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1.
PLoS Genet ; 15(3): e1008027, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30849090

RESUMO

Populations in sub-Saharan Africa have historically been exposed to intense selection from chronic infection with falciparum malaria. Interestingly, populations with the highest malaria intensity can be identified by the increased occurrence of endemic Burkitt Lymphoma (eBL), a pediatric cancer that affects populations with intense malaria exposure, in the so called "eBL belt" in sub-Saharan Africa. However, the effects of intense malaria exposure and sub-Saharan populations' genetic histories remain poorly explored. To determine if historical migrations and intense malaria exposure have shaped the genetic composition of the eBL belt populations, we genotyped ~4.3 million SNPs in 1,708 individuals from Ghana and Northern Uganda, located on opposite sides of eBL belt and with ≥ 7 months/year of intense malaria exposure and published evidence of high incidence of BL. Among 35 Ghanaian tribes, we showed a predominantly West-Central African ancestry and genomic footprints of gene flow from Gambian and East African populations. In Uganda, the North West population showed a predominantly Nilotic ancestry, and the North Central population was a mixture of Nilotic and Southern Bantu ancestry, while the Southwest Ugandan population showed a predominant Southern Bantu ancestry. Our results support the hypothesis of diverse ancestral origins of the Ugandan, Kenyan and Tanzanian Great Lakes African populations, reflecting a confluence of Nilotic, Cushitic and Bantu migrations in the last 3000 years. Natural selection analyses suggest, for the first time, a strong positive selection signal in the ATP2B4 gene (rs10900588) in Northern Ugandan populations. These findings provide important baseline genomic data to facilitate disease association studies, including of eBL, in eBL belt populations.


Assuntos
Linfoma de Burkitt/genética , Fluxo Gênico , Malária Falciparum/genética , Seleção Genética , Adolescente , África ao Sul do Saara , Idoso , Linfoma de Burkitt/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Doenças Endêmicas , Feminino , Genética Populacional , Estudo de Associação Genômica Ampla , Gana/epidemiologia , Migração Humana , Humanos , Incidência , Lactente , Recém-Nascido , Malária Falciparum/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos Genéticos , ATPases Transportadoras de Cálcio da Membrana Plasmática/genética , Polimorfismo de Nucleotídeo Único , Uganda/epidemiologia
2.
J Am Geriatr Soc ; 66(10): 1956-1962, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30221750

RESUMO

OBJECTIVES: To investigate the association between African and Native American genomic ancestry and long-term cognitive trajectories in admixed Brazilians. DESIGN: Population-based longitudinal study. SETTING: Bambui-Epigen (Brazil) cohort study. PARTICIPANTS: Adults aged 60 and older (N=1,215) MEASUREMENTS: Participants were followed from January 1997 to December 2011. Cognitive function was assessed annually using the Mini-Mental State Examination (MMSE), totaling 12,208 measurements. We used linear mixed-effects pattern models to assess MMSE score trajectories. Ancestry was assessed using a genome-wide approach. RESULTS: After adjustments for covariates, the highest quintile of African ancestry was associated with poorer baseline cognitive performance (ß=-0.73, 95% confidence interval (CI)=-1.36 to -0.11) but not with cognitive trajectory. Educational level modified the baseline association between highest African ancestry and cognitive performance in that the association was observed only in those with very low (<4 years) education (ß=-1.13, 95% CI=-2.02 to -0.23). No association was found between Native American ancestry and baseline cognitive function or its trajectory. CONCLUSION: Genomic African and Native American ancestry levels had no prognostic value for age-related cognitive decline in this admixed population.


