100% Orange Juice Consumption is Associated with Socioeconomic Status, Improved Nutrient Adequacy, and Higher Bioactive Compounds Intake: Results from Brazilian National Dietary Survey 2017-2018.

OBJECTIVE: The consumption of 100% orange juice (OJ) has been associated with nutrient adequacy and better diet quality. To date, there are few analyses exploring 100% OJ consumption patterns across populations, with no data from Brazil. We aimed to explore the associations between 100% OJ consumption, sociodemographic factors, and nutrient intake in a representative sample of the Brazilian general population aged 10 years or older. METHODS: Data were obtained from the National Dietary Survey 2017-2018, a cross-sectional study including data on individual food intake of 46,164 subjects aged ≥10 years collected using two 24-h dietary recalls. RESULTS: 100% OJ was consumed by 11% of the population, with a mean intake of 43.0 ml/d. Males were more frequent consumers compared to females, and the percentage of consumers increased with education and income. 100% OJ consumption was associated with higher intakes of energy, vitamin C, folate, calcium, magnesium, potassium, polyphenols, and carotenoids. There is no significant difference in fiber intake between consumers and non-consumers. 100% OJ consumers had a higher percentage of the population meeting the Estimated Average Requirement for vitamin A, vitamin C, vitamin D, folate, calcium, and magnesium. CONCLUSION: Our results suggest that 100% OJ could be a component of a healthy diet, helping individuals to achieve nutrient recommendations.

Association of dyslipidemia with single nucleotide polymorphisms of the cholesteryl ester transfer protein gene and cardiovascular disease risk factors in a highly admixed population.

BACKGROUND AND AIMS: Cardiovascular diseases (CVD) are major causes of mortality worldwide, leading to premature deaths, loss of quality of life, and extensive socioeconomic impacts. Alterations in normal plasma lipid concentrations comprise important risk factors associated with CVD due to mechanisms involved in the pathophysiology of atherosclerosis. Genetic markers such as single nucleotide polymorphisms (SNPs) are known to be associated with lipid metabolism, including variants in the cholesteryl ester transfer protein (CETP) gene. Thus, the study's objective was to assess the relationship among lipid profile, socioeconomic and demographic characteristics, health status, inflammatory biomarkers, and CETP genetic variants in individuals living in a highly admixed population. METHODS: The study comprises an analysis of observational cross-sectional data representative at the population level from a highly admixed population, encompassing 901 individuals from three age groups (adolescents, adults, and older adults). Socioeconomic, demographic, health, and lifestyle characteristics were collected using semi-structured questionnaires. In addition, biochemical markers and lipid profiles were obtained from individuals' blood samples. After DNA extraction, genotyping, and quality control according to Affymetrix's guidelines, information on 15 SNPs in the CETP gene was available for 707 individuals. Lipid profile and CVD risk factors were evaluated by principal component analysis (PCA), and associations between lipid traits and those factors were assessed through multiple linear regression and logistic regression. RESULTS: There were low linear correlations between lipid profile and other individuals' characteristics. Two principal components were responsible for 80.8 % of the total variance, and there were minor differences in lipid profiles among individuals in different age groups. Non-HDL-c, total cholesterol, and LDL-c had the highest loadings in the first PC, and triacylglycerols, VLDL-c and HDL-c were responsible for a major part of the loading in the second PC;, whilst HDL-c and LDL-c/HDL-c ratio were significant in the third PC. In addition, there were minor differences between groups of individuals with or without dyslipidemia regarding inflammatory biomarkers (IL-1ß, IL- 6, IL-10, TNF-α, CRP, and MCP-1). Being overweight, insulin resistance, and lifestyle characteristics (calories from solid fat, added sugar, alcohol and sodium, leisure physical activity, and smoking) were strong predictors of lipid traits, especially HDL-c and dyslipidemia (p < 0.05). The CETP SNPs rs7499892 and rs12691052, rs291044, and rs80180245 were significantly associated with HDL-c (p < 0.05), and their inclusion in the multiple linear regression model increased its accuracy (adjusted R2 rose from 0.12 to 0.18). CONCLUSION: This study identified correlations between lipid traits and other CVD risk factors. In addition, similar lipid and inflammatory profiles across age groups in the population suggested that adolescents might already present a significant risk for developing cardiovascular diseases in the population. The risk can be primarily attributed to decreased HDL-c concentrations, which appear to be influenced by genetic factors, as evidenced by associations between SNPs in the CETP gene and HDL-c concentrations, as well as potential gene-diet interactions. Our findings underscore the significant impact of genetic and lifestyle factors on lipid profile within admixed populations in developing countries.

