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

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

GlycA Levels Independently Predict Coronary Artery Calcium Incidence and Progression in the ELSA-Brasil Cohort (Brazilian Longitudinal Study of Adult Health).

Atherosclerosis is an inflammatory disease. Coronary artery calcium (CAC) is a marker of atherosclerotic disease events and mortality risk. Elevated GlycA, an emerging marker of inflammation, is associated with a higher risk for coronary artery disease (CAD). However, there is conflicting evidence on whether GlycA predicts subclinical CAD progression. We hypothesized that GlycA can predict subclinical CAC incidence/progression in healthy individuals. We included 2,690 ELSA-Brasil cohort participants without cardiovascular/chronic inflammatory disease not receiving statin therapy who had GlycA levels measured and two interval CAC assessments between 2010 through 2018. Multivariable logistic and linear regression models were computed to evaluate GlycA as a predictor of CAC incidence and progression. CAC incidence required a baseline CAC of 0. CAC progression required a baseline CAC > 0. The mean age of participants was 48.6 ± 7.7 years, 56.7% were female, 54.6% and 16.1% (429/2690) were White and Black, respectively. The mean CAC interscan period was 5.1 ± 0.9 years, the mean GlycA level was 414.7 ± 65 µmol/L, and the incidence of CAC was 13.1% (280/2,129). GlycA level odds ratio (OR) for CAC incidence was 1.002 [95% confidence interval (CI) 1.0005-1.005, p=0.016] adjusted for demographics, lifestyle, a family history of early CAD (≤60 years), lipids, and comorbidities. The GlycA (≤p25 vs ≥p75) OR for CAC progression (Berry definition) was 1.77 (95% CI 1.07-2.96, p=0.03) in a similar multivariable-adjusted model. Higher GlycA levels were associated with CAC incidence and progression in a healthy Brazilian cohort.

Effects of environmental exposure to iron powder on healthy and elastase-exposed mice.

Prolonged exposure to iron powder and other mineral dusts can threaten the health of individuals, especially those with COPD. The goal of this study was to determine how environmental exposure to metal dust from two different mining centers in Brazil affects lung mechanics, inflammation, remodeling and oxidative stress responses in healthy and elastase-exposed mice. This study divided 72 male C57Bl/6 mice into two groups, the summer group and the winter group. These groups were further divided into six groups: control, nonexposed (SAL); nonexposed, given elastase (ELA); exposed to metal powder at a mining company (SAL-L1 and ELA-L1); and exposed to a location three miles away from the mining company (SAL-L2 and ELA-L2) for four weeks. On the 29th day of the protocol, the researchers assessed lung mechanics, bronchoalveolar lavage fluid (BALF), inflammation, remodeling, oxidative stress, macrophage iron and alveolar wall alterations (mean linear intercept-Lm). The Lm was increased in the ELA, ELA-L1 and ELA-L2 groups compared to the SAL group (p < 0.05). There was an increase in the total number of cells and macrophages in the ELA-L1 and ELA-L2 groups compared to the other groups (p < 0.05). Compared to the ELA and SAL groups, the exposed groups (ELA-L1, ELA-L2, SAL-L1, and SAL-L2) exhibited increased expression of IL-1ß, IL-6, IL-10, IL-17, TNF-α, neutrophil elastase, TIMP-1, MMP-9, MMP-12, TGF-ß, collagen fibers, MUC5AC, iNOS, Gp91phox, NFkB and iron positive macrophages (p < 0.05). Although we did not find differences in lung mechanics across all groups, there were low to moderate correlations between inflammation remodeling, oxidative stress and NFkB with elastance, resistance of lung tissue and iron positive macrophages (p < 0.05). Environmental exposure to iron, confirmed by evaluation of iron in alveolar macrophages and in air, exacerbated inflammation, initiated remodeling, and induced oxidative stress responses in exposed mice with and without emphysema. Activation of the iNOS, Gp91phox and NFkB pathways play a role in these changes.

Religion and sociodemographic characteristics at baseline of the Brazilian Longitudinal Study of Adult Health study.

