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1.
Eur J Nutr ; 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34626206

RESUMO

PURPOSE: To investigate whether the consumption of dairy products and their subgroups is associated with the risk of death from cardiovascular disease (CVD) after 8-year follow-up, and verify if dairy products predict changes in high-sensitivity C-reactive protein (hs-CRP) between two follow-up visits of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: Prospective study with 6671 participants without CVD at baseline. Consumption in grams/day of total dairy, full-fat and low-fat dairy, fermented dairy, and milk was obtained through a food frequency questionnaire and categorized into sex-specific quartiles. Cox regression and linear mixed-effect models were used to estimate associations of dairy products intake with death from CVD and changes in hs-CRP levels, respectively. RESULTS: After adjustments, individuals in the 3rd and 4th quartiles of total dairy consumption presented, respectively, 62% (HR 0.38; 95% CI 0.15-0.99) and 64% (HR 0.36; 95% CI 0.14-0.94) lower hazards of death from CVD compared to the 1st quartile. Also, participants in the 4th quartile of milk consumption had 66% (HR 0.34; 95% CI 0.14-0.86) lower hazard to die from CVD, but only the 2nd quartile of full-fat dairy consumption indicated a lower hazard to die from CVD (HR 0.30; 95% CI 0.10-0.92). No association was observed between low-fat or fermented dairy products and cardiovascular mortality. Consumption of total dairy and their subgroups did not predict changes in hs-CRP levels after 4-year follow-up. CONCLUSION: Results suggest beneficial effects of total dairy and milk, but only low-to-moderate full-fat dairy consumption, on the risk of death from CVD. Assuming true effects, public policies should encourage the consumption of dairy products, especially milk.

2.
Health Place ; 72: 102699, 2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34688118

RESUMO

Greater neighborhood greenspace has been associated with better cardiometabolic risk factors, especially in high-income countries. This cross-sectional and longitudinal study assessed this association in approximately 2000 participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) residing in Belo Horizonte, a large Brazilian capital city. Neighborhood greenspace was studied through the Normalized Difference Vegetation Index (NDVI) and two additional types, percentages of tree cover and herbaceous cover. Multivariable logistic regression models estimated the cross-sectional and longitudinal associations of neighborhood greenspace with three metabolic factors - (i) obesity, (ii) abdominal obesity, and (iii) low HDL-cholesterol - after adjustment for individual sociodemographic factors and neighborhood average household income per capita. Cross-sectional results showed that higher neighborhood greenspace was associated with lower odds of obesity, abdominal obesity and low HDL-c. However, neighborhood greenspace was not associated with the incidence of any of these risk factors. The percentage of tree cover seemed to contribute more to the associations found with NDVI than the percentage of herbaceous cover. The results support the evidence that increased neighborhood greenspace contributes to maintain a better cardiometabolic health.

3.
Cad Saude Publica ; 37(9): e00255920, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34669776

RESUMO

There is a conflict in the literature regarding the association between serum uric acid (SUA) levels and glycemic status. Therefore, we evaluated the association between SUA level and glycemic status - impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus - and insulin resistance, in a large Brazilian study. This is a cross-sectional, observational study with 13,207 participants aged 35-74 years, at baseline (2008-2010) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). A multinomial regression analysis was performed to test the association between SUA and glycemic status (IFG, IGT, and newly diagnosed type 2 diabetes at the cohort baseline) after adjustments by age, sex, skin color, body mass index, physical activity, smoking, alcohol consumption, comorbidities, and medicines use. Logistic regression model was used to evaluate the association between SUA and insulin resistance by HOMA-IR. Stratified analyses by sex were performed. The mean age (standard deviation) was 51.4 (8.9) years, 55.2% of participants were women. There were 1,439 newly diagnosed diabetes. After all adjustments, higher SUA was associated with IFG, IGT, and diabetes, with odds ratio (OR) = 1.15 (95%CI: 1.06; 1.25), 1.23 (95%CI: 1.14; 1.33), and 1.37 (95%CI: 1.24; 1.51), respectively. There was association between SUA levels and insulin resistance with OR = 1.24 (95%CI: 1.13; 1.36). In analysis stratified by sex, higher SUA persisted independently associated with impaired glycemic status. Our results suggest that a higher SUA levels were significantly associated with glycemic status in a large Latin American population, mainly among women.


