Desarrollo y validación de la puntuación de calidad alimentaria en el ELSA-brasil / Development and validation of the food quality score in ELSA-Brasil

Introducción: la epidemiología nutricional busca comprender la relación entre el consumo de alimentos y la ocurrencia de enfermedades.Durante la pandemia de COVID-19, el Estudio Longitudinal de Salud del Adulto (ELSA-Brasil) utilizó un Cuestionario de Frecuencia de Alimentos(CFA) reducido para comparar la calidad de la dieta en diferentes etapas de la cohorte.Objetivo: desarrollar y validar un índice creado a partir de un score (o puntuación) de calidad alimentaria (SCA) utilizando el CFA del ELSA-Brasil.Métodos: estudio transversal realizado entre agosto de 2020 y marzo de 2021 con 4262 participantes. Para cada categoría de frecuencia deconsumo de alimentos indicadores de alimentación saludable y no saludable, se otorgó una puntuación. La validez y la fiabilidad se estimaronmediante el coeficiente de correlación de Pearson, el análisis de componentes principales (ACP) y la alfa de Cronbach. Se realizaron pruebaspara verificar las diferencias entre las características individuales y la SCA.Resultados: el ACP indicó una variabilidad total del 42,5 %. Las mujeres y los individuos con mayor edad, actividad física e ingreso per cápitaobtuvieron un valor de SCA más alto, mientras que aquellos que reportaron un mayor consumo de alcohol y tabaquismo obtuvieron una puntuaciónmás baja. La alfa de Cronbach fue de 0,47.Conclusión: la SCA mostró una validez y confiabilidad satisfactorias y se asoció con datos socioeconómicos y de estilo de vida. Por lo tanto, esuna herramienta útil para comparar la información dietética, contribuyendo a los futuros análisis en epidemiología nutricional.(AU)

Introduction: nutritional epidemiology seeks to understand the relationship between food consumption and the occurrence of diseases. Duringthe COVID-19 pandemic, the Longitudinal Study of Adult Health (ELSA-Brasil) used a reduced Food Frequency Questionnaire (FFQ) to comparediet quality between cohort stages.Objective: to develop and validate an index created using a food quality score (FQS) using the FFQ of ELSA-Brasil.Methods: a cross-sectional study carried out between August 2020 and March 2021 with 4262 participants. For each frequency of consumptionof healthy and unhealthy food markers, a score was given. Validity and reliability were tested using Pearson’s correlation, principal componentanalysis (PCA) and Cronbach’s alpha. Tests were performed to verify differences between individual characteristics and FQS.Results: the PCA indicated a total variability of 42.5 %. Women and individuals with higher age, physical activity and per capita income had ahigher FQS, while those who reported higher consumption of alcohol and being smokers had a lower score. Cronbach’s alpha was 0.47.Conclusion: the FQS showed a satisfactory validity and reliability and was associated with socioeconomic and lifestyle data. Therefore, it is auseful tool for comparing dietary information, thus contributing to nutritional epidemiology.(AU)

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.

[Development and validation of the food quality score in ELSA-Brasil]. / Desarrollo y validación de la puntuación de calidad alimentaria en el ELSA-Brasil.

Introduction: miology.Introduction: nutritional epidemiology seeks to understand the relationship between food consumption and the occurrence of diseases. During the COVID-19 pandemic, the Longitudinal Study of Adult Health (ELSA-Brasil) used a reduced Food Frequency Questionnaire (FFQ) to compare diet quality between cohort stages. Objective: to develop and validate an index created using a food quality score (FQS) using the FFQ of ELSA-Brasil. Methods: a cross-sectional study carried out between August 2020 and March 2021 with 4262 participants. For each frequency of consumption of healthy and unhealthy food markers, a score was given. Validity and reliability were tested using Pearson's correlation, principal component analysis (PCA) and Cronbach's alpha. Tests were performed to verify differences between individual characteristics and FQS. Results: the PCA indicated a total variability of 42.5 %. Women and individuals with higher age, physical activity and per capita income had a higher FQS, while those who reported higher consumption of alcohol and being smokers had a lower score. Cronbach's alpha was 0.47. Conclusion: the FQS showed a satisfactory validity and reliability and was associated with socioeconomic and lifestyle data. Therefore, it is a useful tool for comparing dietary information, thus contributing to nutritional epidemiology.

Introducción: Introducción: la epidemiología nutricional busca comprender la relación entre el consumo de alimentos y la ocurrencia de enfermedades. Durante la pandemia de COVID-19, el Estudio Longitudinal de Salud del Adulto (ELSA-Brasil) utilizó un Cuestionario de Frecuencia de Alimentos (CFA) reducido para comparar la calidad de la dieta en diferentes etapas de la cohorte. Objetivo: desarrollar y validar un índice creado a partir de un score (o puntuación) de calidad alimentaria (SCA) utilizando el CFA del ELSA-Brasil. Métodos: estudio transversal realizado entre agosto de 2020 y marzo de 2021 con 4262 participantes. Para cada categoría de frecuencia de consumo de alimentos indicadores de alimentación saludable y no saludable, se otorgó una puntuación. La validez y la fiabilidad se estimaron mediante el coeficiente de correlación de Pearson, el análisis de componentes principales (ACP) y la alfa de Cronbach. Se realizaron pruebas para verificar las diferencias entre las características individuales y la SCA. Resultados: el ACP indicó una variabilidad total del 42,5 %. Las mujeres y los individuos con mayor edad, actividad física e ingreso per cápita obtuvieron un valor de SCA más alto, mientras que aquellos que reportaron un mayor consumo de alcohol y tabaquismo obtuvieron una puntuación más baja. La alfa de Cronbach fue de 0,47. Conclusión: la SCA mostró una validez y confiabilidad satisfactorias y se asoció con datos socioeconómicos y de estilo de vida. Por lo tanto, es una herramienta útil para comparar la información dietética, contribuyendo a los futuros análisis en epidemiología nutricional.

