Racial inequalities in the development of multimorbidity of chronic conditions: results from a Brazilian prospective cohort.

BACKGROUND: The occurrence of multimorbidity and its impacts have differentially affected population subgroups. Evidence on its incidence has mainly come from high-income regions, with limited exploration of racial disparities. This study investigated the association between racial groups and the development of multimorbidity and chronic conditions in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: Data from self-reported white, brown (pardos or mixed-race), and black participants at baseline of ELSA-Brasil (2008-2010) who were at risk for multimorbidity were analysed. The development of chronic conditions was assessed through in-person visits and self-reported diagnosis via telephone until the third follow-up visit (2017-2019). Multimorbidity was defined when, at the follow-up visit, the participant had two or more morbidities. Cumulative incidences, incidence rates, and adjusted incidence rate ratios (IRRs) were estimated using Poisson models. RESULTS: Over an 8.3-year follow-up, compared to white participants: browns had a 27% greater incidence of hypertension and obesity; and blacks had a 62% and 45% greater incidence, respectively. Blacks also had 58% more diabetes. The cancer incidence was greater among whites. Multimorbidity affected 41% of the participants, with a crude incidence rate of 57.5 cases per 1000 person-years (ranging from 56.3 for whites to 63.9 for blacks). Adjusted estimates showed a 20% higher incidence of multimorbidity in black participants compared to white participants (IRR: 1.20; 95% CI: 1.05-1.38). CONCLUSIONS: Significant racial disparities in the risk of chronic conditions and multimorbidity were observed. Many associations revealed a gradient increase in illness risk according to darker skin tones. Addressing fundamental causes such as racism and racial discrimination, alongside considering social determinants of health, is vital for comprehensive multimorbidity care. Intersectoral, equitable policies are essential for ensuring health rights for historically marginalized groups.

Food consumption by degree of processing is associated with nocturnal dipping and blood pressure variability: The ELSA-Brasil study.

BACKGROUND AND AIMS: Ambulatory blood pressure monitoring (ABPM) allows the assessment of cardiovascular risk markers that cannot be obtained by casual measurements; however, the evidence on the association between food consumption and blood pressure (BP) assessed by ABPM is scarce. We aimed to evaluate the association between food consumption by degree of processing and ambulatory BP. METHODS AND RESULTS: Cross-sectional analysis (2012-2014) of data from a subsample (n = 815) of ELSA-Brasil cohort participants who performed 24-h ABPM was conducted. Systolic (SBP) and diastolic (DBP) BP means and variability during the 24 h and subperiods (sleep and wake), nocturnal dipping, and morning surge were evaluated. Food consumption was classified according to NOVA. Associations were tested by generalized linear models. The consumption of unprocessed, minimally processed foods, and culinary ingredients (U/MPF&CI) was 63.1% of daily caloric intake, 10.8% of processed (PF), and 24.8% of ultraprocessed (UPF). A negative association was found between U/MPF&CI consumption and extreme dipping (T2: odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.55-0.58; T3: OR = 0.55; 95% CI = 0.54-0.57); and between UPF consumption and nondipping (T2: OR = 0.68, 95% CI = 0.55-0.85) and extreme dipping (T2: OR = 0.63, 95% CI = 0.61-0.65; T3: OR = 0.95, 95% CI = 0.91-0.99). There was a positive association between PF consumption and extreme dipping (T2: OR = 1.22, 95% CI = 1.18-1.27; T3: OR = 1.34, 95% CI = 1.29-1.39) and sleep SBP variability (T3: Coef = 0.56, 95% CI = 0.03-1.10). CONCLUSIONS: The high consumption of PF was associated with greater BP variability and extreme dipping, while the U/MPF&CI and UPF consumption were negatively associated with alterations in nocturnal dipping.

Consumption of ultra-processed foods and eight-year risk of death from all causes and noncommunicable diseases in the ELSA-Brasil cohort.

