Prevalência de Fatores de Risco Cardiovascular em Pacientes em Hemodiálise - O Estudo CORDIAL / Prevalence of Cardiovascular Risk Factors in Hemodialysis Patients - The CORDIAL Study

Fundamentos: Há uma carência de dados epidemiológicos sobre o perfil de risco cardiovascular nos pacientes renais crônicos em hemodiálise no Brasil. Objetivo: O estudo CORDIAL foi planejado para avaliar fatores de risco cardiovascular e acompanhar a evolução de uma população em programa de hemodiálise numa cidade metropolitana do Brasil. Métodos: Todos os pacientes em hemodiálise por doença renal crônica nos quinze centros de nefrologia de Porto Alegre foram considerados para inclusão na fase inicial do estudo CORDIAL. Dados clínicos, laboratoriais e demográficos foram obtidos nos registros médicos, e em entrevistas individuais estruturadas realizadas com todos os pacientes por pesquisadores treinados. Resultados: Foram incluídos 1215 pacientes (97,3% de todos os que estavam em hemodiálise na cidade de Porto Alegre). A média de idade era 58,3 anos, 59,5% eram homens e 62,8% eram brancos. A prevalência de fatores de risco cardiovascular encontrada foi 87,5% para hipertensão, 84,7% para dislipidemia, 73,1% para sedentarismo, 53,7% para tabagismo e 35,8% para diabetes. Em uma análise multivariada ajustada, sedentarismo (p = 0,032; RP 1,08 - IC95%: 1,01-1,15), dislipidemia (p = 0,019; RP 1,08 - IC95%: 1,01-1,14), e obesidade (p < 0,001; RP 1,96 - IC95%: 1,45-2,63) foram mais frequentes em mulheres; e hipertensão (p = 0,018; PR 1,06 - IC95%: 1,01-1,11) e tabagismo (p = 0,006; RP 2,7 - IC95%: 1,79-4,17) foram mais frequentes naqueles com menos de 65 anos. Sedentarismo apresentou uma associação independente com tempo em diálise inferior a 12 meses (p < 0,001; RP 1,23 - IC95%: 1,14-1,33). Conclusão: Pacientes em hemodiálise nesta metrópole do sul do Brasil apresentaram uma prevalência elevada de fatores de risco cardiovascular similar a diversos países do hemisfério norte. .

Background: There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. Objective: The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. Methods: All patients undergoing regular hemodialysis for chronic renal failure in all fifteen nephrology centers of Porto Alegre were considered for inclusion in the baseline phase of the CORDIAL study. Clinical, laboratory and demographic data were obtained in medical records and in structured individual interviews performed in all patients by trained researchers. Results: A total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p < 0.001, PR 1.96 - 95%CI: 1.45-2.63) were more frequent in women; and hypertension (p = 0.018, PR 1.06 - 95%CI: 1.01-1.11) and tobacco use (p = 0.006, PR 2.7 - 95%CI: 1.79-4.17) were more often found among patients under 65 years old. Sedentary lifestyle was independently associated with time in dialysis less than 12 months (p < 0.001, PR 1.23 - 95% CI: 1.14-1.33). Conclusion: Hemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries. .

Prevalence of cardiovascular risk factors in hemodialysis patients - The CORDIAL study.

BACKGROUND: There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. OBJECTIVE: The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. METHODS: All patients undergoing regular hemodialysis for chronic renal failure in all fifteen nephrology centers of Porto Alegre were considered for inclusion in the baseline phase of the CORDIAL study. Clinical, laboratory and demographic data were obtained in medical records and in structured individual interviews performed in all patients by trained researchers. RESULTS: A total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p < 0.001, PR 1.96 - 95%CI: 1.45-2.63) were more frequent in women; and hypertension (p = 0.018, PR 1.06 - 95%CI: 1.01-1.11) and tobacco use (p = 0.006, PR 2.7 - 95%CI: 1.79-4.17) were more often found among patients under 65 years old. Sedentary lifestyle was independently associated with time in dialysis less than 12 months (p < 0.001, PR 1.23 - 95% CI: 1.14-1.33). CONCLUSION: Hemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries.

