Association between ultra-processed food consumption and the incidence of type 2 diabetes: the ELSA-Brasil cohort.

BACKGROUND: Ultra-processed food (UPF) consumption increases the risk of type 2 diabetes in various high-income countries, with some variation in the magnitude across studies. Our objective was to investigate the association of UPF consumption and specific subgroups with incident type 2 diabetes in Brazilian adults. METHODS: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a multicenter cohort study of 15,105 adults (35-74 years) enrolled in public institutions in Brazil (2008-2010). We followed participants with two clinic visits (2012-2014; 2017-2019) and annual telephone surveillance. After excluding those with diabetes at baseline, who died or were lost in the follow-up, with missing data, with implausible energy food intake, or reporting bariatric surgery, there were 10,202 participants. We used the NOVA classification to assess UPF consumption based on a food frequency questionnaire. We defined type 2 diabetes by self-report, medication use, or comprehensive laboratory tests. We estimated relative risks (RR) and 95% confidence intervals (95% CI) using robust Poisson regression. RESULTS: Median UPF consumption was 372 g/day. Over 8.2 (0.7) years of follow-up, we detected 1799 (17.6%) incident cases. After adjustment for socio-demographics, family history of diabetes, and behavioral risk factors, comparing the fourth (≥ 566 g/day) with the first (< 236 g/day) quartile of UPF distribution, RR was 1.24 (1.10-1.39); every 150 g/day increments in UPF consumption resulted in a RR of 1.05 (1.03-1.07). Reclassifying natural beverages with added sweeteners as UPF increased risk (RR 1.40; 1.25-1.58). Among UPF subgroupings, consumption of processed meats and sweetened beverages increased diabetes risk, while yogurt and dairy sweets decreased the risk (p < 0.05). CONCLUSIONS: UPF consumption increased the incidence of type 2 diabetes in Brazilian adults, with heterogeneity across specific food items. These findings add to previous evidence for the role of UPFs in the development of diabetes and other chronic diseases, supporting recommendations to avoid their intake in diabetes prevention and management.

Impact of Work-Family Conflict on Sleep Complaints: Results From the Longitudinal Study of Adult Health (ELSA-Brasil).

Background: Balancing work and family demands is often a challenge. Family and job responsibilities may affect many aspects of health, and sleep is an important issue. Work-family conflict (WFC) refers to situations where it is difficult to reconcile family and professional demands. WFC can act in two directions: work-to-family conflicts occur when job demands interfere in family life; family-to-work conflicts arise when family demands interfere with job performance. This study evaluated whether dimensions of WFC-time- and strain-related, work-to-family conflict; family-to-work conflict; and lack of time for self-care and leisure due to work and family demands-were cross-sectionally and longitudinally associated with sleep complaints, by gender. Methods: The sample comprised 9,704 active workers (5,057 women and 4,647 men) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Standardized questionnaires were used to collect data. WFC was measured at baseline (2008-2010), and sleep complaints were measured at baseline and approximately 4 years after the first visit (2012-2014). To test the association between the four WFC dimensions and sleep complaints, crude and multiple logistic regressions were conducted to estimate odds ratios and 95% confidence intervals. The adjusted model included age, education, marital status, hours worked and work schedule. Results: Mean age at baseline was 48.2 years. Most participants were educated to University degree level (54.5%), married (68.2%) and worked ≤ 40 h/week (66.1%). At baseline, 48.3% of women and 41.1% of men reported sleep complaints. Frequent WFC was reported by women and men, respectively, as follows: time-related work-to-family conflict (32.6 and 26.1%), strain-related work-to-family conflict (25.3 and 16.0%), family-to-work conflict (6.6 and 7.6%) and lack of time for self-care (35.2 and 24.7%). For both women and men, time- and strain-related work-to-family conflicts and conflicts for lack of time for self-care were cross-sectionally and longitudinally associated with sleep complaints. The findings also suggest a weaker and non-significant association between family-to-work conflict and sleep complaints. Conclusions: The statistically significant associations observed here underline the importance of reducing WFC. In the modern world, both WFC and sleep problems are increasingly recognized as frequent problems that often lead to ill health, thus posing a public health challenge.

Prognostic value of electrocardiographic abnormalities in adults from the Brazilian longitudinal study of adults' health.

OBJECTIVE: Cardiovascular diseases (CVDs) are highly preventable non-communicable diseases. ECG is a potential tool for risk stratification with respect to CVD. Our aim was to evaluate ECG's role in all-cause and cardiovascular mortality prediction. METHODS: Participants from the Brazilian Longitudinal Study of Adult Health, free of known CVD at baseline were included. A 12-lead ECG was obtained at baseline (2008-2010). Participants were followed up to 2018 by annual interviews. Deaths were independently reviewed. Cox as well as Fine and Grey multivariable regression models were applied to evaluate if the presence of any major electrocardiographic abnormality (MEA), defined according to the Minnesota Code system, would predict total and cardiovascular deaths. We also evaluated the Net Reclassification Index of adding MEA to the Systematic Coronary Risk Evaluation (SCORE). RESULTS: The 13 428 participants (median age 51 years, 45% men) were followed up for 8±1 years. All-cause and cardiovascular mortality occurred in 2.8% and 1.2% of the population, respectively. Prevalent MEA was an independent predictor of overall (HR=2.3, 95% CI 1.7 to 2.9) and cardiovascular mortality (HR=4.6, 95% CI 3.0 to 7.0) after adjustments for age, race, education and traditional cardiovascular risk factors. Adding MEA to the SCORE resulted in 9% mis-reclassification in the non-event subgroup and 33% correct reclassification in those with a fatal cardiovascular event. CONCLUSION: Presence of MEA was an independent predictor of overall and cardiovascular mortality. ECG may have a role in risk prediction of cardiovascular mortality in primary care.