Increased consumption of ultra-processed foods (UPF) is associated with higher incidences of many noncommunicable diseases (NCDs) and death from all causes. However, the association between UPF and cardiovascular disease (CVD) mortality remains controversial. Our study investigated whether UPF consumption is associated with a higher risk of death from all causes, NCDs, and CVD. This study includes 14,747 participants from the ELSA-Brasil cohort followed up over an eight-year period. The NOVA classification was used to estimate the proportion of UPF (grams/day) in one's diet. Cox regression was also applied. After adjustment for sociodemographic, health, and behavioural factors, a 10% increase in UPF in participants' diets raised the risk of death from all causes and NCDs by 10% (95%CI: 1.01-1.19) and 11% (95%CI:1.02-1.21), respectively. However, UPF consumption was not associated with CVD mortality. The findings support public policies aimed at reducing UPF consumption in an attempt to reduce the NCD burden.

Sex differences in the association between alcohol intake and cognitive decline over 4 years in a middle-aged cohort: The Brazilian Longitudinal Study of Adult Health.

BACKGROUND AND PURPOSE: The association between alcohol intake and cognitive decline has been widely studied. Sex differences and cognitive domains affected by alcohol intake patterns make this topic complex. The objective of this study was to investigate the effect of alcohol intake on cognition in middle-aged participants in the Brazilian Longitudinal Study of Adult Health by sex during 4 years of follow-up. METHODS: A total of 7595 participants (55% women) aged between 50 and 75 years at baseline were assessed. Semantic and phonemic fluency, memory, and executive functions were assessed at baseline (2008-2010) and repeated during Visit 2. Linear mixed models were used to investigate the association between cognition and current abstainers, never drinkers, light drinkers, moderate drinkers, and heavy drinkers. RESULTS: Heavy alcohol intake accentuated the decline in executive functions for men (ß = -0.01, p < 0.05), and in semantic fluency (ß = -0.02, p < 0.05) and memory (ß = -0.02, p < 0.05) for women. Never drinker men also showed an accentuated decline in semantic fluency (ß = -0.02, p < 0.01). Moderate alcohol intake slowed cognitive decline in phonemic fluency for men (ß = 0.02, p < 0.01) and women (ß = 0.01, p < 0.01), and in executive functions (ß = 0.01, p < 0.05) for women. CONCLUSIONS: Having more than 14 drinks per week can impact executive functions in men and memory in women. In addition, alcohol consumption of seven to 14 drinks per week may have a protective effect on gender-specific cognitive functions. These findings should be considered in public health policies and guidelines on alcohol and cognitive aging.

Different statistical methods identify similar population-specific dietary patterns: an analysis of Longitudinal Study of Adult Health (ELSA-Brasil).

In recent decades, different data-driven approaches have emerged to identify dietary patterns (DP) and little is discussed about how these methods are able to capture diet complexity within the same population. This study aimed to apply three statistical methods to identify the DP of the Longitudinal Study of Adult Health (ELSA-Brasil) population and evaluate the similarities and differences between them. Dietary data were assessed at baseline in the ELSA-Brasil study using a FFQ. DP were identified by applying three statistical methods: (1) factor analysis (FA), (2) treelet transform (TT) and (3) reduced rank regression (RRR). The characteristics of individuals classified in the last tertile of each DP were compared. Cross-classification and Pearson's correlation coefficients were assessed to evaluate the agreement between individuals' adherence to DP of the three methods. A similar convenience DP was identified for all three methods. FA and TT also identified a similar prudent DP and a DP highly loaded for the food groups rice and beans. Individuals classified in the third tertile of similar DP of each method presented similar socio-demographic and nutrient intake characteristics. Regarding the cross-classification, prudent DP from FA and TT presented a higher level of agreement (75 %), while convenience DP from TT and RRR presented the lowest agreement (44·8 %). The different statistical methods were able to capture the populations' DP in a similar way while highlighting the particularities of each method.

Ultra-processed foods, incident overweight and obesity, and longitudinal changes in weight and waist circumference: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