Time trends of physical activity among Brazilian adolescents over a 7-year period.

PURPOSE: To evaluate time trends in physical activity among adolescents aged 10 to 19 years living in southern Brazil over a 7-year period. METHODS: Two population-based cross-sectional surveys with similar methodologies were carried out in the city of Pelotas, Brazil, in 2005 and 2012. Leisure-time and transport-related physical activity were measured using a validated questionnaire. A cut-off point of 300 minutes per week was used to classify adolescents as active or not. We also analyzed the two domains of physical activity (leisure time and transportation) separately. RESULTS: The prevalence of physical inactivity was 69.6% (95% CI 66.5-73.2) in 2005 and 69.9% (95% CI 66.5-72.7) in 2012. The percentage of active adolescents in leisure time also remained stable in the period (26.3% in 2005 [95% CI 23.3-29.2] vs. 28.1% in 2012 [95% CI 24.9-31.4]). Among boys, we observed an increase in the practice of some leisure-time activities-weight lifting (87%) and running (78%)-and a decline in others-volleyball (61%) and basketball (56%). Among girls, the only significant difference was an increase in the practice of weight lifting (271%). The prevalence of active commuting to and from school declined from 69% (95% CI 65.6-72.4) in 2005 to 56.5% (95% CI 52.5-60.2) in 2012. CONCLUSIONS: There was a significant decline in active commuting to school among adolescents. Interventions promoting active commuting modes to school are urgently needed in Brazil.

Prevalence of insufficient physical activity in adolescents in South Brazil / Prevalência de atividade física insuficiente em adolescentes do Sul do Brasil

The purpose of the study was to estimate the prevalence of insufficient physical activity and associated factors in adolescents 10 to 19 years old living in the Health Districts of Restinga and Extremo Sul of Porto Alegre, RS. A population-based, cross-sectional study was conducted by a systematic sampling with 967 adolescents randomly selected. Data was collected by using a questionnaire with the following variables: gender, age, skin color, if currently studying, occupation, socioeconomic status, weight and height, as well as insufficient physical activity, which was defined as less than 300 minutes per week of physical activity, not counting physical education classes. The prevalence of insufficient physical activity found was 70.5%: 58.9% in boys and 81.9% in girls. The higher prevalence of insufficient levels of PA was found among adolescents who are not studying (p=0.01) and next by those who are between 16 and 19 years old (p=0.05). In boys it was observed that as they got older, physical activity decreased (p=0.05). The most types of activities found were field soccer and riding bikes for boys, and walking and field soccer for girls. In conclusion, the prevalence of insufficient physical activity found in the adolescents evaluated was high. Being a girl, not studying, and between the ages of 16 and 19, were factors that increased the levels of insufficient physical activity. This reveals, therefore, the importance to developed interventions to promote the practice of physical activity in this population.

O objetivo do estudo foi estimar a prevalência de atividade física insuficiente e fatores associados em adolescentes de 10 a 19 anos, residentes nos Distritos Sanitários da Restinga e Extremo Sul, Porto Alegre, RS. Este é um estudo transversal de base populacional por amostragem sistemática, com 967 adolescentes selecionados de forma randomizada, os quais responderam um questionário composto pelas seguintes variáveis: sexo, idade, cor da pele, estar estudando, ocupação, nível socioeconômico, massa corporal e estatura, e atividade física insuficiente; definida como prática menor que 300 minutos semanais de atividade física, sem contar as aulas de educação física. A prevalência de atividade física insuficiente encontrada foi de 70,5%, sendo 58,9% nos meninos e 81,9% nas meninas. As prevalências mais altas de níveis insuficientes de AF foram observadas nos adolescentes que não se encontram estudando (p=0,01), sucedidos pelos da faixa etária entre 16 e 19 anos (p=0,05). Nos meninos, observou-se que, com o aumento da idade, ocorreu diminuição na prática de atividade física (p=0,05). Dentre os tipos de atividade, o futebol de campo e o andar de bicicleta mostraram-se os mais frequentes para os meninos, e a caminhada e o futebol de campo para as meninas. Conclui-se que foi elevada a prevalência de atividade física insuficiente nos adolescentes avaliados. Sexo feminino, não estar estudando e estar na faixa etária entre 16 e 19 anos, foram fatores que aumentaram os níveis de atividade física insuficiente. Assim, revela-se a importância de que sejam desenvolvidas intervenções para promoção da prática de atividade física nessa população.