OBJECTIVE: The aim of this study was to investigate whether sex, age, race, income, education, and marital status are associated with having a religion in a sample of Brazilian men and women. METHODS: Data were obtained from 15,098 participants of the Brazilian Longitudinal Study of Adult Health, a longitudinal study that ultimately aims to investigate long-term outcomes of chronic diseases. The sociodemographic characteristics and data on religion status were self-reported during interviews conducted by trained personnel. All study procedures followed standard and validated protocols. RESULTS: There was a strong association between being a woman and having a religion (adjusted OR=2.12, 95%CI 1.95-2.31) when compared to men. Regarding age, those with 45-54 years were more likely to have a religion (adjusted OR=1.14, 95%CI 1.03-1.27). Blacks and Browns were more religious (adjusted OR=1.31, 95%CI 1.15-1.49, and OR=1.22, 95%CI 1.10-1.34, respectively) compared to Whites. Those with high income and education were less likely to state having a religion (adjusted OR=0.78, 95%CI 0.70-0.87, and adjusted OR=0.50, 95%CI 0.43-0.59, respectively). Those who did not have a stable conjugal union were found to be less religious (adjusted OR=0.82, 95%CI 0.75-0.89). Stratifying the analysis according to income showed that higher education was inversely associated with religion on both strata: lower and higher annual earnings. CONCLUSION: This study suggests that education is one of the most important socioeconomic characteristics to consider when studying religion. Race, sex, income, and marital status are also important factors; however, there was not a clear association between religion and age.

Association of mental health symptoms with the migraine-tension-type headache spectrum in the Brazilian longitudinal study of adult health.

OBJECTIVE: To investigate the relationship between mental health symptoms and the migraine-tension-type headache (TTH) spectrum in middle-aged adults from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil study). METHODS: In this cross-sectional analysis (baseline data: 2008-2010), it was evaluated the relationship between each mental health symptom assessed by the Clinical Interview Schedule-Revised (CIS-R) questionnaire and headache subtypes (migraine and TTH) according to international criteria. It was performed binary logistic regression models, with estimated odds ratios (OR) with their respective 95% confidence intervals (CI) adjusted for confounders including migraine attack frequency. RESULTS: Among 13,916 participants, 70.1% reported any major primary headache subtype within the last year. The most common subtype was definite TTH (33.4%), followed by probable migraine (21.0%), definite migraine (8.5%), and probable TTH (7.2%). Our main findings indicated positive associations between anxiety-related symptoms and the migraine-tension type headache (TTH) spectrum with a clear trend toward definite migraine more than tension-type headache. The presence of somatic symptoms presented a high likelihood for the associations with headaches, mainly definite migraine (OR: 7.9, 95% CI: 6.4-9.8), probable migraine (OR: 4.5, 95% CI 3.7-5.4) and probable TTH (OR: 3.0, 95% CI: 2.3-3.8). Other symptoms associated with headache disorders included fatigue, panic, irritability, anxiety symptoms, concentration problems, forgetfulness, depressive symptoms, and worry. The effect of associations remained significant after controlling for headache attack frequency. CONCLUSION: This study provides evidence of consistent associations between mental health symptoms and primary headache disorders, with a higher burden of anxiety-based symptoms observed in people with migraine than those with TTH.

Association between branched-chain amino acids and renal function in the ELSA-Brasil study.

BACKGROUND & AIMS: Epidemiologic studies show high circulating Branched-chain amino acids (BCAA) are associated with excess body weight, impaired fasting glucose, insulin resistance, high blood pressure, and dyslipidemia. There is scarce data on the association between renal function and circulating levels of BCAA. Therefore, we aim to study this association in a sample of the Brazilian Longitudinal Study of Adults (ELSA-Brasil) METHODS: We analyzed participants who had at the baseline BCAA: valine, isoleucine, and leucine measured through nuclear magnetic resonance. The outcomes evaluated were estimated glomerular function (eGFR - CKD-EPI without race) and 12h-albumin-creatinine ratio (ACR). In addition, we built unadjusted and adjusted multivariable linear regression models to investigate the association between the BCAA (total and individual) and eGFR and ACR. RESULTS: We studied 4912 participants (age 51.7(±9.0) years, 53.4% women, 59.5% White (59.5%), 32.7% hypertension, and 18.2% diabetes). The mean BCAA level was 429.15 ± 87.15. The mean eGFR was 84.95 ± 15 ml/min/1.73 m2, and the median ACR was 6.5 (1.8-4920) mg/g. Descriptive analyses comparing eGFR stratified <60 ml/min/1.73 m2 and ACR≥30 mg/g demonstrate that BCAA levels are higher in patients with eGFR<60 and ACR ≥30. Regarding eGFR, an inverse association was detected with BCAA levels when adjusted for demographic variables, and it is not maintained after adjustments for other confounders. Also, a positive association was found for ACR≥30 mg/g, and BCAA levels, and this association is not confirmed after adjustments. CONCLUSIONS: BCAA levels were inversely associated with eGFR and positively associated with ACR. Further studies are necessary to allow the comprehension of those associations.