Examining the Usage Patterns of Non-Nutritive Sweeteners among Non-Diabetic Individuals: Insights from the Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: Although non-nutritive sweeteners (NNSs) were formulated primarily for sugar-restricted diets, nowadays, their consumption has become widespread among the general population. Thus, the purpose of this study was to estimate the prevalence of the regular use of NNSs and their associated factors among non-diabetic individuals from the baseline of the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: In total, 9226 individuals were analysed, and the regular consumption of NNSs was defined as follows: NSSs are used at least once a day. Associations between exposure and outcomes were analysed using chi-square and Student's t-tests. Significant variables were inserted into a binary logistic regression model to determine the adjusted association measures (significance level of 5%). RESULTS: The prevalence of regular NNS consumption was 25.7%. Regular NNS consumption increased with age, categories of BMI, income, and schooling. The odds of regularly consuming NNSs were 1.9-times higher among women, 6.1-times higher among obese individuals, and 1.8-times higher among those with higher schooling and income. CONCLUSIONS: Specific groups seem to present a larger association relative to the use of NNS. Based on the significant overall prevalence of the regular use of NNSs, a discussion regarding country-wide policies related to their intake is needed to address recent WHO directions concerning this additive.

Impact of socioeconomic factors on lifestyle changes among employees of public higher education institutions in ELSA-Brasil during COVID-19 pandemic.

This study aimed to identify lifestyle changes and associated sociodemographic factors in women and men participating in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) cohort during the COVID-19 pandemic. Longitudinal study with 3,776 (aged 58.8 years; SD ± 8.5) employees of public higher education institutions in the second follow-up and the wave-COVID of ELSA-Brasil. Data collected using structured questionnaires. An exploratory analysis was performed using binary and multinomial logistic regression on the dependent variables with two and three categories, respectively, by obtaining crude and adjusted odds ratio estimates in SPSS 20.0, considering a p-value < 0.05. There was a reduction in physical activity of 195.5 (SD ± 1,146.4) metabolic equivalents per week in women and 240.5 (SD ± 1,474.2) in men, and in smoking by 15.2%. There was an increase in alcohol consumption in men and women (434.2 ± 5,144.0; and 366.1 ± 4,879.0, respectively), in the food quality score (0.8 ± 3.7, women; 0.5 ± 3.7, men), sleeping time (0.4 ± 1.2, women; 0.5 ± 1.1, men), screen time (1.7 ± 2.4, women; 1.4 ± 2.3, men), and sitting time (1.7 ± 2.6, women; 1.5 ± 2.4, men) (hours/day). In total, 18.6% increased the purchase of ultra-processed foods and 36% increased the purchase of natural foods. Age and work activity contributed to increase the chance of purchasing ultra-processed foods, and age and adherence to social distancing influenced the shift to a more sedentary behavior, while income and active work favored the increase in alcoholic beverage consumption. These factors should be considered when developing public policies to avoid individual behaviors that are harmful to health during pandemics.

Consumption of ultra-processed foods and eight-year risk of death from all causes and noncommunicable diseases in the ELSA-Brasil cohort.

Increased consumption of ultra-processed foods (UPF) is associated with higher incidences of many noncommunicable diseases (NCDs) and death from all causes. However, the association between UPF and cardiovascular disease (CVD) mortality remains controversial. Our study investigated whether UPF consumption is associated with a higher risk of death from all causes, NCDs, and CVD. This study includes 14,747 participants from the ELSA-Brasil cohort followed up over an eight-year period. The NOVA classification was used to estimate the proportion of UPF (grams/day) in one's diet. Cox regression was also applied. After adjustment for sociodemographic, health, and behavioural factors, a 10% increase in UPF in participants' diets raised the risk of death from all causes and NCDs by 10% (95%CI: 1.01-1.19) and 11% (95%CI:1.02-1.21), respectively. However, UPF consumption was not associated with CVD mortality. The findings support public policies aimed at reducing UPF consumption in an attempt to reduce the NCD burden.

[Factors associated with adherence to COVID-19 preventive behaviors in ELSA-Brasil participants]. / Fatores associados à adesão a comportamentos preventivos da COVID-19 em participantes do ELSA-Brasil.

The aim of the study is to assess the adherence to recommended prevention measures during the COVID-19 pandemic and to investigate the factors associated with this adherence in the adult population. This study has a cross-sectional design and used data from the complementary study Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) - COVID, conducted from 2020 to 2021. Data were analyzed using the chi-square test and multinomial logistic regression. The sample consisted of 5,440 participants. The preventive measure with the highest adherence was the use of a face mask (95.5%). There was greater adherence by females and lower chance of adherence by white people, by those who consume alcoholic beverages, people who were retired, as well as for those who live alone or who have family members who did not follow the recommendations to stay at home. Greater adherence to preventive behaviors was observed in only one third of the participating population, which demonstrates that there was a need for greater awareness of the risks in specific populations. The findings contribute to improving our understanding about health promotion and COVID-19 prevention.