Prática de atividade física na adolescência e prevalência de osteoporose na idade adulta / Physical andactivity practice in adolescence prevalence of osteoporosis in adulthood

O objetivo deste trabalho foi avaliar a associação entre prática de atividade física na adolescência e osteoporose na vida adulta. Realizou-se um estudo de base populacional incluindo uma amostra aleatória de 1.016 indivíduos de 50 anos ou mais. Atividade física no lazer foi avaliada utilizando o Questionário Internacional de Atividade Física - IPAQ. Os indivíduos foram definidos como ativos se estiveram engajados em atividade física durante a sua adolescência (10-19 anos) pelo menos por seis meses consecutivos. Os indivíduos ativos na adolescência demonstraram probabilidade 67 por cento menor do que os inativos de apresentar osteoporose na vida adulta (p < 0,001). Esse resultado se manteve significativo após ajuste para os fatores de confusão (p = 0,005) e para o efeito mediador do nível de atividade física na idade adulta (p = 0,007). Conclui-se que a prática de atividade física na adolescência reduz o risco de osteoporose, independentemente do nível de atividade física na vida adulta. Desse modo, a adolescência é um importante período no desenvolvimento da saúde óssea.

The aim of the present study was to assess the association between physical activity practice in adolescence and the prevalence of osteoporosis in adulthood. A population-based study with a randomly-selected sample of 1.016 individuals, aged 50 years or older was carried out. Leisure physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). Individuals were defined as active in adolescence (10-19 years) if had been engaged in physical activity for at least six consecutive months. Individuals classified as active in adolescence were 67% less likely to present osteoporosis in adulthood than inactive ones (p/

Correlates of leisure-time physical activity differ by body-mass-index status in Brazilian adults.

OBJECTIVES: The objective of this study was to evaluate physical activity (PA) levels in adults and their association with sex, age, and education level across categories of body mass index (BMI). METHODS: We conducted a population-based, cross-sectional study including 3100 individuals age >20 years living in Pelotas, Brazil. PA was assessed using the leisure-time section of the long International Physical Activity Questionnaire. "No PA" was defined as zero minutes of activity/ week; "insufficient PA" was defined as <150 minutes of activity/week; "high PA" was defined as > or =500 minutes of activity/week. BMI was categorized into normal (<25 kg/m2), overweight (25-29.9 kg/m2), and obesity (>or =30 kg/m2). RESULTS: The prevalence of insufficient PA was 71.6% among normal BMI subjects, 71.3% among overweight individuals, and 73.7% among obese ones (P = .67). No PA and high PA were also not associated with BMI. The associations between sex, age, and education level and PA levels tended to be stronger among normal-weight individuals compared with overweight and obese individuals. Among the obese, most associations were not significant. Among normal-weight individuals, higher PA levels were observed in men, young adults, and those with higher education. CONCLUSIONS: Variables associated with leisure-time PA differed between normalweight, overweight, and obese individuals. Studies on PA correlates might benefit from stratifying by BMI.

Prevalence of insufficient physical activity and associated factors in Brazilian adolescents.

BACKGROUND: We aimed to describe levels of physical activity (PA) in adolescents living in southern Brazil and to explore associations between PA levels and demographic, socioeconomic, health-related, and parental variables. A further aim was to test the validity and reliability of the questionnaire used. METHODS: We conducted a population-based, cross-sectional study including 857 adolescents selected randomly. Insufficient PA was defined as <300 min/wk of MVPA. PA data collected by questionnaire were compared with pedometer counts and with a longer version of the questionnaire in a subsample of 92 adolescents. RESULTS: Reliability of the questionnaire was good, and its validity in comparison with a longer questionnaire was also satisfactory. In comparison with pedometer data, the questionnaire presented moderate agreement. The prevalence of insufficient PA in the whole sample was 69.8% (95% CI = 66.7-72.9). Boys were more active than girls. The prevalence of insufficient PA increased with age in girls but not in boys. Among boys, those from low socioeconomic levels were more likely to be sedentary. Among girls, paternal PA was directly associated with adolescent activity levels. CONCLUSIONS: Urgent strategies aimed at increasing levels of activity of adolescents are necessary in Brazil given the high prevalence of insufficient PA detected in this study. The variables associated with insufficient PA varied between boys and girls.

