Consumption of ultra-processed foods and incidence of dyslipidemias: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Ultra-processed foods (UPF) have been associated with cardiometabolic outcomes, but the literature has still not reported their association with incidence of dyslipidemias, one of the most important risk factors for the occurrence of cardiovascular diseases. The objective of this study was to verify the association between consumption of UPF and incidence of dyslipidemia in Brazilian civil servants at a 4-year follow-up. The study used data from 5,275 participants at baseline and on the first follow-up visit in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We applied a food frequency questionnaire (FFQ) at baseline and identified UPF from NOVA, classification of foods as to the extent and purpose of processing. The proportion (in weight) of UPF in the total diet was calculated for each participant and categorized in tertiles, corresponding to low (first tertile), medium (second tertile), and high (third tertile) consumption. A mixed-effects logistic model was used to obtain the incidence of dyslipidemia associated with consumption of UPF. Individuals with medium and high consumption of UPF showed increases in the risks of development of isolated hypercholesterolemia by 12% (OR=1.12, CI:1.00-1.27) and 28% (OR=1.28, CI:1.12-1.47), of isolated hypertriglyceridemia by 14% (OR=1.14, CI:1.03-1.26) and 30% (OR=1.30, CI:1.17-1.45), of mixed hyperlipidemia by 21% (OR=1.21, CI:1.05-1.39) and 38% (OR=1.38, CI:1.18-1.62), and of low-HDL by 12% (OR=1.12, CI:1.00-1.24) and 18% (OR=1.18, CI:1.05-1.32), respectively, compared to participants that consumed less UPF. Our findings showed important cardiovascular risk associated with consumption of UPF and a gradient in the consumption´s effect, so these products should be discouraged.

Ultra-processed foods, changes in blood pressure and incidence of hypertension: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

OBJECTIVE: To estimate changes in blood pressure and the incidence of hypertension associated with consumption of ultra-processed foods (UPF) by Brazilian civil servants at a 4-year follow-up. DESIGN: Longitudinal analysis of the ELSA-Brasil with non-hypertensive individuals at baseline. We applied the FFQ at the baseline and categorised energy intake by degree of processing, using the NOVA classification. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at baseline (2008-2010) and again at first follow-up (2012-2014). Incidence of arterial hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or antihypertensive medication during the previous 2 weeks. A mixed-effect linear regression model and mixed-effect logistic regression model were used to estimate associations between UPF consumption and, respectively, changes in blood pressure and incidence of hypertension. SETTING: Brazil. PARTICIPANTS: Civil servants of Brazilian public academic institutions in six cities (n 8754), aged 35-74 years at baseline (2008-2010). RESULTS: UPF consumption contributed 25·2 % (sd = 9·6) of total energies consumed. After adjustment, participants with high UPF consumption presented a 23 % greater risk of developing hypertension (OR = 1·23, 95 % CI 1·06, 1·44) than those with low UPF consumption. We did not find association between UPF consumption and changes in blood pressure over time. CONCLUSIONS: The higher the UPF consumption, the higher the risk of hypertension in adults. Reducing UPF consumption is thus important to promote health and prevent hypertension.

Hair cortisol levels are associated with overweight and obesity in the ELSA-Brasil cohort.

