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PARÂMETROS DIETÉTICOS ASSOCIADOS AO FENÓTIPO DE RESISTÊNCIA À INSULINA EM ADOLESCENTES: CONSÓRCIO RPS, SÃO LUÍS

Detalhes bibliográficos
Ano de defesa: 2025
Autor(a) principal: SÁ, Rafaela Vitória Pereira lattes
Orientador(a): ALMEIDA, Cecilia Claudia Costa Ribeiro de lattes
Banca de defesa: RIBEIRO, Cecilia Claudia Costa lattes, VITOLO, Márcia Regina lattes, SOUZA, Bruno Feres de lattes
Tipo de documento: Dissertação
Tipo de acesso: Acesso aberto
Idioma: por
Instituição de defesa: Universidade Federal do Maranhão
Programa de Pós-Graduação: PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA/CCBS
Departamento: DEPARTAMENTO DE ODONTOLOGIA II/CCBS
País: Brasil
Palavras-chave em Português:
Palavras-chave em Inglês:
Área do conhecimento CNPq:
Link de acesso: https://tedebc.ufma.br/jspui/handle/tede/5889
Resumo: Adolescence is a period of development that encompasses a wide range of changes and is seen as a crucial window of opportunity for shaping lifelong health, especially with regard to insulin resistance (IR). IR is a common part of the pathophysiology of multiple cardiometabolic diseases and there is a need for attention to this condition in the face of the increasing prevalence of DM2 in adolescents and young adults. Although insulin resistance and the changes that accompany it have a multifactorial origin, adolescent food consumption and some specific dietary components appear to be an important modifiable risk factor in this process. This dissertation therefore aims to investigate the association of dietary parameters with the Insulin Resistance Phenotype in adolescents. This is a cross-sectional study developed using data from the second follow-up of the RPS Consortium cohort, São Luís (n = 1 874), in which the outcome was the latent variable Insulin Resistance Phenotype, formed by three indicators: Triglycerides/HDL ratio, Triglycerides-Glycemia Index and VLDL level. A theoretical model stratified by sex, including Socioeconomic Status, the dietary parameters of carbohydrate and saturated fat intake, and obesity as a mediator in association with the outcome in adolescents were analyzed using Structural Equation Models. The results showed that the consumption of added sugars greater than 25g had a direct risk effect in boys (Standardized Coefficient – SC = 0.093; p = 0.015) and girls (SC = 0.100; p = 0.018) for Insulin Resistance Phenotype. Consumption of more than 10% of the total energy value from saturated fats was also associated with the Insulin Resistance Phenotype in boys (SC = 0.071; p = 0.027) and girls (SC = 0.117; p < 0.001). The other parameters were not associated with the outcome in adolescents. The findings show that consumption of added sugars and saturated fats above the international recommendations explained insulin resistance in adolescents, regardless of obesity. Dietary interventions aimed at strengthening international recommendations among young people should be encouraged in order to prevent the risk of diabetes in the future.
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spelling ALMEIDA, Cecilia Claudia Costa Ribeiro dehttp://lattes.cnpq.br/1783658679814263RIBEIRO, Cecilia Claudia Costahttp://lattes.cnpq.br/1783658679814263VITOLO, Márcia Reginahttp://lattes.cnpq.br/7439522652953604SOUZA, Bruno Feres dehttp://lattes.cnpq.br/4112635495117258http://lattes.cnpq.br/4680070010890951SÁ, Rafaela Vitória Pereira2025-02-10T14:12:23Z2025-01-28SÁ, Rafaela Vitória Pereira. Parâmetros dietéticos associados ao fenótipo de resistência à insulina em adolescentes: Consórcio RPS, São Luís. 2025. 