los patrones de comportamiento de riesgo y de protección y la adiposidad abdominal en adultos en una ciudad brasileña. Material y métodos: se llevó a cabo un estudio transversal basado en la población en Viçosa, Brasil, con 1.226 adultos de ambos sexos. Se recogió información sobre las características sociodemográficas, la ingesta de alimentos, el nivel de actividad física, el consumo de bebidas alcohólicas y el hábito tabáquico mediante un cuestionario. La medición antropométrica de la circunferencia de la cintura y de los índices antropométricos cintura/cadera y cintura/altura fueron los indicadores de adiposidad abdominal. Para identificar los patrones de comportamiento, se aplicó un análisis factorial exploratorio de las variables de riesgo o factores de protección considerados. La asociación de los patrones identificados con la adiposidad abdominal se estimó por regresión lineal múltiple, ajustada por género, edad y nivel socioeconómico. Resultados: se establecieron dos patrones, "sano" y "riesgo". El patrón "sano", compuesto por la agrupación de las variables consumo de alimentos, frutas, zumos de fruta fresca, verdura cruda y cocida y el nivel apropiado de actividad física, se asoció negativamente con la adiposidad abdominal identificada por la circunferencia de la cintura (p = 0,048) y los índices cintura/cadera (p = 0,013) y cintura/altura (p = 0,018). El patrón de "riesgo", compuesto por hábito tabáquico, abuso de alcohol y consumo de grasa visible en carnes rojas ricas en grasa o piel de las aves, se asoció positivamente con la adiposidad abdominal identificada por la circunferencia de la cintura (p = 0,002) y las ratios cintura/cadera (p = 0,007) y cintura/altura (p = 0,006). Conclusiones: fueron identificados dos patrones de comportamiento, el patrón de riesgo y el patrón de protección, relacionados con la adiposidad abdominal en la población estudiada. El estudio muestra la importancia de agrupar múltiples factores de riesgo y de protección para explicar mejor las condiciones de salud de un grupo (AU)

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OBJECTIVE: To evaluate the association between calcium intake and serum vitamin D levels and childhood obesity by an integrative review. DATA SOURCE: The research was conducted in the databases PubMed/medLine, Science Direct and SciELO with 2001 to 2014 publications. We used the combined terms in English: ''children'' and ''calcium'' or ''children'' and ''vitamin D'' associated with the descriptors: ''obesity'', ''adiposity'' or ''body fat'' for all bases. Cross-sectional and cohort studies, as well as clinical trials, were included. Review articles or those that that have not addressed the association of interest were excluded. DATA SYNTHESIS: Eight articles were part of this review, five of which were related to calcium and three to vitamin D. Most studies had a longitudinal design. The analyzed studies found an association between calcium intake and obesity, especially when age and sex were considered. Inverse relationship between serum vitamin D and measures of adiposity in children has been observed and this association was influenced by the sex of the patient and by the seasons of the year. CONCLUSIONS: The studies reviewed showed an association between calcium and vitamin D with childhood obesity. Considering the possible protective effect of these micronutrients in relation to childhood obesity, preventive public health actions should be designed, with emphasis on nutritional education.

OBJETIVO: Avaliar a associação da ingestão de cálcio e níveis séricos de vitamina D e a obesidade infantil, por meio de uma revisão integrativa. FONTES DE DADOS: A pesquisa foi feita nas bases Pubmed/MedLine, Science Direct e SciELO com publicações de 2001 a 2014. Usaram-se os termos em inglês combinados: "children" e "calcium" ou "children" e "vitamina D" associados, cada um, aos descritores: "obesity", "adiposity" ou "body fat", para todas as bases. Foram incluídos estudos que relacionassem as palavraschave da pesquisa, com delineamento transversal, estudos de coorte e ensaios clínicos. Foram excluídos artigos de revisão ou artigos que não estudaram a associação de interesse. SÍNTESE DOS DADOS: Oito artigos fizeram parte dessa revisão, dos quais cinco eram referentes ao cálcio e três abordaram a vitamina D. A maioria dos estudos foi de delineamento longitudinal. Os estudos analisados encontraram associação entre ingestão cálcio e obesidade, especialmente quando consideradas características como idade e sexo. Tem-se observado relação inversa entre concentrações séricas de vitamina D e medidas de adiposidade em crianças. Essas são influenciadas pelo sexo e pelas estações do ano. CONCLUSÕES: Os estudos avaliados mostraram associação entre cálcio e vitamina D com a obesidade na infância. Assim, considerando o possível efeito protetor desses micronutrientes em relação à obesidade infantil, as ações preventivas de saúde pública podem ser pautadas com ênfase na educação nutricional.

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OBJECTIVE: To evaluate the association between calcium intake and serum vitamin D levels and childhood obesity by an integrative review. DATA SOURCE: The research was conducted in the databases PubMed/medLine, Science Direct and SciELO with 2001 to 2014 publications. We used the combined terms in English: "children" and "calcium" or "children" and "vitamin D" associated with the descriptors: "obesity", "adiposity" or "body fat" for all bases. Cross-sectional and cohort studies, as well as clinical trials, were included. Review articles or those that that have not addressed the association of interest were excluded. DATA SYNTHESIS: Eight articles were part of this review, five of which were related to calcium and three to vitamin D. Most studies had a longitudinal design. The analyzed studies found an association between calcium intake and obesity, especially when age and sex were considered. Inverse relationship between serum vitamin D and measures of adiposity in children has been observed and this association was influenced by the sex of the patient and by the seasons of the year. CONCLUSIONS: The studies reviewed showed an association between calcium and vitamin D with childhood obesity. Considering the possible protective effect of these micronutrients in relation to childhood obesity, preventive public health actions should be designed, with emphasis on nutritional education.

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