Assuntos
Diabetes Mellitus Tipo 2 , Intolerância à Glucose , Adulto , Glicemia , Brasil/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Jejum , Feminino , Intolerância à Glucose/epidemiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Ácido Úrico
4.
Arq Bras Cardiol ; 117(3): 426-434, 2021 09.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34550227

RESUMO

BACKGROUND: Atrial fibrillation or flutter (AFF) is the most common sustained cardiac arrhythmia. Limited data can be found on AFF epidemiology in South America. OBJECTIVE: The present study sought to describe the clinical epidemiology of AFF and the use of stroke prevention medication in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment. METHODS: This study analyzed data from 13,260 ELSA-Brasil participants. AFF was defined according to ECG recording or by self-report. Logistic regression models were built to analyze factors associated with AFF. This study also analyzed if age and sex were associated with anticoagulant use for stroke prevention. Significance level was set at 5%. RESULTS: Median age was 51 years and 7,213 (54.4%) participants were women. AFF was present in 333 (2.5%) participants. Increasing age (odds ratio [OR]:1.05; 95% confidence interval [95%CI]: 1.04-1.07), hypertension (OR:1.44; 95%CI: 1.14-1.81), coronary heart disease (OR: 5.11; 95%CI: 3.85-6.79), heart failure (OR:7.37; 95%CI: 5.00-10.87), and rheumatic fever (OR:3.38; 95%CI: 2.28-5.02) were associated with AFF. From 185 participants with AFF and a CHA2DS2-VASc score ≥2, only 20 (10.8%) used anticoagulants (50.0% among those with AFF in the baseline ECG). Stroke prevention in this group was associated with a higher age (1.8% vs 17.7% in those aged ≤ 54 and ≥ 65 years, respectively; p=0.013). A trend towards a reduced anticoagulant use was observed in women (7.1% vs. 16.4% in women and men, respectively; p=0.055). CONCLUSIONS: At the ELSA-Brasil baseline, 2.5% of the participants had AFF. The lack of stroke prevention was common, which is an especially challenging point for healthcare in this setting.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Adulto , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Estudos Transversais , Eletrocardiografia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Autorrelato , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle
5.
Cien Saude Colet ; 26(suppl 2): 3825-3837, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34468676

RESUMO

The study aims to describe the consumption of alcoholic and non-alcoholic beverages according to sociodemographic, health and location variables. Cross-sectional study with ELSA-Brasil data (2008-2010). A questionnaire was used to collect sociodemographic, food, health data and anthropometry. Descriptive analysis and association with variables of interest were carried out. In the sample, 8% of the total caloric value comes from non-alcoholic beverages (5.6%: sugary drinks), and 4% from alcoholic beverages (2.7%: beer). Consumers of unsweetened and artificially sweetened beverages reported moderate/strong physical activity, former smokers and higher education. The opposite was true for sugary drinks. Eutrophic people reported higher consumption of sugary drinks and those obese, artificially sweetened and beer. Alcohol consumption varied with age (young: beer; elderly: wine/spirits) and education (low education: beer/spirits; higher education: wine). Coffee, natural juice and soda were the most consumed non-alcoholic beverages and beer was the most prevalent alcoholic beverage. Consumption variation was observed according to geographic location. The consumption of sugary and alcoholic beverages is high in Brazil and public health strategies are required.


Assuntos
Bebidas Alcoólicas , Edulcorantes , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Bebidas , Brasil/epidemiologia , Estudos Transversais , Humanos
6.
Arq. bras. cardiol ; 117(3): 426-434, Sept. 2021. tab
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1339193