OBJECTIVE: To evaluate the association of ultra-processed food (UPF) consumption with gains in weight and waist circumference, and incident overweight/obesity, in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. DESIGN: We applied FFQ at baseline and categorized energy intake by degree of processing using the NOVA classification. Height, weight and waist circumference were measured at baseline and after a mean 3·8-year follow-up. We assessed associations, through Poisson regression with robust variance, of UPF consumption with large weight gain (1·68 kg/year) and large waist gain (2·42 cm/year), both being defined as ≥90th percentile in the cohort, and with incident overweight/obesity. SETTING: Brazil. PARTICIPANTS: Civil servants of Brazilian public academic institutions in six cities (n 11 827), aged 35-74 years at baseline (2008-2010). RESULTS: UPF provided a mean 24·6 (sd 9·6) % of ingested energy. After adjustment for smoking, physical activity, adiposity and other factors, fourth (>30·8 %) v. first (<17·8 %) quartile of UPF consumption was associated (relative risk (95 % CI)) with 27 and 33 % greater risk of large weight and waist gains (1·27 (1·07, 1·50) and 1·33 (1·12, 1·58)), respectively. Similarly, those in the fourth consumption quartile presented 20 % greater risk (1·20 (1·03, 1·40)) of incident overweight/obesity and 2 % greater risk (1·02; (0·85, 1·21)) of incident obesity. Approximately 15 % of cases of large weight and waist gains and of incident overweight/obesity could be attributed to consumption of >17·8 % of energy as UPF. CONCLUSIONS: Greater UPF consumption predicts large gains in overall and central adiposity and may contribute to the inexorable rise in obesity seen worldwide.

[Consumption of red and processed meat, insulin resistance, and diabetes in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)Consumo de carnes rojas y de carne procesada, resistencia a la insulina y diabetes en el estudio longitudinal de salud del adulto (ELSA-Brasil)]. / Consumo de carne vermelha e processada, resistência insulínica e diabetes no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil).

OBJECTIVE: To investigate the association between red and processed meat consumption and the occurrence of new cases of insulin resistance (IR) and diabetes mellitus (DM) in participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHOD: This cohort study included 15 105 civil servants (age: 35-74 years). Biochemical, anthropometric, and socioeconomic data, as well as lifestyle characteristics, were collected at baseline (2008-2010) and wave 2 (2012-2014). Meat consumption (g/day) was estimated using a food frequency questionnaire. To categorize low, medium, and high consumption, independent variables were divided into tertiles. DM was diagnosed as fasting glucose ≥ 126 mg/dL, postload glucose ≥ 200 mg/dL, or glycated hemoglobin ≥ 6.5. IR was determined by HOMA-IR with cutoff points based on the sample's 75th percentile. RESULTS: Men and participants with lower income and schooling reported higher consumption of red and processed meat. High consumption of processed meat (highest tertile, > 27.1 g/day) was associated with new cases of IR in men (OR = 1.68; 95%CI: 1.31-2.16) and women (OR = 1.23; 95%CI: 1.00-1>52). High consumption of red meat increased by 40% (95%CI: 1.04-1.96) the likelihood of new cases of DM in men. CONCLUSIONS: High consumption of red/processed meat negatively impacted the health of participants. Moderate consumption of meats may be recommended for the general population and for prevention of DM.

OBJETIVO: Investigar la relación entre el consumo de carnes rojas y de carne procesada y la incidencia de nuevos casos de resistencia a la insulina y de diabetes mellitus en los participantes en el estudio longitudinal de salud del adulto (ELSA-Brasil). MÉTODOS: Estudio de cohorte con 15 105 funcionarios públicos (de 35 a 74 años de edad). Se recopilaron datos bioquímicos, antropométricos, socioeconómicos y sobre el estilo de vida en la línea de base (2008­2010) y en la segunda fase (2012­2014). Se calculó el consumo de carne (g/día) por medio de un cuestionario sobre la frecuencia del consumo de alimentos. Para las clasificaciones de consumo bajo, mediano y alto, las variables independientes se dividieron en terciles. La diabetes mellitus se diagnosticó como glucemia en ayunas ≥ 126 mg/dl, glucosa después de una sobrecarga ≥ 200 mg/dl o glucohemoglobina ≥ 6,5. La resistencia a la insulina se determinó con el modelo homeostático HOMA-IR con puntos de corte a partir del percentil 75 de la muestra. RESULTADOS: Los hombres y los participantes de menores ingresos y menor grado de escolaridad declararon un mayor consumo de carnes rojas y de carnes procesadas. El mayor consumo de carne procesada (último tercil, > 27,1 g/día) guardó relación con nuevos casos de resistencia a la insulina en los hombres (razón de probabilidades [OR] = 1,68; IC95%: 1,31-2,16) y las mujeres (OR = 1,23; IC95%: 1,00-1,52). El consumo alto de carnes rojas aumentó un 40% (IC95%: 1,04-1,96) la posibilidad de manifestación de nuevos casos de diabetes mellitus en los hombres. CONCLUSIONES: El consumo alto de carnes rojas y de carne procesada afectó desfavorablemente la salud de los participantes. El consumo moderado de carne puede recomendarse a la población en general y para la prevención de la diabetes mellitus.

