Sex and population differences in the cardiometabolic continuum: a machine learning study using the UK Biobank and ELSA-Brasil cohorts.

BACKGROUND: The temporal relationships across cardiometabolic diseases (CMDs) were recently conceptualized as the cardiometabolic continuum (CMC), sequence of cardiovascular events that stem from gene-environmental interactions, unhealthy lifestyle influences, and metabolic diseases such as diabetes, and hypertension. While the physiological pathways linking metabolic and cardiovascular diseases have been investigated, the study of the sex and population differences in the CMC have still not been described. METHODS: We present a machine learning approach to model the CMC and investigate sex and population differences in two distinct cohorts: the UK Biobank (17,700 participants) and the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) (7162 participants). We consider the following CMDs: hypertension (Hyp), diabetes (DM), heart diseases (HD: angina, myocardial infarction, or heart failure), and stroke (STK). For the identification of the CMC patterns, individual trajectories with the time of disease occurrence were clustered using k-means. Based on clinical, sociodemographic, and lifestyle characteristics, we built multiclass random forest classifiers and used the SHAP methodology to evaluate feature importance. RESULTS: Five CMC patterns were identified across both sexes and cohorts: EarlyHyp, FirstDM, FirstHD, Healthy, and LateHyp, named according to prevalence and disease occurrence time that depicted around 95%, 78%, 75%, 88% and 99% of individuals, respectively. Within the UK Biobank, more women were classified in the Healthy cluster and more men in all others. In the EarlyHyp and LateHyp clusters, isolated hypertension occurred earlier among women. Smoking habits and education had high importance and clear directionality for both sexes. For ELSA-Brasil, more men were classified in the Healthy cluster and more women in the FirstDM. The diabetes occurrence time when followed by hypertension was lower among women. Education and ethnicity had high importance and clear directionality for women, while for men these features were smoking, alcohol, and coffee consumption. CONCLUSIONS: There are clear sex differences in the CMC that varied across the UK and Brazilian cohorts. In particular, disadvantages regarding incidence and the time to onset of diseases were more pronounced in Brazil, against woman. The results show the need to strengthen public health policies to prevent and control the time course of CMD, with an emphasis on women.

Does physical activity and inflammation mediate the job stress-headache relationship? A sequential mediation analysis in the ELSA-Brasil study.

BACKGROUND: Evidence indicates that physical activity reduces stress and promote a myriad of health-enhancing effects through anti-inflammatory mechanisms. However, it is unknown whether these mechanisms interfere in the association between psychosocial job stress and headache disorders. OBJECTIVE: To test whether physical activity and its interplay with the systemic inflammation biomarkers high-sensitivity C-reactive protein (hs-CRP) and acute phase glycoproteins (GlycA) would mediate the associations between job stress and headache disorders. METHODS: We cross-sectionally evaluated the baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) regarding job stress (higher demand and lower control and support subscales), migraine and tension-type headache (ICHD-2 criteria), self-reported leisure-time physical activity, and plasma hs-CRP and GlycA levels. Conditional process analyses with a sequential mediation approach were employed to compute path coefficients and 95 % confidence intervals (CI) around the indirect effects of physical activity and biomarkers on the job stress-headache relationship. Separate models were adjusted for sex, age, and depression and anxiety. Further adjustments added BMI smoking status, and socioeconomic factors. RESULTS: In total, 7,644 people were included in the study. The 1-year prevalence of migraine and tension-type headache were 13.1 % and 49.4 %, respectively. In models adjusted for sex, age, anxiety, and depression, the association between job stress (lower job control) and migraine was mediated by physical activity [effect = -0.039 (95 %CI: -0.074, -0.010)] but not hs-CRP or GlycA. TTH was associated with higher job control and lower job demand, which was mediated by the inverse associations between physical activity and GlycA [Job Control: effect = 0.0005 (95 %CI: 0.0001, 0.0010); Job Demand: effect = 0.0003 (95 %CI: 0.0001, 0.0007]. Only the mediating effect of physical activity in the job stress-migraine link remained after further adjustments including socioeconomic factors, BMI, smoking, and the exclusion of major chronic diseases. CONCLUSION: In the ELSA-Brasil study, physical activity reversed the link between job stress and migraine independently of systemic inflammation, while the LTPA-mediated downregulation of GlycA was associated with lower job stress-related TTH.