RESUMO

Resumo Fundamento: A fibrilação ou flutter atrial (FFA) é a arritmia cardíaca sustentada mais comum. Existem poucos dados sobre a epidemiologia da FFA na América do Sul. Objetivo: O presente estudo procurou descrever a epidemiologia clínica da FFA e o uso de anticoagulantes na avaliação da linha de base do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). Métodos: Foram analisados dados de 13.260 participantes do ELSA-Brasil. A FFA foi definida pelo eletrocardiograma ou por autorrelato. Modelos de regressão logística foram construídos para analisar fatores associados à FFA. Este estudo também analisou se idade e sexo estavam associados ao uso de anticoagulantes para evitar acidente vascular cerebral. O nível de significância foi de 5%. Resultados: A idade mediana foi de 51 anos, e 7.213 (54,4%) participantes eram mulheres. A FFA foi detectada em 333 (2,5%) participantes. O aumento da idade (razão de chances [RC]:1,05; intervalo de confiança de 95% [IC95%]: 1,04-1,07), hipertensão (RC:1,44; IC95%:1,14-1,81) coronariopatia (RC: 5,11; IC95%:3,85-6,79), insuficiência cardíaca (RC:7,37; IC95%:5,00-10,87) e febre reumática (RC:3,38; IC95%:2,28-5,02) foram associadas à FFA. Dos 185 participantes com FFA e pontuação no CHA2DS2-VASc≥2, apenas 20 (10,8%) usavam anticoagulantes (50,0% entre aqueles com FFA no eletrocardiograma de linha de base). O uso de anticoagulantes nesse grupo foi associado a maior idade (1,8% vs 17,7% naqueles com idade ≤ 54 e ≥ 65 anos, respectivamente; p=0,013). Observou-se uma tendência ao menor uso de anticoagulantes em mulheres (7,1% vs. 16,4% em mulheres e homens, respectivamente; p=0,055). Conclusões: No recrutamento do ELSA-Brasil, 2,5% dos participantes tinham FFA. O baixo uso de anticoagulantes era comum, o que representa um desafio para os cuidados de saúde nesse cenário.


Abstract Background: Atrial fibrillation or flutter (AFF) is the most common sustained cardiac arrhythmia. Limited data can be found on AFF epidemiology in South America. Objective: The present study sought to describe the clinical epidemiology of AFF and the use of stroke prevention medication in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment. Methods: This study analyzed data from 13,260 ELSA-Brasil participants. AFF was defined according to ECG recording or by self-report. Logistic regression models were built to analyze factors associated with AFF. This study also analyzed if age and sex were associated with anticoagulant use for stroke prevention. Significance level was set at 5%. Results: Median age was 51 years and 7,213 (54.4%) participants were women. AFF was present in 333 (2.5%) participants. Increasing age (odds ratio [OR]:1.05; 95% confidence interval [95%CI]: 1.04-1.07), hypertension (OR:1.44; 95%CI: 1.14-1.81), coronary heart disease (OR: 5.11; 95%CI: 3.85-6.79), heart failure (OR:7.37; 95%CI: 5.00-10.87), and rheumatic fever (OR:3.38; 95%CI: 2.28-5.02) were associated with AFF. From 185 participants with AFF and a CHA2DS2-VASc score ≥2, only 20 (10.8%) used anticoagulants (50.0% among those with AFF in the baseline ECG). Stroke prevention in this group was associated with a higher age (1.8% vs 17.7% in those aged ≤ 54 and ≥ 65 years, respectively; p=0.013). A trend towards a reduced anticoagulant use was observed in women (7.1% vs. 16.4% in women and men, respectively; p=0.055). Conclusions: At the ELSA-Brasil baseline, 2.5% of the participants had AFF. The lack of stroke prevention was common, which is an especially challenging point for healthcare in this setting.

7.
Parasitol Int ; 85: 102440, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34411740

RESUMO

Chagas disease (ChD) affects millions of people worldwide, being endemic in Latin America and emerging in the United States and Europe. Classically described as targeting the heart and gastrointestinal tract, Trypanosoma cruzi parasitism leads to structural and pro-inflammatory changes in the adipose tissue and pancreas. The effects of these changes on insulin resistance (IR), beta cell dysfunction, diabetes mellitus (DM),and metabolic syndrome (MS) are unclear. We aim to evaluate the association of ChD with DM, IR, beta cell dysfunction and MS in the baseline of multi-centric cohort study 'Brazilian Longitudinal Study of Adult Health' (ELSA-Brasil). This cross-sectional analysis included 14,922 (98%) participants of ELSA-Brasil at baseline. To investigate the associations of ChD with DM, IR (assessed by HOMA-IR) and beta cell dysfunction (assessed by HOMA beta), and MS we fitted logistic regression models including socio-demographic and anthropometric variables, health-related conditions and laboratory results. ChD, defined by positive serology, was prevalent in 1.9% (n = 283) of the sample, 17.3% (n = 49) of whom had cardiomyopathy. DM prevalence was 17.25% (n = 2574) and was not different among those with and without ChD (20.5% vs 17.2%; p = 0.28). Fasting and 2 h-blood glucose after a 75 g anhydrous glucose were slightly higher among participants positive for ChD, when compared with those with negative serology (102 mg/dL versus 100 mg/dL, respectively; and 127 mg/dL versus 124 mg/dL, respectively), only in univariate analysis. There was no significant association between these variables and ChD after adjustments. In addition, there was no significant association between DM, IR, beta cell dysfunction or MS and ChD (without and with cardiomyopathy). Our results showed that ChD, regardless of the presence of cardiomyopathy, is not associated with DM, IR, beta cell dysfunction or MS. These findings suggest the parasitism of the adipose tissue and pancreas in Chagas disease do not translate into clinically relevant glucose abnormalities.