Predicting cardiometabolic disturbances from waist-to-height ratio: findings from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline.

OBJECTIVE: To evaluate the performance of waist-to-height ratio (WHtR) in predicting cardiometabolic outcomes and compare cut-off points for Brazilian adults. DESIGN: Cross-sectional study. WHtR areas under the curve (AUC) were compared with those for BMI, waist circumference (WC) and waist-to-hip ratio (WHR). The outcomes of interest were hypertension, diabetes, hypertriacylglycerolaemia and presence of at least two components of metabolic syndrome (≥2 MetS). Cut-offs for WHtR were compared and validity measures were estimated for each point. SETTING: Teaching and research institutions in six Brazilian state capitals, 2008-2010. SUBJECTS: Women (n 5026) and men (n 4238) aged 35-54 years who participated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) at baseline. RESULTS: WHtR age-adjusted AUC ranged from 0·68 to 0·72 in men and 0·69 to 0·75 in women, with smaller AUC for hypertriacylglycerolaemia and the largest for ≥2 MetS. WHtR performed better than BMI for practically all outcomes; better than WHR for hypertension in both sexes; and displayed larger AUC than WC in predicting diabetes mellitus. It also offered better discriminatory power for ≥2 MetS in men; and was better than WC, but not WHR, in women. Optimal cut-off points of WHtR were 0·55 (women) and 0·54 (men), but they presented high false-negative rate compared with 0·50. CONCLUSIONS: We recommend using WHtR (which performed similarly to, or better than, other available indices of adiposity) as an anthropometric index with good discriminatory power for cardiometabolic outcomes in Brazilian adults, indicating the already referenced limit of WHtR≥0·50.

Consumption of ultra-processed food and obesity: cross sectional results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort (2008-2010).

OBJECTIVE: To verify if the intake of ultra-processed foods is associated with higher BMI and waist circumference (WC) among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. DESIGN: Cross-sectional analysis of the ELSA-Brasil baseline (2008-2010). Dietary information obtained through an FFQ was classified according to characteristics of food processing (NOVA) and used to estimate the percentage energy contribution from ultra-processed foods (i.e. industrial formulations, elaborated from food processing, synthetic constituents and food additives) to individuals' total energy intake. BMI and WC and their respective cut-off points served as response variables. Associations were estimated through linear and multinomial logistic regression models, after adjusting for confounders and total energy intake. SETTING: Six Brazilian capital cities, 2008-2010. SUBJECTS: Active and retired civil servants, aged 35-64 years, from universities and research organizations (n 8977). RESULTS: Ultra-processed foods accounted for 22·7 % of total energy intake. After adjustments, individuals in the fourth quartile of percentage energy contribution from ultra-processed foods presented (ß; 95 % CI) a higher BMI (0·80; CI 0·53, 1·07 kg/m2) and WC (1·71; 1·02, 2·40 cm), and higher chances (OR; 95 % CI) of being overweight (1·31; 1·13, 1·51), obese (1·41; 1·18, 1·69) and having significantly increased WC (1·41; 1·20, 1·66), compared with those in the first quartile. All associations suggest a dose-response gradient. CONCLUSIONS: Results indicate the existence of associations between greater energy contribution from ultra-processed foods and higher BMI and WC, which are independent of total energy intake. These findings corroborate public policies designed to reduce the intake of this type of food.

Early-life nutritional status and metabolic syndrome: gender-specific associations from a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