O objetivo deste estudo foi avaliar a adesão a medidas de prevenção recomendadas durante a pandemia de COVID-19 e investigar os fatores associados a essa adesão na população adulta. Por meio de delineamento transversal, utilizam-se dados do estudo complementar Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) - COVID, realizado de 2020 a 2021, que foram analisados por meio do teste qui-quadrado e regressão logística multinomial. A amostra é composta por 5.440 participantes. A medida preventiva com maior adesão foi o uso de máscara facial (95,5%). Houve maior adesão pelo sexo feminino e menor chance de adesão pela raça/cor branca, por aqueles que consomem bebidas alcoólicas, aposentados, assim como para aqueles que moram sozinhos ou que possuem familiares que não seguiram as recomendações de ficar em casa. A maior adesão aos comportamentos preventivos foi verificada em apenas um terço da população participante, o que demonstra que havia a necessidade de uma maior conscientização quanto aos riscos em populações específicas. Os achados contribuem para melhorar o conhecimento sobre promoção da saúde e prevenção da COVID-19.

El objetivo del estudio fue evaluar la adhesión a las medidas de prevención recomendadas durante la pandemia de COVID-19 e investigar los factores asociados con esta adhesión en la población adulta. El presente estudio tiene un diseño transversal y utilizó datos del estudio complementario Estudio Longitudinal de Salud del Adulto en Brasil (ELSA-Brasil) - COVID, realizado de 2020 a 2021. Los datos se analizaron mediante la prueba de chi-cuadrado y la regresión logística multinomial. La muestra fue compuesta por 5.440 participantes. La medida preventiva con mayor adhesión fue el uso de mascarilla facial (95,5%). Hubo mayor adhesión por el sexo femenino y menor posibilidad de adhesión por la raza/color blanca, por aquellos que consumen bebidas alcohólicas, jubilados, así como para aquellos que viven solos o que tienen familiares que no siguieron las recomendaciones de quedarse en casa. Solo se comprobó una mayor adhesión a los comportamientos preventivos en un tercio de la población participante, lo que demuestra que había la necesidad de una mayor concientización en cuanto a los riesgos en poblaciones específicas. Los resultados contribuyen a mejorar el conocimiento sobre la promoción de la salud y la prevención del COVID-19.

Nutritional intake in high-performance para athletes.

OBJECTIVE: This study aimed to describe the eating habits of para-athletes who attended a specialized training center in Brazil. METHODS: Participants were recruited from the Sports Training Center at the Universidade Federal de Minas Gerais, Brazil. Energy, macronutrient (expressed in absolute terms and relative to body weight), fiber, cholesterol, and micronutrient intakes were assessed via a food frequency questionnaire, based on intakes over the preceding 12 mo. Sociodemographic factors were assessed using a purpose-designed survey, which included self-reported weight and height. Differences in nutrient intake based on sex, age, body mass index, and sporting factors were evaluated. RESULTS: A total of 30 para-athletes (in para athletics, para-powerlifting, para-swimming, and para-taekwondo) were included in the study. The median total energy intake was 4089 (2855-5829) kcal. The median consumption of carbohydrates, proteins, and fats was 512.3 (358.7-853.5), 184.5 (118.5-246.4), and 137.1 (96.8-189.5) g/d, respectively. Adolescent athletes had higher protein intakes than adult athletes (P = 0.02). Para-athletes with a longer sports career had lower consumption of fiber (P = 0.01) and thiamine (P = 0.02). Participants with a higher body mass index had higher intake of alcohol (P = 0.04) and monounsaturated fats (P = 0.01). Higher consumption of alcohol was also reported by older para-athletes (P = 0.02). CONCLUSIONS: We identified a higher saturated fat intake in male than in female para-athletes as well as higher protein intake (g/kg) in younger compared with older athletes. In addition, sociodemographic characteristics influenced the dietary intake of some para-athletes, such as length of sports career, age, and income.

Racial discrimination predicts the increase in body weight and BMI in Black individuals from ELSA-Brasil cohort / Discriminação racial prediz o aumento do peso corporal e do IMC em indivíduos pretos da coorte ELSA-Brasil

Abstract We investigated whether racial discrimination accelerates the weight and Body Mass Index (BMI) gain in Blacks and Browns participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) in four years of follow-up. We compared body weight and BMI between the 1st (2008-2010) and 2nd visit (2012-2014) of 5,983 Blacks and Browns participants. Exposure to racial discrimination and covariates (age, sex, education, and research center) were obtained at the 1st visit. Linear mixed effects models stratified by race/skin color were used. Report of racial discrimination was more frequent among Blacks (32.1%) than Browns (6.3%). During the follow-up period, Blacks and Browns gained an average of 1.4kg and 1.2kg, respectively. This increase was greater among those who reported discrimination when compared to those who did not, both in Blacks (2.1kg vs.1.0kg, p < 0.001) and Browns (1.9kg vs. 1.1kg, p < 0.05). The results of the interaction between racial discrimination and time showed that Blacks, but not Browns, who reported racial discrimination had greater weight and BMI gains between visits. Our results suggest that reducing racial discrimination would contribute to prevent and/or control obesity increase in the country.