Evolução da pesquisa epidemiológica em atividade física no Brasil: revisão sistemática / Evolution of the epidemiological research on physical activity in Brazil: a systematic review

OBJETIVO: Descrever a evolução da pesquisa epidemiológica em atividade física no Brasil. MÉTODOS: Revisão sistemática da literatura, realizada em bases de dados eletrônicas (Medline/PubMed, Lilacs, Ovid, Science Direct, BioMed Central e High Wire), em periódicos nacionais não indexados, por busca específica por autores e contato com pesquisadores. A seleção dos artigos teve como critérios de inclusão: amostra representativa de alguma população definida; tamanho da amostra de pelo menos 500 indivíduos; coleta de dados realizada no Brasil; mensuração de atividade física e relato dos resultados com base nessa variável. RESULTADOS: Foram incluídos 42 estudos. O primeiro artigo foi publicado em 1990, observando-se tendência de aumento de publicações a partir de 2000. Foi detectada disparidade regional nas publicações, com concentração de estudos nas regiões Sudeste e Sul. A maioria dos estudos (93 por cento) utilizou questionários como instrumentos de pesquisa, cujos conteúdos variaram, assim como as definições operacionais de sedentarismo, dificultando a comparação dos resultados. CONCLUSÕES: Embora a literatura em epidemiologia da atividade física venha crescendo quantitativamente no Brasil, limitações metodológicas dificultam a comparação entre os estudos, tornando a padronização de instrumentos e definições essenciais para o avanço científico da área.

OBJECTIVE: To describe the evolution of the epidemiological research on physical activity in Brazil. METHODS: A systematic review of the literature was carried out in electronic databases (Medline/PubMed, Lilacs, Ovid, Science Direct, BioMed Central and High Wire), non-indexed Brazilian journals, query by specific authors, and contact with other researchers. The inclusion criteria were: the sample should be representative of a defined population; sample size equal to or greater than 500 individuals; data collection in Brazil; measurement of physical activity; and report of data on this variable. RESULTS: A total of 42 studies were reviewed. The first study was published in 1990, and there has been a clear growth in the number of publications since 2000. Great regional disparities were seen and most studies were carried out in the Southeast and South regions. Almost all studies (93 percent) used questionnaires but operational definitions of sedentary lifestyle and questionnaires used varied markedly across studies preventing result comparisons. CONCLUSIONS: Although the literature on physical activity in Brazil has quantitatively increased, methodological limitations make it difficult to compare study results. Therefore, standardization of instruments and definitions is essential for the improvement of scientific knowledge in the area.

[Evolution of the epidemiological research on physical activity in Brazil: a systematic review]. / Evolução da pesquisa epidemiológica em atividade física no Brasil: revisão sistemática.

OBJECTIVE: To describe the evolution of the epidemiological research on physical activity in Brazil. METHODS: A systematic review of the literature was carried out in electronic databases (Medline/PubMed, Lilacs, Ovid, Science Direct, BioMed Central and High Wire), non-indexed Brazilian journals, query by specific authors, and contact with other researchers. The inclusion criteria were: the sample should be representative of a defined population; sample size equal to or greater than 500 individuals; data collection in Brazil; measurement of physical activity; and report of data on this variable. RESULTS: A total of 42 studies were reviewed. The first study was published in 1990, and there has been a clear growth in the number of publications since 2000. Great regional disparities were seen and most studies were carried out in the Southeast and South regions. Almost all studies (93%) used questionnaires but operational definitions of sedentary lifestyle and questionnaires used varied markedly across studies preventing result comparisons. CONCLUSIONS: Although the literature on physical activity in Brazil has quantitatively increased, methodological limitations make it difficult to compare study results. Therefore, standardization of instruments and definitions is essential for the improvement of scientific knowledge in the area.