OBJECTIVE: In the present study we investigated gender-specific associations of low birth weight (LBW) and shorter relative leg length with metabolic syndrome (MetS) after adjusting for sociodemographic characteristics and health-related behaviours. We also investigated whether these associations are independent of age at menarche and BMI at 20 years old. DESIGN: Cross-sectional analysis. SUBJECTS: Baseline data from 12 602 participants (35-74 years) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), 2008-2010. SETTING: MetS was defined according to the revised National Cholesterol Education Program Adult Treatment Panel III guidelines. LBW (<2·5 kg) and age- and sex-standardized relative leg length (high, medium and low) were the explanatory variables studied. The strength of the associations between the explanatory variables and MetS was estimated by Poisson regression with robust variance. RESULTS: MetS prevalence was 34·2 %; it was more prevalent in men (36·8 %) than in women (32·2 %). In multivariate analysis, LBW was associated (prevalence ratio; 95 % CI) with MetS only in women (1·28; 1·24, 1·45). Shorter leg length was associated with MetS in both men (1·21; 1·09, 1·35 and 1·46; 1·29, 1·65 for low and medium lengths, respectively) and women (1·12; 1·00, 1·25 and 1·40; 1·22, 1·59 for low and medium lengths, respectively). Additional adjustments for age at menarche and BMI at 20 years old did not change the associations. CONCLUSIONS: Poor nutritional status as estimated by LBW and lower leg length in childhood was associated with a higher prevalence of MetS, although LBW was a significant factor only among women.

Factors associated with leisure time physical activity among ELSA-Brasil participants: Ecological model.

The main objective of the study was identify the prevalence and factors associated with leisure time physical activity (LTPA) in adult participants of the Longitudinal Study of Adult Health (ELSA-Brasil). The LTPA was measured using the International Physical Activity Questionnaire (IPAQ), long version. A hierarchical ecological model was built with the possible factors associated with LTPA distributed across blocks. We estimated crude and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) using logistic regression. In men, being more educated, having a high family income, living in environments with conditions and opportunities for PA, being retired and being overweight were positively associated, while current smoking, obesity and abdominal obesity were associated negatively with the LTPA. Among women, being over 60years old, being more educated, having a high family income, living in an environment with conditions and opportunities for PA practice and being retired were positively associated, while being overweight, obese and having abdominal obesity were associated negatively with the LTPA. The proposed ecological model explains the LTPA through the social, physical and personal environment and highlights gender differences in physical activity.

Active and sedentary behaviours in children aged 7 to 10 years old: the urban and rural contexts, Brazil.

BACKGROUND: Although the effects of physical activity (PA) on health and wellness are well-established, incorporating sedentary behaviours in the daily lives of populations from high- and medium-income countries is becoming increasingly common. Regardless of other factors, the area of residence can influence the physical activity level and sedentary behaviours. The aim of this study was to identify and analyse active and sedentary behaviours and factors associated with physical activity in two different geographical areas in south-eastern Brazil. METHODS: 1.770 schoolchildren aged 7-10 years old were studied. Parents or caregivers completed a validated questionnaire on PA and sedentary behaviours. Screen time (ST) was calculated from the time spent watching television, playing video games and using the computer. The level of active PA (>300 minutes per week) was identified and compared between the areas of study. Parametric and non-parametric tests and Poisson regression model with robust variance were used for statistical analysis. RESULTS: Compared to schoolchildren from the urban area, those from the rural area showed a higher percentage of compliance with the PA recommendations (87 vs. 69.7%) and screen time <2 h (34.8 vs. 18.8%) and less participation in supervised PA. Active commuting to school was more common among schoolchildren from urban areas, although using a bicycle was more common in rural areas. The characteristics of children who do not meet the recommended weekly PA are as follows: being female, living in urban areas, being overweight, not using video games or performing supervised PA. Total ST as well as daily use of television and the computer was not associated with physical activity level in the present sample. Participation in supervised physical activities in both areas was found to increase the prevalence of being active in the areas studied. CONCLUSIONS: The results of the present study suggest that while schoolchildren from rural areas are more active and spend less time on sedentary activities than those from the urban area, the time spent in sedentary behaviors, such as watching television, playing video games and using the computer, is high in both contexts, and it is not associated with physical activity recommendation compliance.

[Development and validation of the food quality score in ELSA-Brasil]. / Desarrollo y validación de la puntuación de calidad alimentaria en el ELSA-Brasil.

