Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
PLoS One. 2019 Jul 3;14(7):e0219370. doi: 10.1371/journal.pone.0219370. eCollection 2019.
The major non-communicable chronic diseases (NCD) are associated with a small group of modifiable lifestyle-related risk factors, including smoking, insufficient physical activity, unhealthy eating, and alcohol abuse. In this study, we evaluated the co-occurrence and clustering of the major NCD risk factors among Brazilian adolescents.
This cross-sectional study analyzed data of 101,607 adolescents from the Brazilian National Survey of School Health (PeNSE) 2015. The risk factors included were: regular consumption of ultra-processed foods, irregular consumption of fruits and vegetables, insufficient physical activity, smoking, and alcohol consumption. Clustering was defined through the ratio between observed and expected prevalences of combination of risk factors greater than 1. Expected prevalence of the co-occurrence of risk factors was calculated from the joint probability of the behaviors. Additionally, we examined the presence of at least four risk factors according to socioeconomic characteristics.
Of the 32 combinations of risk factors, 13 corresponded to clustering. We observed a strong correlation between alcohol consumption and smoking, which were found together in 8 of the 13 clusters identified. The most frequent combinations of risk factors involved unhealthy eating and insufficient physical activity. Only 2.9% of the adolescents did not present any risk behaviors, while 38.0%, 32.9%, 9.4% and 1.8% accumulated two, three, four and five risk factors, respectively. The accumulation of risk factors was higher in girls, older adolescents, those who did not live with both parents, children of less-educated mothers, students attending public school, and residents of cities in more developed urban areas of the country.
The main risk factors for NCD are frequent and not randomly distributed among Brazilian adolescents. Our results provide information for policymakers to target specific groups and joint behavioral risk factors for health improvement in adolescents.
主要的非传染性慢性疾病（NCD）与一小部分可改变的与生活方式相关的风险因素有关，包括吸烟、身体活动不足、不健康饮食和酗酒。在这项研究中，我们评估了巴西青少年主要 NCD 风险因素的同时发生和聚类情况。
这是一项横断面研究，分析了 2015 年巴西全国学校卫生调查（PeNSE）中 101607 名青少年的数据。所包括的风险因素为：经常食用超加工食品、不规律食用水果和蔬菜、身体活动不足、吸烟和饮酒。聚类通过观察到的与预期的风险因素组合的流行率之比大于 1 来定义。预期的风险因素同时发生的流行率是根据行为的联合概率计算的。此外，我们还根据社会经济特征检查了至少存在四种风险因素的情况。
在 32 种风险因素组合中，有 13 种符合聚类标准。我们观察到饮酒和吸烟之间存在很强的相关性，在确定的 13 个聚类中有 8 个同时存在这两种行为。最常见的风险因素组合涉及不健康的饮食和身体活动不足。只有 2.9%的青少年没有任何风险行为，而 38.0%、32.9%、9.4%和 1.8%分别积累了两种、三种、四种和五种风险因素。在女孩、年龄较大的青少年、与父母双方不同住的青少年、母亲受教育程度较低的青少年、就读于公立学校的青少年以及居住在该国城市化程度较高的城市的青少年中，风险因素的积累程度更高。
巴西青少年主要的 NCD 风险因素很常见，且并非随机分布。我们的研究结果为决策者提供了信息，以便针对特定群体和青少年健康改善的共同行为风险因素进行有针对性的干预。