8.
J Clin Lipidol ; 2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34389285

RESUMO

BACKGROUND: Among several lipid ratios available, the triglyceride/HDL-cholesterol (TG/HDL-C) may detect individuals at risk of cardiometabolic diseases. However, its reference values for different ethnicities are not well established. OBJECTIVE: To define sex- and ethnicity-specific reference values for TG/HDL-C ratio in a large sample of healthy multiethnic adults and test its association with cardiometabolic conditions. METHODS: An apparently healthy sample (n = 2,472), aged 35-74, free of major cardiovascular risk factors, was used to generate the reference values for the TG/HDL-C. Exclusion criteria were diabetes, elevated blood pressure, obesity, hypercholesterolemia, severe hypertriglyceridemia, and smoking history. Cut-offs based on the reference values were tested in the whole ELSA Brasil study (n = 13,245), stratified by sex and ethnicity, to identify cardiometabolic conditions. RESULTS: TG/HDL-C ratio was higher in men than women, and did not change significantly with age, regardless of sex and ethnicity. Also, black individuals showed lower levels of TG/HDL-C as compared to other ethnic groups. ROC curve showed that the cut-off based on the 75th percentile displayed better sensitivities and specificities for men and women, regardless of ethnicity. Also, the sex- and ethnicity-specific cut-offs based on the 75th percentile were significantly associated with all tested cardiometabolic conditions (hypertension, diabetes, obesity, metabolic syndrome, and insulin resistance). Also, we observed that the use of a single sex-specific cut-off (men: 2.6; women: 1.7) could be used for the different ethnicities with good reliability. CONCLUSION: The defined TG/HDL-C cut-offs (men: 2.6; women: 1.7) are reliable and showed good clinical applicability to detect cardiometabolic conditions in a multiethnic population.

9.
Eur J Neurol ; 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34328669

RESUMO

BACKGROUND AND PURPOSE: Early life socioeconomic status (SES) may impact cognitive performance later in life. We investigated the effect on cognitive performance of early life SES, education, and late life SES in the Brazilian Longitudinal Study of Adult Health. METHODS: Path analysis was used to decompose associations between SES measures across the lifespan and cognition. The model included direct paths to cognition from early life SES, education, and late life SES, and indirect paths from early life passing through education and late life SES. We investigated whether the effects of early life SES are similar across middle-aged and older adults. RESULTS: In 13,395 adults, the mean age was 51.5 (8.9) years, 54% were female, 53% were white, and 56% had at least college education. The direct path from early life SES remained significant in the presence of mediation paths through education, late life SES, or both, contributing to cognitive performance in both middle-aged and older adults. The indirect and total effect of early life SES was smaller for middle-aged compared to older adults. Early life SES continues to impact cognitive performance later in life independently of educational attainment and late life SES. The higher percent of mediation through education suggests that education may improve later life cognition even in the presence of low early life SES. CONCLUSIONS: Our results highlight the importance of public health initiatives to improve early life SES and education to foster cognitive aging in low- and middle-income countries.