Association between circulating micro-ribonucleic acids and metabolic syndrome in older adults from a population-based study.

BACKGROUND AND AIMS: Aging is a major factor in development of chronic non-communicable diseases (NCD). Epigenetic causes are risk factors in NCD development since studies indicate that the expression of micro-ribonucleic acids (miRs) is altered under different clinical conditions. This study aimed to analyze the expression profile of circulating miRs and investigate their association with biomarkers of cardiometabolic risk in older adults living in São Paulo municipality, Brazil. METHODS: A cross-sectional study was conducted based on the analysis of data from 200 older adults, with a mean age of 69.1 (0.5) years old participating in the ISA-Nutrition. The expression profiles of 21 plasma miRs related to glycemic and lipid metabolism, adiposity, and inflammation were evaluated in relation to cardiometabolic risk. Individuals were distributed into groups according to diagnosis of metabolic syndrome (MetS). The Stata Somersd module was used to calculate confidence intervals for Kendall's tau-a to estimate the correlations among variables. RESULTS: Differences in the plasma expression were observed in two of the 21 miRs evaluated according to the MetS presence in participants. Individuals with MetS showed higher expression of miR-30a and miR-122 than individuals without MetS. CONCLUSIONS: Considering that miR-30, and miR-122 were altered due to MetS, these miRs may be potential biomarkers for MetS in older adults.

Bioactive compounds intake in the Brazilian population: Trends and determinants of socioeconomic inequalities between 2008 and 2018.

OBJECTIVE: The present study aims at evaluating trends and determinants of socioeconomic inequalities in consumption of bioactive compounds in representative sample of the Brazilian population the period from 2008-2009 to 2017-2018. METHODS: Data from two cross-sectional population-based surveys were analyzed in the study, using descriptive analysis and estimation of inequalities in consumption. Trends in polyphenol and carotenoid intake were estimated using food consumption data from National Dietary Survey (NDS) 2008-2009 (n = 34,003) and 2017-2018 (n = 46,164). Evolution and determinants of inequalities in bioactive compounds intake were identified using analysis of inequality based on concentration index. RESULTS: Consumption of total polyphenols, phenolic acids, flavonoids and carotenoid classes (except for zeaxanthin) was significantly associated with per capita income after adjustment for potential confounders, being higher income associated with higher intake of bioactive compounds. Disaggregation of inequalities showed that education was the main factor associated with consumption of flavonoids, other polyphenols and ß-cryptoxanthin in 2008-2009; whilst income was the main barrier to intake of polyphenols and carotenoids in 2017-2018. CONCLUSION: Income level and educational attainment have been important determinants to inequalities in bioactive compounds intake in the Brazilian population throughout the period of analysis, being higher intake of bioactive compounds-rich foods and beverages associated with higher income.

Bioactive Compounds Intake of the Brazilian Population According to Geographic Region.

Studies have been conducted in order to estimate bioactive compound consumption across populations, with substantial disparities according to the origin of the cohort examined. In this sense, Brazil is a continental country with marked differences in food plant availability across geographic regions. We aimed to estimate the bioactive compound intake according to Brazilian geographic region, as well as to determine the major contributors. Data were obtained from the National Dietary Survey 2017-2018, a cross-sectional population-based study including data on the individual food intake of 46,164 subjects aged ≥10 years. The consumption of polyphenols (total and classes) was significantly higher in the South compared with other regions (p = 0.0001). Total carotenoid intake was higher in the Midwest, followed by the Southeast (p = 0.0001). Tea was the main supplier of total polyphenol intake in the South, whereas coffee contributed the most to total polyphenol intake in other Brazilian regions. Açaí, caja juice, mango and corn were important suppliers of carotenoid intake in the North and Northeast. Bioactive compound intake presented variations according to Brazilian region, and individuals living in the South, Midwest and Southeast may experience higher bioactive-dense diets. We highlight the potential of many food plants for sustained explorations to the development of marketable products, possibly increasing the bioactive compound intake.

Circulating MiRNAs Are Associated With Low-grade Systemic Inflammation and Leptin Levels in Older Adults.