Resumo Investigou-se se a discriminação racial acelera o ganho de peso corporal e o Índice de Massa Corporal (IMC) em pretos e pardos participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) em quatro anos de seguimento. Comparou-se o peso corporal e o IMC entre a 1ª (2008-2010) e a 2ª visita (2012-2014) de 5.983 participantes pretos e pardos. A exposição à discriminação racial e às covariáveis ​​(idade, sexo, escolaridade e centro de pesquisa) foram obtidas na 1ª visita. Foram utilizados modelos lineares de efeitos mistos estratificados por raça/cor da pele. O relato de discriminação racial foi mais frequente entre pretos (32,1%) do que em pardos (6,3%). Durante o período de acompanhamento, pretos e pardos ganharam uma média de 1,4kg e 1,2kg, respectivamente. Esse aumento foi maior entre os que relataram discriminação, quando comparados aos que não relataram, tanto em pretos (2,1 kg vs. 1,0 kg, p < 0,001) quanto em pardos (1,9kg vs. 1,1kg, p < 0,05). Após ajustes, os pretos, mas não os pardos, que relataram discriminação racial apresentaram maiores ganhos de peso e IMC entre as visitas. Nossos resultados sugerem que a redução da discriminação racial pode contribuir para prevenir e/ou controlar o aumento da obesidade no país.

Racial discrimination predicts the increase in body weight and BMI in Black individuals from ELSA-Brasil cohort.

We investigated whether racial discrimination accelerates the weight and Body Mass Index (BMI) gain in Blacks and Browns participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) in four years of follow-up. We compared body weight and BMI between the 1st (2008-2010) and 2nd visit (2012-2014) of 5,983 Blacks and Browns participants. Exposure to racial discrimination and covariates (age, sex, education, and research center) were obtained at the 1st visit. Linear mixed effects models stratified by race/skin color were used. Report of racial discrimination was more frequent among Blacks (32.1%) than Browns (6.3%). During the follow-up period, Blacks and Browns gained an average of 1.4kg and 1.2kg, respectively. This increase was greater among those who reported discrimination when compared to those who did not, both in Blacks (2.1kg vs.1.0kg, p < 0.001) and Browns (1.9kg vs. 1.1kg, p < 0.05). The results of the interaction between racial discrimination and time showed that Blacks, but not Browns, who reported racial discrimination had greater weight and BMI gains between visits. Our results suggest that reducing racial discrimination would contribute to prevent and/or control obesity increase in the country.

Food consumption by degree of processing is associated with nocturnal dipping and blood pressure variability: The ELSA-Brasil study.

BACKGROUND AND AIMS: Ambulatory blood pressure monitoring (ABPM) allows the assessment of cardiovascular risk markers that cannot be obtained by casual measurements; however, the evidence on the association between food consumption and blood pressure (BP) assessed by ABPM is scarce. We aimed to evaluate the association between food consumption by degree of processing and ambulatory BP. METHODS AND RESULTS: Cross-sectional analysis (2012-2014) of data from a subsample (n = 815) of ELSA-Brasil cohort participants who performed 24-h ABPM was conducted. Systolic (SBP) and diastolic (DBP) BP means and variability during the 24 h and subperiods (sleep and wake), nocturnal dipping, and morning surge were evaluated. Food consumption was classified according to NOVA. Associations were tested by generalized linear models. The consumption of unprocessed, minimally processed foods, and culinary ingredients (U/MPF&CI) was 63.1% of daily caloric intake, 10.8% of processed (PF), and 24.8% of ultraprocessed (UPF). A negative association was found between U/MPF&CI consumption and extreme dipping (T2: odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.55-0.58; T3: OR = 0.55; 95% CI = 0.54-0.57); and between UPF consumption and nondipping (T2: OR = 0.68, 95% CI = 0.55-0.85) and extreme dipping (T2: OR = 0.63, 95% CI = 0.61-0.65; T3: OR = 0.95, 95% CI = 0.91-0.99). There was a positive association between PF consumption and extreme dipping (T2: OR = 1.22, 95% CI = 1.18-1.27; T3: OR = 1.34, 95% CI = 1.29-1.39) and sleep SBP variability (T3: Coef = 0.56, 95% CI = 0.03-1.10). CONCLUSIONS: The high consumption of PF was associated with greater BP variability and extreme dipping, while the U/MPF&CI and UPF consumption were negatively associated with alterations in nocturnal dipping.

Excessive Consumption of Alcoholic Beverages and Extremely High Levels of High-Density Lipoprotein Cholesterol (HALP) in the ELSA-Brasil Cohort Baseline.

BACKGROUND: It has already been established that the consumption of alcoholic beverages increases high-density lipoprotein cholesterol (HDL-C) levels in dose-response. METHODS AND RESULTS: A cross-sectional analysis was carried out with 6132 participants of both sexes aged between 35 and 74 years, who were active and retired workers from six Brazilian states. Heavy drinkers were categorized by sex: men > 210 g/week and women > 140 g/week; moderate drinkers: men ≤ 209 g/week and women ≤ 139 g/week. The HDL-C level was dichotomized into normal (40 mg/dL-82.9 mg/dL) and extremely high (≥83 mg/dL). We used binary logistic regression to assess associations between baseline alcohol intake and HDL-C, which were adjusted for sex, age, income, physical activity, kilocalories and body mass index (BMI), and we found an positive association between extremely high HDL-C and the excessive consumption of alcoholic beverages. These participants were mostly women with a high income, lower waist circumference, kilocalorie consumption and also a higher consumption in all categories of alcoholic beverages. CONCLUSION: Excessive alcohol consumption was associated with a higher probability of extremely high HDL-C.