Dietary patterns and adiposity over time - analysis of the ELSA-Brasil.

PURPOSE: Combining different statistical methods to identify dietary patterns (DP) may provide new insights on how diet is associated with adiposity. This study investigated the association of DP derived from three data-driven methods and adiposity indicators over time. METHODS: This study used data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). DP were identified at baseline applying three statistical methods: Factor Analysis (FA), Treelet Transform (TT), and Reduced Rank Regression (RRR). The association between DP and adiposity indicators (weight, body mass index, waist circumference, body fat percentage and fat mass index) over the period of 8.2 years of follow-up was assessed by linear mixed-models. RESULTS: Convenience DP, marked by unhealthy food groups, was associated with higher adiposity over the follow-up period, regardless of the method applied. The DP identified by TT and marked by high consumption of rice and beans was associated with lower adiposity, whereas the similar DP identified by FA, but additionally characterised by consumption of poultry and red meat was associated with higher adiposity. Prudent DP, marked by plant-based food groups and fish, identified by FA was associated with lower adiposity across the median follow-up time. CONCLUSION: Applying different methods to identify DP showed that a convenience DP was associated with higher adiposity independent of the method applied. We also identified the nuances within adherence to a Brazilian traditional dietary pattern characterised by the consumption of rice and beans, that only when combined with reduced consumption of animal protein and unhealthy foods was associated with lower adiposity over time.

Triglyceride-glucose index demonstrates reasonable performance as a screening tool but exhibits limited diagnostic utility for insulin resistance: Data from the ELSA-Brasil cohort.

Insulin resistance (IR) is a key risk factor for chronic metabolic diseases, but its laboratory diagnosis is still costly; thus, the triglyceride-glucose (TyG) index has been proposed as a surrogate method. Our aim was to provide a detailed analysis of cutoffs and test the hypothesis that the TyG index would present reasonable performance parameters for IR screening. This is a cross-sectional study with baseline data from 12,367 eligible participants of both sexes (aged 35-74 years) from the Brazilian Longitudinal Study of Adult Health. TyG correlation and agreement with the Homeostasis Model Assessment for Insulin Resistance were analyzed. Positive and negative predictive values (PV+, PV-) and likelihood ratio (LR+, LR-) were calculated. A moderate positive correlation between TyG and Homeostasis Model Assessment for Insulin Resistance was observed (Pearson r = 0.419). The area under the receiver operating characteristic curve of TyG for IR diagnosis was 0.742 and the optimal cutoff was 4.665, reaching a kappa agreement value of 0.354. For this cutoff, a PV+ of 59.3% and PV- of 76.0%, as well as an LR+ of 2.07 and LR- of 0.45 were obtained. Alternatively, because high sensitivity is desired for screening tests, selecting a lower cutoff, such as 4.505, increases the PV- to 82.1%, despite decreasing the PV+ to 50.8%. We conclude that TyG has important performance limitations for detecting IR, but that it may still be reasonably useful to help screening for IR in adults because it can be calculated from low-cost routine blood tests.

Home-Use Transcranial Direct Current Stimulation for the Treatment of a Major Depressive Episode: A Randomized Clinical Trial.