10.
Cells ; 10(5)2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-34070075

RESUMO

Thoracic aortic calcium (TAC) appears to be a subclinical marker of cardiovascular disease (CVD) and to predict cardiovascular (CV) mortality. However, studies on TAC use tomographic scans obtained for coronary artery calcium (CAC) score, which does not include the aortic arch. This study evaluates TAC prevalence in aortic arch (AAC), ascending (ATAC) and descending thoracic aorta (DTAC) and verify whether they are associated with the same CV risk factors. Cross-sectional analysis, including 2427 participants (mean age 55.6 ± 8.7; 54.1% women) of the ELSA-Brasil cohort. Nonenhanced ECG-gated tomographies were performed in 2015-2016. Multivariable logistic regression estimated the CV risk factors associated with calcium in each segment. Overall prevalence of ATAC, AAC and DTAC was, 23.1%, 62.1%, and 31.2%, respectively. About 90.4% of the individuals with TAC had AAC and only 19.5% had calcium in all segments. In the multivariable analysis, increasing age, lower levels of schooling, current smoking, higher body mass index, and hypertension remained associated with calcium in all segments. No sex or race/ethnicity differences were found in any aortic segment. Diabetes and dyslipidemia were associated with ATAC and DTAC, but not with AAC, suggesting that AAC may reflect an overlap of mechanisms that impact vascular health, including atherosclerosis.

11.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 43(3): 254-261, May-June 2021. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1249185

RESUMO

Objective: Longitudinal measurement invariance analyses are an important way to assess a test's ability to estimate the underlying construct over time, ensuring that cognitive scores across visits represent a similar underlying construct, and that changes in test performance are attributable to individual change in cognitive abilities. We aimed to evaluate longitudinal measurement invariance in a large, social and culturally diverse sample over time. Methods: A total of 5,949 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were included, whose cognition was reassessed after four years. Longitudinal measurement invariance analysis was performed by comparing a nested series of multiple-group confirmatory factor analysis models (for memory and executive function factors). Results: Configural, metric, scalar and strict invariance were tested and supported over time. Conclusion: Cognitive temporal changes in this sample are more likely to be due to normal and/or pathological aging. Testing longitudinal measurement invariance is essential for diverse samples at high risk of dementia, such as in low- and middle-income countries.

12.
J Alzheimers Dis ; 81(4): 1529-1540, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33967048

RESUMO

BACKGROUND: Subtle thyroid alterations have a controversial role in cognition. OBJECTIVE: We investigated the longitudinal association of baseline thyroid function, thyrotropin (TSH), and thyroxine (FT4) levels with cognitive performance after 4 years of follow-up in middle-aged and older adults without overt thyroid dysfunction. METHODS: We included 4,473 individuals, age≥55 years at the second study wave, without overt thyroid dysfunction at baseline. Individuals were divided according to thyroid function and TSH and FT4 tertiles. Cognition was assessed at baseline and after 4 years of follow-up by the word recall (DWR), semantic verbal fluency (SVF), and trail making (TMT) tests. The longitudinal association of thyroid function and TSH and FT4 tertiles with cognitive performance was investigated using generalized estimating equations adjusted for sociodemographic characteristics, lifestyle, cardiovascular risk factors and depression. RESULTS: There was no longitudinal association of thyroid function and TSH and FT4 baseline levels with performance on the cognitive tests. However, there was a baseline cross-sectional U-shaped association of FT4 tertiles with poorer performance in the SVF (first FT4 tertile: ß= -0.11, 95% CI = -0.17; -0.04; third FT4 tertile: ß= -0.10, 95% CI = -0.17; -0.04) and of the third FT4 tertile with poorer performance in the DWR (ß= -0.09, 95% CI = -0.16; -0.02). CONCLUSION: Thyroid function and hormone levels were not associated with cognitive decline during 4 years of follow-up in middle-aged and older adults without overt thyroid dysfunction. Future studies with longer follow-up could clarify the implications of subtle thyroid alterations in cognition.


Assuntos
Cognição/fisiologia , Disfunção Cognitiva/epidemiologia , Doenças da Glândula Tireoide/epidemiologia , Tireotropina/sangue , Tiroxina/sangue , Idoso , Brasil/epidemiologia , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos
13.
Eur J Clin Pharmacol ; 77(11): 1725-1735, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34014336