Prevalence and factors associated with self-reported anxiety in adults during the COVID-19 pandemic in Argentina, Brazil, Peru, Mexico, and Spain: A cross-sectional Ibero-American study.

The present study evaluated the factors associated with the perception of anxiety during the first wave of covid-19 in Ibero-American countries. This cross-sectional study was carried out with 5.845 participants of both sexes, over 18 years of age, and residents of four Latin American countries-Argentina (16.7%), Brazil (34.5%), Mexico (11.1%), and Peru (17.5%), and one European country-Spain (20.1%). Data were collected in 2020, between April 1st and June 30th in Spain and between July 13th and September 26th in the Latin American countries. We used an online questionnaire with sociodemographic, lifestyle, self-reported anxiety, and covid-19 related questions. The chi-square statistical test and Multivariate logistic regressions were performed to analyze the factors associated with self-reported anxiety. The presence of self-reported anxiety was found in 63.8% of the participants during the isolation period. The association occurred mainly in women (OR:1.52; CI: 1.3-1.7), those aged 18 to 29 years (OR: 1.51; CI: 1.2-1.9) and 30 to 49 years (OR: 1.56; CI: 1.3-1.9), residents of Argentina (OR: 1.55 CI: 1.2-1.9), Brazil (OR: 2.38; CI: 2.0-2.8) and Mexico (OR: 1.52; CI: 1.2-1.9), those who gained weight (OR:1.71 CI: 1.5-1.9) or lost weight (OR: 1.40; CI: 1.2-1.6), and those who reported having slept more (OR: 1.56; CI: 1.3-1.8) or less (OR: 2.89; CI: 2.5-3.4). We conclude that the prevalence of self-reported anxiety in Ibero-American countries was high during the period studied, highlighting a higher likelihood of its occurrence in Brazil, in those who began to sleep less and gained weight.

Depression is a risk factor for metabolic syndrome: Results from the ELSA-Brasil cohort study.

INTRODUCTION: Metabolic Syndrome (MetS) and depression comorbidity has been recognized, but its directionality is still uncertain. The aims of this study was to assess the association between depression (diagnosis and severity) and MetS (components, diagnosis and trajectory) in the baseline and over a 4-year follow-up period. MATERIAL AND METHODS: Baseline and follow-up data from 13,883 participants of the Brazilian Longitudinal Study of Adult Health were analyzed. The Clinical Interview Schedule Revised assessed depressive episode and its severity. MetS components and diagnosis were assessed according to the National Cholesterol Education Program Adult Treatment Panel III. Participants were grouped according to MetS trajectory as recovered, incident and persistent MetS. Logistic regression analysis was conducted estimating odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: Baseline depression was positively associated with recovered (OR = 1.59, 95%CI 1.18-2.14), incident (OR = 1.45, 95%CI 1.09-1.91) and persistent (OR = 1.70, 95%CI 1.39-2.07) MetS. Baseline depression was also associated with large waist circumference (OR = 1.47, 95%CI 1.23-1.75), high triglycerides (OR = 1.23, 95%CI 1.02-1.49), low high-density lipoprotein cholesterol (OR = 1.30, 95%CI 1.08-1.56), and hyperglycemia (OR = 1.38, 95%CI 1.15-1.66) at follow-up. Having three or more MetS components at follow-up was associated with baseline depression, with a positive dose-response effect (OR = 1.77, 95%CI 1.29-2.43; OR = 1.79, 95%CI 1.26-2.54; OR = 2.27, 95%CI 1.50-3.46, respectively). The magnitude of associations was greater in severe depression, when compared to moderate and mild. DISCUSSION: These results support that depression is a risk factor for the development of MetS and highlights the need to follow metabolic and cardiovascular alterations in the presence of depression.

Fatores associados à adesão a comportamentos preventivos da COVID-19 em participantes do ELSA-Brasil / Factors associated with adherence to COVID-19 preventive behaviors in ELSA-Brasil participants / Factores asociados a la adhesión a comportamientos preventivos de COVID-19 en participantes de ELSA-Brasil

O objetivo deste estudo foi avaliar a adesão a medidas de prevenção recomendadas durante a pandemia de COVID-19 e investigar os fatores associados a essa adesão na população adulta. Por meio de delineamento transversal, utilizam-se dados do estudo complementar Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) - COVID, realizado de 2020 a 2021, que foram analisados por meio do teste qui-quadrado e regressão logística multinomial. A amostra é composta por 5.440 participantes. A medida preventiva com maior adesão foi o uso de máscara facial (95,5%). Houve maior adesão pelo sexo feminino e menor chance de adesão pela raça/cor branca, por aqueles que consomem bebidas alcoólicas, aposentados, assim como para aqueles que moram sozinhos ou que possuem familiares que não seguiram as recomendações de ficar em casa. A maior adesão aos comportamentos preventivos foi verificada em apenas um terço da população participante, o que demonstra que havia a necessidade de uma maior conscientização quanto aos riscos em populações específicas. Os achados contribuem para melhorar o conhecimento sobre promoção da saúde e prevenção da COVID-19.