Importance: Transcranial direct current stimulation (tDCS) is moderately effective for depression when applied by trained staff. It is not known whether self-applied tDCS, combined or not with a digital psychological intervention, is also effective. Objective: To determine whether fully unsupervised home-use tDCS, combined with a digital psychological intervention or digital placebo, is effective for a major depressive episode. Design, Setting, and Participants: This was a double-blinded, sham-controlled, randomized clinical trial with 3 arms: (1) home-use tDCS plus a digital psychological intervention (double active); (2) home-use tDCS plus digital placebo (tDCS only), and (3) sham home-use tDCS plus digital placebo (double sham). The study was conducted between April 2021 and October 2022 at participants' homes and at Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. Included participants were aged 18 to 59 years with major depression and a Hamilton Depression Rating Scale, 17-item version (HDRS-17), score above 16, a minimum of 8 years of education, and access to a smartphone and internet at home. Exclusion criteria were other psychiatric disorders, except for anxiety; neurologic or clinical disorders; and tDCS contraindications. Interventions: tDCS was administered in 2-mA, 30-minute prefrontal sessions for 15 consecutive weekdays (1-mA, 90-second duration for sham) and twice-weekly sessions for 3 weeks. The digital intervention consisted of 46 sessions based on behavioral therapy. Digital placebo was internet browsing. Main Outcomes and Measures: Change in HDRS-17 score at week 6. Results: Of 837 volunteers screened, 210 participants were enrolled (180 [86%] female; mean [SD] age, 38.9 [9.3] years) and allocated to double active (n = 64), tDCS only (n = 73), or double sham (n = 73). Of the 210 participants enrolled, 199 finished the trial. Linear mixed-effects models did not reveal statistically significant group differences in treatment by time interactions for HDRS-17 scores, and the estimated effect sizes between groups were as follows: double active vs tDCS only (Cohen d, 0.05; 95% CI, -0.48 to 0.58; P = .86), double active vs double sham (Cohen d, -0.20; 95% CI, -0.73 to 0.34; P = .47), and tDCS only vs double sham (Cohen d, -0.25; 95% CI, -0.76 to 0.27; P = .35). Skin redness and heat or burning sensations were more frequent in the double active and tDCS only groups. One nonfatal suicide attempt occurred in the tDCS only group. Conclusions and Relevance: Unsupervised home-use tDCS combined with a digital psychological intervention or digital placebo was not found to be superior to sham for treatment of a major depressive episode in this trial. Trial Registration: ClinicalTrials.gov Identifier: NCT04889976.

Genome-wide study investigating effector genes and polygenic prediction for kidney function in persons with ancestry from Africa and the Americas.

Chronic kidney disease is a leading cause of death and disability globally and impacts individuals of African ancestry (AFR) or with ancestry in the Americas (AMS) who are under-represented in genome-wide association studies (GWASs) of kidney function. To address this bias, we conducted a large meta-analysis of GWASs of estimated glomerular filtration rate (eGFR) in 145,732 AFR and AMS individuals. We identified 41 loci at genome-wide significance (p < 5 × 10-8), of which two have not been previously reported in any ancestry group. We integrated fine-mapped loci with epigenomic and transcriptomic resources to highlight potential effector genes relevant to kidney physiology and disease, and reveal key regulatory elements and pathways involved in renal function and development. We demonstrate the varying but increased predictive power offered by a multi-ancestry polygenic score for eGFR and highlight the importance of population diversity in GWASs and multi-omics resources to enhance opportunities for clinical translation for all.

Incidence of Suicidal Ideation in a Civil Servants Cohort During the COVID-19 Pandemic in Brazil: Insights from the ELSA-Brasil Study.

OBJECTIVE: This study investigated the incidence of suicidal ideation and its associated risk factors in the São Paulo state of ELSA-Brasil cohort during the COVID-19 pandemic. METHODS: During a pre-pandemic ELSA-Brasil onsite assessment in 2016-2018 (wave 3) and a pandemic online assessment in May-July 2020 (wave COVID), we assessed suicidal ideation using the Clinical Interview Scheduled-Revised (CIS-R). Single and multi predictor logistic regressions were performed using sociodemographic characteristics, household finance impact during pandemic, presence of previous chronic diseases, alcohol abuse, adverse childhood experiences (ACE), living alone, and previous CMD as predictors. Suicidal ideation incidence was used as outcome. RESULTS: Out of 4191 participants of wave 3, 2117 (50.5%) answered wave COVID. There was a threefold increase in suicide ideation, from 34 (1.8%) to 104 (5.6%).In multiple predictor models, we found that previous CMD (OR 7.17; 95% CI 4.43 - 11.58) and ACE (OR 1.72; 95% CI 1.09 - 2.72) increased the odds of incident suicidal ideation. The sociodemographic predictors female sex, younger age and low income were significant risk factors only in the single predictor model. Conclusions These findings underscore the importance of monitoring and supporting individuals who suffered ACE and have a history of mental health disorders. This is especially critical in times of heightened societal stress, such as the COVID-19 pandemic. CONCLUSIONS: These findings underscore the importance of monitoring and supporting individuals who suffered ACE and have a history of mental health disorders. This is especially critical in times of heightened societal stress, such as the COVID-19 pandemic.

