Association between leisure-time physical activity and arterial stiffness in adults of the ELSA-Brasil study: a mediation analysis.

OBJECTIVES: We aimed at defining the direct and the mediated pathways for the association between leisure-time physical activity (LTPA) and carotid-to-femoral pulse wave velocity (cf-PWV), and also to identify whether these effects are influenced by sex and age. METHODS: Cross-sectional data from 13 718 adults (35-74 years) were obtained at the baseline of the ELSA-Brasil study. The cf-PWV was obtained by measuring the pulse transit time and the distance traveled by the pulse between the carotid and the femoral, as well as clinical and anthropometric parameters were measured. The levels of LTPA were determined by applying the long form of the International Physical Activity Questionnaire (IPAQ). RESULTS: Classical cardiovascular risk factors were independently associated with cf-PWV. Path analysis showed that increased levels of LTPA were directly associated with lower cf-PWV in both men and women (ß: -0.123 ±â€Š0.03 vs. 0.065 ±â€Š0.029, P for sex = 0.165), except for diabetes. Also, the mediated effect of LTPA on SBP and DBPs, heart rate, BMI, and fasting glucose, was associated with lower cf-PWV in men and women (ß: -0.113 ±â€Š0.016 vs. -0.104 ±â€Š0.016, P for sex = 0.692), except for diabetes. When age was tested as a moderator, the direct effect did not change significantly according to participants' age, regardless of sex. However, the mediated effect increases in both men and women over 50 years. CONCLUSION: Our findings support that LTPA in adults reduces cf-PWV by acting in different ways according to age. Physical activity in older individuals improves cardiometabolic risk factors and thus mitigates the stiffening of large arteries.

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.

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.

Job stress and chronic low back pain: incidence, number of episodes, and severity in a 4-year follow-up of the ELSA-Brasil Musculoskeletal cohort.

ABSTRACT: We investigated the association between job stress, as assessed by the effort-reward imbalance model, and the incidence of chronic low back pain (CLBP) over a 4-year period. A total of 1733 participants from the ELSA-Brasil Musculoskeletal cohort, who were free from LBP at baseline (2012-2014), were included. Episodes of LBP in the past 30 days, intensity, and the presence of disability were investigated in annual telephone follow-ups (2015-2018). Chronic LBP was defined as episodes of LBP lasting >3 months with at least moderate intensity. We analyzed the incidence of at least one episode of CLBP (yes/no), the number of CLBP episodes (0, 1, ≥2), and CLBP severity/disability (absent, nondisabling, severe/disabling). The association between these outcomes and tertiles of the effort-to-reward ratio, as well as each dimension of the effort-reward imbalance model, was investigated using multinomial logistic and Poisson regression models adjusting for sociodemographic and occupational variables. The cumulative incidence of CLBP over 4 years was 24.8%. High effort-reward imbalance increased the chances of experiencing multiple CLBP episodes and severe/disabling CLBP by 67% (95% confidence interval [CI]: 1.12-2.47) and 70% (95% CI: 1.14-2.53), respectively. High overcommitment increased the incidence of CLBP by 23% (95% CI: 1.01-1.50) and the chances of multiple CLBP episodes and severe/disabling CLBP by 67% (95% CI: 1.11-2.50) and 57% (95% CI: 1.05-2.34), respectively. These results indicate that exposure to job stress is associated with a higher incidence, a greater number of episodes, and increased severity of CLBP over a 4-year period. If this association is causal, measures aimed at reducing exposure to job stress are likely to alleviate the burden of CLBP.

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.

Salt Intake in Adults with Diabetes and Hypertension: The Longitudinal Study of Adult Health-Brasil Study.