RESUMO

OBJECTIVE: The study aims to investigate the longitudinal association of use and time of use of proton pump inhibitors (PPIs) with decreased performance in three cognitive tests. METHODS: Prospective cohort study included 7115 participants with mean age of 58.9 years at baseline (2008-2010) who participated in the second wave (2012-2014) of ELSA-Brasil (average interval between visits = 3.9 years (range: 1.7 to 6.0 years)). Cognitive performance was assessed by tests of memory, phonemic and semantic verbal fluency, and the trail making test, applied to both waves. Associations with the use and time of use of PPIs at baseline were investigated using linear models with mixed effects after adjusting for confounding factors. RESULTS: At baseline, 7.4% (529) of the participants used PPIs on a regular basis. After all adjustments, the interaction term use of PPI × age was not statistically significant for the cognitive tests evaluated, indicating that the use of PPI at baseline was not associated with a more accelerated decline in cognitive performance between waves. The interaction term PPI use × age was not statistically significant, in any of the categories of medication use time, any of the cognitive function tests evaluated, indicating that PPI use time is not associated with decrease in cognitive scores as the time interval between visits increases. CONCLUSION: In this cohort middle-aged and elderly adults, after average interval of 3.9 years (relatively short time to detect cognitive decline in a young cohort), the use and time of use of PPIs at the beginning of the study were not associated with a decline in cognitive performance in these tests between visits.

14.
Am J Hum Biol ; : e23606, 2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33909940

RESUMO

OBJECTIVE: To estimate annual weight gain and the incidence of overweight and obesity, stratified according to gender and socioeconomic factors. METHODS: From the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), we included 13 625 women and men aged 35-74 (2008-2010) who attended a follow-up visit after a mean 3.8-years. Standardized questionnaires were used to record sociodemographic data, and height and weight were measured on all participants during in-person visits at research centers. The incidence rate to overweight was calculated among those not having excess weight at baseline, and incident obesity among those not having this condition at baseline. We evaluated the incidence of overweight and obesity in men and women, adjusted by age, through Poisson regression with robust variance. Large annual weight gain by gender was being defined as ≥90th percentile in the cohort. RESULTS: A global incidence of 7.7% for overweight and 10.6% for obesity was observed, with higher levels seen among black woman (28.5%), young men (21.1%) and woman with low educational level (35.0%). The proportions of overweight and obesity increased with age at both time points, more commonly among those with the lowest levels of per capita income and fewer years of schooling. Large annual weight gain was greater among participants with an intermediate level of education and those who self-identified as black. CONCLUSIONS: A high overall risk of becoming overweight/obese was found, especially among women. The roles of race and education level are fundamental to understanding the effects produced by social inequalities in rates of excess weight.

15.
Pharmacoepidemiol Drug Saf ; 30(6): 749-757, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33772928

RESUMO

PURPOSE: To determine whether desirable diabetes control is associated with polypharmacy and to evaluate potential drug interactions (DI) in participants with diabetes mellitus in the Brazilian Longitudinal Study on Adult Health (ELSA-Brasil). METHODS: This cross-sectional study included 1418 participants with medical diagnosis of diabetes at study baseline (2008-2010). Polypharmacy was defined as the use of ≥5 drugs. We described the frequency of the most common pharmacological groups used by patients and the potential DI.The association between desirable diabetes control (normal A1c, blood pressure and lipid levels) and polypharmacy was investigated using logistic regression. RESULTS: Most participants were men (52.5%), mean age 57.6 (SD 8.4) years, educated to the university level (39.4%), and self-reported as white (42.9%). In this study, 7.1% (n = 101) of participants had desirable control of diabetes, while 40.4% (n = 573) used polypharmacy, and this use was not significantly associated with better diabetes control (adjusted odds ratio (OR = 1.35 [95%CI 0.86-2.13] P = .19).The pharmacological groups most frequently used were oral antidiabetics followed by acetylsalicylic acid, angiotensin-converting enzyme inhibitors (ACE inhibitors) and statins.The prevalence of potentially mild, moderate and severe DI were, respectively, 2.5%, 14.7% and 0.9%; however, in the desirable control of DM group, these potential DI were related to comorbidity control. CONCLUSION: Faced with the importance of achieving optimal control of diabetes and minimizing risks of potential DI, these results, which are in keeping with previous findings described in the literature, might indicate that guidelines for the patient-centered management of control of diabetes must be revised.