Assuntos
Grupo com Ancestrais do Continente Africano/genética , Cognição , Disfunção Cognitiva/etnologia , Disfunção Cognitiva/genética , Índios Norte-Americanos/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/etnologia , Envelhecimento/genética , Brasil/epidemiologia , Disfunção Cognitiva/epidemiologia , Escolaridade , Feminino , Estudo de Associação Genômica Ampla , Genômica , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco
3.
Sci Rep ; 8(1): 14475, 2018 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-30262839

RESUMO

The genetic architecture of asthma was relatively well explored. However, some work remains in the field to improve our understanding on asthma genetics, especially in non-Caucasian populations and with regards to commonly neglected genetic variants, such as Copy Number Variations (CNVs). In the present study, we investigated the contribution of CNVs on asthma risk among Latin Americans. CNVs were inferred from SNP genotyping data. Genome wide burden and association analyses were conducted to evaluate the impact of CNVs on asthma outcome. We found no significant difference in the numbers of CNVs between asthmatics and non-asthmatics. Nevertheless, we found that CNVs are larger in patients then in healthy controls and that CNVs from cases intersect significantly more genes and regulatory elements. We also found that a deletion at 6p22.1 is associated with asthma symptoms in children from Salvador (Brazil) and in young adults from Pelotas (Brazil). To support our results, we conducted an in silico functional analysis and found that this deletion spans several regulatory elements, including two promoter elements active in lung cells. In conclusion, we found robust evidence that CNVs could contribute for asthma susceptibility. These results uncover a new perspective on the influence of genetic factors modulating asthma risk.


Assuntos
Asma/genética , Deleção Cromossômica , Cromossomos Humanos Par 6/genética , Dosagem de Genes , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único , Adulto , Asma/etnologia , Brasil/etnologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino
4.
Am J Epidemiol ; 187(7): 1345-1353, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29394304

RESUMO

Brazil is experiencing among the world's fastest demographic aging worldwide. This demographic transition is occurring in a context of few resources and great social inequalities. The Brazilian Longitudinal Study of Aging (ELSI-Brazil) is a nationally representative study of 9,412 people aged 50 years or older, residing in 70 municipalities across the 5 Brazilian regions. ELSI-Brazil allows investigations of the aging process, its health, psychosocial and economic determinants, and societal consequences. The baseline examination (2015-2016) included detailed household and individual interviews and physical measurements (blood pressure, anthropometry, grip strength, and timed walk and balance tests). Blood tests and sample storage were performed in a subsample of study participants. Subsequent waves are planned for every 3 years. The study adopts a conceptual framework common to other large-scale longitudinal studies of aging in the world, such as the Health and Retirement Study, allowing cross-national comparisons. The goal of ELSI-Brazil is not only to build an understanding of aging in a large, Western, middle-income country in a rapid demographic transition but also to provide scientific data to support and study policy changes that may affect older adults. We describe the methodology of the study and some descriptive results of the baseline survey.


Assuntos
Envelhecimento , Projetos de Pesquisa Epidemiológica , Transição Epidemiológica , Idoso , Idoso de 80 Anos ou mais , Antropometria , Pressão Sanguínea , Brasil/epidemiologia , Características da Família , Feminino , Força da Mão , Humanos , Renda , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Aposentadoria , Fatores Socioeconômicos , Teste de Caminhada
5.
PLoS Med ; 14(3): e1002261, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28323832