Background and Objective: Hypertension and type-2 diabetes are strong risk factors for cardiovascular diseases, and their management requires lifestyle changes, including a shift in dietary habits. The consumption of salt has increased in the last decades in some countries, but its association with type-2 diabetes remains unknown. Thus, we aimed to estimate the amount of salt intake among adults with and without diabetes and to assess whether concomitant hypertension and diabetes are associated with higher salt intake. Methods: Data from 11,982 adults 35-74 years of age enrolled in the baseline of the Longitudinal Study of Adult Health-Brasil study (2008-2010) were studied. A clinical and anthropometric evaluation was performed, and their daily salt intake was estimated by the overnight 12-hr urine sodium excretion. Results: Salt intake (gram per day) was higher in participants with diabetes as compared with those without diabetes, regardless of sex (men: 14.2 ± 6.4 vs. 12.4 ± 5.6, P < 0.05; women: 10.5 ± 4.8 vs. 9.1 ± 4.1, P < 0.05). However, salt intake is high in participants with fasting glucose ≥126 mg/dL or HbA1c ≥6.5%, but not in participants with blood glucose 2 hr after the glucose tolerance test ≥200 mg/dL. When hypertension and diabetes coexisted, salt consumption was higher than among people without these conditions. The prevalence of hypertension increased with increasing salt intake in women with diabetes, but not in men with this condition. Conclusions: Our findings highlight the high consumption of salt in individuals with diabetes and/or hypertension, and the need for effective strategies to reduce salt consumption in these groups of increased risk for major cardiovascular events, especially in women.

[Body image perception, socioeconomic characteristics, and lifestyle in women participating in ELSA-Brasil in Bahia, Brazil]. / Percepção de imagem corporal, características socioeconômicas e estilo de vida em mulheres participantes do ELSA-Brasil na Bahia, Brasil.

Body image distortion is an alteration in the perception of the body that can have repercussions on health. This study aims to estimate the prevalence of body image accuracy and distortion among women participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) living in Bahia State, Brazil, and to investigate associations with socioeconomic characteristics, lifestyle, and gynecological care seeking. A total of 609 women aged 50 to 69 years participated in the study, who answered face-to-face questionnaires from 2012 to 2014. The Stunkard silhouette scale was used to investigate accurate or distorted perception for more or less weight. The relative risk ratio (RR) was calculated by multinomial logistic regression using Stata 13. Most participants have an accurate perception of their own bodies (53.7%). Among those with distorted perception, there is a tendency to distort towards less weight (38.1%). In the multinomial regression analysis, the variables race/skin color and education remained associated with the distortion towards underweight. The race/skin color variable was positively associated with the distortion towards underweight among Mixed-race women (RR = 1.89; 95%CI: 1.13-3.16) and black (RR = 2.10; 95%CI: 1.25-3.55), while the education variable among those with up to high school education (RR = 1.65; 95%CI: 1.18-2.33). There were no associations with the other variables or with distortion for more weight. The results contribute to explaining the relationships between body image perception and socioeconomic factors, revealing that women of different races/skin colors and varying educational levels are influenced in different ways by social discourses, impacting the perception of their body image.

Distorção da imagem corporal é uma alteração da percepção do corpo que pode repercutir na saúde. Este estudo visa estimar, entre mulheres participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) residentes na Bahia, Brasil, a prevalência de acurácia e distorção da imagem corporal e investigar associações com características socioeconômicas, estilo de vida e procura de cuidados ginecológicos. Participaram 609 mulheres de 50-69 anos de idade que responderam, entre 2012-2014, questionários aplicados face a face. Foi utilizada a escala de silhuetas de Stunkard para investigar a percepção acurada ou distorcida para mais ou menos peso. A razão de risco relativo (RR) foi calculada por meio de regressão logística multinomial por meio do Stata 13. A maioria das participantes tem perspectiva acurada do próprio corpo (53,7%). Entre aquelas com percepção distorcida, há uma tendência à distorção para menos peso (38,1%). Na análise de regressão multinomial, permaneceram associadas à distorção para menos peso as variáveis raça/cor e escolaridade, sendo que a primeira foi positivamente associada à distorção para menos peso entre as pardas (RR = 1,89; IC95%: 1,13-3,16) e pretas (RR = 2,10; IC95%: 1,25-3,55), enquanto a segunda entre aquelas com escolaridade até o Ensino Médio (RR = 1,65; IC95%: 1,18-2,33). Não houve associações quanto às demais variáveis, nem com distorção para mais peso. Os resultados contribuem para a explicação das relações entre percepção da imagem corporal e fatores socioeconômicos, revelando que mulheres de raça/cor diferentes e variados níveis de escolaridade são influenciadas de formas distintas pelos discursos sociais, o que impacta a percepção da sua imagem corporal.