The aim of the study is to assess the adherence to recommended prevention measures during the COVID-19 pandemic and to investigate the factors associated with this adherence in the adult population. This study has a cross-sectional design and used data from the complementary study Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) - COVID, conducted from 2020 to 2021. Data were analyzed using the chi-square test and multinomial logistic regression. The sample consisted of 5,440 participants. The preventive measure with the highest adherence was the use of a face mask (95.5%). There was greater adherence by females and lower chance of adherence by white people, by those who consume alcoholic beverages, people who were retired, as well as for those who live alone or who have family members who did not follow the recommendations to stay at home. Greater adherence to preventive behaviors was observed in only one third of the participating population, which demonstrates that there was a need for greater awareness of the risks in specific populations. The findings contribute to improving our understanding about health promotion and COVID-19 prevention.

El objetivo del estudio fue evaluar la adhesión a las medidas de prevención recomendadas durante la pandemia de COVID-19 e investigar los factores asociados con esta adhesión en la población adulta. El presente estudio tiene un diseño transversal y utilizó datos del estudio complementario Estudio Longitudinal de Salud del Adulto en Brasil (ELSA-Brasil) - COVID, realizado de 2020 a 2021. Los datos se analizaron mediante la prueba de chi-cuadrado y la regresión logística multinomial. La muestra fue compuesta por 5.440 participantes. La medida preventiva con mayor adhesión fue el uso de mascarilla facial (95,5%). Hubo mayor adhesión por el sexo femenino y menor posibilidad de adhesión por la raza/color blanca, por aquellos que consumen bebidas alcohólicas, jubilados, así como para aquellos que viven solos o que tienen familiares que no siguieron las recomendaciones de quedarse en casa. Solo se comprobó una mayor adhesión a los comportamientos preventivos en un tercio de la población participante, lo que demuestra que había la necesidad de una mayor concientización en cuanto a los riesgos en poblaciones específicas. Los resultados contribuyen a mejorar el conocimiento sobre la promoción de la salud y la prevención del COVID-19.

Impact of socioeconomic factors on lifestyle changes among employees of public higher education institutions in ELSA-Brasil during COVID-19 pandemic / Impacto de fatores socioeconômicos na mudança do estilo de vida de funcionários de instituições públicas de Ensino Superior no ELSA-Brasil durante a pandemia de COVID-19 / Impacto de los factores socioeconómicos en el cambio del estilo de vida de los funcionarios en instituciones públicas de educación superior en ELSA-Brasil durante la pandemia de la COVID-19

Abstract: This study aimed to identify lifestyle changes and associated sociodemographic factors in women and men participating in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) cohort during the COVID-19 pandemic. Longitudinal study with 3,776 (aged 58.8 years; SD ± 8.5) employees of public higher education institutions in the second follow-up and the wave-COVID of ELSA-Brasil. Data collected using structured questionnaires. An exploratory analysis was performed using binary and multinomial logistic regression on the dependent variables with two and three categories, respectively, by obtaining crude and adjusted odds ratio estimates in SPSS 20.0, considering a p-value < 0.05. There was a reduction in physical activity of 195.5 (SD ± 1,146.4) metabolic equivalents per week in women and 240.5 (SD ± 1,474.2) in men, and in smoking by 15.2%. There was an increase in alcohol consumption in men and women (434.2 ± 5,144.0; and 366.1 ± 4,879.0, respectively), in the food quality score (0.8 ± 3.7, women; 0.5 ± 3.7, men), sleeping time (0.4 ± 1.2, women; 0.5 ± 1.1, men), screen time (1.7 ± 2.4, women; 1.4 ± 2.3, men), and sitting time (1.7 ± 2.6, women; 1.5 ± 2.4, men) (hours/day). In total, 18.6% increased the purchase of ultra-processed foods and 36% increased the purchase of natural foods. Age and work activity contributed to increase the chance of purchasing ultra-processed foods, and age and adherence to social distancing influenced the shift to a more sedentary behavior, while income and active work favored the increase in alcoholic beverage consumption. These factors should be considered when developing public policies to avoid individual behaviors that are harmful to health during pandemics.

Resumo: O objetivo do estudo é identificar mudanças no estilo de vida e fatores sociodemográficos associados em mulheres e homens participantes da coorte Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil) durante a pandemia de COVID-19. Estudo longitudinal com 3.776 (58,8 anos; DP ± 8,5) funcionários de instituições públicas de Ensino Superior no segundo acompanhamento e na onda COVID do ELSA-Brasil. Os dados foram coletados por meio de questionários estruturados. Foi realizada análise exploratória por meio de regressão logística binária e multinomial nas variáveis dependentes com duas e três categorias, respectivamente, obtendo-se estimativas brutas e ajustadas de odds ratio no SPSS 20.0, considerando um valor de p < 0,05. Houve redução da atividade física de 195,5 (DP ± 1.146,4) equivalentes metabólicos por semana nas mulheres e de 240,5 (DP ± 1.474,2) nos homens, e do tabagismo de 15,2%. Houve aumento do consumo de álcool em homens e mulheres (434,2 ± 5.144,0 e 366,1 ± 4.879,0, respectivamente), do escore de qualidade alimentar (0,8 ± 3,7, mulheres; 0,5 ± 3,7, homens), do tempo de sono (0,4 ± 1,2, mulheres; 0,5 ± 1,1, homens), do tempo de tela (1,7 ± 2,4, mulheres; 1,4 ± 2,3, homens) e do tempo sentado (1,7 ± 2,6, mulheres; 1,5 ± 2,4, homens) (horas/dia). Além disso, 18,6% aumentaram a compra de alimentos ultraprocessados e 36% aumentaram a compra de alimentos naturais. A idade e a atividade laboral contribuíram para aumentar a chance de compra de alimentos ultraprocessados, e a idade e a adesão ao distanciamento social influenciaram a mudança para um comportamento mais sedentário, enquanto a renda e o trabalho ativo favoreceram o aumento do consumo de bebidas alcoólicas. Estes fatores devem ser considerados na elaboração de políticas públicas a fim de evitar comportamentos individuais deletérios à saúde em períodos de pandemia.