Inflammaging refers to the low-grade systemic inflammation that occurs with aging present in chronic non-communicable diseases. MicroRNAs (miRNAs) are potential biomarkers for these diseases in older adults. This study aimed to assess the expression of 21 circulating miRNAs and their associations with inflammatory biomarkers in older adults. This cross-sectional study was performed with 200 individuals participating in ISA-Nutrition. The systemic low-grade inflammation score (SIS) was calculated from the plasma concentration of 10 inflammatory biomarkers. Circulating miRNA expression was assessed using the Fluidigm method. Wilcoxon-Mann-Whitney test was employed to determine differences in SIS among groups distributed according to sex and presence of MetS. Spearman's correlation was used to estimate correlations among SIS, leptin levels, miRNA expression, and variables of interest. Analyses were performed using software R version 4.2.3, with a significance level of 0.05. The final sample consisted of 193 individuals with a mean age of 69.1 (SE = 0.5) years, being 64.7% individuals with metabolic syndrome (MetS). Positive correlations were observed between leptin concentration and metabolic risk factors, and leptin concentration was higher in individuals with MetS compared to those without MetS. The expression of 15 circulating miRNAs was negatively correlated with leptin concentration. GLMs showed negative associations between miRNAs (miR-15a, miR-16, miR-223, miR-363, miR-532), leptin, and/or SIS values; and only miR-21 showed positive association with SIS values. The results suggest the presence of peripheral leptin resistance associated with low-grade inflammation and plasma expression of miRNAs in older adults. These findings suggest the potential role of miRNAs as biomarkers for cardiometabolic risk.

Estimated polyphenol intake and major food sources of the Brazilian population: changes between 2008-2009 and 2017-2018.

Assessing the dietary intake of polyphenols and their major food sources is the first step towards documenting the associations with health outcomes. Considering recent changes in dietary patterns of the Brazilian population, continuous monitoring of polyphenol intake is important. Thus, the present study was conducted to estimate the polyphenol intake and major food sources in the diet of the Brazilian population using data from the most recent National Dietary Survey (NDS, 2017-2018), to characterise the intake changes according to demographic characteristics and to compare the intake over the past decade in Brazil. Data from two cross-sectional population-based surveys were analyzed in the study. Trends in polyphenol intake and major food sources were estimated using food consumption data from NDS 2008-2009 (n 34 003) and 2017-2018 (n 46 164). The median (25-75th percentiles) of energy-adjusted polyphenol intake in 2017-2018 was 216·3 mg (125·3-495·2 mg) per 1000 kcal/d (4184 kJ/d), representing an increase of 12·3 mg/d from 2008-2009. However, unadjusted polyphenol intakes were similar between the surveys (medians: 364·3 mg/d in 2008-2009 and 366·9 mg/d in 2017-2018). The main food sources of total and polyphenol intake classes presented some variations between 2008-2009 and 2017-2018, with greater contribution of beans preparations, salads and tea to polyphenol intake, and decrease of orange contribution. Our study provided an updated information on polyphenol intake and its major food sources. The median intake remains lower than the reported by other populations. Furthermore, the results may contribute to future studies investigating temporal trends in polyphenol intake and disease risk.

Circulating microRNA Related to Cardiometabolic Risk Factors for Metabolic Syndrome: A Systematic Review.

MicroRNA regulates multiple pathways in inflammatory response, adipogenesis, and glucose and lipid metabolism, which are involved in metabolic syndrome (MetS). Thus, this systematic review aimed at synthesizing the evidence on the relationships between circulating microRNA and risk factors for MetS. The systematic review was registered in the PROSPERO database (CRD42020168100) and included 24 case-control studies evaluating microRNA expression in serum/plasma of individuals ≥5 years old. Most of the studies focused on 13 microRNAs with higher frequency and there were robust connections between miR-146a and miR-122 with risk factors for MetS, based on average weighted degree. In addition, there was an association of miR-222 with adiposity, lipid metabolism, glycemic metabolism, and chronic inflammation and an association of miR-126, miR-221, and miR-423 with adiposity, lipid, and glycemic metabolism. A major part of circulating microRNA was upregulated in individuals with risk factors for MetS, showing correlations with glycemic and lipid markers and body adiposity. Circulating microRNA showed distinct expression profiles according to the clinical condition of individuals, being particularly linked with increased body fat. However, the exploration of factors associated with variations in microRNA expression was limited by the variety of microRNAs investigated by risk factor in diverse studies identified in this systematic review.