RESUMO

BACKGROUND: The prevalence of dementia varies around the world, potentially contributed to by international differences in rates of age-related cognitive decline. Our primary goal was to investigate how rates of age-related decline in cognitive test performance varied among international cohort studies of cognitive aging. We also determined the extent to which sex, educational attainment, and apolipoprotein E ε4 allele (APOE*4) carrier status were associated with decline. METHODS AND FINDINGS: We harmonized longitudinal data for 14 cohorts from 12 countries (Australia, Brazil, France, Greece, Hong Kong, Italy, Japan, Singapore, Spain, South Korea, United Kingdom, United States), for a total of 42,170 individuals aged 54-105 y (42% male), including 3.3% with dementia at baseline. The studies began between 1989 and 2011, with all but three ongoing, and each had 2-16 assessment waves (median = 3) and a follow-up duration of 2-15 y. We analyzed standardized Mini-Mental State Examination (MMSE) and memory, processing speed, language, and executive functioning test scores using linear mixed models, adjusted for sex and education, and meta-analytic techniques. Performance on all cognitive measures declined with age, with the most rapid rate of change pooled across cohorts a moderate -0.26 standard deviations per decade (SD/decade) (95% confidence interval [CI] [-0.35, -0.16], p < 0.001) for processing speed. Rates of decline accelerated slightly with age, with executive functioning showing the largest additional rate of decline with every further decade of age (-0.07 SD/decade, 95% CI [-0.10, -0.03], p = 0.002). There was a considerable degree of heterogeneity in the associations across cohorts, including a slightly faster decline (p = 0.021) on the MMSE for Asians (-0.20 SD/decade, 95% CI [-0.28, -0.12], p < 0.001) than for whites (-0.09 SD/decade, 95% CI [-0.16, -0.02], p = 0.009). Males declined on the MMSE at a slightly slower rate than females (difference = 0.023 SD/decade, 95% CI [0.011, 0.035], p < 0.001), and every additional year of education was associated with a rate of decline slightly slower for the MMSE (0.004 SD/decade less, 95% CI [0.002, 0.006], p = 0.001), but slightly faster for language (-0.007 SD/decade more, 95% CI [-0.011, -0.003], p = 0.001). APOE*4 carriers declined slightly more rapidly than non-carriers on most cognitive measures, with processing speed showing the greatest difference (-0.08 SD/decade, 95% CI [-0.15, -0.01], p = 0.019). The same overall pattern of results was found when analyses were repeated with baseline dementia cases excluded. We used only one test to represent cognitive domains, and though a prototypical one, we nevertheless urge caution in generalizing the results to domains rather than viewing them as test-specific associations. This study lacked cohorts from Africa, India, and mainland China. CONCLUSIONS: Cognitive performance declined with age, and more rapidly with increasing age, across samples from diverse ethnocultural groups and geographical regions. Associations varied across cohorts, suggesting that different rates of cognitive decline might contribute to the global variation in dementia prevalence. However, the many similarities and consistent associations with education and APOE genotype indicate a need to explore how international differences in associations with other risk factors such as genetics, cardiovascular health, and lifestyle are involved. Future studies should attempt to use multiple tests for each cognitive domain and feature populations from ethnocultural groups and geographical regions for which we lacked data.


Assuntos
Apolipoproteínas E/genética , Disfunção Cognitiva/epidemiologia , Escolaridade , Genótipo , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/etiologia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais
6.
PLoS Negl Trop Dis ; 10(5): e0004724, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27182885

RESUMO

BACKGROUND: The influence of genetic ancestry on Trypanosoma cruzi infection and Chagas disease outcomes is unknown. METHODOLOGY/PRINCIPAL FINDINGS: We used 370,539 Single Nucleotide Polymorphisms (SNPs) to examine the association between individual proportions of African, European and Native American genomic ancestry with T. cruzi infection and related outcomes in 1,341 participants (aged ≥ 60 years) of the Bambui (Brazil) population-based cohort study of aging. Potential confounding variables included sociodemographic characteristics and an array of health measures. The prevalence of T. cruzi infection was 37.5% and 56.3% of those infected had a major ECG abnormality. Baseline T. cruzi infection was correlated with higher levels of African and Native American ancestry, which in turn were strongly associated with poor socioeconomic circumstances. Cardiomyopathy in infected persons was not significantly associated with African or Native American ancestry levels. Infected persons with a major ECG abnormality were at increased risk of 15-year mortality relative to their counterparts with no such abnormalities (adjusted hazard ratio = 1.80; 95% 1.41, 2.32). African and Native American ancestry levels had no significant effect modifying this association. CONCLUSIONS/SIGNIFICANCE: Our findings indicate that African and Native American ancestry have no influence on the presence of major ECG abnormalities and had no influence on the ability of an ECG abnormality to predict mortality in older people infected with T. cruzi. In contrast, our results revealed a strong and independent association between prevalent T. cruzi infection and higher levels of African and Native American ancestry. Whether this association is a consequence of genetic background or differential exposure to infection remains to be determined.