Association between Sedentary Behavior and Cognitive Performance in Middle-Aged and Elderly Adults: Cross-Sectional Results from ELSA-Brasil.

BACKGROUND: This study aimed to verify the association between Sedentary Behavior (SB) and performance on cognitive function tests in middle-aged and elderly adults. METHODS: This cross-sectional study included 6505 participants (55.2% women) of ELSA-Brasil, with a median age of 61 years. The different types of SB considered were sitting time and screen time. The scores obtained in the memory, language, and executive function tests were used to assess cognitive performance (CP). The association between SB and CP was assessed using linear regression. RESULTS: For men, sitting time was associated with better performance in memory, language, and executive function tests. Screen time on the weekend, showed a favorable association with performance in the executive function test. Occupational screen time on weekdays was positively associated with language test performance. For women, sitting time and occupational screen time were positively associated with performance on memory tests. SB was favorably associated with performance in language tests and executive function tests. CONCLUSIONS: SB seems to favor CP in this population without evident dementia and with a high level of education. The type of SB (mentally active or passive) and the schooling seem to be of particular interest for cognitive performance.

Body image distortion among Brazilian and Portuguese women with children: A comparative study between the ELSA-Brasil and Generation XXI cohorts.

Solid evidence indicates that body image distortion is associated with various physical and mental health problems in women (e.g. Lee and Lee, 2016; Mölbert et al., 2017; Raj and Ploriya, 2020; Sagar, 2005; Shin et al., 2015). Furthermore, body image has been shown to vary according to life context and stage, particularly after a woman has had children. This scenario justifies the comparison between different countries and cultures. The objective of the present study was to evaluate the prevalence and associated factors of body image distortion/accuracy in Brazilian and Portuguese women with children. The study assessed women selected from two epidemiological cohorts: ELSA-Brasil in Brazil (n = 1468) and Generation XXI in Portugal (n = 3380). The data analyzed were based on multidimensional questionnaires from which sociodemographic and family characteristics as well as data associated with lifestyle and health were obtained. The results show that most women in both cohorts had an accurate perception of their own body size. In cases of distorted self-perception, the likelihood of the Brazilian women perceiving themselves as being heavier was greater if they had had cancer, whereas the Portuguese women were less likely to perceive themselves as heavier when they had less schooling. Perceiving themselves as thinner than they actually are, was associated with poorer self-perception of their own state of health in the Brazilian women and with poorer schooling in both the Brazilian and Portuguese women. The present findings contribute towards improving understanding of the influence of body image distortion on the health and wellbeing of Brazilian and Portuguese women, possibly leading to the implementation of health-promoting policies in both countries.

Longitudinal association between binge eating and metabolic syndrome in adults: Findings from the ELSA-Brasil cohort.

OBJECTIVE: Individuals with bulimia nervosa and binge eating disorder have greater cardiovascular morbidity than the general population. Longitudinal research on the association between binge eating and metabolic syndrome is limited. We tested the longitudinal association between binge eating and metabolic syndrome and its components in a large population sample of Brazilian adults. METHODS: We used data from Brazilian Longitudinal Study of Adult Health (ELSA-Brasil, N = 15,105). To test for the association between binge eating at baseline (2008-2010) and metabolic syndrome at follow-up (2012-2014), we used univariable and multivariable logistic regression models progressively adjusting for potential socio-demographic confounders, number of metabolic syndrome components, and body mass index (BMI) at baseline. RESULTS: In total, 13,388 participants (54.8% female; 52.2% white) had complete data on all variables of interest. Binge eating was associated with increased odds of metabolic syndrome at follow-up (odds ratio (OR):1.66, 95% confidence intervals (CI): 1.44, 1.75). However, the size of this association was attenuated after including number of metabolic syndrome components at baseline (OR:1.19, 95% CI: 1.05, 1.35) and was no longer present after adjusting for baseline BMI (OR:1.09, 95% CI: 0.96, 1.25). Binge eating was also associated with higher odds of hypertension (OR:1.14, 95% CI: 0.99, 1.37) and hypertriglyceridemia (OR:1.21, 95% CI: 1.06, 1.37) at the follow-up assessment after adjustment for all confounders. CONCLUSIONS: Individuals who binge eat are at increased risk of metabolic syndrome via increased BMI, and of hypertriglyceridemia and hypertension independently of BMI. If these are causal associations, effective interventions for binge eating could also have beneficial effects on metabolic health outcomes.