99 f. Dissertação( Programa de Pós-graduação em Saúde Coletiva/CCBS) - Universidade Federal do Maranhão, São Luís, 2025.https://tedebc.ufma.br/jspui/handle/tede/5889Adolescence is a period of development that encompasses a wide range of changes and is seen as a crucial window of opportunity for shaping lifelong health, especially with regard to insulin resistance (IR). IR is a common part of the pathophysiology of multiple cardiometabolic diseases and there is a need for attention to this condition in the face of the increasing prevalence of DM2 in adolescents and young adults. Although insulin resistance and the changes that accompany it have a multifactorial origin, adolescent food consumption and some specific dietary components appear to be an important modifiable risk factor in this process. This dissertation therefore aims to investigate the association of dietary parameters with the Insulin Resistance Phenotype in adolescents. This is a cross-sectional study developed using data from the second follow-up of the RPS Consortium cohort, São Luís (n = 1 874), in which the outcome was the latent variable Insulin Resistance Phenotype, formed by three indicators: Triglycerides/HDL ratio, Triglycerides-Glycemia Index and VLDL level. A theoretical model stratified by sex, including Socioeconomic Status, the dietary parameters of carbohydrate and saturated fat intake, and obesity as a mediator in association with the outcome in adolescents were analyzed using Structural Equation Models. The results showed that the consumption of added sugars greater than 25g had a direct risk effect in boys (Standardized Coefficient – SC = 0.093; p = 0.015) and girls (SC = 0.100; p = 0.018) for Insulin Resistance Phenotype. Consumption of more than 10% of the total energy value from saturated fats was also associated with the Insulin Resistance Phenotype in boys (SC = 0.071; p = 0.027) and girls (SC = 0.117; p < 0.001). The other parameters were not associated with the outcome in adolescents. The findings show that consumption of added sugars and saturated fats above the international recommendations explained insulin resistance in adolescents, regardless of obesity. Dietary interventions aimed at strengthening international recommendations among young people should be encouraged in order to prevent the risk of diabetes in the future.A adolescência é um período do desenvolvimento que engloba ampla gama de mudanças, encarada como uma janela de oportunidade crucial para moldar a saúde ao longo da vida, especialmente no que se refere à resistência à insulina (RI). A RI é parte comum da fisiopatologia de múltiplas doenças cardiometabólicas e há uma necessidade de atenção à essa condição diante do crescente aumento da prevalência do Diabetes Mellitus tipo 2 em adolescentes e jovens adultos. Embora a RI e as alterações que a acompanham tenham origem multifatorial, o consumo alimentar dos adolescentes e alguns componentes da dieta específicos surgem como fator de risco modificável importante no processo. A presente dissertação tem, portanto, o objetivo de investigar a associação de parâmetros dietéticos em associação ao Fenótipo de Resistência à Insulina em adolescentes. Trata-se de um estudo transversal desenvolvido utilizando dados do segundo seguimento da coorte do Consórcio RPS, São Luís (n = 1,874), em que o desfecho foi a variável latente Fenótipo de Resistência à Insulina, formada pelos indicadores razão Triglicerídeos/HDL, Índice Triglicerídeos-Glicemia e nível de VLDL. Um modelo teórico estratificado por sexo, incluindo a Situação Socioeconômica, os parâmetros dietéticos de carboidratos e ingestão de gorduras saturadas, e obesidade como mediadora em associação com o desfecho em adolescentes foram analisados utilizando Modelagem de Equações Estruturais. Como resultados obteve-se o consumo de açúcares de adição maior que 25g apresentou um efeito direto de risco em meninos (Coeficiente Padronizado- CP = 0.093; p = 0.015) e meninas (CP = 0.100; p = 0.018) para o Fenótipo de Resistência à Insulina e um efeito total de risco nas meninas (CP = 0.094; p = 0.010). O consumo acima de 10% do valor energético total de gorduras saturadas também se associou ao Fenótipo de Resistência à Insulina em meninos (CP = 0.071; p =0.027) e meninas (CP = 0.117; p < 0.001). Os demais parâmetros não se associaram ao desfecho nos adolescentes. Os achados demonstram que o consumo acima das recomendações internacionais de açúcares de adição e gorduras saturadas explicou a resistência insulínica em adolescentes, independente da obesidade. Intervenções dietéticas visando o fortalecimento das recomendações internacionais entre os jovens devem ser estimuladas, a fim de prevenir o risco de diabetes no futuro.Submitted