Introduction: miology.Introduction: nutritional epidemiology seeks to understand the relationship between food consumption and the occurrence of diseases. During the COVID-19 pandemic, the Longitudinal Study of Adult Health (ELSA-Brasil) used a reduced Food Frequency Questionnaire (FFQ) to compare diet quality between cohort stages. Objective: to develop and validate an index created using a food quality score (FQS) using the FFQ of ELSA-Brasil. Methods: a cross-sectional study carried out between August 2020 and March 2021 with 4262 participants. For each frequency of consumption of healthy and unhealthy food markers, a score was given. Validity and reliability were tested using Pearson's correlation, principal component analysis (PCA) and Cronbach's alpha. Tests were performed to verify differences between individual characteristics and FQS. Results: the PCA indicated a total variability of 42.5 %. Women and individuals with higher age, physical activity and per capita income had a higher FQS, while those who reported higher consumption of alcohol and being smokers had a lower score. Cronbach's alpha was 0.47. Conclusion: the FQS showed a satisfactory validity and reliability and was associated with socioeconomic and lifestyle data. Therefore, it is a useful tool for comparing dietary information, thus contributing to nutritional epidemiology.

Introducción: Introducción: la epidemiología nutricional busca comprender la relación entre el consumo de alimentos y la ocurrencia de enfermedades. Durante la pandemia de COVID-19, el Estudio Longitudinal de Salud del Adulto (ELSA-Brasil) utilizó un Cuestionario de Frecuencia de Alimentos (CFA) reducido para comparar la calidad de la dieta en diferentes etapas de la cohorte. Objetivo: desarrollar y validar un índice creado a partir de un score (o puntuación) de calidad alimentaria (SCA) utilizando el CFA del ELSA-Brasil. Métodos: estudio transversal realizado entre agosto de 2020 y marzo de 2021 con 4262 participantes. Para cada categoría de frecuencia de consumo de alimentos indicadores de alimentación saludable y no saludable, se otorgó una puntuación. La validez y la fiabilidad se estimaron mediante el coeficiente de correlación de Pearson, el análisis de componentes principales (ACP) y la alfa de Cronbach. Se realizaron pruebas para verificar las diferencias entre las características individuales y la SCA. Resultados: el ACP indicó una variabilidad total del 42,5 %. Las mujeres y los individuos con mayor edad, actividad física e ingreso per cápita obtuvieron un valor de SCA más alto, mientras que aquellos que reportaron un mayor consumo de alcohol y tabaquismo obtuvieron una puntuación más baja. La alfa de Cronbach fue de 0,47. Conclusión: la SCA mostró una validez y confiabilidad satisfactorias y se asoció con datos socioeconómicos y de estilo de vida. Por lo tanto, es una herramienta útil para comparar la información dietética, contribuyendo a los futuros análisis en epidemiología nutricional.

Triglyceride-glucose index demonstrates reasonable performance as a screening tool but exhibits limited diagnostic utility for insulin resistance: Data from the ELSA-Brasil cohort.

Insulin resistance (IR) is a key risk factor for chronic metabolic diseases, but its laboratory diagnosis is still costly; thus, the triglyceride-glucose (TyG) index has been proposed as a surrogate method. Our aim was to provide a detailed analysis of cutoffs and test the hypothesis that the TyG index would present reasonable performance parameters for IR screening. This is a cross-sectional study with baseline data from 12,367 eligible participants of both sexes (aged 35-74 years) from the Brazilian Longitudinal Study of Adult Health. TyG correlation and agreement with the Homeostasis Model Assessment for Insulin Resistance were analyzed. Positive and negative predictive values (PV+, PV-) and likelihood ratio (LR+, LR-) were calculated. A moderate positive correlation between TyG and Homeostasis Model Assessment for Insulin Resistance was observed (Pearson r = 0.419). The area under the receiver operating characteristic curve of TyG for IR diagnosis was 0.742 and the optimal cutoff was 4.665, reaching a kappa agreement value of 0.354. For this cutoff, a PV+ of 59.3% and PV- of 76.0%, as well as an LR+ of 2.07 and LR- of 0.45 were obtained. Alternatively, because high sensitivity is desired for screening tests, selecting a lower cutoff, such as 4.505, increases the PV- to 82.1%, despite decreasing the PV+ to 50.8%. We conclude that TyG has important performance limitations for detecting IR, but that it may still be reasonably useful to help screening for IR in adults because it can be calculated from low-cost routine blood tests.

Correction: Prevalence and factors associated with self-reported anxiety in adults during the COVID-19 pandemic in Argentina, Brazil, Peru, Mexico, and Spain: A cross-sectional Ibero-American study.

[This corrects the article DOI: 10.1371/journal.pone.0280528.].

