Dietary fructose, fruits, fruit juices and glucose tolerance status in Japanese-Brazilians.

BACKGROUND AND AIMS: Evidence suggests that fructose and sweetened beverages may be a risk factor for obesity and type 2 diabetes, but the role of sweetened fruit juices in glucose disturbances has been minimally explored. The aim of this study was to examine the association of total fructose, fresh fruit and sweetened fruit juice intake with glucose tolerance homeostasis in Japanese-Brazilians. METHODS AND RESULTS: A total of 475 men and 579 women aged >or=30 years were evaluated in a cross-sectional population-based survey with a standardized protocol including a 2-h oral glucose tolerance test (WHO criteria). Habitual food consumption was obtained using a validated food frequency questionnaire for Japanese-Brazilians. After adjustments for potential confounding variables, the odds ratio (OR; 95%CI) for impaired glucose tolerance was 2.1 (1.0-4.5; P for trend=0.05) for the highest as compared to the lowest tertile intake of total fructose and 2.3 (1.1-5.1; P for trend=0.05) for the highest as compared to the lowest tertile intake of sweetened fruit juices. CONCLUSION: Our results showed that high intakes of dietary fructose and sweetened fruit juices, but not whole fresh fruits, were associated with impaired glucose tolerance among genetically susceptible individuals.

Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30-69 yr. The Brazilian Cooperative Group on the Study of Diabetes Prevalence.

OBJECTIVE: To assess the prevalence of diabetes and IGT in the urban adult Brazilian population. RESEARCH DESIGN AND METHODS: We used a two-stage, multicenter, cross-sectional survey in a random sample of 21,847 individuals aged 30-69 yr from nine large cities. Subjects were first screened by FCG. All positive screenees (FCG > or = 5.6 mM/L) and every sixth consecutive negative screenee were administered a 75 g OGTT and classified as diabetic, IGT, or normal (nondiabetic) according to WHO recommendations. OGTT findings from the negative screenees were extrapolated to all negative screenees after adjustments for potential biases. RESULTS: The overall rates were 7.6 and 7.8% for diabetes and IGT, respectively. Men (7.5%) and women (7.6%) had similar rates of diabetes. Similar rates resulted with whites (7.8%) and nonwhites (7.3%). Diabetes prevalence increased from 2.7% in the 30-39-yr age-group to 17.4% in the 60-69-yr age-group. Diabetes was more prevalent among less educated people, but this difference disappeared after adjusting for age. Family history of diabetes was associated with a twofold increase in diabetes prevalence (12.5 vs. 5.8%); the same increase occurred with obesity (11.6 vs. 5.2%). Undiagnosed diabetes accounted for 46% of the total prevalence. Among previously diagnosed cases, 22.3% were not under treatment, 7.9% were on insulin, 40.7% were on oral agents, and 29.1% were on dietary treatment only. Self-reported diabetes prevalence was 0.1, 3.2, and 11.6% in the age groups < 30, 30-69, and > 70 yr, respectively. CONCLUSIONS: The prevalence of diabetes in Brazil is comparable with that of more developed countries, where it is considered a major health problem.

The prevalence of diabetes in Rio de Janeiro, Brazil. The Cooperative Group for the Study of Diabetes Prevalence in Rio De Janeiro.