Dietary acid load and the risk of events of mortality and kidney replacement therapy in people with chronic kidney disease: the Progredir Cohort Study.

BACKGROUND/OBJECTIVES: The association between dietary acid load (DAL) and chronic kidney disease (CKD) progression remains controversial. Also, there is a gap in the literature on the association between DAL and mortality. In this study, we evaluated the association between NEAP (net endogenous acid production) and PRAL (potential renal acid load) and the risk of events of all-cause mortality and kidney replacement therapy (KRT) in people with CKD. SUBJECTS/METHODS: We included 442 patients (250 diabetics) from the Progredir Cohort Study, based in São Paulo, Brazil. We estimated NEAP and PRAL from dietary intake. Events of death before KRT and KRT were ascertained after a median follow-up of 5.8 and 5.1 years, respectively. Cox proportional hazards regression, Weibull regression, and competing risk models were performed. RESULTS: Median NEAP and PRAL were 49.5 and 4.8 mEq/d. There were 200 deaths and 75 KRT events. Neither NEAP nor PRAL were associated with mortality or KRT when all participants were analyzed. After stratification for diabetes, both estimates were positively related to the risk of KRT even after adjustment for age, sex, weight status, glomerular filtration rate, serum bicarbonate, and intakes of protein, phosphorus, and energy (HR 1.31; 95% CI 1.07, 1.60 for NEAP, and HR 1.27; 95% CI 1.04, 1.57 for every 10 mEq/d increments). Competing risk analyses confirmed these findings. CONCLUSIONS: DAL estimates were associated with the risk of KRT in people with CKD and diabetes but not in non-diabetics. There was no association between all-cause mortality and DAL.

Predictive value of functional disability scales among stroke survivors: A long-term mortality evaluation in a Brazilian stroke cohort.

OBJECTIVE: To assess the influence of two functional scales- Modified Rankin Scale (m-RS) and Modified Katz Index (m-Katz Index) on long-term mortality in a stroke cohort. MATERIAL AND METHODS: Among 760 stroke survivors (median age: 66 (IQR:56-75), 56.4 % women) m-Katz Index and m-RS scales applied at 1 and 6 months after stroke, were investigated in relation to 12-years of all-cause mortality. Kaplan-Meier survival curves were computed, and time-varying covariate Cox regression models were fitted to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) in all sample and by sex. The prognostic ability of the fitted models was computed for each model by six different measures. RESULTS: After 12 years of follow-up (median survival time: 7.3 years), 311 participants died. Overall survival curves show lower survival rates among those with the highest levels of disability/dependence (all log-rank p-values <0.0001). These findings were confirmed in all regression models for both sexes, particularly in men who had higher levels of dependence on Activities of Daily Living (ADLs) by m-Katz Index and severe disability by m-RS and presented the highest HR of dying (HR: 3.34 (95 %CI: 2.27-4.92) and HR: 4.94 (95 % CI: 3.15-7.75), respectively). CONCLUSIONS: Both the m-Katz Index and the m-RS scale were good predictors of long-term mortality, which is of importance for guiding the functional rehabilitation of stroke patients. Besides, high levels of disability and dependence were implicated with high mortality risks, regardless of sex.

Optimal cardiovascular health is associated with slower cognitive decline.

BACKGROUND: Life's Simple 7, a lifestyle and cardiovascular index associated with cognition, has been updated to Life's Essential 8 (LE8) to include sleep. LE8 has been related to cardiovascular outcomes but its association with cognition is unclear. METHODS: In this longitudinal analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), LE8 score was based on health behaviors (diet, physical activity, nicotine exposure, and sleep health) as well as health-related factors (body mass index, blood lipids, blood glucose, and blood pressure). Cognition was assessed in three waves, 4 years apart, using the Consortium to Establish a Registry for Alzheimer's Disease - Word List, semantic and phonemic verbal fluency, the Trail-Making Test B (TMT-B), and a global composite score. We used linear mixed-model analysis, inverse probability weighting, and interaction analysis. RESULTS: At baseline, the mean age of the study cohort was 51.4 ± 8.9 years, 56% were women, and 53% were White. Higher baseline LE8 scores were associated with slower decline in global cognition (ß = 0.001, 95% confidence interval [CI] 0.001, 0.002; p < 0.001), memory (ß = 0.001, 95% CI 0.000, 0.002; p = 0.013), verbal fluency (ß = 0.001, 95% CI 0.000, 0.002; p = 0.003), and TMT-B (ß = 0.004, 95% CI 0.003, 0.005; p < 0.001). This association was mainly driven by LE8 health factors, particularly blood glucose and blood pressure. Age, sex, and race were modifiers of the association between LE8 and global cognitive decline (p < 0.001), suggesting it was more pronounced in older, male, and Black participants. CONCLUSIONS: Higher baseline LE8 scores were associated with slower global and domain-specific cognitive decline during 8 years of follow-up, mainly due to health factors such as blood glucose and blood pressure. Sociodemographic factors were modifiers of this association.