Examining the Usage Patterns of Non-Nutritive Sweeteners among Non-Diabetic Individuals: Insights from the Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: Although non-nutritive sweeteners (NNSs) were formulated primarily for sugar-restricted diets, nowadays, their consumption has become widespread among the general population. Thus, the purpose of this study was to estimate the prevalence of the regular use of NNSs and their associated factors among non-diabetic individuals from the baseline of the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: In total, 9226 individuals were analysed, and the regular consumption of NNSs was defined as follows: NSSs are used at least once a day. Associations between exposure and outcomes were analysed using chi-square and Student's t-tests. Significant variables were inserted into a binary logistic regression model to determine the adjusted association measures (significance level of 5%). RESULTS: The prevalence of regular NNS consumption was 25.7%. Regular NNS consumption increased with age, categories of BMI, income, and schooling. The odds of regularly consuming NNSs were 1.9-times higher among women, 6.1-times higher among obese individuals, and 1.8-times higher among those with higher schooling and income. CONCLUSIONS: Specific groups seem to present a larger association relative to the use of NNS. Based on the significant overall prevalence of the regular use of NNSs, a discussion regarding country-wide policies related to their intake is needed to address recent WHO directions concerning this additive.

Nutritional intake in high-performance para athletes.

OBJECTIVE: This study aimed to describe the eating habits of para-athletes who attended a specialized training center in Brazil. METHODS: Participants were recruited from the Sports Training Center at the Universidade Federal de Minas Gerais, Brazil. Energy, macronutrient (expressed in absolute terms and relative to body weight), fiber, cholesterol, and micronutrient intakes were assessed via a food frequency questionnaire, based on intakes over the preceding 12 mo. Sociodemographic factors were assessed using a purpose-designed survey, which included self-reported weight and height. Differences in nutrient intake based on sex, age, body mass index, and sporting factors were evaluated. RESULTS: A total of 30 para-athletes (in para athletics, para-powerlifting, para-swimming, and para-taekwondo) were included in the study. The median total energy intake was 4089 (2855-5829) kcal. The median consumption of carbohydrates, proteins, and fats was 512.3 (358.7-853.5), 184.5 (118.5-246.4), and 137.1 (96.8-189.5) g/d, respectively. Adolescent athletes had higher protein intakes than adult athletes (P = 0.02). Para-athletes with a longer sports career had lower consumption of fiber (P = 0.01) and thiamine (P = 0.02). Participants with a higher body mass index had higher intake of alcohol (P = 0.04) and monounsaturated fats (P = 0.01). Higher consumption of alcohol was also reported by older para-athletes (P = 0.02). CONCLUSIONS: We identified a higher saturated fat intake in male than in female para-athletes as well as higher protein intake (g/kg) in younger compared with older athletes. In addition, sociodemographic characteristics influenced the dietary intake of some para-athletes, such as length of sports career, age, and income.

Racial discrimination predicts the increase in body weight and BMI in Black individuals from ELSA-Brasil cohort.

We investigated whether racial discrimination accelerates the weight and Body Mass Index (BMI) gain in Blacks and Browns participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) in four years of follow-up. We compared body weight and BMI between the 1st (2008-2010) and 2nd visit (2012-2014) of 5,983 Blacks and Browns participants. Exposure to racial discrimination and covariates (age, sex, education, and research center) were obtained at the 1st visit. Linear mixed effects models stratified by race/skin color were used. Report of racial discrimination was more frequent among Blacks (32.1%) than Browns (6.3%). During the follow-up period, Blacks and Browns gained an average of 1.4kg and 1.2kg, respectively. This increase was greater among those who reported discrimination when compared to those who did not, both in Blacks (2.1kg vs.1.0kg, p < 0.001) and Browns (1.9kg vs. 1.1kg, p < 0.05). The results of the interaction between racial discrimination and time showed that Blacks, but not Browns, who reported racial discrimination had greater weight and BMI gains between visits. Our results suggest that reducing racial discrimination would contribute to prevent and/or control obesity increase in the country.

Excessive Consumption of Alcoholic Beverages and Extremely High Levels of High-Density Lipoprotein Cholesterol (HALP) in the ELSA-Brasil Cohort Baseline.