OBJECTIVE: To assess the prevalence of diabetes and impaired glucose tolerance (IGT) in the adult population of Rio de Janeiro, a two-stage cross-sectional survey was carried out in a random sample of 2,051 individuals aged 30-69 years from Rio de Janeiro city in Brazil. RESEARCH DESIGN AND METHODS: Subjects were first screened by fasting capillary glycemia (FCG). All individuals who screened positive (FCG > 5.6 mmol/l) and every sixth consecutive person who screened negative (FCG < 5.6 mmol/l) were subjected to a 75-g glucose load. Diagnoses of diabetes and IGT were based on World Health Organization criteria. RESULTS: Results from every sixth individual who screened negative were extrapolated to all individuals who screened negative after adjustment for some potential bias in the subsample. Age-adjusted prevalence rates for diabetes and IGT were 7.1 and 9.0%, respectively. The rates were higher (P < 0.01) among women than among men (8.7 vs. 5.2% for diabetes and 11.7 vs. 5.8% for IGT), among obese individuals than among nonobese individuals (7.9 vs. 6.2% for diabetes and 11.4 vs. 7.3% for IGT), and among those with family history of diabetes than among those without family history of diabetes (12.4 vs. 4.8% for diabetes and 13.8 vs. 6.7% for IGT). The rates for diabetes and IGT increased with age, being 1.7 and 4.5%, respectively, for the age-group of 30-39 years, 3.9 and 8.5% for the age-group of 40-49 years, 13.6 and 13% for the age-group of 50-59 years, and 17.3 and 15.3% for the age-group of 60-69 years (P < 0.01). The prevalence of diabetes was higher among individuals with low educational levels than among those with high educational levels (7.3 vs 4.2%). For IGT, the rates increased from the group with intermediate level of education (8.3%) to the low- (11.3%) and high-education group (12.6%). Differences in the rates for whites and non-whites (6.9 vs. 7.1% for diabetes and 8.8 vs. 9.6% for IGT) were not statistically significant. Among those with confirmed diabetes in the survey, 27.6% did not know of their diabetic condition. Among previously diagnosed diabetes (self-reported diabetes), 19.5% were not being treated, 31.8% were on diet only, 40.7% were on oral hypoglycemic drugs, and 8.0% were on insulin. Self-reported prevalence of diabetes was 0.1% for the population < 30 years of age, 4.3% for the 30-69 year old age-group, and 16.6% for those > 70 years of age. CONCLUSIONS: The numbers found for Rio de Janeiro are similar to those for more developed countries and lead us to conclude that the impact of diabetes on public health is the same as in those countries where this disease is considered an important health problem.

The ROC curve in the evaluation of fasting capillary blood glucose as a screening test for diabetes and IGT.

OBJECTIVE: To assess the performance of different cutoff points of fasting capillary glycemia (FCG) in the diagnosis of diabetes and impaired glucose tolerance (IGT) using the receiver operating characteristics (ROC) curve approach. RESEARCH DESIGN AND METHODS: This study included a sample of 4,019 subjects without a previous history of diabetes who were recruited for a confirmatory 2-h post-glucose challenge capillary glycemia from a larger sample of 21,847 individuals screened with FCG. The sensitivity and the specificity of FCG as a screening test were analyzed in the cutoff range 3.9-8.9 mmol/l, and the corresponding ROC curves were plotted to assess the performance of the test. RESULTS: The screening test performance was better for diabetes than for IGT in the full range of cutoff points studied. Sensitivities ranged between 37.9 and 97.1% for diabetes and 1.8 and 94.4% for IGT; the areas under the ROC curves were 0.91 +/- 0.01 and 0.75 +/- 0.01, respectively. The cutoffs showing the best equilibrium between sensitivity and specificity approached 5.6 and 5.0 mmol/l for diabetes and IGT, respectively. Factors such as age, color, and family history of diabetes can affect the screening test performance. CONCLUSIONS: ROC curves can provide useful information toward improving the usefulness of FCG as a screening test for abnormalities of glucose tolerance.

Comparison of glucose tolerance categories according to World Health Organization and American Diabetes Association diagnostic criteria in a population-based study in Brazil. The Japanese-Brazilian Diabetes Study Group.

OBJECTIVE: To compare the prevalence of different categories of glucose tolerance in a Japanese-Brazihan population using World Health Organization (WHO) and American Diabetes Association (ADA) diagnostic criteria. RESEARCH DIVISION AND METHODS: The analyses were based on the data obtained from a study conducted in a representative sample of the Japanese-Brazilian population composed of 647 subjects (40-79 years) who were submitted to a 2-h oral glucose tolerance test. Prevalence of glucose tolerance categories and the level of agreement (K statistics) were obtained using WHO and ADA criteria. Cardiovascular risk profile of the subjects with different diagnostic categories were compared. RESULTS: Similar prevalences of diabetes were found considering both criteria (WHO, 20.3%; ADA, 19.2%). The prevalence of impaired glucose tolerance (IGT) by WHO criteria was 14.7%, contrasting with 7.4% of impaired fasting glucose (IFG) by ADA criteria. Subjects with discordant diagnostic categories by the criteria, considered at risk for diabetes (IGT/IFG), showed a worse metabolic profile than the concordant normal subjects. However, subjects with discordant diagnoses who had IGT or diabetes by WHO criteria but who were normal by ADA criteria exhibited a higher number of cardiovascular risk factors (higher blood pressure and triglyceride and low HDL cholesterol) than those who were discordant (IFG/diabetes) by ADA criteria but normal by WHO criteria. CONCLUSIONS: Although the number of diabetic subjects was similar between the criteria, those identified as being at risk for diabetes were quite distinct. Fewer subjects were classified as having IFG by ADA criteria than as having IGT by WHO criteria. Abnormal glucose tolerance based on WHO criteria seems to identify a worse cardiovascular profile than abnormal tolerance based on ADA criteria. Follow-up studies are necessary to know the prognostic significance of IFG to predict subsequent diabetes.