Overview of Cardiovascular Disease Risk Factors in Adults in São Paulo, Brazil: Prevalence and Associated Factors in 2008 and 2015

Abstract Background Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality in Brazil. Objective To provide population-based data on prevalence and factors associated with CVD risk factors. Methods Individuals aged ≥20 years from two editions of the cross-sectional Health Survey of São Paulo focusing on Nutrition (ISA-Nutrition), performed in Sao Paulo city in 2008 (n=590) and 2015 (n=610), were evaluated for: obesity, central obesity, waist/height ratio, high blood pressure (HBP), dyslipidemia, diabetes, and number of CVD risk factors ≥3. Prevalence was estimated according to complex survey procedures. Factors associated with cardiovascular risk factors were assessed using logistic regression, with statistical significance of p<0.05. Results Obesity and older age were associated with higher odds of all cardiovascular risk factors investigated, except for dyslipidemia. HBP was positively associated with being Black/Brown and negatively associated with being physicaly active in leisure time. Women were more likely to have increased adiposity indicators and three or more cardiovascular risk factors than men. Those with higher education had lower chances of having diabetes, HBP and dyslipidemia, and those with higher income had higher chances of having three or more risk factors. Former smokers had higher odds of diabetes, obesity, and high waist/height ratio, and smokers had higher odds of high non-HDL cholesterol levels. From 2008 to 2015, there was an increase (p<0.001) in the prevalence of diabetes (6.9% to 17.3%), HBP (31.9% to 41.8%), dyslipidemia (51.3% to 67.6%), and number of CVD risk factors ≥3 (18.9% to 34.1%). Conclusion This study shows increasing prevalence of CVD risk factors in adult population in Sao Paulo and may support the definition of target groups and priority actions on CVD prevention and treatment.

Assessment of dietary intake of bioactive food compounds according to income level in the Brazilian population.

There is an inverse association between bioactive compounds intake and disease risk. The knowledge of its consumption according to socio-economic strata is important, which allows identification of potential intervention targets. Thus, we aimed to investigate bioactive compounds intake according to income level in Brazilian population. Data were obtained from the Brazilian Household Budget Survey, a cross-sectional survey which included data on individual food intake of 34,003 subjects aged 10 years and over collected using two 24-h dietary records. Polyphenol and carotenoid content of foods was identified using published databases. Total polyphenol and carotenoid intake were determined according to per capita income, as well as main food sources. Total polyphenols and flavonoids intake increased with income level, and subjects with lower income showed higher phenolic acids intake than individuals in highest income (p = 0.0001). Total carotenoids and classes intake (with exception to ß-cryptoxanthin and zeaxanthin) were higher among subjects in highest income quartile, compared to the lowest quartile (p = 0.0001). Coffee was major source to total polyphenols and phenolic acids intake, and orange juice was main flavonoid provider in individuals from all income levels. In the upper income quartile, total carotenoid was supplied mainly by tomato and kale, and fruits had important contribution to carotenoid intake in the lowest income quartile. There is important influence of income level on diet quality regarding intake of foods with bioactive compounds, and individuals with lower income may experience lower quality diets due to less availability of foods with bioactive compounds.

Influence of foods and nutrients on COVID-19 recovery: A multivariate analysis of data from 170 countries using a generalized linear model.

BACKGROUND & AIMS: COVID-19 is an emergency public health problem of global importance. This study aimed to investigate the effect of foods and nutrients as complementary approaches on the recovery from COVID-19 in 170 countries, especially considering the complexity of the disease and the current scarcity of active treatments. METHODS: A retrospective study was performed using the Kaggle database, which links the consumption of various foods with recovery from COVID-19 in 170 countries, using multivariate analysis based on a generalized linear model. RESULTS: The results showed that certain foods had a positive effect on recovery from COVID-19: eggs, fish and seafood, fruits, meat, milk, starchy roots, stimulants, vegetable products, nuts, vegetable oil and vegetables. In general, consumption of higher levels of proteins and lipids had a positive effect on COVID-19 recovery, whereas high consumption of alcoholic beverages had a negative effect. In developed countries, where hunger had been eradicated, the effect of food on recovery from COVID-19 had a greater magnitude than in countries with a higher global hunger index (GHI), where there was almost no identifiable effect. CONCLUSION: Several foods had a positive effect on COVID-19 recovery in developed countries, especially food groups with a higher content of lipids, proteins, antioxidants and micronutrients (e.g., selenium and zinc). In countries with extreme poverty (high GHI), foods presented little effect on recovery from COVID-19.