La distorsión de la imagen corporal es una alteración en la percepción del cuerpo que puede repercutir en la salud. Este estudio busca estimar, entre las mujeres participantes del Estudio Longitudinal de Salud del Adulto (ELSA-Brasil) que viven en Bahía, Brasil, la prevalencia de precisión y distorsión de la imagen corporal e investigar asociaciones con las características socioeconómicas, el estilo de vida y la busca de atención ginecológica. Participaron 609 mujeres que tenían entre 50 y 69 años que contestaron los cuestionarios aplicados cara a cara entre 2012 y 2014. Se utilizó la escala de siluetas de Stunkard para investigar la percepción precisa o distorsionada para más o menos peso. El cociente de riesgo relativo (RR) se calculó a través de regresión logística multinomial utilizando el Stata 13. La mayoría de los participantes tiene una perspectiva precisa del propio cuerpo (53,7%). Entre las personas con percepción distorsionada hay una tendencia a la distorsión para menos peso (38,1%). En el análisis de regresión multinomial, las variables raza/color y escolaridad permanecieron asociadas con la distorsión para menos peso, siendo la primera positivamente asociada con la distorsión para menos peso entre las mujeres pardas (RR = 1,89; IC95%: 1,13-3,16) y negras (RR = 2,10; IC95%: 1,25-3,55), mientras la segunda entre las mujeres que estudiaron hasta la enseñanza secundaria (RR = 1,65; IC95%: 1,18-2,33). No hubo asociaciones con las otras variables ni con la distorsión para más peso. Los resultados contribuyen para explicar las relaciones entre la percepción de la imagen corporal y los factores socioeconómicos, demostrando que mujeres de diferentes razas/colores y diferentes niveles de educación se influyen de distintas formas a través de discursos sociales, lo que impacta en la percepción de su imagen corporal.

Sleep duration, insomnia and cognitive performance in the Elsa-Brasil cohort: a cross-sectional analysis.

OBJECTIVE: To investigate the single and combined associations between sleep disturbances (sleep duration, insomnia symptoms in the last 30 nights, and daytime tiredness) and performance in cognitive tests. METHODS: Cross-sectional analysis of data from visit 2 (2012-2014) of the Longitudinal Study of Adult Health from a cohort of active and retired civil servants from six Brazilian capitals. Polynomial regression with quadratic term and multiple linear regression models were performed to assess single and combined associations between sleep disturbances and memory performance, fluency, executive functions, and global cognition. RESULTS: A total of 7,248 participants were included, with a mean age of 62.7 years (standard deviation [SD]=5.9), and 55.2% were women. Inverted U-shaped associations were observed between sleep duration and performance on all cognitive abilities, suggesting that durations shorter or longer than seven hours are associated with worse performance, regardless of age. Reported insomnia was associated with worse executive function (ß: -0.08; 95% confidence interval [CI]: -0.15 to -0.01), and the magnitudes of associations were higher for individuals with insomnia at two or more moments (ß: -0.12; 95%CI -0.19 to -0.05) or, especially, insomnia combined with short sleep (ß: -0.18; 95%CI -0.24 to -0.11). Insomnia in two or more periods was also associated with lower memory and global cognition. There was no association between any sleep disturbance tested and verbal fluency. Isolated daytime tiredness was not associated with performance in the evaluated tests. CONCLUSION: The results suggest that extreme sleep durations are detrimental to almost all cognitive abilities investigated, whereas insomnia appears to affect more severely the executive function.

Life satisfaction and ideal cardiovascular health score: A cross-sectional study from ELSA-Brasil.

OBJECTIVES: To investigate whether higher levels of life satisfaction are associated with a higher ideal cardiovascular health (CVH) score in middle-aged and older populations in the Brazilian context. METHOD: Cross-sectional analysis of 12,936 participants of the Brazilian Longitudinal Study of Adult Health, Visit 2 (2012-2014), aged 38-79 years. The response variables were the global, lifestyle, and biological ideal CVH scores, as defined by the American Heart Association Life's Simple 7. The scores were categorized as low, intermediate, and optimal. Life satisfaction was measured by the Satisfaction with the Life Scale. Multinomial logistic regression was used to estimate the magnitude with adjustment for potential confounding factors. Low scores were the categories of reference for the analyses. RESULTS: Only 10.5% of the participants had an optimal (≥5) global ideal CVH score. After total adjustment, 1 SD increment in the life satisfaction score was associated with an odds ratio (OR) of 1.05 (95% confidence interval [CI: 1.01-1.09]) and 1.15 (95% CI [1.07-1.23]) for intermediate and optimal global ideal CVH scores, respectively. Regarding the lifestyle ideal CVH score, the increment of 1 SD in the life satisfaction scale determined an OR of 1.11 (95% CI [1.06-1.15]) and 1.22 (95% CI [1.14-1.31]) for intermediate and optimal lifestyle ideal CVH score, respectively. Life satisfaction was not associated with the biological ideal CVH score. CONCLUSION: The results suggested that the higher the life satisfaction, the higher the CVH. The findings add to the knowledge of assets to promote CVH. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Racial Inequities in the Control of Hypertension and the Explanatory Role of Residential Segregation: a Decomposition Analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