Evaluation of three potential screening tests for diabetes mellitus in a biethnic population.

We tested the ability of three potential screening tests for diabetes (fasting plasma glucose value greater than or equal to 140 mg/dl, 1-h postglucose (PG) load value greater than or equal to 200 mg/dl, and 2-h PG value greater than or equal to 200 mg/dl) to detect non-insulin-dependent diabetes in 130 diabetic Mexican Americans (MAs) and 50 diabetic Anglo Americans (AA) using the National Diabetes Data Group criteria as the standard. The sensitivity of the fasting plasma glucose (FPG) cutpoint in detecting diabetes was low in both AAs (36.0%) and MAs (59.3%) and was related to the age-adjusted prevalence rates of diabetes in the two ethnic groups (AAs, 4.9%; MAs, 10.9%). The 2-h PG load cutpoint had good sensitivity (greater than 93%) and specificity (greater than 99%) in both ethnic groups. The ethnic difference in the sensitivity of the FPG cutpoint appeared to be related to the greater hyperglycemia of diabetic MAs compared with diabetic AAs. Nearly 30% of diabetic MAs had FPG values greater than or equal to 200 mg/dl as contrasted with only 10% of diabetic AAs. The difference in severity of hyperglycemia between the ethnic groups appears to be unrelated to ethnic differences in adiposity, pharmacologic treatment, or delay in diagnosis, although longer disease duration in MAs may explain part of the difference.

Population-based incidence of IDDM in the state of São Paulo, Brazil.

OBJECTIVE: To study the incidence of IDDM among children, infants to 14 yr of age, in the state of São Paulo, Brazil, 1987-1991. RESEARCH DESIGN AND METHODS: A prospective population-based register was established, using physician reports of newly diagnosed IDDM patients < 15 yr of age as the primary source of case identification and school surveys as the main secondary source. Data were collected according to the methods recommended by the Diabetes Epidemiology Research International group. RESULTS: Case ascertainment was estimated at 95.0, 92.8, and 98.8% complete for each of the three cities studied. The average annual IDDM incidence was 7.6/100,000 inhabitants (95% confidence interval, 5.6-9.7). We found a higher incidence rate in girls than boys. CONCLUSIONS: The incidence of childhood IDDM in a tropical region in South America (São Paulo, Brazil) is in the middle incidence range observed in developed countries throughout the world. Increased incidence of IDDM in girls compared with boys will be tested by the ongoing Brazilian incidence study being developed in 18 other centers across the country.

Fasting plasma glucose is a useful test for the detection of gestational diabetes. Brazilian Study of Gestational Diabetes (EBDG) Working Group.