Different Components of Subjective Well-being Are Associated With Chronic Nondisabling and Disabling Knee Pain: ELSA-Brasil Musculoskeletal Cohort.

BACKGROUND/OBJECTIVE: Chronic knee pain (CKP) is a common pain complaint in older adults that is often associated with disability. This study investigated the relationship between 2 components of subjective well-being (depressive symptoms and life satisfaction) and CKP phenotypes based on the presence of knee disability. METHODS: A cross-sectional study was performed at baseline of ELSA-Brasil Musculoskeletal cohort (2012-2014). Chronic knee pain phenotypes were identified according to the presence of CKP that was accompanied or not by disability, which was assessed by a question on pain-related limitations to perform everyday activities (overall), Western Ontario and McMaster Universities Osteoarthritis Index's physical function subscale (daily tasks) and 5-times sit-to-stand test (objective). Depressive symptoms were assessed by the Clinical Interview Schedule-Revised and life satisfaction by the Satisfaction With Life Scale. Multinomial logistic regressions used CKP phenotypes as response variables (no CKP as reference). RESULTS: The sample comprised 2898 participants (mean age, 55.9 ± 8.9 years; 52.9% were female). After adjustments for sociodemographic and clinical factors, depressive symptoms were associated with daily tasks disabling CKP (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.45-3.66) and objective disabling CKP (OR, 1.95; 95% CI, 1.29-2.93) and with nondisabling CKP for the overall disability measure (OR, 1.54; 95% CI, 1.17-2.04). Life satisfaction was inversely associated with all phenotypes in fully adjusted models, with strongest magnitude of associations observed for disabling CKP. CONCLUSIONS: The association of depressive symptoms and life satisfaction with CKP phenotypes suggest the need to address both negative and positive components of subjective well-being in the assessment of individuals with knee complaints.

Combined Use of Job Stress Models and the Incidence of Glycemic Alterations (Prediabetes and Diabetes): Results from ELSA-Brasil Study.

Evidence of psychosocial stress at work as a risk factor for diabetes and prediabetes is restricted. OBJECTIVES: Analyze the independent and combined association of the models, demand-control and social support (DC-SS) and the effort-reward imbalance and overcommitment (ERI-OC), and the incidence of glycemic alterations (prediabetes and diabetes). METHODS: A prospective study was carried out with data from 7503 active workers from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study in the period 2008-2014. Work stress was measured by two stress models. Glycemic levels were evaluated by glycated hemoglobin (HbA1c) in two moments and classified in four groups: normal, maintenance of prediabetes, incident prediabetes, and incident diabetes. Multinomial logistic regression was analyzed with 5% significance levels stratified by sex, and multiplicative interactions were investigated. RESULTS: Work stress and glycemic alterations were more frequent in women. Psychosocial stress at work was shown to be associated to the risk of prediabetes and diabetes only among women. For women, the combination of models enlarged the magnitude of the association: prediabetes (DC-ERI = OR 1.51, 95% CI 1.15-1.99) and diabetes (DC-ERI = OR 2.10, 95% CI 1.20-3.65). Highly-educated women exposed to ERI-OC were four times more likely to have diabetes. CONCLUSION: Both models may contribute to explaining the psychosocial stress load according to each pattern of glycemic alteration among women.

Job Stress and Heart Rate Variability: Findings From the ELSA-Brasil Cohort.