Cost-Effectiveness of Molecular Method Diagnostic for Rapid Detection of Antibiotic-Resistant Bacteria.

OBJECTIVES: This study aimed to perform a cost-effectiveness analysis (CEA) of the molecular diagnostic method (MM) associated with conventional diagnostic method (CM) compared with the CM alone, for the detection of resistant profile in bacteremia, from the perspective of the Brazilian Public Health System, in intensive care units setting. METHODS: The clinical parameters regarding methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Gram-negative bacteria (CRGNB), and vancomycin-resistant Enterococcus spp. (VRE) infections were collected from searches on PubMed, Scopus, and SciELO, using specific keywords. Data on direct medical costs to treat these infections were collected according to Brazilian Public Health System perspective from Brazilian databases, in tables of 2018 to 2019. CEA was performed after building a dynamic model, which was calibrated and validated according to international recommendations. The incremental cost-effectiveness ratio of the MM + CM compared with the CM was calculated using the outcomes "avoided death" and "avoided resistant infections." One-way sensitivity analyses were performed. RESULTS: This CEA demonstrated that the MM + CM was dominant in all scenarios. Estimates showed that for MRSA, CRGNB, and VRE infections, every avoided death would lead to savings of Brazilian real (R$) 4.9 million ($937 301), R$2.2 million ($419 899), and R$1.3 million ($248 919), respectively. The same infections assessed by avoided resistant infections savings were projected to be R$24 964 ($4686), R$40 260 ($7558), and R$23 867 ($4480). CONCLUSIONS: MM leads to cost reduction and increased benefits, optimizing the use of financial resources on the health system in the intensive care unit setting, in bacteremia caused by MRSA, CRGNB, and VRE.

Circulating microRNAs Showed Specific Responses according to Metabolic Syndrome Components and Sex of Adults from a Population-Based Study.

MicroRNAs (miRNAs) regulate several metabolic pathways and are potential biomarkers for early risk prediction of metabolic syndrome (MetS). Our aim was to evaluate the levels of 21 miRNAs in plasma according to MetS components and sex in adults. We employed a cross-sectional study of 192 adults aged 20 to 59 years old from the 2015 Health Survey of São Paulo with Focus in Nutrition. Data showed reduced levels of miR-16 and miR-363 in women with MetS; however, men with one or more risk factors showed higher levels of miR-let-7c and miR-30a. Individuals with raised waist circumference showed higher levels of miR-let-7c, miR-122, miR-30a, miR-146a, miR-15a, miR-30d and miR-222. Individuals with raised blood pressure had higher miR-30a, miR-122 and miR-30a levels. Plasma levels of four miRNAs (miR-16, miR-363, miR-375 and miR-486) were lower in individuals with low HDL-cholesterol concentrations. In addition, plasma levels of five miRNAs (miR-122, miR-139, miR-let-7c, miR-126 and miR-30a) were increased in individuals with high fasting plasma glucose and/or insulin resistance. Our results suggest that the pattern of miRNA levels in plasma may be a useful early biomarker of cardiometabolic components of MetS and highlight the sex differences in the plasma levels of miRNAs in individuals with MetS.

Association between selected individual and environmental characteristics in relation to health behavior of Brazilian adolescents.

OBJECTIVE: The study investigates the evolution of healthy behaviors (healthy eating and regular physical activity) in Brazilian adolescents during 2012 and 2015, and its associations with self-assessment of body weight and adoption of weight control attitudes, in the context of diverse household features, school environments, and regional characteristics. METHODS: Two cross-sectional surveys of Brazilian adolescents attending the ninth grade in 2012 and 2015 were gathered comprising a national sample. Data from 209,601 completed surveys were analyzed using robust error estimates of ordinary least squares regressions. RESULTS: Results showed that there was a decrease in the frequency of healthy foods consumption and recommended physical activity level between 2012 and 2015. The regression analyses revealed that healthy eating and physical activity were significantly higher for adolescents with normal weight perception (i.e., did not perceive themselves to have either low or excess body weight) and for adolescents who were male, were members of middle socioeconomic stratum families, and had mothers with college degrees. In addition, healthy eating was significantly higher for adolescents who did not wish to lose weight, did not watch TV while eating, went to public schools, and lived with both parents. Ethnic differences varied based on region, with healthy eating being significantly higher among black/mulato/indigenous adolescents in the South and Southeast regions, but significantly higher among white/yellow adolescents in the North region. CONCLUSIONS: Ethnic and gender-related differences were identified in health behaviors and attitudes towards weight control of Brazilian adolescents. Findings indicate the relevance of individual characteristics combined with the influence of social networks for the adoption of healthy behaviors among adolescent students. LEVEL OF EVIDENCE: Level IV, evidence obtained from multiple time series without intervention.