BACKGROUND: It has already been established that the consumption of alcoholic beverages increases high-density lipoprotein cholesterol (HDL-C) levels in dose-response. METHODS AND RESULTS: A cross-sectional analysis was carried out with 6132 participants of both sexes aged between 35 and 74 years, who were active and retired workers from six Brazilian states. Heavy drinkers were categorized by sex: men > 210 g/week and women > 140 g/week; moderate drinkers: men ≤ 209 g/week and women ≤ 139 g/week. The HDL-C level was dichotomized into normal (40 mg/dL-82.9 mg/dL) and extremely high (≥83 mg/dL). We used binary logistic regression to assess associations between baseline alcohol intake and HDL-C, which were adjusted for sex, age, income, physical activity, kilocalories and body mass index (BMI), and we found an positive association between extremely high HDL-C and the excessive consumption of alcoholic beverages. These participants were mostly women with a high income, lower waist circumference, kilocalorie consumption and also a higher consumption in all categories of alcoholic beverages. CONCLUSION: Excessive alcohol consumption was associated with a higher probability of extremely high HDL-C.

[Factors associated with adherence to COVID-19 preventive behaviors in ELSA-Brasil participants]. / Fatores associados à adesão a comportamentos preventivos da COVID-19 em participantes do ELSA-Brasil.

The aim of the study is to assess the adherence to recommended prevention measures during the COVID-19 pandemic and to investigate the factors associated with this adherence in the adult population. This study has a cross-sectional design and used data from the complementary study Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) - COVID, conducted from 2020 to 2021. Data were analyzed using the chi-square test and multinomial logistic regression. The sample consisted of 5,440 participants. The preventive measure with the highest adherence was the use of a face mask (95.5%). There was greater adherence by females and lower chance of adherence by white people, by those who consume alcoholic beverages, people who were retired, as well as for those who live alone or who have family members who did not follow the recommendations to stay at home. Greater adherence to preventive behaviors was observed in only one third of the participating population, which demonstrates that there was a need for greater awareness of the risks in specific populations. The findings contribute to improving our understanding about health promotion and COVID-19 prevention.

O objetivo deste estudo foi avaliar a adesão a medidas de prevenção recomendadas durante a pandemia de COVID-19 e investigar os fatores associados a essa adesão na população adulta. Por meio de delineamento transversal, utilizam-se dados do estudo complementar Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) - COVID, realizado de 2020 a 2021, que foram analisados por meio do teste qui-quadrado e regressão logística multinomial. A amostra é composta por 5.440 participantes. A medida preventiva com maior adesão foi o uso de máscara facial (95,5%). Houve maior adesão pelo sexo feminino e menor chance de adesão pela raça/cor branca, por aqueles que consomem bebidas alcoólicas, aposentados, assim como para aqueles que moram sozinhos ou que possuem familiares que não seguiram as recomendações de ficar em casa. A maior adesão aos comportamentos preventivos foi verificada em apenas um terço da população participante, o que demonstra que havia a necessidade de uma maior conscientização quanto aos riscos em populações específicas. Os achados contribuem para melhorar o conhecimento sobre promoção da saúde e prevenção da COVID-19.

El objetivo del estudio fue evaluar la adhesión a las medidas de prevención recomendadas durante la pandemia de COVID-19 e investigar los factores asociados con esta adhesión en la población adulta. El presente estudio tiene un diseño transversal y utilizó datos del estudio complementario Estudio Longitudinal de Salud del Adulto en Brasil (ELSA-Brasil) - COVID, realizado de 2020 a 2021. Los datos se analizaron mediante la prueba de chi-cuadrado y la regresión logística multinomial. La muestra fue compuesta por 5.440 participantes. La medida preventiva con mayor adhesión fue el uso de mascarilla facial (95,5%). Hubo mayor adhesión por el sexo femenino y menor posibilidad de adhesión por la raza/color blanca, por aquellos que consumen bebidas alcohólicas, jubilados, así como para aquellos que viven solos o que tienen familiares que no siguieron las recomendaciones de quedarse en casa. Solo se comprobó una mayor adhesión a los comportamientos preventivos en un tercio de la población participante, lo que demuestra que había la necesidad de una mayor concientización en cuanto a los riesgos en poblaciones específicas. Los resultados contribuyen a mejorar el conocimiento sobre la promoción de la salud y la prevención del COVID-19.