The mechanisms underlying racial inequities in uncontrolled hypertension have been limited to individual factors. We investigated racial inequities in uncontrolled hypertension and the explanatory role of economic segregation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). All 3897 baseline participants with hypertension (2008-2010) were included. Uncontrolled hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg), self-reported race (White/Brown/Black people), and neighborhood economic segregation (low/medium/high) were analyzed cross-sectionally. We used decomposition analysis, which describes how much a disparity would change (disparity reduction; explained portion) and remain (disparity residual; unexplained portion) upon removing racial differences in economic segregation (i.e., if Black people had the distribution of segregation of White people, how much we would expect uncontrolled hypertension to decrease among Black people). Age- and gender-adjusted prevalence of uncontrolled hypertension (39.0%, 52.6%, and 54.2% for White, Brown, and Black participants, respectively) remained higher for Black and Brown vs White participants, regardless of economic segregation. Uncontrolled hypertension showed a dose-response pattern with increasing segregation levels for White but not for Black and Brown participants. After adjusting for age, gender, education, and study center, unexplained portion (disparity residual) of race on uncontrolled hypertension was 18.2% (95% CI 13.4%; 22.9%) for Black vs White participants and 12.6% (8.2%; 17.1%) for Brown vs White participants. However, explained portion (disparity reduction) through economic segregation was - 2.1% (- 5.1%; 1.3%) for Black vs White and 0.5% (- 1.7%; 2.8%) for Brown vs White participants. Although uncontrolled hypertension was greater for Black and Brown vs White people, racial inequities in uncontrolled hypertension were not explained by economic segregation.

Percepção de imagem corporal, características socioeconômicas e estilo de vida em mulheres participantes do ELSA-Brasil na Bahia, Brasil / Body image perception, socioeconomic characteristics, and lifestyle in women participating in ELSA-Brasil in Bahia, Brazil / Percepción de la imagen corporal, características socioeconómicas y estilo de vida en mujeres participantes del ELSA-Brasil en Bahía, Brasil

Distorção da imagem corporal é uma alteração da percepção do corpo que pode repercutir na saúde. Este estudo visa estimar, entre mulheres participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) residentes na Bahia, Brasil, a prevalência de acurácia e distorção da imagem corporal e investigar associações com características socioeconômicas, estilo de vida e procura de cuidados ginecológicos. Participaram 609 mulheres de 50-69 anos de idade que responderam, entre 2012-2014, questionários aplicados face a face. Foi utilizada a escala de silhuetas de Stunkard para investigar a percepção acurada ou distorcida para mais ou menos peso. A razão de risco relativo (RR) foi calculada por meio de regressão logística multinomial por meio do Stata 13. A maioria das participantes tem perspectiva acurada do próprio corpo (53,7%). Entre aquelas com percepção distorcida, há uma tendência à distorção para menos peso (38,1%). Na análise de regressão multinomial, permaneceram associadas à distorção para menos peso as variáveis raça/cor e escolaridade, sendo que a primeira foi positivamente associada à distorção para menos peso entre as pardas (RR = 1,89; IC95%: 1,13-3,16) e pretas (RR = 2,10; IC95%: 1,25-3,55), enquanto a segunda entre aquelas com escolaridade até o Ensino Médio (RR = 1,65; IC95%: 1,18-2,33). Não houve associações quanto às demais variáveis, nem com distorção para mais peso. Os resultados contribuem para a explicação das relações entre percepção da imagem corporal e fatores socioeconômicos, revelando que mulheres de raça/cor diferentes e variados níveis de escolaridade são influenciadas de formas distintas pelos discursos sociais, o que impacta a percepção da sua imagem corporal.