Introduction: Hair cortisol level has recently been identified as a promising marker for detecting long-term cortisol levels and a marker of hypothalamic-pituitary-adrenal cortex (HPA) axis activity. However, research on the association between obesity and an altered cortisol metabolism remains controversial. Objective: This study aimed to investigate the relationship between hair cortisol levels and overweight and obesity in participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: This was a cross-sectional study involving 2,499 participants from the second follow-up (visit 3, 2017-2019) attending research centers in Rio de Janeiro and Rio Grande do Sul states. Hair samples were collected, and cortisol levels were analyzed using enzyme-linked immunosorbent assay (ELISA) kits. Cortisol levels were classified as low (< 40 pg/mg), medium (40-128 pg/mg), or high (> 128 pg/mg). The participants were classified as eutrophic, overweight, or obese according to their weight (kg) and height (m2). Odds ratios (ORs) with 95% confidence intervals (95%CI) were estimated. Results: Of the 2499 individuals, 30% had eutrophic weight, 40% were overweight, and 30% were obese. Notably, cortisol levels gradually increased with increasing body weight. Among participants with high hair cortisol levels, 41.2% were classified as overweight and 34.2% as obese. Multinomial logistic regression analysis indicated that participants with high cortisol levels were 43% (OR =1.43; 95%CI: 1.02-2.03) more likely to be overweight and 72% (OR =1.72; 95%CI:1.20-2.47) more likely to be obese than participants with low hair cortisol levels. After adjustment for all covariates, high cortisol levels remained associated with obesity (OR = 1.54; 95%CI:1.02-2.31) and overweight (OR =1.33; 95%CI:0.91-1.94). Conclusion: In the ELSA-Brazil cohort, hair stress were positively associated with overweight and obesity. These results underscore the importance of considering stress and cortisol as potential factors in obesity prevention and intervention efforts, and highlight a novel aspect of the complex relationship between stress and obesity in the Brazilian population.

Consumo de alimentos ultraprocessados e seus efeitos sobre os lipídios plasmáticos e a pressão arterial Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) / Consumption of ultra-processed foods and their effects on plasma lipids and blood pressure Longitudinal Study of Adult Health (ELSA-Brasil)

Este estudo avaliou os efeitos do consumo dos alimentos ultraprocessados (AUP) em parâmetros da saúde cardiovascular. No artigo 1, estudamos as mudanças nos lipídios plasmáticos e a incidência de dislipidemias segundo sexo associadas ao consumo dos AUP ao longo de 3,8 anos de seguimento. No artigo 2, analisamos a relação entre os AUP e alterações na pressão arterial (PA) e a incidência de hipertensão arterial. Foram analisados os dados da linha de base (2008-2010) e da primeira visita de acompanhamento (2012-2014) de participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Um Questionário de Frequência Alimentar aplicado na linha de base foi utilizado para avaliar o consumo alimentar e identificar os AUP segundo a NOVA, classificação de alimentos quanto à extensão e ao propósito do processamento industrial. O percentual calórico proveniente de AUP em relação à ingestão calórica diária foi calculado e categorizado em tercis de consumo. Os lipídios sanguíneos analisados foram LDL-c, HDL-c e triglicerídeos e, a partir destes, foram estudadas as dislipidemias: hipercolesterolemia isolada, hipertrigliceridemia isolada, hiperlipidemia mista e baixo-HDL-c. As PA sistólica e diastólica foram aferidas e a partir delas foi identificada a hipertensão arterial. Foi utilizado modelo linear de efeito misto para estimar a associação entre consumo de AUP e mudanças nos níveis de lipídios plasmáticos e de PA e modelo logístico de efeitos mistos para as estimativas de incidência de dislipidemias e de hipertensão arterial. Em média, cerca de 25% das calorias ingeridas diariamente em relação à energia total foram provenientes de AUP. Observou-se que o consumo elevado de AUP se associou à redução de 1,08 mg/dL nos níveis de HDL-c em homens no seguimento. O risco foi ainda maior se consideramos apenas os indivíduos com excesso de peso (ß=-1,35; IC95%: -2,65;-0,05). Evidenciou-se associação entre o alto consumo de AUP e aumento da PA diastólica em 0,48 mmHg e do risco de hipertensão em 23%. Em ambos os trabalhos, evidenciamos a questão do estado nutricional como mediador. Nossos resultados corroboram as recomendações já apresentadas no Guia Alimentar para a População Brasileira que aponta a necessidade de redução dos AUP e dão suporte para novas políticas que visem a melhorar a saúde da população, especialmente a prevenção de dislipidemias e hipertensão arterial.