OBJECTIVE: To evaluate fasting plasma glucose as a screening test for states of gestational diabetes. RESEARCH DESIGN AND METHODS: Baseline data of a cohort conducted in general prenatal care units in Brazil, enrolling 5,579 women aged > or = 20 years with gestational ages of 24-28 weeks at the time of testing and no previous diagnosis of diabetes. A standardized 2-h 75-g oral glucose tolerance test was performed in 5,010 women. Gestational diabetes and its subcategories--diabetes and impaired glucose tolerance--were defined according to the 1994 World Health Organization panel recommendations. We evaluated screening properties of calculated sensitivity and specificity for fasting plasma glucose with receiver operator characteristic curves. RESULTS: For detection of the subcategory diabetes, a fasting plasma glucose of 89 mg/dl jointly maximizes sensitivity (88%) and specificity (78%), identifying 22% of the women as test-positive. For detection of impaired glucose tolerance, a value of 85 mg/dl jointly maximizes sensitivity and specificity (68%), identifying as test-positive 35% of the women. Lowering the cut point to 81 mg/dl increases sensitivity to 81%, but decreases specificity to 54%, labeling as test-positive 49% of the women. CONCLUSIONS: Fasting plasma glucose is a useful test for the screening of both subcategories of gestational diabetes, a threshold of 85 mg/dl being an acceptable option. Effective screening for the subcategory diabetes can be achieved using a cut point of 89 mg/dl. If greater emphasis is placed on the detection of impaired glucose tolerance, a lower value, 81 mg/dl, may be needed.

Is insulin or its precursor independently associated with hypertension? An epidemiological study in Japanese-Brazilians.

Japanese individuals living outside Japan are more susceptible to chronic diseases included in the insulin resistance syndrome. Hyperinsulinemia and hypertension are associated, but large studies adjusting for confounders are still required. The present evaluated if insulin (I) or proinsulin (PI) was associated with hypertension after adjustment for other risk factors, in first (n=238) and second (n=292) generation Japanese-Brazilians, aged 40 to 79 years, living in a developed city in Brazil. Blood pressure (BP) was measured by random-zero sphygmomanometry. People with mean systolic/diastolic BP >140/90 mm Hg or taking antihypertensive drugs were considered hypertensive. Diagnosis of diabetes was based on results of an oral glucose tolerance test using WHO criteria. I and PI after fasting and 2 hours after glucose load were determined by specific immunofluorimetric assays. The first generation was older than the second (65.6+/-9.2 versus 53.6+/-8.4 years, P<.01) and male/female ratios were 1.14 and 0.87, respectively. The age-adjusted prevalence of hypertension was 29.2% with no difference between sexes or generations. Higher body mass index (25.2+/-4.3 versus 23.8+/-3.3 kg/m2), waist-to-hip ratio (0.939+/-0.067 versus 0.919+/-0.073), plasma glucose (6.3+/-2.3 versus 5.6+/-1.8 mmol/L), cholesterol (5.74+/-1.19 versus 5.48+/-1.08 mmol/L), and creatinine (74+/-26 versus 83+/-36 micromol/L) were found among the hypertensives (P<.05). Univariate analyses showed associations of obesity, diabetes, and dyslipidemia with hypertension. Logistic regression analyses demonstrated that 2-hour I (OR, 1.22; 95% CI, 1.02 to 1.46) and fasting PI (OR, 1.14; 95% CI, 1.00 to 1.31) remained significantly associated with hypertension, after adjustment for age, sex, generation, family history of hypertension, smoking habits, waist-to-hip ratio, serum creatinine, glucose intolerance, and dyslipidemia. Japanese-Brazilians have a higher prevalence of hypertension than the general population in Brazil. High levels of 2-hour I, seen in hypertensives, may be interpreted as independent risk factors for hypertension in this population. Our findings suggest that fasting PI should be useful, in addition to insulin, to assess risk factors for hypertension in epidemiological studies.

Blood pressure in four remote populations in the INTERSALT Study.

Four remote population samples (Yanomamo and Xingu Indians of Brazil and rural populations in Kenya and Papua New Guinea) had the lowest average blood pressures among all 52 populations studied in INTERSALT, an international cooperative investigation of electrolytes and blood pressure. Average systolic blood pressure was 103 versus 120 mm Hg in the remaining INTERSALT centers; diastolic blood pressure in these four population samples averaged 63 versus 74 mm Hg in the 48 other centers. There was little or no upward slope of blood pressure with age; hypertension was present in only 5% of the rural Kenyan sample and virtually absent in the other three centers. Also in marked contrast with the rest of the centers was level of daily salt intake, as estimated by 24-hour urinary sodium excretion. Median salt intake ranged from under 1 g to 3 g daily versus more than 9 g in the rest of INTERSALT populations. Average body weight was also low in these four centers, with no or low average alcohol intake, again unlike the other centers. The association within these four centers between the above variables and blood pressure was low, possibly reflecting their limited variability. While several other INTERSALT centers also had low average body weight or low prevalence of alcohol drinking, when this was accompanied by much higher salt intake (7-12 g salt or 120-210 mmol sodium daily), hypertension prevalence ranged from 8% to 19%. These findings confirm previous reports that in populations with a low salt intake, there is little or no hypertension or rise of blood pressure with age.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes in Japanese-Brazilians--influence of the acculturation process.