by Maria Aparecida (cidazen@gmail.com) on 2025-02-10T14:12:23Z No. of bitstreams: 1 Rafaela Vitória Pereira Sá.pdf: 2300275 bytes, checksum: 9a5f0bd1251f3c4f243838f1b020b804 (MD5)Made available in DSpace on 2025-02-10T14:12:23Z (GMT). No. of bitstreams: 1 Rafaela Vitória Pereira Sá.pdf: 2300275 bytes, checksum: 9a5f0bd1251f3c4f243838f1b020b804 (MD5) Previous issue date: 2025-01-28application/pdfporUniversidade Federal do MaranhãoPROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA/CCBSUFMABrasilDEPARTAMENTO DE ODONTOLOGIA II/CCBSAdolescência;Resistência à Insulina;Distúrbios Metabólicos;Carboidratos da dieta;Lipídios da dietaAdolescence;Insulin Resistance;Metabolic Disease;Dietary Carbohydrates;Dietary FatsAnálise Nutricional de PopulaçãoPARÂMETROS DIETÉTICOS ASSOCIADOS AO FENÓTIPO DE RESISTÊNCIA À INSULINA EM ADOLESCENTES: CONSÓRCIO RPS, SÃO LUÍSDIETARY PARAMETERS ASSOCIATED WITH INSULIN RESISTANCE PHENOTYPE IN ADOLESCENTS: RPS CONSORTIUM, SÃO LUÍSinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFMAinstname:Universidade Federal do Maranhão (UFMA)instacron:UFMAORIGINALRafaela Vitória Pereira Sá.pdfRafaela Vitória Pereira Sá.pdfapplication/pdf2300275http://tedebc.ufma.br:8080/bitstream/tede/5889/2/Rafaela+Vit%C3%B3ria+Pereira+S%C3%A1.pdf9a5f0bd1251f3c4f243838f1b020b804MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82255http://tedebc.ufma.br:8080/bitstream/tede/5889/1/license.txt97eeade1fce43278e63fe063657f8083MD51tede/58892025-02-10 11:12:23.227oai:tede2: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Biblioteca Digital de Teses e Dissertaçõeshttps://tedebc.ufma.br/jspui/PUBhttp://tedebc.ufma.br:8080/oai/requestrepositorio@ufma.br||repositorio@ufma.bropendoar:21312025-02-10T14:12:23Biblioteca Digital de Teses e Dissertações da UFMA - Universidade Federal do Maranhão (UFMA)false
dc.title.por.fl_str_mv PARÂMETROS DIETÉTICOS ASSOCIADOS AO FENÓTIPO DE RESISTÊNCIA À INSULINA EM ADOLESCENTES: CONSÓRCIO RPS, SÃO LUÍS
dc.title.alternative.eng.fl_str_mv DIETARY PARAMETERS ASSOCIATED WITH INSULIN RESISTANCE PHENOTYPE IN ADOLESCENTS: RPS CONSORTIUM, SÃO LUÍS
title PARÂMETROS DIETÉTICOS ASSOCIADOS AO FENÓTIPO DE RESISTÊNCIA À INSULINA EM ADOLESCENTES: CONSÓRCIO RPS, SÃO LUÍS
spellingShingle PARÂMETROS DIETÉTICOS ASSOCIADOS AO FENÓTIPO DE RESISTÊNCIA À INSULINA EM ADOLESCENTES: CONSÓRCIO RPS, SÃO LUÍS
SÁ, Rafaela Vitória Pereira
Adolescência;
Resistência à Insulina;
Distúrbios Metabólicos;
Carboidratos da dieta;
Lipídios da dieta
Adolescence;
Insulin Resistance;
Metabolic Disease;
Dietary Carbohydrates;
Dietary Fats
Análise Nutricional de População
title_short PARÂMETROS DIETÉTICOS ASSOCIADOS AO FENÓTIPO DE RESISTÊNCIA À INSULINA EM ADOLESCENTES: CONSÓRCIO RPS, SÃO LUÍS
title_full PARÂMETROS DIETÉTICOS ASSOCIADOS AO FENÓTIPO DE RESISTÊNCIA À INSULINA EM ADOLESCENTES: CONSÓRCIO RPS, SÃO LUÍS
title_fullStr PARÂMETROS DIETÉTICOS ASSOCIADOS AO FENÓTIPO DE RESISTÊNCIA À INSULINA EM ADOLESCENTES: CONSÓRCIO RPS, SÃO LUÍS
title_full_unstemmed PARÂMETROS DIETÉTICOS ASSOCIADOS AO FENÓTIPO DE RESISTÊNCIA À INSULINA EM ADOLESCENTES: CONSÓRCIO RPS, SÃO LUÍS
title_sort PARÂMETROS DIETÉTICOS ASSOCIADOS AO FENÓTIPO DE RESISTÊNCIA À INSULINA EM ADOLESCENTES: CONSÓRCIO RPS, SÃO LUÍS
author SÁ, Rafaela Vitória Pereira
author_facet SÁ, Rafaela Vitória Pereira
author_role author
dc.contributor.advisor1.fl_str_mv ALMEIDA, Cecilia Claudia Costa Ribeiro de
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/1783658679814263
dc.contributor.referee1.fl_str_mv RIBEIRO, Cecilia Claudia Costa
dc.contributor.referee1Lattes.fl_str_mv http://lattes.cnpq.br/1783658679814263
dc.contributor.referee2.fl_str_mv VITOLO, Márcia Regina
dc.contributor.referee2Lattes.fl_str_mv http://lattes.cnpq.br/7439522652953604
dc.contributor.referee3.fl_str_mv SOUZA, Bruno Feres de
dc.contributor.referee3Lattes.fl_str_mv http://lattes.cnpq.br/4112635495117258
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/4680070010890951
dc.contributor.author.fl_str_mv SÁ, Rafaela Vitória Pereira
contributor_str_mv ALMEIDA, Cecilia Claudia Costa Ribeiro de
RIBEIRO, Cecilia Claudia Costa
VITOLO, Márcia Regina
SOUZA, Bruno Feres de
dc.subject.por.fl_str_mv Adolescência;