Body image distortion is an alteration in the perception of the body that can have repercussions on health. This study aims to estimate the prevalence of body image accuracy and distortion among women participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) living in Bahia State, Brazil, and to investigate associations with socioeconomic characteristics, lifestyle, and gynecological care seeking. A total of 609 women aged 50 to 69 years participated in the study, who answered face-to-face questionnaires from 2012 to 2014. The Stunkard silhouette scale was used to investigate accurate or distorted perception for more or less weight. The relative risk ratio (RR) was calculated by multinomial logistic regression using Stata 13. Most participants have an accurate perception of their own bodies (53.7%). Among those with distorted perception, there is a tendency to distort towards less weight (38.1%). In the multinomial regression analysis, the variables race/skin color and education remained associated with the distortion towards underweight. The race/skin color variable was positively associated with the distortion towards underweight among Mixed-race women (RR = 1.89; 95%CI: 1.13-3.16) and black (RR = 2.10; 95%CI: 1.25-3.55), while the education variable among those with up to high school education (RR = 1.65; 95%CI: 1.18-2.33). There were no associations with the other variables or with distortion for more weight. The results contribute to explaining the relationships between body image perception and socioeconomic factors, revealing that women of different races/skin colors and varying educational levels are influenced in different ways by social discourses, impacting the perception of their body image.

La distorsión de la imagen corporal es una alteración en la percepción del cuerpo que puede repercutir en la salud. Este estudio busca estimar, entre las mujeres participantes del Estudio Longitudinal de Salud del Adulto (ELSA-Brasil) que viven en Bahía, Brasil, la prevalencia de precisión y distorsión de la imagen corporal e investigar asociaciones con las características socioeconómicas, el estilo de vida y la busca de atención ginecológica. Participaron 609 mujeres que tenían entre 50 y 69 años que contestaron los cuestionarios aplicados cara a cara entre 2012 y 2014. Se utilizó la escala de siluetas de Stunkard para investigar la percepción precisa o distorsionada para más o menos peso. El cociente de riesgo relativo (RR) se calculó a través de regresión logística multinomial utilizando el Stata 13. La mayoría de los participantes tiene una perspectiva precisa del propio cuerpo (53,7%). Entre las personas con percepción distorsionada hay una tendencia a la distorsión para menos peso (38,1%). En el análisis de regresión multinomial, las variables raza/color y escolaridad permanecieron asociadas con la distorsión para menos peso, siendo la primera positivamente asociada con la distorsión para menos peso entre las mujeres pardas (RR = 1,89; IC95%: 1,13-3,16) y negras (RR = 2,10; IC95%: 1,25-3,55), mientras la segunda entre las mujeres que estudiaron hasta la enseñanza secundaria (RR = 1,65; IC95%: 1,18-2,33). No hubo asociaciones con las otras variables ni con la distorsión para más peso. Los resultados contribuyen para explicar las relaciones entre la percepción de la imagen corporal y los factores socioeconómicos, demostrando que mujeres de diferentes razas/colores y diferentes niveles de educación se influyen de distintas formas a través de discursos sociales, lo que impacta en la percepción de su imagen corporal.

Sleep duration, insomnia and cognitive performance in the Elsa-Brasil cohort: a cross-sectional analysis / Duração do sono, insônia e desempenho cognitivo na coorte Elsa-Brasil: uma análise transversal

ABSTRACT Objective: To investigate the single and combined associations between sleep disturbances (sleep duration, insomnia symptoms in the last 30 nights, and daytime tiredness) and performance in cognitive tests. Methods: Cross-sectional analysis of data from visit 2 (2012-2014) of the Longitudinal Study of Adult Health from a cohort of active and retired civil servants from six Brazilian capitals. Polynomial regression with quadratic term and multiple linear regression models were performed to assess single and combined associations between sleep disturbances and memory performance, fluency, executive functions, and global cognition. Results: A total of 7,248 participants were included, with a mean age of 62.7 years (standard deviation [SD]=5.9), and 55.2% were women. Inverted U-shaped associations were observed between sleep duration and performance on all cognitive abilities, suggesting that durations shorter or longer than seven hours are associated with worse performance, regardless of age. Reported insomnia was associated with worse executive function (β: -0.08; 95% confidence interval [CI]: -0.15 to -0.01), and the magnitudes of associations were higher for individuals with insomnia at two or more moments (β: -0.12; 95%CI -0.19 to -0.05) or, especially, insomnia combined with short sleep (β: -0.18; 95%CI -0.24 to -0.11). Insomnia in two or more periods was also associated with lower memory and global cognition. There was no association between any sleep disturbance tested and verbal fluency. Isolated daytime tiredness was not associated with performance in the evaluated tests. Conclusion: The results suggest that extreme sleep durations are detrimental to almost all cognitive abilities investigated, whereas insomnia appears to affect more severely the executive function.