Epidemiologic studies of migrant populations provide very promising clues towards understanding the roles of genetics and environmental factors in the etiology of diabetes mellitus. Populations of Japanese ancestry are of particular interest due to marked differences in prevalence rates of non-insulin dependent diabetes (NIDDM) when comparing those living in Japan with those who migrated to western countries. Brazil offers very favorable conditions of the study of diabetes in the Japanese origin population. Presently, Brazil has the largest population of Japanese ancestry outside Japan. A cross-sectional study comparing first (Issei) and second (Nisei) generations of Japanese-Brazilians living in the city of Bauru, in the industrialized state of São Paulo, southeast of Brazil, was carried out between May and November 1993. The study sample consisted of all first generation (127 men and 111 women) and a random sample of second generation (136 men and 156 women) aged 40-79 years. Results show that: 1--The prevalence of diabetes in Japanese Brazilians (12.8 and 16.2% for first and second generations) are higher than the rates reported for Japan at comparable age-groups. 2--Comparing generations, the age-adjusted prevalence of diabetes was higher in the second generation only for men (men: 12.4 vs. 21.7%; women: 11.6 vs. 11.4%). 3--Obesity was more prevalent in the second generation among men (Men: 34.6 vs. 45.7% women, 39.6 vs. 40.8%).

Disturbances of glucose and lipid metabolism in first and second generation Japanese-Brazilians. Japanese-Brazilian Diabetes Study Group.

Increased prevalence of self-reported NIDDM in Japanese-Brazilians was reported when compared to Japan. This study aimed at determining the prevalence of NIDDM and IGT in Japanese-Brazilians living in the city of Bauru, São Paulo, Brazil. The impact of western environment on the frequency of obesity, dyslipidemia and hypertension was investigated. All Issei (first generation; n = 238) and a random sample of Nisei (second generation; n = 292), aged 40-79 years, were selected for clinical examination and OGTT (WHO criteria). Age-adjusted prevalence of NIDDM did not differ between men and women for Issei (12.4 vs. 11.6%, respectively), but it became different for Nisei (21.7 vs. 11.4%, P < 0.03) due to an increased rate among men. Increased IGT prevalence was also observed between Issei and Nisei men (8.5 vs. 19.3%, P < 0.03). Issei women had a higher IGT rate than Issei men (27. 3 vs. 8.5%, P < 0.0005). Body mass index (BMI) was higher in the second generation (24.1 +/- 3.6 vs. 23.3 +/- 3.1 kg/m2, P < 0.00005) and also the frequency of obesity, defined as BMI > 25 kg/m2. Comparison of waist/hip ratio by gender showed that only among women, Nisei had lower ratio than Issei (0.90 vs. 0.88, P < 0.05). Nisei had a lower total and LDL-cholesterol than Issei but triglyceride and HDL-cholesterol did not differ. Nisei women (younger than the Issei) had lower triglyceride and total cholesterol. This pattern was not seen between the two generations of men. Considering the mean blood pressure values, Issei and Nisei groups with normal glucose tolerance were not hypertensive. Systolic blood pressure was lower in Nisei and the inverse was found concerning diastolic levels. NIDDM prevalence in Japanese-Brazilians is higher than in Japan and in the general Brazilian population. Besides environment, genetic factors may confer susceptibility to NIDDM when they are exposed to a western environment. Before developing glucose intolerance, disturbances of lipid profile and blood pressure could be detected. Nisei may be more affected due to a longer exposure to an unfavorable environment and these changes seem to occur earlier among men than women.

Self-reported prevalence of non-insulin-dependent diabetes mellitus in the 1st (Issei) and 2nd (Nisei) generation of Japanese-Brazilians over 40 years of age.