OBJECTIVE: Evidence suggests that exposure to psychosocial stress at work can inhibit vagal tonus, influencing the capacity to respond to environmental stimuli. We investigated whether job strain and low control and high demand at work, as separate measures, are associated with a reduction in heart rate variability (HRV). METHODS: This is a cross-sectional study with 9658 active workers at the baseline (2008-2010) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). HRV was estimated using electrocardiographic recordings for 10 minutes, at rest, examining the following indices were used: root mean square of successive difference, standard deviation of normal to normal, percentage of adjacent R-R intervals with a difference lasting more than 50 ms, low frequency (LF), and high frequency. Job strain was defined based on the demand-control model. Independent associations between job strain and HRV indices were verified using generalized linear models and the magnitude of the association was estimated by evaluating the ratios of arithmetic means. RESULTS: Neither the unfavorable demand-control relation nor job demand dimension separately was associated with HRV. However, the increase of one unit in the control dimension was associated with an increment of 2.2% (95% confidence interval = 1.014-1.029) in the LF mean. After adjustments for sociodemographic characteristics, assessment site, health-related behaviors, and depression, this association remained statistically significant (ratio of arithmetic means = 1.008; 95% confidence interval = 1.0002-1.017). CONCLUSIONS: Job control was associated with HRV in a large cohort of civil servants. Nevertheless, it is important to emphasize that only the LF index remained associated with low job control. Further studies are needed to develop a greater understanding of the relationship of psychosocial aspects and autonomic balance.

Association between Body Image Dissatisfaction and Self-Rated Health, as Mediated by Physical Activity and Eating Habits: Structural Equation Modelling in ELSA-Brasil.

This study investigated whether the association between body image dissatisfaction and poor self-rated health is mediated by insufficient physical activity and unhealthy eating habits. The participants were 6727 men and 8037 women from the baseline (2008–2010) of the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil). Structural equation modelling was used. Associations were found between body image dissatisfaction and poor self-rated health in both sexes. Insufficient physical activity was a mediator. However, unhealthy eating habits were found to exert a mediator effect only via insufficient physical activity. Body image dissatisfaction was found to associate, both directly and possibly indirectly, with poor self-rated health, mediated by insufficient physical activity and unhealthy eating habits. Accordingly, encouraging physical activity and healthy eating can contribute to reducing body image dissatisfaction and favour better self-rated health.

Validez y confiabilidad del Índice de Capacidad para el Trabajo en trabajadores del primer nivel de atención de salud en Argentina / Validity and reliability of the Work Ability Index in primary care workers in Argentina

Este estudio evalúa la validez y confiabilidad del Índice de Capacidad para el Trabajo (ICT) en Argentina. El instrumento se aplicó a 100 trabajadores, agentes de Atención Primaria de la Salud del Partido de General Pueyrredón. En la validez del constructo se investigó la estructura dimensional por medio de análisis factorial exploratorio, a partir de una matriz policórica y un análisis paralelo para la obtención del número de factores. En la validación correlacional se estimó la correlación de Spearman entre el ICT y las dimensiones del Cuestionario de Salud SF-36. La evaluación de confiabilidad se midió a través del estimador Alfa de Cronbach. El resultado de la consistencia interna de la escala fue 0,80, indicando una fiabilidad aceptable. La puntuación de ICT arrojó como resultado: moderado 12%, bueno 50% y óptimo 38%. En el proceso de validación se identificó una estructura de tres dimensiones que explica el 66% de la variación total de los datos a través de los componentes principales. Los supuestos teóricos de la validez del constructo confirmaron la correlación directa y significativa con las puntuaciones del ICT y las dimensiones de evaluación del estado de salud, siendo el mayor valor función física (0,478) y menor la dimensión dolor (-0,218). Se concluyó que el ICT, traducido y adaptado al español, mostró propiedades psicométricas adecuadas pudiendo ser utilizada en estudios de asociación entre aspectos de trabajo y su impacto en la salud.

