Accuracy of the Simplified Version of the Global Risk Score in Detecting Cardiovascular Risk in Women from Quilombola Communities in the State of Alagoas, Brazil

Abstract Background: Cardiovascular risk (CVR) monitoring is important for defining preventive actions against cardiovascular disease; this condition prevails more intensely in scenarios with less infrastructure such as African descent communities. The Framingham Risk Score (FRS) and the Global Risk Score (GRS) have been used in Brazil for CVR monitoring based on scales of points for certain risk factors. Among these, hypercholesterolemia and low high-density lipoprotein cholesterol require tests not always available in primary care. An alternative would be the simplified GRS (sGRS), in which these tests are replaced by the body mass index (kg/m2). Objective: To determine the accuracy of the sGRS in estimating CVR in African descent women (quilombolas) from Alagoas. Method: This is a cross-sectional study with a representative sample (n=1015) of women from African descent communities in Alagoas. GRS, sGRS, and FRS consisted in the sum of points obtained according to their respective scales. Receiver operating characteristic curves were used to compare the accuracy of these instruments as CVR predictors, assuming the GRS as reference. Statistical significance was assumed when p<0.05. Results: The prevalence of high CVR assessed with the GRS or sGRS was similar (20.1% vs. 20.7%; p>0.05) and higher than that found with the FRS (4.5%; p<0.001). Considering the area under the curve (AUC), the sGRS had a higher discriminatory power (AUC=0.98; 95%CI: 0.98-0.99) than the FRS (AUC=0.91; 95%CI: 0.90-0.93). Conclusion: Among black women living in regions with less infrastructure, the sGRS produced similar results to the GRS, with greater operational simplicity.

Stunting and overweight among children in Northeast Brazil: prevalence, trends (1992-2005-2015) and associated risk factors from repeated cross-sectional surveys.

BACKGROUND: A study involving children from Alagoas (Northeast Brazil) revealed that, as a consequence of a drastic reduction in the prevalence of stunting between 1992 to 2005, (22.5 to 11.4%) combined with an increase in overweight prevalence (6.7 to 9.3%), the prevalence of these two conditions in 2005 was very close. If these trends were maintained, it is very likely that, at this time, the childhood overweight prevalence has already exceeded that of the stunting. However, no study is available to confirm this hypothesis. The identification of these changes is relevant to the planning and evaluation of public policies. This study aimed to investigate the prevalence, time trends and associated factors with stunting and overweight in children from Alagoas. METHODS: Independent cross-sectional household surveys were conducted in 1992 (n = 1231), 2005 (n = 1381) and 2015 (n = 988). Data were collected from probabilistic samples of children aged 0-60 months. Stunting was defined by stature-for-age < - 2 sd and overweight by weight-for-stature > 2 sd. RESULTS: Between 1992, 2005 and 2015, the stunting prevalence was 22.6, 11.2 and 3.2% (reduction of 85.8%), while the overweight prevalence was 6.9, 7.5 and 14.9% (increase of 115.9%), respectively. After multivariate analysis, the following positive associations with stunting were observed in 1992: age group > 24 months (28.3% vs 14.5%), mother with ≥2 children (28.8% vs 12.8%), low birth weight (28.3% vs 15.7%) and mother with low schooling (29.3% vs 7.2%). In 2015 there was a higher prevalence of stunting in males (4.2% vs 2.2%), in children < 24 months (4.6% vs 2.2%), with low birth weight (8.6% vs 3.0%) and in those who had mothers with low schooling (7.0% vs 2.6%). Regarding overweight, in 1992 there was higher prevalence for male (9.1% vs 4.7%) and in children whose mothers had ≤2 children (8.9% vs 5.8%), while in 2015 only birth weight >  4 kg was associated to overweight (27.3% vs 14.2%). CONCLUSIONS: During the analyzed period, there was a significant decrease in stunting prevalence. At the same time, a substantial increase was observed in the overweight prevalence. Currently, stunting is a problem of low magnitude, while overweight has become a worrying public health problem.