The immigration of Japanese people to Brazil began in 1908 with two major waves, from 1925 to 1940 and from 1952 to the 1960s. Brazil has the largest population (about 1,288,000) of Japanese origin outside Japan with varying age groups. A mortality study revealed that diabetes as an underlying cause of death was higher in the first-generation Japanese than in Japan (3.4 vs. 1.9 per 100,000 for men, and 7.2 vs. 1.9 for women). The self-reported prevalences of known diabetes in subjects aged 40 years or older were obtained by questionnaires from three sources. In six Japanese cultural associations in Säo Paulo city, the prevalences were 9.7% and 6.9% for the first generation (mean age 61.5 years) and for the second generation (mean age 40.0 years), respectively. Age-adjusted prevalences, according to the Brazilian population in the 1980 national census, were 6.9% and 8.1% for the first and second generations. According to a study carried out as a part of a socioeconomic census of the Japanese population in Brazil, the prevalences of diabetes were 7.4% and 5.2%, and the age-adjusted prevalences were 5.3% and 5.8% in the first and second generations, respectively. Another study carried out for employees of a bank, owned by Japanese-Brazilian community members, revealed crude prevalences of diabetes in the first and second generations of 7.1% and 4.2%, and age-adjusted prevalences of 7.3% and 8.2%, respectively. These data indicate an increased prevalence of diabetes in this population compared to Japan, suggesting the importance of environmental factors in the pathogenesis of diabetes.

Proinsulin and insulin levels according to glucose tolerance among Japanese-Brazilians, aged 40-79 years. Japanese-Brazilian Diabetes Study Group.

This study of the Japanese-Brazilians living in Bauru, Sao Paulo, Brazil, aimed at determining the prevalence of DM in the first (Issei) and second (Nisei) generations, according to WHO criteria. Insulin and proinsulin were determined by new immunofluorimetric assays (IMFA), that measure true insulin and intact proinsulin, at fasting and 2 h after glucose load. The data showed a very scattered distribution, so only medians are shown and no statistical testing applied. There was a tendency for higher proinsulin levels in the diabetic groups. The highest fasting proinsulin levels were seen in the diabetic patients, either obese or non-obese. The post-load insulin levels were higher in diabetic and IGT individuals, compared to normals. Both generations showed a distinct behaviour for the obese and non-obese groups, and no major differences were observed between generations. This population seems to be sensitive to environmental changes, since the obese groups showed the higher levels of proinsulin and insulin. In the evaluation of the role of the environmental factors in the pathogenesis of DM, proinsulin and insulin levels could act as early markers of pancreatic dysfunctions.

Independent impact of glycemia and blood pressure in albuminuria on high-risk subjects for metabolic syndrome.

BACKGROUND: Microalbuminuria may reflect diffuse endothelial damage. Considering that diabetes and hypertension cause vasculopathy, we investigated associations of albumin-to-creatinine ratio (ACR) with plasma glucose and blood pressure levels in high-risk subjects for metabolic syndrome. METHODS: A sample of 519 (246 men) Japanese-Brazilians (aged 60 +/- 11 years), who participated in a population-based study, had their ACR determined in a morning urine specimen. Backward models of multiple linear regression were created for each gender including log-transformed values of ACR as dependent variable; an interaction term between diabetes and hypertension was included. RESULTS: Macroalbuminuria was found in 18 subjects. ACR mean values for subjects with normal glucose tolerance, impaired fasting glycemia, impaired glucose tolerance and diabetes were 9.9 +/- 6.0, 19.0 +/- 35.4, 20.7 +/- 35.4, and 33.9 +/- 55.0 mg/g, respectively. Diabetic subjects showed higher ACR than the others (p < 0.05). An increase in the proportion of albuminuric subjects was observed as glucose metabolism deteriorated (4.9, 17.0, 23.0 and 36.0%). Stratifying into 4 groups according to postchallenge glycemia (< 7.8 mmol/l, n = 91; > or = 7.8 mmol/l, n = 410) and hypertension, hypertensive and glucose-intolerant subgroups showed higher ACR values. ACR was associated with gender, waist circumference, blood pressure, plasma glucose and triglyceride (p < 0.05); albuminuric subjects had significantly higher levels of such variables than the normoalbuminuric ones. In the final models of linear regression, systolic blood pressure and 2-hour glycemia were shown to be independent predictors of ACR for both genders (p < 0.05). In men, also waist was independently associated with ACR. No interaction was detected between "diabetes and hypertension". CONCLUSIONS: These findings suggest that both glucose intolerance and hypertension could have independent but not synergistic effects on endothelial function--reflected by albumin loss in urine. Such hypothesis needs to be confirmed in prospective studies.