16.
Public Health Nutr ; 24(11): 3352-3360, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33658095

RESUMO

OBJECTIVE: To estimate changes in blood pressure and the incidence of hypertension associated with consumption of ultra-processed foods (UPF) by Brazilian civil servants at a 4-year follow-up. DESIGN: Longitudinal analysis of the ELSA-Brasil with non-hypertensive individuals at baseline. We applied the FFQ at the baseline and categorised energy intake by degree of processing, using the NOVA classification. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at baseline (2008-2010) and again at first follow-up (2012-2014). Incidence of arterial hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or antihypertensive medication during the previous 2 weeks. A mixed-effect linear regression model and mixed-effect logistic regression model were used to estimate associations between UPF consumption and, respectively, changes in blood pressure and incidence of hypertension. SETTING: Brazil. PARTICIPANTS: Civil servants of Brazilian public academic institutions in six cities (n 8754), aged 35-74 years at baseline (2008-2010). RESULTS: UPF consumption contributed 25·2 % (sd = 9·6) of total energies consumed. After adjustment, participants with high UPF consumption presented a 23 % greater risk of developing hypertension (OR = 1·23, 95 % CI 1·06, 1·44) than those with low UPF consumption. We did not find association between UPF consumption and changes in blood pressure over time. CONCLUSIONS: The higher the UPF consumption, the higher the risk of hypertension in adults. Reducing UPF consumption is thus important to promote health and prevent hypertension.

17.
Cad Saude Publica ; 37(2): e00061619, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729303

RESUMO

Intrauterine life is a critical period for the development of body fat and metabolic risk. This study investigated associations between birth weight and total and truncal body fat in adults. To do so, we analyzed data on 10,011 adults participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) who self-reported birth weight as < 2.5kg, 2.5-4.0kg, or > 4.0kg at baseline (2008-2010) and underwent bioimpedance in the next follow-up visit (2012-2014). Greater mean total and truncal fat mass were seen in those with high birth weight compared with adequate birth weight (p < 0.001) in both sexes (total fat: 25.2 vs. 23.1kg in men and 31.4 vs. 27.7kg in women, and truncal fat: 13.5 vs. 12.4kg in men and 15.9 vs. 14.2kg in women). U-shaped patterns were observed in restricted cubic-spline analyses in the subset of 5,212 individuals reporting exact birth weights, although statistically significant only for those with high birth weight. In the whole sample, in comparing high to adequate birth weight, the latter predicted having a large (> 85 percentile) total and truncal fat mass, respectively: OR = 1.76, 95%CI: 1.37-2.25 (men) and OR = 1.86, 95%CI: 1.42-2.44 (women); OR = 1.68, 95% CI: 1.31-2.16 (men) and OR = 1.73, 95%CI: 1.31-2.28 (women). However, low birth weight predicted having a large (> 85 percentile) % truncal fat only in women (OR = 1.40, 95%CI: 1.03-1.91). In conclusion, in these men and women born in a period in which fetal malnutrition was prevalent, birth weight showed complex, frequently non-linear associations with adult body fat, highlighting the need for interventions to prevent low and high birth weight during pregnancy.


Assuntos
Tecido Adiposo , Obesidade , Adulto , Peso ao Nascer , Composição Corporal , Índice de Massa Corporal , Peso Corporal , Brasil/epidemiologia , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Gravidez
18.
Am J Hypertens ; 34(8): 801-809, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-33544821

RESUMO

BACKGROUND: Life course epidemiology is a powerful framework to unravel the role of socioeconomic position (SEP) disparities in hypertension (HTN). This study investigated whether life course SEP is associated with HTN incidence. Specifically, to test whether cumulative low SEP throughout life and unfavorable intergenerational social mobility increased HTN incidence. METHODS: Longitudinal analysis of 8,754 ELSA-Brasil participants without HTN or cardiovascular in visit 1 (2008-2010). The response variable was the incidence of HTN between visits 1 and 2 (2012-2014). The explanatory variables were childhood, youth, and adulthood SEP, cumulative low SEP, and intergenerational social mobility. Associations were estimated by incidence rate ratios (IRRs) obtained by generalized linear models, with Poisson distribution and logarithmic link function, after adjustment for sociodemographic, behavioral, and health factors. RESULTS: The incidence of HTN was 43.2/1,000 person-years, being higher in males, elderly (70-74 years), self-declared black, and low SEP individuals. After considering sociodemographic factors, low SEP in childhood, youth, and adulthood remained statistically associated with increased HTN incidence. Individuals in the third (IRR: 1.26; 95% confidence interval (CI): 1.11-1.44) and fourth top quartiles (IRR: 1.29; 95% CI: 1.11-1.49) of cumulative low SEP, vs. first, as well as those with low stable intergenerational trajectory (IRR: 1.29; 95% CI: 1.16-1.43), vs. high stable, also had increased HTN incidence rates. CONCLUSIONS: Socioeconomic disparities at all phases of the life cycle appear to raise HTN incidence rates, being the individuals with greater accumulation of exposure to low SEP and with more unfavorable intergenerational mobility at greatest risk, even in a short follow-up time.