RESUMO Objetivo: Investigar a associação isolada e combinada entre distúrbios do sono (duração do sono, sintomas de insônia nas últimas 30 noites e cansaço diurno) e desempenho em testes cognitivos. Métodos: Análise transversal dos dados da visita 2 (2012-2014) do Estudo Longitudinal de Saúde do Adulto de coorte de servidores públicos ativos e aposentados de seis capitais brasileiras. Regressão polinomial com termo quadrático e modelos de regressão linear múltipla foram realizados para avaliar associações isoladas e combinadas entre distúrbios do sono e desempenho na memória, fluência, funções executivas e cognição global. Resultados: Foram incluídos um total de 7.248 participantes, com média etária de 62,7 anos (desvio padrão [DP]=5,9), sendo 55,2% mulheres. Associações em forma de U invertido foram observadas entre duração do sono e desempenho em todas as habilidades cognitivas, sugerindo que durações menores ou maiores que sete horas estão associadas ao pior desempenho, independentemente da idade. O relato de insônia foi associado à pior função executiva (β: -0.08; IC95% -0.15 a -0.01), sendo as magnitudes das associações maiores para indivíduos com insônia em dois ou mais momentos (β: -0.12; intervalo de confiança [IC]95% -0.19 a -0.05) ou, especialmente, insônia combinada com sono curto (β: -0.18; IC95% -0.24 a -0.11). Insônia em dois ou mais períodos também foi associada à menor memória e cognição global. Não houve associação entre qualquer distúrbio do sono testado e fluência verbal. Cansaço diurno isolado não foi associado ao desempenho nos testes avaliados. Conclusão: Os resultados sugerem que a duração extrema do sono é prejudicial para quase todas as funções cognitivas investigadas, enquanto a insônia parece afetar mais fortemente a função executiva.

Achievement of Treatment Goals and Mortality in Individuals with Diabetes: The ELSA-Brasil Study.

BACKGROUND: To prevent diabetes complications, the American Diabetes Association (ADA) has recommended the treatment of blood glucose, blood pressure, and LDL-cholesterol (LDL-c) to target levels. Our aim is to characterize the risk of death according to the achievement of these goals in subjects with diabetes participating in the ELSA-Brasil study. METHODS: ELSA-Brasil is an occupational cohort study of middle-aged and elderly adults followed from a 2008-2010 baseline to 2019 by two additional clinic visits and annual telephone interviews. We ascertained known diabetes by self-reported diagnosis or anti-diabetic medication use. We used treatment targets based on the 2022 ADA guidelines. We ascertained deaths from any cause based on the annual surveillance confirmed by death certificates. RESULTS: After 11 (1.8) years of follow-up, 261 subjects had died among 2423 with known diabetes. Within-target HbA1c was associated with the greatest protection (HR = 0.66; 95%CI 0.50-0.88) against all-cause mortality. Achieving both glycemic and blood pressure targets conferred substantial protection (HR = 0.54; 95%CI 0.37-0.78). Within-target LDL-c, however, was associated with increased mortality (HR = 1.44; 95%CI 1.11-1.88). CONCLUSIONS: Glucose and blood pressure control, especially when concomitant, reduced mortality. The increased mortality associated with achieving the LDL-c target merits further investigation.

Are ambulatory blood pressure parameters associated more with central adiposity than with total adiposity? Results of the ELSA-Brasil study.