[The relationship between oral habits and malocclusion in preschool children]. / Relação entre hábitos bucais e má oclusão em pré-escolares.

OBJECTIVE: To evaluate the way oral habits and speech problems affect dental occlusion in preschool children. METHODS: A random sample of 2,139 boys and girls aged 3-5 years old was evaluated. The children were enrolled in private and state institutions in the city of Bauru, São Paulo State, Brazil. The cross-sectional study was developed in two steps: occlusion assessment, and a questionnaire about their social and economic status. The occlusal anatomical-functional characteristics assessment was done according to Angle classification. Additionally, overjet, overbite, crowding, anterior open bite, posterior crossbite, and anterior crossbite were evaluated. A sub-sample of 618 children filled out the questionnaire. The prevalence of malocclusion and some variables of exposure were tested by bivariate analysis. RESULTS: The prevalence of malocclusion was 51.3% for boys and 56.9% for girls. There was no difference related to gender. In regard to age, there was a higher prevalence of malocclusion in the 3 year-old group, which decreased significantly with age (p<0.05). CONCLUSIONS: Among the environmental factors evaluated, the habit of sucking a pacifier was the most important in the association with malocclusion (OR=5.46) followed by the habit of sucking fingers (OR=1.54). Speech problems did not show any influence in malocclusion occurrence.

[Increase in mortality associated with the presence of diabetes mellitus in Japanese-Brazilians]. / Incremento na mortalidade associada à presença de diabetes mellitus em nipo-brasileiros. Grupo de Estudo de Diabetes em Nipo-Brasileiros.

OBJECTIVE: As part of a study involving Japanese migrants, living in a developed city in the state of S. Paulo, Southeastern Brazil, a four-year experience of mortality among diabetic and non-diabetic subjects is described and their respective death rates are compared. In 1993, a cohort of 530 Japanese-Brazilians (236 issei or 1st generation and 294 nisei or 2nd generation) of both sexes, aged 40 from to 79 years old, were identified. RESEARCH DESIGN AND METHOD: At that time, 91 (17%) were classified as non-insulin-dependent diabetic subjects (NIDDM), 90 (17%) with impaired glucose tolerance (IGT) and 349 (66%) as normal, according to WHO criteria. In 1996, families were questioned with a view detecting the deaths which had occurred among the subjects previously studied. This information, in addition to that from death certificates was used to record the date and the causes of death. Mortality rates for all causes and for specific causes (circulatory and renal diseases) were obtained for the three groups of subjects, by glucose tolerance status. Proportional hazard regression models were used to compare the mortality rates, adjusted for several covariables (gender, age, generation, hypertension, dyslipidemia, obesity and serum creatinine). RESULTS AND CONCLUSIONS: Crude mortality rate ratios for all causes and specific causes, for NIDDM, and normal subjects were 2.95 (95% CI: 1.10-7.62) and 4.57 (95% CI: 1.31-16.48), respectively. No difference was observed between the crude mortality rate ratio for IGT and normal subjects. After simultaneous adjustments for the covariates, higher mortality rates for specific causes were observed among NIDDM than in the normal subjects (mortality rates ratio: 3.86; 95% CI: 1.11-13.38). These results in Japanese-Brazilians are consistent with previous reports of increased mortality in other diabetic subjects, thus confirming the adverse effect of this metabolic disturbance on mortality among diabetic subjects.

[Prevalence of dental caries in children from 0 to 6 years old attending nursery: the influence of socioeconomic factors]. / Prevalência de cárie dentária em crianças da faixa etária de 0 a 6 anos matriculadas em creches: importância de fatores socioeconômicos.