Sociodemographic determinants of health behaviors among Brazilian adolescents: Trends in physical activity and food consumption, 2009-2015.

INTRODUCTION: Food consumption habits and physical activity levels are health behaviors influenced by sociocultural factors during adolescence. This study analyzes the trends and the sociodemographic determinants in the adoption of health behaviors among students in Brazilian state capitals regarding frequencies of consumption of healthy and unhealthy foods and level of physical activity in 2009, 2012 and 2015. METHODS: This study comprises an investigation of three editions of a cross-sectional survey conducted, at national level, by the Brazilian Institute for Geography and Statistics in partnership with the Brazilian Ministry of Health. Students attending elementary school ninth grade in public and private schools were selected using two stage sampling process to participate in the survey in 2009, 2012 and 2015. We selected variables that were comparable in the three editions of the survey, including individual-level sociodemographic and behavioral features, and household-level family and geographical characteristics. The dependent variables selected for multivariate logistic regression models included physical activity levels and frequencies of healthy and unhealthy foods consumption. RESULTS: Male adolescents from higher socioeconomic strata in 2009 and 2015 and students who declared frequent consumption of healthy foods were more likely to practice physical activities. However, there was a significant decrease in physical activity among Brazilian adolescents during the period analyzed, independently of socioeconomic strata. Healthy eating patterns were observed among non-white adolescents, students who declared having meals with their parents, and individuals who fulfill recommendations of physical activity level throughout the week. On the other hand, unhealthy eating pattern was more frequently observed among female adolescents and students who declared having meals while watching television. CONCLUSION: Evidence shows limited effects of socioeconomic level on the adoption of healthy behaviors among adolescents in Brazil, and influence of family practices on the establishment of healthy food consumption patterns (e.g., presence of parents and absence of practices like watching television during meals).

Association between quality of life, physical activity, use of medication and costs of treatment for chronic diseases in Primary Care.

BACKGROUND: The aim of this study was to investigate the costs and the health outcomes of primary care treatments for chronic diseases and to analyze the association between domains of quality of life (QoL), physical activity and healthcare costs. METHODS: The sample encompassed 292 patients aged 50 years or more in Brazilian primary care facilities, categorized in three groups: no drug treatment or only regular physical activity, only drug treatment, and drug treatment with regular physical activity. Patients were assessed in relation to quality of life, healthcare costs, regular physical activity, and use of medications. RESULTS: Results indicate higher cost-utility ratio among primary care patients adopting only drug treatment (3.92), followed by drug treatment with regular physical activity (3.21), and no drug treatment or only regular physical activity (0.12). CONCLUSIONS: QoL was significantly associated with risk factors for chronic diseases, especially obesity, and limitations in mobility showed important increases in healthcare costs. The dominant strategy in terms of cost-utility ratio was identified among primary care patients without drug treatment or physically active, followed by patients in drug treatment combined with regular physical activity. Drug treatment without regular physical activity showed worst results in relation to other primary care strategies.

An assessment of direct and indirect costs of dementia in Brazil.

BACKGROUND: To analyze costs associated with dementia based on a cross-sectional study in the Brazilian health system. METHODS: Direct and indirect costs were estimated by conducting comprehensive interviews on the use of resources in a sample of 156 patients with dementia treated at an outpatient memory clinic of a tertiary hospital. A regression model was used to determine the main determinants of costs associated with dementia. RESULTS: Global costs of dementia were US$1,012.35; US$1,683.18 and US$1,372.30 per patient/month for mild, moderate and severe stages, respectively. Indirect costs ranged from US$536.62 to US$545.17 according to severity. Dementia costs were influenced by medication, FAST score, and educational level of caregiver. DISCUSSION: The study represents an original contribution toward establishing direct and indirect costs of dementia in Brazil. Results indicate significant economic impacts, including projection of annual costs of US$16,548.24 per patient.