Resumen: El objetivo de este estudio es identificar los cambios en el estilo de vida y los factores sociodemográficos asociados en mujeres y hombres que participan en la cohorte Estudio Longitudinal de Salud del Adulto en Brasil (ELSA-Brasil) durante la pandemia de la COVID-19. Estudio longitudinal con 3.776 (58,8 años; DE ± 8,5) funcionarios en instituciones públicas de educación superior en el segundo seguimiento y en la ola COVID de ELSA-Brasil. Los datos se recopilaron de cuestionarios estructurados. El análisis exploratorio se realizó mediante regresión logística binaria y multinomial en variables dependientes con dos y tres categorías, respectivamente, en la cual se obtuvieron estimaciones brutas y ajustadas de odds ratios en SPSS 20.0, teniendo en cuenta un valor de p < 0,05. Hubo una reducción en la actividad física de 195,5 (DE ± 1.146,4) equivalentes metabólicos por semana en mujeres y de 240,5 (DE ± 1.474,2) en hombres, y del tabaquismo del 15,2%. Hubo un aumento en el consumo de alcohol en hombres y mujeres (434,2 ± 5.144,0 y 366,1 ± 4.879,0, respectivamente), en el puntaje de calidad de los alimentos (0,8 ± 3,7, mujeres; 0,5 ± 3,7, hombres), en el tiempo de sueño (0,4 ± 1,2, mujeres; 0,5 ± 1,1, hombres), en el tiempo frente a la pantalla (1,7 ± 2,4, mujeres; 1,4 ± 2,3, hombres) y en el tiempo sentado (1,7 ± 2,6, mujeres; 1,5 ± 2,4, hombres) (horas/día). Además, el 18,6% aumentó la compra de alimentos ultraprocesados y el 36% la compra de alimentos.

Food insecurity and depressive symptoms among older adults assisted by the Family Health Strategy in the Northeast region of Brazil / Insegurança alimentar e sintomas depressivos em idosos atendidos pela Estratégia Saúde da Família na Região Nordeste do Brasil

ABSTRACT Objective This study aimed to investigate the association between depressive symptoms and food insecurity in households with older adults. Methods This is a cross-sectional, quantitative study conducted with community-dwelling older adults attended to in the Family Health Strategy in a municipality in the Brazilian Northeast. Depressive symptoms were evaluated using the Geriatric Depression Scale and food insecurity was assessed using the Brazilian Food Insecurity Scale. The chi-squared test was applied for a bivariate analysis and binary logistic regression was used to verify the association between depressive symptoms and food insecurity, adjusted for potential confounding variables. The significance level was p<0.05. Results A total of 316 older adults were evaluated, with a mean age of 70.5 (±7.5 years). The prevalence of depressive symptoms was 27.5% and that of food insecurity was 63.3%, with 25.6% of households with older adults experiencing moderate/severe insecurity. In the multivariate analysis, households experiencing mild food insecurity presented 3 times (OR: 3.02; 95% CI: 1.42-6.39) more chance of developing depressive symptoms, while in those experiencing moderate/severe food insecurity the chance was 5 times higher (OR: 5.01; 95% CI: 2.30-10.92). Conclusion An association was found between food insecurity and depressive symptoms in households with older adults of the Family Health Strategy, with more chances for those experiencing moderate/severe food insecurity.

RESUMO Objetivo Investigar a associação entre sintomas depressivos e insegurança alimentar em domicílios com idosos. Métodos Estudo transversal, quantitativo e realizado com idosos comunitários atendidos na Estratégia Saúde da Família em um município do Nordeste brasileiro. Sintomas depressivos foram avaliados pela Escala Geriátrica de Depressão; e a insegurança alimentar, com a Escala Brasileira de Insegurança Alimentar. Foi aplicado o teste qui-quadrado para análise bivariada e a regressão logística binária para verificar a associação entre sintomas depressivos e insegurança alimentar, ajustada por potenciais variáveis de confundimento. O nível de significância foi p<0,05. Resultados Foram avaliados 316 idosos, com média de idade de 70,5 (±7,5 anos). A prevalência de sintomas depressivos foi de 27,5% e a de insegurança alimentar foi de 63,3%, sendo que 25,6% dos domicílios com idosos estavam em insegurança moderada/grave. Na análise multivariada, domicílios com insegurança alimentar leve apresentaram 3 vezes (OR=3,02; IC 95%1,42-6,39) mais chances de desenvolverem sintomas depressivos, enquanto que aqueles em insegurança alimentar moderada/grave a chance foi 5 vezes maior (OR=5,01; IC 95% 2,30-10,92). Conclusão Foi encontrada associação entre insegurança alimentar e sintomas depressivos em domicílios com idosos da Estratégia Saúde da Família, com mais chances para aqueles com insegurança alimentar moderada/grave.