This study evaluates the validity and reliability of the Work Ability Index (WAI) in Argentina. An instrument was applied to 100 workers, all agents of Primary Health Care in the county of General Pueyrredón. In the construct validity, the dimensional structure was studied by means of exploratory factor analysis, based on a polychoric matrix and parallel analysis to obtain the number of factors. In the correlation validation, the Spearman correlation was estimated between the WAI and the dimensions of the 36-Item Short Form Health Survey (SF-36). The reliability assessment was measured by Cronbach's alpha estimate. The result of the internal consistency of the scale was 0.80, indicating acceptable reliability. The WAI score yielded the following results: 12% moderate, 50% good and 38% optimal. In the validation process, a three-dimensional structure was identified which accounts for 66% of the total variance of the data through the main components. The theoretical assumptions of the construct validity confirmed the direct and significant correlation between WAI scores and the dimensions of health status assessment, with the highest value in the physical functioning dimension (0.478) and the lowest in the bodily pain dimension (-0.218). It was concluded that the WAI, translated and adapted into Spanish, showed adequate psychometric properties and can therefore be used in association studies between aspects of work and their impact on health.

[Validity and reliability of the Work Ability Index in primary care workers in Argentina]. / Validez y confiabilidad del Índice de Capacidad para el Trabajo en trabajadores del primer nivel de atención de salud en Argentina.

This study evaluates the validity and reliability of the Work Ability Index (WAI) in Argentina. An instrument was applied to 100 workers, all agents of Primary Health Care in the county of General Pueyrredón. In the construct validity, the dimensional structure was studied by means of exploratory factor analysis, based on a polychoric matrix and parallel analysis to obtain the number of factors. In the correlation validation, the Spearman correlation was estimated between the WAI and the dimensions of the 36-Item Short Form Health Survey (SF-36). The reliability assessment was measured by Cronbach's alpha estimate. The result of the internal consistency of the scale was 0.80, indicating acceptable reliability. The WAI score yielded the following results: 12% moderate, 50% good and 38% optimal. In the validation process, a three-dimensional structure was identified which accounts for 66% of the total variance of the data through the main components. The theoretical assumptions of the construct validity confirmed the direct and significant correlation between WAI scores and the dimensions of health status assessment, with the highest value in the physical functioning dimension (0.478) and the lowest in the bodily pain dimension (-0.218). It was concluded that the WAI, translated and adapted into Spanish, showed adequate psychometric properties and can therefore be used in association studies between aspects of work and their impact on health.

[Association between cutaneous leishmaniasis incidence and the human development index and its components in four endemic states of Venezuela]. / Asociación entre la incidencia de leishmaniosis cutánea y el índice de desarrollo humano y sus componentes en cuatro estados endémicos de Venezuela.

OBJECTIVES: Assess potential relationships between the Human Development Index (HDI) and its components and the incidence of cutaneous leishmaniasis (CL) in four endemic States of Venezuela (Mérida, Trujillo, Lara and Sucre) in the period 1994-2003. MATERIAL AND METHODS: Socioeconomical data (classified according the World Bank) was obtained from the National Institute of Statistics, and the epidemiological data from the Ministry of Health, both from Venezuela. For this ecological study the annual variation of the variables was assessed and also regression models were done. RESULTS: The HDI varied in the period from 0.6746 in 1994 to 0.8144 in 2003 (p=0.90). During this time an increase in the cumulative incidence of Leishmaniasis was observed, particularly from 1998 (7.3 cases/100,000 pop) to 1999 (11.3 cases/100,000 pop). Analyzing the linear regression models, it was observed that the relationship between epidemiological and social variables was different at States levels. For Mérida and Trujillo it was observed a significant decrease in the CL regard to the increase of literacy (p<0.05), of the gross combined enrollment (p<0.05), life expectancy (p<0.05), money income (p<0.05) and the HDI (p<0.05). CONCLUSION: This information reflects the significant influence of socioeconomical indicators on the CL incidence at Trujillo and Merida, being an inverse relationship between both types of variables; with an increase or improvement in the socioeconomical indicators, the disease incidence rate decreased.