New-Onset Diabetes Mellitus in COVID-19: A Scoping Review.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic became superimposed on the pre-existing obesity and diabetes mellitus (DM) pandemics. Since COVID-19 infection alters the metabolic equilibrium, it may induce pathophysiologic mechanisms that potentiate new-onset DM, and we evaluated this issue. METHOD: A systematic review of the literature published from the 1 January 2020 until the 20 July 2023 was performed (PROSPERO registration number CRD42022341638). We included only full-text articles of both human clinical and randomized controlled trials published in English and enrolling adults (age > 18 years old) with ongoing or preceding COVID-19 in whom hyperglycemia was detected. The search was based on the following criteria: "(new-onset diabetes mellitus OR new-onset DM) AND (COVID-19) AND adults". RESULTS: Articles on MEDLINE (n = 70) and the Web of Science database (n = 16) were included and analyzed by two researchers who selected 20 relevant articles. We found evidence of a bidirectional relationship between COVID-19 and DM. CONCLUSIONS: This link operates as a pathophysiological mechanism supported by epidemiological data and also by the clinical and biological findings obtained from the affected individuals. The COVID-19 pandemic raised the incidence of DM through different pathophysiological and psychosocial factors.

Potential Determinants of Thyroid Peroxidase Antibodies and Mortality Risk: Results From the ELSA-Brasil Study.

CONTEXT: The presence of thyroid peroxidase antibodies (TPOAbs) may be considered as an indicator of adverse health outcomes. OBJECTIVE: We aimed to investigate the potential determinants of TPOAb levels and to analyze the association between TPOAb titers and the risk of all- and specific-cause mortality. METHODS: Baseline and longitudinal data of 13 187 participants from the ELSA-Brasil Study were analyzed. We investigated the association of TPOAb, detectability, positivity, and persistent positivity with sociodemographic and lifestyle factors using logistic regressions. Cox proportional hazards and Fine-Gray subdistribution hazard regression analyses were used to verify the association of TPOAbs with mortality. RESULTS: The determinants of TPOAb detectability and positivity were younger age, higher body mass index, female sex, and former and current smoking status. Black, mixed, and other self-reported races, intermediate and higher education, and heavy drinking were determinants of detectable and positive TPOAb levels. Female sex, White race, and former smoking were determinants of persistent TPOAb positivity at 2 visits, although only the female sex maintained its association at 3 visits. Moreover, after multivariate adjustment, there were associations between higher levels of TPOAbs and higher risk of cancer-related mortality among men, and TPOAb detectability and mortality by other causes among women. CONCLUSION: Sociodemographic and lifestyle-related factors were determinants of multiple TPOAb categories. TPOAb levels were associated with mortality risk; however, the low mortality rate in this sample might have compromised this finding. We suggest further studies to explore the clinical importance of detectable TPOAb levels, not only its positivity, as a potential marker of inflammation.

Incident Coronary Calcium Score in Patients With OSA With and Without Excessive Sleepiness: Brazilian Longitudinal Study of Adult Health.