Background: Worldwide obesity has a high prevalence, as well as carries a high risk of several chronic diseases, including hypertension. Studies of the association between obesity and ambulatory blood pressure (BP) are scarce and most use only body mass index (BMI) as indicator of adiposity. Thus, we aimed to examine for associations between total and central adiposity and ambulatory BP parameters (BP means and variability, nocturnal dipping and morning surge) among participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: This cross-sectional study (2012-2014) used a subsample of participants (n = 812) of ELSA-Brasil who underwent 24-hour ambulatory BP monitoring to assess systolic and diastolic BP (SBP and DBP, respectively) over 24-hour periods and sub-periods. Indicators for total adiposity were BMI and body fat (BF) and, for central adiposity, waist circumference (WC) and waist-to-height ratio (WHR). Associations were tested using crude and adjusted gamma and logistic regression. Results: Overweight (BMI) and abdominal obesity (WC and WHR) associated positively with mean 24-hour (Coef = 2.71, 3.09 and 4.00, respectively), waking (Coef = 2.87, 3.26 and 4.16, respectively), and sleeping (Coef = 2.30, 2.74 and 3.50, respectively) SBP; mean DBP associated with high WHR in these three periods (Coef = 2.00, 2.10 and 1.68, respectively) and with WC in the waking period (Coef = 1.44). Overweight and abdominal obesity (WC and WHR) were positively associated with SBP variability over 24 h (Coef = 0.53, 0.45 and 0.49, respectively) and in sleep (Coef = 0.80, 0.74 and 0.59, respectively), and with DBP variability in 24 h (Coef = 0.64, 0.73 and 0.58, respectively), wakefulness (Coef = 0.50, 0.52 and 0.52, respectively) and sleep (Coef = 0.53, 0.45 and 0.49); excess BF associated positively with DBP variability over 24 h (Coef = 0.43) and in wakefulness (Coef = 0.38). Lastly, high WHR and excess BF were associated with higher odds of extreme dipping (OR = 1.03 for both), while high WC and WHR associated with higher odds of exacerbated diastolic morning surge (OR = 3.18 and 3.66, respectively). Conclusion: Indicators of adiposity were associated with the BP means and variability, nocturnal dipping and morning surge, with more substantial results for indicators of central adiposity that the others.

Impact of socioeconomic factors on lifestyle changes among employees of public higher education institutions in ELSA-Brasil during COVID-19 pandemic.

This study aimed to identify lifestyle changes and associated sociodemographic factors in women and men participating in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) cohort during the COVID-19 pandemic. Longitudinal study with 3,776 (aged 58.8 years; SD ± 8.5) employees of public higher education institutions in the second follow-up and the wave-COVID of ELSA-Brasil. Data collected using structured questionnaires. An exploratory analysis was performed using binary and multinomial logistic regression on the dependent variables with two and three categories, respectively, by obtaining crude and adjusted odds ratio estimates in SPSS 20.0, considering a p-value < 0.05. There was a reduction in physical activity of 195.5 (SD ± 1,146.4) metabolic equivalents per week in women and 240.5 (SD ± 1,474.2) in men, and in smoking by 15.2%. There was an increase in alcohol consumption in men and women (434.2 ± 5,144.0; and 366.1 ± 4,879.0, respectively), in the food quality score (0.8 ± 3.7, women; 0.5 ± 3.7, men), sleeping time (0.4 ± 1.2, women; 0.5 ± 1.1, men), screen time (1.7 ± 2.4, women; 1.4 ± 2.3, men), and sitting time (1.7 ± 2.6, women; 1.5 ± 2.4, men) (hours/day). In total, 18.6% increased the purchase of ultra-processed foods and 36% increased the purchase of natural foods. Age and work activity contributed to increase the chance of purchasing ultra-processed foods, and age and adherence to social distancing influenced the shift to a more sedentary behavior, while income and active work favored the increase in alcoholic beverage consumption. These factors should be considered when developing public policies to avoid individual behaviors that are harmful to health during pandemics.

Untangle the relationship of muscle mass and bone mineral content on handgrip strength: Results of ELSA-Brasil.

The study aims to investigate the independent association of muscle mass (MM) and bone mineral content (BMC) in the performance of the handgrip strength (HGS) test and whether there is effect modification by sex and age. In 12,491 participants from the ELSA-Brasil we estimated the associations between MM, BMC and HGS using linear regression models. All the analyses were performed for total population, also stratified for sex and age. For total population an interaction term was included between each explanatory variable of interest with sex and age to verify the presence of effect modification. We observed that the higher quintiles of MM and BMC were associated to an increasing in the mean of HGS compared to the first quintile, with greater magnitudes in men compared to women, also adults compared to elderly. When we estimated the independent effect of each exposure of interest, MM showed stronger effect in HGS in women, men and adults then BMC. In conclusion, we observed that higher amounts of MM and BMC are associated with higher HGS, regardless of sociodemographic characteristics, health conditions and lifestyle, with this effect being greater in men and adults.