The burden of abdominal obesity with physical inactivity on health expenditure in Brazil

The purpose of this study was to analyze the association between the clustering of physical inactivity with abdominal obesity and public health care expenditure in Brazilian adults. The sample was composed of 963 patients of both genders, randomly selected in the Brazilian Public Health care System during 2010. Entire health care expenditures during the last year were computed and stratified into: medical consultations, medication dispensing, laboratory tests and overall expenditure. Waist circumference was used to diagnose abdominal obesity and physical activity was assessed by previously validated questionnaire. Sedentary and abdominally obese patients (OR= 3.01 [OR95%CI= 1.81-4.99]) had higher likelihood be inserted in the group of higher expenditures than only abdominally obese patients (OR= 1.66 [OR95%CI= 1.07-2.59]). There is a synergic effect between abdominal obesity and physical inactivity on overall health care expenditures.

O objetivo deste estudo foi analisar a associação entre a agregação de inatividade física com a obesidade abdominal e despesas de saúde pública em adultos brasileiros. A amostra foi composta de 963 pacientes de ambos os sexos, selecionados aleatoriamente no Sistema Único de Saúde em 2010. Gastos com saúde durante o último ano foram computados e estratificados em: consultas médicas, distribuição de medicamentos, exames laboratoriais e gasto total. A circunferência da cintura foi usada para diagnosticar a obesidade abdominal e atividade física foi avaliada através de um questionário previamente validado. Pacientes sedentários e com obesidade abdominal (OR = 3.01 [IC95% = 1.81-4.99]) apresentaram maior probabilidade de ser inserido no grupo de despesas mais elevadas do que apenas os pacientes com obesidade abdominal (OR= 1.66 [IC95%= 1.07-2.59]). Existe um efeito sinérgico entre a obesidade abdominal e sedentarismo em despesas totais de saúde.

El objetivo de este estudio fue analizar la asociación entre la agregación de la inactividad física con la obesidad abdominal y el gasto público en salud en adultos brasileños. La muestra consistió en 963 pacientes de ambos sexos, seleccionados al azar en el Sistema de la Salud en 2010. El gasto en salud en el último año se calcula y se estratificó en: consultas médicas, medicamentos, exámenes de laboratorio y el gasto total. Circunferencia de la cintura se utiliza para diagnosticar la obesidad abdominal y la actividad física se evaluó mediante un cuestionario previamente validado. Pacientes sedentarios y con obesidad abdominal (OR= 3,01 [IC95%= 1,81-4,99]) tenían más probabilidades de ser incluido en el grupo de los mayores gastos que sólo los pacientes con obesidad abdominal (OR= 1,66 [IC95%= 1,07-2,59]). Existe un efecto sinérgico entre la obesidad abdominal y la inactividad física en el gasto total en salud.

The burden of physical activity on type 2 diabetes public healthcare expenditures among adults: a retrospective study.

BACKGROUND: Determinants of public healthcare expenditures in type 2 diabetics are not well investigated in developing nations and, therefore, it is not clear if higher physical activity decreases healthcare costs. The purpose of this study was to analyze the relationship between physical activity and the expenditures in public healthcare on type 2 diabetes mellitus treatment. METHODS: Cross-sectional study carried out in Brazil. A total of 121 type 2 diabetics attended to in two Basic Healthcare Units were evaluated. Public healthcare expenditures in the last year were estimated using a specific standard table. Also evaluated were: socio-demographic variables; chronological age; exogenous insulin use; smoking habits; fasting glucose test; diabetic neuropathy and anthropometric measures. Habitual physical activity was assessed by questionnaire. RESULTS: Age (r = 0.20; p = 0.023), body mass index (r = 0.33; p = 0.001) and waist-to-hip ratio (r = 0.20; p = 0.025) were positively related to expenditures on medication for the treatment of diseases other than diabetes. Insulin use was associated with increased expenditures. Higher physical activity was associated with lower expenditure, provided medication for treatment of diseases other than diabetes (OR = 0.19; p = 0.007) and medical consultations (OR = 0.26; p = 0.029). CONCLUSIONS: Type 2 diabetics with higher enrollment in physical activity presented consistently lower healthcare expenditures for the public healthcare system.