Alimentación, estilo de vida y distanciamiento social: un estudio en el sureste brasilero durante la pandemia de COVID-19

Introducción: a raíz de la emergencia por la COVID-19, las medidas de distanciamiento social adoptadas para mitigar la tasa de infección pueden influenciar los hábitos alimentarios y otros factores de estilo de vida. El objetivo de este estudio fue evaluar la relación del distanciamiento social y los factores de estilo de vida en adultos del sureste brasilero durante la primera ola pandémica. Metodología: se trata de un estudio transversal con 1828 adultos de entre 18 y 83 años, de ambos sexos, realizado a través de un cuestionario en línea; se recolectaron y analizaron datos sociodemográficos, alimentarios, sanitarios y de estilo de vida, en función de si se guardó o no el distanciamiento social. Resultados: los resultados mostraron disminución del desayuno (12,5 %) y aumento del consumo de meriendas (24,5 % matutina y 12,5 % vespertina) y picoteos entre comidas (20,4 %), así como de la ingesta de verduras y leguminosas entre quienes estaban en distanciamiento social y de pescado y comida rápida entre los que no lo estaban; la mayoría de participantes reportó ganancia de peso a lo largo de este periodo. Las personas en confinamiento dormían más y su principal causa de ansiedad fueron las estadísticas de la enfermedad. Conclusiones: los hallazgos sugieren la necesidad de implementar estrategias de promoción de la salud acordes a circunstancias como la actual.

Introduction: In the context of the COVID-19 pandemic, measures of social distancing to reduce the rate of infection can influence eating habits and other lifestyle factors. This study aimed to assess the relationship between social distancing and lifestyle factors in adults in southeastern Brazil during the first wave of the COVID-19 pandemic. Methods:: It was a cross-sectional study with 1,828 adults between 18 and 83 years of age, of both sexes, carried out through an online questionnaire; sociodemographic, food, health, and lifestyle data were collected and analyzed based on whether or not the social distancing was carried out. Results: The results showed a decrease in breakfast consumption (12.5%) and an increase in the consumption of snacks (24.5% morning snack; 12.5% afternoon snack) and snacks between meals (20.4%) during the pandemic, as well as an increase in the consumption of vegetables and legumes among people who did social distancing and in the consumption of fish and fast food among those who did not do social distancing; most participants reported weight gain during social distancing. People who were in social distancing slept more compared to those who were not in social distancing. The main cause of anxiety among those who kept social distancing were COVID-19 statistics. Conclusion: The findings suggest the need for health promotion strategies adapted to the condition of confinement in circumstances such as the current pandemic.

Multimorbidity and health care of community health workers in Vitória, Espírito Santo, Brazil, 2019: a cross-sectional study. / Multimorbidade e cuidado com a saúde de agentes comunitários de saúde em Vitória, Espírito Santo, 2019: um estudo transversal.

OBJECTIVE: To assess health conditions, health care and lifestyle habits of community health workers (CHW) in Vitória, Espírito Santo, Brazil. METHODS: This was a cross-sectional study using baseline data from an intervention study. Biochemical, anthropometric and hemodynamic examinations and interviews were carried out between October 2018 and March 2019 in Vitória. Appropriate statistical tests, in accordance with the sample design, were performed using SPSS software version 21.0, adopting p<0.05. RESULTS: We assessed 262 CHWs with a mean age of 46.1±9.3 years. High prevalence of prediabetes (22.9%), diabetes mellitus (17.2%), hypertension (37.0%), obesity (39.8%), hypercholesterolemia (57.3%), hypertriglyceridemia (27.1%), multimorbidity (40.8%), physical inactivity (60.9%) and use of anxiolytics/antidepressants (22.5%) was found. Some 40% of the CHWs had three or more morbidities. CONCLUSION: High percentages of chronic diseases, multimorbidity, sedentary lifestyle and use of anxiolytics/antidepressants were found in CHWs in Vitória.

Sex differences in the association between alcohol intake and cognitive decline over 4 years in a middle-aged cohort: The Brazilian Longitudinal Study of Adult Health.

BACKGROUND AND PURPOSE: The association between alcohol intake and cognitive decline has been widely studied. Sex differences and cognitive domains affected by alcohol intake patterns make this topic complex. The objective of this study was to investigate the effect of alcohol intake on cognition in middle-aged participants in the Brazilian Longitudinal Study of Adult Health by sex during 4 years of follow-up. METHODS: A total of 7595 participants (55% women) aged between 50 and 75 years at baseline were assessed. Semantic and phonemic fluency, memory, and executive functions were assessed at baseline (2008-2010) and repeated during Visit 2. Linear mixed models were used to investigate the association between cognition and current abstainers, never drinkers, light drinkers, moderate drinkers, and heavy drinkers. RESULTS: Heavy alcohol intake accentuated the decline in executive functions for men (ß = -0.01, p < 0.05), and in semantic fluency (ß = -0.02, p < 0.05) and memory (ß = -0.02, p < 0.05) for women. Never drinker men also showed an accentuated decline in semantic fluency (ß = -0.02, p < 0.01). Moderate alcohol intake slowed cognitive decline in phonemic fluency for men (ß = 0.02, p < 0.01) and women (ß = 0.01, p < 0.01), and in executive functions (ß = 0.01, p < 0.05) for women. CONCLUSIONS: Having more than 14 drinks per week can impact executive functions in men and memory in women. In addition, alcohol consumption of seven to 14 drinks per week may have a protective effect on gender-specific cognitive functions. These findings should be considered in public health policies and guidelines on alcohol and cognitive aging.