Sleep problems and their association with weight and waist gain - The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

OBJECTIVE: To evaluate the association of sleep problems with weight and waist size gain during four years of follow-up. METHODS: We investigated 13,030 participants (35-74 years) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicentric cohort conducted with civil servants from six academic institutions recruited between 2008 and 2010. Sleep problems were assessed at baseline by the Clinical Interview Schedule - Revised (CIS-R), designed to detect common mental disorders based on somatic, depressive and anxiety symptoms. Weight and waist size were measured at baseline and at follow-up (2012-2014). Large weight and waist size gain were defined as ≥ 90th percentile (≥1.65 kg/year and ≥2.41 cm/year, respectively). RESULTS: Sleep problems were associated with higher risk of a large weight gain (RR = 1.11; 95% CI 1.01-1.24) and large waist size gain (RR = 1.19; 95% CI 1.07-1.32), adjusted for age, sex, ethnicity, income, educational level, investigation center, smoking, alcohol intake, dietary energy intake, leisure-time physical activity and body mass index (BMI) or waist circumference at baseline. After additional adjustment for common mental disorders the associations became non-significant (RR = 0.99; 95% CI 0.88-1.12; RR = 1.08; 95% CI 0.97-1.22, respectively). CONCLUSION: Sleep problems are associated with increased risk of developing large weight and waist size gain, but are not independently associated with common mental disorders.

Postmenopausal hormone therapy in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): who still uses it?

PURPOSE: We aim to investigate the patterns of hormone therapy (HT) use and associated factors in women participating in the Brazilian Longitudinal Study of Adult Health. METHODS: This study included 3281 naturally menopausal women of 40 to 74 years of age at enrollment to the Brazilian Longitudinal Study of Adult Health study, who answered questions regarding their use and discontinuation of HT. Prevalence rates of current and previous HT use were calculated, and a multinomial logistic regression model was constructed to simultaneously analyze the associated factors. RESULTS: The prevalence of HT use increased from 1995 onwards, peaking at 55.7% in 1997. A sharp decline occurred in the decade beginning in 2000, reaching 11.1% at the study baseline interview (2008-2010). Current use was associated with being ≥60 years of age (Relative Risk Ratio (RRR): 1.81; 95%CI: 1.10-2.96), divorced (RRR: 1.72; 95%CI: 1.14-2.60), or married (RRR: 2.09; 95%CI: 1.41-3.10); having a university education (RRR: 1.66; 95%CI: 1.14-2.40) or postgraduate degree (RRR: 2.45; 95%CI: 1.80-3.35); and having private health insurance (RRR: 2.86; 95%CI: 2.00-4.09). Body mass index ≥30 kg/m(2) was inversely associated with HT use (RRR: 0.37; 95%CI: 0.26-0.53) as was the presence of at least one contraindication to HT use (RRR: 0.63; 95%CI: 0.44-0.89). Of the current users ≥60 years of age, 79.1% had been using HT for at least 5 years, and 73.6% had been menopausal for at least 10 years. CONCLUSION: Although the use of HT has declined in Brazil, the women who continue using it are largely exceeding evidence-based limits of age, time since menopause, and time of use. Copyright © 2016 John Wiley & Sons, Ltd.

Traditional risk factors are more relevant than HIV-specific ones for carotid intima-media thickness (cIMT) in a Brazilian cohort of HIV-infected patients.

BACKGROUND: Combination antiretroviral therapy (cART) had a dramatic impact on the mortality profile in human immunodeficiency virus (HIV) infected individuals and increased their life-expectancy. Conditions associated with the aging process have been diagnosed more frequently among HIV-infected patients, particularly, cardiovascular diseases. METHODS: Patients followed in the Instituto de Pesquisa Clínica Evandro Chagas (IPEC) prospective cohort in Rio de Janeiro were submitted to the general procedures from the Brazilian Longitudinal Study of Adult Health, comprising several anthropometric, laboratory and imaging data. Carotid intima-media thickness (cIMT) was measured by ultrasonography, following the Mannheim protocol. Linear regression and proportional odds models were used to compare groups and covariables in respect to cIMT. The best model was chosen with the adaptive lasso procedure. RESULTS: A valid cIMT exam was available for 591 patients. Median cIMT was significantly larger for men than women (0.56mm vs. 0.53mm; p = 0.002; overall = 0.54mm). In univariable linear regression analysis, both traditional risk factors for cardiovascular diseases (CVD) and HIV-specific characteristics were significantly associated with cIMT values, but the best multivariable model chosen included only traditional characteristics. Hypertension presented the strongest association with higher cIMT terciles (OR = 2.51; 95%CI = 1.69-3.73), followed by current smoking (OR = 1,82; 95%CI = 1.19-2.79), family history of acute myocardial infarction or stroke (OR = 1.60; 95%CI = 1.10-2.32) and age (OR per year = 1.12; 95%CI = 1.10-1.14). CONCLUSIONS: Our results show that traditional cardiovascular disease (CVD) risk factors are the major players in determining increased cIMT among HIV infected patients in Brazil. This finding reinforces the need for thorough assessment of those risk factors in these patients to guarantee the incidence of CVD events remain under control.