Resistência à Insulina;
Distúrbios Metabólicos;
Carboidratos da dieta;
Lipídios da dieta
topic Adolescência;
Resistência à Insulina;
Distúrbios Metabólicos;
Carboidratos da dieta;
Lipídios da dieta
Adolescence;
Insulin Resistance;
Metabolic Disease;
Dietary Carbohydrates;
Dietary Fats
Análise Nutricional de População
dc.subject.eng.fl_str_mv Adolescence;
Insulin Resistance;
Metabolic Disease;
Dietary Carbohydrates;
Dietary Fats
dc.subject.cnpq.fl_str_mv Análise Nutricional de População
description Adolescence is a period of development that encompasses a wide range of changes and is seen as a crucial window of opportunity for shaping lifelong health, especially with regard to insulin resistance (IR). IR is a common part of the pathophysiology of multiple cardiometabolic diseases and there is a need for attention to this condition in the face of the increasing prevalence of DM2 in adolescents and young adults. Although insulin resistance and the changes that accompany it have a multifactorial origin, adolescent food consumption and some specific dietary components appear to be an important modifiable risk factor in this process. This dissertation therefore aims to investigate the association of dietary parameters with the Insulin Resistance Phenotype in adolescents. This is a cross-sectional study developed using data from the second follow-up of the RPS Consortium cohort, São Luís (n = 1 874), in which the outcome was the latent variable Insulin Resistance Phenotype, formed by three indicators: Triglycerides/HDL ratio, Triglycerides-Glycemia Index and VLDL level. A theoretical model stratified by sex, including Socioeconomic Status, the dietary parameters of carbohydrate and saturated fat intake, and obesity as a mediator in association with the outcome in adolescents were analyzed using Structural Equation Models. The results showed that the consumption of added sugars greater than 25g had a direct risk effect in boys (Standardized Coefficient – SC = 0.093; p = 0.015) and girls (SC = 0.100; p = 0.018) for Insulin Resistance Phenotype. Consumption of more than 10% of the total energy value from saturated fats was also associated with the Insulin Resistance Phenotype in boys (SC = 0.071; p = 0.027) and girls (SC = 0.117; p < 0.001). The other parameters were not associated with the outcome in adolescents. The findings show that consumption of added sugars and saturated fats above the international recommendations explained insulin resistance in adolescents, regardless of obesity. Dietary interventions aimed at strengthening international recommendations among young people should be encouraged in order to prevent the risk of diabetes in the future.
publishDate 2025
dc.date.accessioned.fl_str_mv 2025-02-10T14:12:23Z
dc.date.issued.fl_str_mv 2025-01-28
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
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dc.identifier.citation.fl_str_mv SÁ, Rafaela Vitória Pereira. Parâmetros dietéticos associados ao fenótipo de resistência à insulina em adolescentes: Consórcio RPS, São Luís. 2025. 99 f. Dissertação( Programa de Pós-graduação em Saúde Coletiva/CCBS) - Universidade Federal do Maranhão, São Luís, 2025.
dc.identifier.uri.fl_str_mv https://tedebc.ufma.br/jspui/handle/tede/5889
identifier_str_mv SÁ, Rafaela Vitória Pereira. Parâmetros dietéticos associados ao fenótipo de resistência à insulina em adolescentes: Consórcio RPS, São Luís. 2025. 99 f. Dissertação( Programa de Pós-graduação em Saúde Coletiva/CCBS) - Universidade Federal do Maranhão, São Luís, 2025.
url https://tedebc.ufma.br/jspui/handle/tede/5889
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language por
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
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dc.publisher.none.fl_str_mv Universidade Federal do Maranhão
dc.publisher.program.fl_str_mv PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA/CCBS
dc.publisher.initials.fl_str_mv UFMA
dc.publisher.country.fl_str_mv Brasil
dc.publisher.department.fl_str_mv DEPARTAMENTO DE ODONTOLOGIA II/CCBS
publisher.none.fl_str_mv Universidade Federal do Maranhão
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