Untangle the relationship of muscle mass and bone mineral content on handgrip strength: Results of ELSA-Brasil / Desvendando a relação entre massa muscular e conteúdo mineral ósseo na força de preensão palmar: Resultados do ELSA-Brasil

Abstract The study aims to investigate the independent association of muscle mass (MM) and bone mineral content (BMC) in the performance of the handgrip strength (HGS) test and whether there is effect modification by sex and age. In 12,491 participants from the ELSA-Brasil we estimated the associations between MM, BMC and HGS using linear regression models. All the analyses were performed for total population, also stratified for sex and age. For total population an interaction term was included between each explanatory variable of interest with sex and age to verify the presence of effect modification. We observed that the higher quintiles of MM and BMC were associated to an increasing in the mean of HGS compared to the first quintile, with greater magnitudes in men compared to women, also adults compared to elderly. When we estimated the independent effect of each exposure of interest, MM showed stronger effect in HGS in women, men and adults then BMC. In conclusion, we observed that higher amounts of MM and BMC are associated with higher HGS, regardless of sociodemographic characteristics, health conditions and lifestyle, with this effect being greater in men and adults.

Resumo O estudo tem como objetivo investigar a associação independente da massa muscular (MM) e conteúdo mineral ósseo (CMO) na realização do teste de força de preensão manual (FPM) e se há modificação do efeito por sexo e idade. Em 12.491 participantes do ELSA-Brasil estimamos as associações entre MM, CMO e FPM usando modelos de regressão linear. Todas as análises foram realizadas para a população total, também estratificada por sexo e idade. Para a população total foi incluído um termo de interação entre cada variável explicativa de interesse com sexo e idade para verificar a presença de modificação de efeito. Observamos que os maiores quintis de MM e BMC estiveram associados a um aumento na média da FPM em relação ao primeiro quintil, com maiores magnitudes em homens em relação a mulheres, também em adultos em relação a idosos. Quando estimamos o efeito independente de cada exposição de interesse, MM mostrou efeito mais forte na FPM em mulheres, homens e adultos do que BMC. Em conclusão, observamos que maiores quantidades de MM e BMC estão associadas a maior FPM, independentemente das características sociodemográficas, condições de saúde e estilo de vida, sendo esse efeito maior em homens e adultos.

[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.

Body shape trajectories are associated with birth weight, body mass index and sociodemographic conditions in participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): a multiple correspondence analysis.

BACKGROUND: Evaluating lifelong weight trajectories is challenging due to the high costs of studies that follow individuals from childhood to adulthood. The use of silhouette scales has been a new approach to assess the body shape trajectory across life as a proxy for body weight trajectory. Depending on body shape trajectories, individuals may be more prone to develop diseases in adulthood. Therefore, identifying factors related to them is essential for public health. This study aimed to evaluate body shape trajectories across the lifespan and to verify associations between them, birth weight, body mass index, and sociodemographic conditions in a Brazilian cohort. METHODS: This is a cross-sectional analysis conducted with 14,014 participants of first follow-up data collection of Longitudinal Study of Adult Health (ELSA-Brasil). ELSA-Brasil is a multicentric prospective cohort study initiated in 2008 with civil servants of six public institutions in the Northeast, South and Southeast regions of Brazil. We applied a clustering method to longitudinal data to identify body shape trajectories from 5 to 40 years of age and assessed the associations between these trajectories and birth weight, body mass index and sociodemographic conditions (race, education, maternal education and monthly per capita family income) using multiple correspondence analysis. RESULTS: We found five body shape trajectories for women and three for men. Low birth weight was associated with a slight to moderate increase in shape. High birth weight was associated with maintaining large body size in both sexes and markedly increased body shape in women. Higher sociodemographic status and white race were associated with marked increases in body shape in men and maintenance of medium body shape in women. CONCLUSIONS: The study shows that variables related to worse lifetime weight status (evaluated by anthropometry), such as presence of obesity, are also associated with worse body shape trajectories, as assessed with silhouette scales. Our results suggest that body shape trajectories are a good indicator of body weight trajectories and may be used when cohort studies are not possible.