BACKGROUND: Uncertainty exists about the impact of OSA and its phenotypes on cardiovascular disease. RESEARCH QUESTION: Are OSA and clinical features such as daytime sleepiness associated with incident subclinical coronary atherosclerosis? STUDY DESIGN AND METHODS: In this prospective community-based cohort study, we administered a sleepiness questionnaire, actigraphy, and home sleep studies at baseline. Coronary artery calcium (CAC; 64-slice multidetector CT scan imaging) was measured at two different time points throughout the study (baseline, between 2010 and 2014, and follow-up, between 2016 and 2018). Incidence of subclinical atherosclerosis was defined as baseline CAC of 0 followed by CAC of > 0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression. Stratified analyses based on excessive daytime sleepiness (EDS) were performed. RESULTS: We analyzed 1,956 participants with available CAC scores at baseline (mean age, 49 ± 8 years; 57.9% female; 32.4% with OSA). In covariate-adjusted analyses (n = 1,247; mean follow-up, 5.1 ± 0.9 years), we found a significant association between OSA and incidence of subclinical atherosclerosis (OR, 1.26; 95% CI, 1.06-1.48), with stronger effects among those reporting EDS (OR, 1.66; 95% CI, 1.30-2.12; P = .028 for interaction). Interestingly, EDS per se was not associated with any CAC outcome. An exploratory analysis of the square root of CAC progression (baseline CAC > 0 followed by a numerical increase in scores at follow-up; n = 319) showed a positive association for both OSA (ß = 1.084; 95% CI, 0.032-2.136; P = .043) and OSA with EDS (ß = 1.651; 95% CI, 0.208-3.094; P = .025). INTERPRETATION: OSA, particularly with EDS, predicts the incidence and progression of CAC. These results support biological plausibility for the increased cardiovascular risk observed among patients with OSA with excessive sleepiness.

The impact of diabetes and subclinical hypothyroidism association with coronary artery calcium: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

ABSTRACT Objective: We aimed to analyze the association of diabetes and subclinical hypothyroidism with subclinical atherosclerosis measured by coronary artery calcium (CAC) in the baseline of the ELSA-Brasil study. Materials and methods: CAC was measured using a 64-detector computed tomographic scanner. The association of CAC > 0 was presented as an odds ratio (OR) and 95% confidence intervals (95%CI) in logistic models and as β (95%CI) in linear models after multivariable adjustment for confounders. Results: We analyzed 3,809 participants (mean-age (SD) 50.5 (8.8); 51.7% women). In the main analysis, we did not find an association of diabetes and subclinical hypothyroidism with CAC. However, in stratified analysis according to age strata, we found no significative interaction terms, an important heterogeneity between the groups, with the younger age strata showing an association of the group with both diseases and CAC > 0 (OR 7.16; 95%CI, 1.14; 44.89) with a wide but significative 95%CI, suggesting that the smaller number of participants in the younger group may influence the results. Our findings also showed an association of CAC > 0 and log (CAC+1) with diabetes in logistic (OR, 1.31; 95%CI, 1.05-1.63) and linear models (β, 0.24, 0.16, 0.40), respectively. Diabetes was independently associated with CAC > 0 in linear models. Discussion: In conclusion, our results showed a great heterogeneity in stratified analysis based on age in the younger age strata. Although we found no significant interaction factors, the smaller sample size for the analysis may influence the negative findings.

Carotid intima-media thickness and incident hypertension: the Brazilian Longitudinal Study of Adult Health.

BACKGROUND: High blood pressure (BP) increases carotid intima-media thickness (CIMT). On the other hand, it is not clear whether the vascular abnormalities reflected in high CIMT may predict incident hypertension. The present study aims to investigate the association between CIMT and incident hypertension after 4 years of follow-up in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multiethnic sample of middle-aged adults from six Brazilian cities. METHODS: We analyzed data from 6682 ELSA-Brasil participants (aged 35-74) without hypertension and with complete CIMT data at baseline. After 4 years of follow-up, we describe hypertension incidence, stratifying the sample according to age, sex, and race-specific CIMT quartiles. We also built crude and adjusted Poisson regression models to analyze the association between mean and maximal CIMT values and incident hypertension. RESULTS: We found incident hypertension in 987 (14.8%) participants. According to mean CIMT quartile groups, hypertension incidence varied from 10.2% (first quartile group) to 22.4% (fourth quartile group; P for trend <0.001). In fully adjusted models, 0.1 mm increments in mean CIMT values were associated with a 16% [relative risk (RR):1.16; 95% confidence interval (95% CI) 1.10-1.21; P  < 0.001] higher risk of incident hypertension, respectively. Results were similar when maximal CIMT values were considered instead of mean CIMT values. CONCLUSION: CIMT values at baseline strongly predicted incident hypertension after 4 years of follow-up in this large multiethnic cohort. This highlights the relationship between CIMT and BP and may provide important insights into the significance of this ultrasound measurement.