Asociación entre la incidencia de leishmaniosis cutánea y el índice de desarrollo humano y sus componentes en cuatro estados endémicos de Venezuela / Association between cutaneous leishmaniasis incidence and the human development index and its components in four endemic states of Venezuela

Objetivos. Evaluar las posibles asociaciones entre el índice de desarrollo humano (IDH) y sus componentes, y la incidencia de Leishmaniosis cutánea (LC) en cuatro estados endémicos de Venezuela (Mérida, Trujillo, Lara y Sucre) en el período 1994 al 2003. Materiales y métodos. La data socioeconómica (clasificada de acuerdo al Banco Mundial) se obtuvo del Instituto Nacional de Estadística y la epidemiológica del Ministerio de Salud, ambos de Venezuela. Para este estudio ecológico se evaluó la variación anual de las variables y se realizó modelos de regresión. Resultados. El IDH varió en el período, de 0,6746 en 1994 a 0,8144 en 2003 (p=0,90), asimismo, se observó un aumento de la incidencia acumulada de Leishmaniosis, en especial del año 1998 (7,3 casos/100 000 hab) a 1999 (11,3 casos/100 000 hab). Al analizar con los modelos de regresión lineal, se observó que la relación entre las variables epidemiológicas y sociales era diferente a nivel de los Estados evaluados. Para Mérida y Trujillo se observó un descenso significativo de la incidencia de LC con relación al aumento del porcentaje de alfabetización (p menor que 0,05), de estudiantes matriculados (p menor que 0,05), la esperanza de vida (p menor que 0,05), su ingreso en USD per cápita por año (p menor que 0,05) e IDH (p minor that 0,05). Conclusión. Esta información refleja la influencia significativa de los indicadores socioeconómicos sobre la incidencia de la LC en los Estados Trujillo y Mérida, siendo inversa entre ambos tipos de variables; con el incremento o mejoría de los indicadores socioeconómicos, la incidencia acumulada de la enfermedad disminuyó.

Objectives. Assess potential relationships between the Human Development Index (HDI) and its components and the incidence of cutaneous leishmaniasis (CL) in four endemic States of Venezuela (Mérida, Trujillo, Lara and Sucre) in the period 1994-2003. Material and methods. Socioeconomical data (classified according the World Bank) wasobtained from the National Institute of Statistics, and the epidemiological data from the Ministry of Health, both fromVenezuela. For this ecological study the annual variation of the variables was assessed and also regression modelswere done. Results. The HDI varied in the period from 0.6746 in 1994 to 0.8144 in 2003 (p=0.90). During this time an increase in the cumulative incidence of Leishmaniasis was observed, particularly from 1998 (7.3 cases/100,000 pop) to 1999 (11.3 cases/100,000 pop). Analyzing the linear regression models, it was observed that the relationship betweenepidemiological and social variables was different at States levels. For Mérida and Trujillo it was observed a significantdecrease in the CL regard to the increase of literacy (p minor that 0.05), of the gross combined enrollment (p minor that 0.05), life expectancy (p minor that 0.05), money income (p minor that 0.05) and the HDI (p minor that 0.05). Conclusion. This information reflects the significant influence of socioeconomical indicators on the CL incidence at Trujillo and Merida, being an inverse relationship between both types of variables; with an increase or improvement in the socioeconomical indicators, the disease incidence rate decreased.

Aspectos sociales de la malaria importada en Latinoamérica / Social Aspects related to imported malaria in Latin America

La malaria continúa siendo un grave problema de salud pública mundial, ya no sólo en países endémicos, sino comenzando a representar un dilema médico en países distantes por la llegada de casos importados. Ahora bien, aun cuando en términos de las disciplinas médicas convencionales se ha publicado muchos estudios clínico-epidemiológicos y reportes de caso, los aspectos sociales, que parecerían obvios en el contexto de la malaria importada por supeditarse a la migración de la población, no han sido exhaustivamente explorados en relación con este fenómeno. Por estas razones, en esta revisión se analiza los aspectos sociales relacionados con el fenómeno de lamalaria importada con énfasis al contexto epidemiológico de América Latina.

Malaria continues to be a world public health problem, not only in those endemic countries but also now beginning to be a medical dilemmain distant countries for the arrival of imported cases. Now, even when in terms of the conventional medical disciplines many clinical andepidemiological studies, as well case reports, have been published, the social aspects, apparently obvious given the fact imported malaria is related to human population migration, have been not furtherly studied in regard to this phenomena. For these reasons in the current review, the social aspects related with the imported malaria phenomena with emphasis in the epidemiological context of Latin Americaare analyzed.