Oral health condition in samples of children from zero to six years old, examined in day nurseries for children from Bauru and S. Paulo County (Brazil) by the caries indicator in primary dentition-dmfs, is assessed. The first group did not receive oral health care where any as the second group received the standard oral care provided by the institution. Variables related to way of life and their relationship to the presence of caries were evaluated. Multiple regression analysis showed a statistically significant association of age and frequency of dental visits with the prevalence of dental caries (p < 0.05). The data also showed that 23.3% of the children from Bauru, and 9.3% of those from S. Paulo were free of caries, numbers that are very far from the 50% proposed by WHO for the year 2000. The overall prevalence of dental caries was greater for the Bauru group than for the S. Paulo group; however, statistical significance was only found in the 3-4 age-group (p < 0.05). Sex differences in the occurrence of dental caries were not statistically significant.

[Diabetes as primary or associated cause of death in the state of São Paulo, Brazil, 1992]. / Diabetes como causa básica ou associada de morte no estado de São Paulo, Brazil, 1992.

INTRODUCTION: Analysis of mortality data are usually performed with reference to the underlying cause of death. The importance of diabetes as a cause of death is always underestimated, because diabetics generally die from chronic complications of the disease, these being considered as the underlying cause of the death. To attenuate this problem, mortality data should be analyzed on the basis of all the causes listed on the death certificate. Frequency of references to diabetes on death certificates and the principal associated causes were evaluated as a contribution to the solution of this problem. METHODOLOGY: Specific death rates and proportional mortality by diabetes, as underlying or associated cause, were calculated on the basis of information derived from death certificates by the ACME program (Automated Classification of Medical Entities), for the State of S. Paulo, in 1992. RESULTS AND CONCLUSIONS: Of a total of 202,141 deaths, diabetes was mentioned in 13,786 (6.8%) and as being the underlying cause in 5,305(2.6%). The proportion was higher for women than men (10.1 vs. 4.6% as mentioned, and 6.1 vs 2.9% as underlying cause). Among deaths with a mention of diabetes on the certificate, the main underlying causes were: diabetes (38.5%), cardiovascular (37.2%) and respiratory (8.5%) diseases, and neoplasias (4.8%). When diabetes was the underlying cause, the main associated causes were: cardiovascular (42.2%), respiratory (10.7%) and genitourinary (10.1%) diseases. When diabetes was an associated cause, the main underlying causes were: cardiovascular (60.5%) and respiratory (13.8%) diseases, and neoplasias (7.9%). In spite of the limitation of the data from death certificates, it is possible to observe the importance of diabetes as cause of death, reflecting its magnitude as a health problem. Also, the analysis by multiple causes of deaths gives an idea of the morbidity profile associated with diabetes at the time of death, showing the importance of the group of cardiovascular diseases.

Performance of glycated haemoglobin (HbA1c) as a screening test for diabetes and impaired glucose tolerance (IGT) in a high risk population--the Brazilian Xavante Indians.

AIMS: To examine the properties of HbA1c to detect diabetes and IGT in adult Brazilian Xavante Indians, a high risk population for diabetes. METHODS: The survey was carried out between October 2010 and January 2012 and based on a 75 g oral glucose tolerance test (OGTT). Basal and 2h capillary glycaemia were measured by HemoCue Glucose 201+; HbA1c using an automated high-performance liquid chromatography analyzer (Tosoh G7). RESULTS: 630 individuals aged ≥ 20 years were examined and 80 had a previous diagnosis of diabetes. Sensitivity, specificity and accuracy for HbA1c ≥ 6.5% (≥ 48 mmol/mol) were 71.3%, 90.5% and 87.2%. The areas under the ROC curve (AUC) was 0.88 (95%CI: 0.83-0.93). To identify IGT, HbA1c values between 5.7% and 6.4% (39-47 mmol/mol) presented sensitivity, specificity and accuracy of 87.2%, 24.7% and 51.4%, with an AUC of 0.62 (95%CI: 0.57-0.67). CONCLUSIONS: The ADA/WHO proposed cut-off of 6.5% (48 mmol/mol) for HbA1c was adequate to detect diabetes among the Xavante. However, the performance of the ADA proposed cut-off points for pre-diabetes, when used to detect IGT was inadequate and should not be recommended.