19.
J Am Coll Nutr ; : 1-7, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33605838

RESUMO

INTRODUCTION: Chronic kidney disease (CKD) is a public health problem and it is associated with a high risk of mortality. Overweight and obesity are known as independent risk factors for CKD. OBJECTIVE: To investigate the association between adiposity indexes and kidney disease. METHODS: This study included 14,636 adults from ELSA-Brazil. Outcome variables: altered glomerular filtration rate (GFR), categorized as yes (GFR <60 mL/min/1.73 m2) and no (GFR ≥60 mL/min/1.73 m2), albuminuria, estimated by albumin-creatinine ratio and categorized as yes (≥30 mg/g) and no (<30 mg/g), and presence of chronic kidney disease (CKD) (altered GFR and/or albuminuria). Exposure variables: obesity and overweight (body mass index (BMI)≥30 and ≥25 kg/m2, respectively), high waist circumference (WC) (≥102 cm in men and ≥88 cm in women), high waist-to-hip ratio (WHR) (≥0.90 in men and ≥0.85 in women), and high waist-to-height ratio (WHtR) (≥0.5). To estimate the association between main exposures and outcomes, logistic regression analyses were performed using models adjusted for sociodemographic variables (age, gender, race/skin color, education), behavioral (smoking, physical activity, alcohol consumption), components of the metabolic syndrome (HDL cholesterol, triglycerides, hypertension, diabetes mellitus) and history of cardiovascular disease (myocardial infarction, angina or heart failure). RESULTS: Individuals with obesity, high WC, WHR and WHtR were more prone to albuminuria when compared to individuals with normal values for these measures. It was also observed that these altered measures were positively associated with the presence of CKD. CONCLUSION: Adiposity indexes have a direct and significant association with albuminuria and CKD.

20.
Diabetes Care ; 44(1): 81-88, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33444159

RESUMO

OBJECTIVE: Glycemic regression is common in real-world settings, but the contribution of regression to the mean (RTM) has been little investigated. We aimed to estimate glycemic regression before and after adjusting for RTM in a free-living cohort of adults with newly ascertained diabetes and intermediate hyperglycemia (IH). RESEARCH DESIGN AND METHODS: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a cohort study of 15,105 adults screened between 2008 and 2010 with standardized oral glucose tolerance test and HbA1c, repeated after 3.84 ± 0.42 years. After excluding those receiving medical treatment for diabetes, we calculated partial or complete regression before and after adjusting baseline values for RTM. RESULTS: Regarding newly ascertained diabetes, partial or complete regression was seen in 49.4% (95% CI 45.2-53.7); after adjustment for RTM, in 20.2% (95% CI 12.1-28.3). Regarding IH, regression to normal levels was seen in 39.5% (95% CI 37.9-41.3) or in 23.7% (95% CI 22.6-24.3), depending on use of the World Health Organization (WHO) or the American Diabetes Association (ADA) definition, respectively; after adjustment, corresponding frequencies were 26.1% (95% CI 22.4-28.1) and 19.4% (95% CI 18.4-20.5). Adjustment for RTM reduced the number of cases detected at screening: 526 to 94 cases of diabetes, 3,118 to 1,986 cases of WHO-defined IH, and 6,182 to 5,711 cases of ADA-defined IH. Weight loss ≥2.6% was associated with greater regression from diabetes (relative risk 1.52, 95% CI 1.26-1.84) and IH (relative risk 1.30, 95% CI 1.17-1.45). CONCLUSIONS: In this quasi-real-world setting, regression from diabetes at ∼4 years was common, less so for IH. Regression was frequently explained by RTM but, in part, also related to improved weight loss and homeostasis over the follow-up.


Assuntos
Diabetes Mellitus Tipo 2 , Adulto , Glicemia , Estudos de Coortes , Teste de Tolerância a Glucose , Humanos , Estudos Longitudinais
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