Assuntos
Grupo com Ancestrais do Continente Africano/genética , Envelhecimento/genética , Doença de Chagas/etnologia , Doença de Chagas/genética , Predisposição Genética para Doença , Índios Norte-Americanos/genética , Brasil/epidemiologia , Brasil/etnologia , Cardiomiopatia Chagásica/epidemiologia , Doença de Chagas/epidemiologia , Doença de Chagas/mortalidade , Estudos de Coortes , Eletrocardiografia , Genômica , Humanos , Polimorfismo de Nucleotídeo Único , Prevalência , Modelos de Riscos Proporcionais , Classe Social , Trypanosoma cruzi/isolamento & purificação
7.
Hypertension ; 67(2): 349-55, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26711733

RESUMO

The study objective is to examine the role of African genome origin on baseline and 11-year blood pressure trajectories in community-based ethnoracially admixed older adults in Brazil. Data come from 1272 participants (aged ≥60 years) of the Bambui cohort study of aging during 11 years of follow-up. Outcome measures were systolic blood pressure, diastolic blood pressure, and hypertension control. Potential confounding variables were demographic characteristics, socioeconomic position (schooling and household income), and health indicators (smoking, sedentary lifestyle, high-density lipoprotein cholesterol, waist circumference, diabetes mellitus, and cardiovascular diseases), including antihypertensive drug use. We used 370 539 single-nucleotide polymorphisms to estimate each individual's African, European, and Native American trihybrid ancestry proportions. Median African, European, and Native American ancestry were 9.6%, 84.0%, and 5.3%, respectively. Among those with African ancestry, 59.4% came from East and 40.6% from West Africa. Baseline systolic and diastolic blood pressure, controlled hypertension, and their respective trajectories, were not significantly (P>0.05) associated with level (in quintiles) of African genomic ancestry. Similar results were found for West and East African subcontinental origins. Lower schooling level (<4 years versus higher) showed a significant and positive association with systolic blood pressure (Adjusted ß=2.92; 95% confidence interval, 0.85-4.99). Lower monthly household income per capita (

Assuntos
Grupo com Ancestrais do Continente Africano/genética , Envelhecimento/etnologia , Pressão Sanguínea/fisiologia , Previsões , Genômica/métodos , Hipertensão/etnologia , Idoso , Envelhecimento/genética , Determinação da Pressão Arterial , Brasil/epidemiologia , Feminino , Seguimentos , Humanos , Hipertensão/genética , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos
8.
PLoS One ; 10(12): e0144456, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26680774

RESUMO

BACKGROUND: Self-rated health (SRH) has strong predictive value for mortality in different contexts and cultures, but there is inconsistent evidence on ethnoracial disparities in SRH in Latin America, possibly due to the complexity surrounding ethnoracial self-classification. MATERIALS/METHODS: We used 370,539 Single Nucleotide Polymorphisms (SNPs) to examine the association between individual genomic proportions of African, European and Native American ancestry, and ethnoracial self-classification, with baseline and 10-year SRH trajectories in 1,311 community dwelling older Brazilians. We also examined whether genomic ancestry and ethnoracial self-classification affect the predictive value of SRH for subsequent mortality. RESULTS: European ancestry predominated among participants, followed by African and Native American (median = 84.0%, 9.6% and 5.3%, respectively); the prevalence of Non-White (Mixed and Black) was 39.8%. Persons at higher levels of African and Native American genomic ancestry, and those self-identified as Non-White, were more likely to report poor health than other groups, even after controlling for socioeconomic conditions and an array of self-reported and objective physical health measures. Increased risks for mortality associated with worse SRH trajectories were strong and remarkably similar (hazard ratio ~3) across all genomic ancestry and ethno-racial groups. CONCLUSIONS: Our results demonstrated for the first time that higher levels of African and Native American genomic ancestry--and the inverse for European ancestry--were strongly correlated with worse SRH in a Latin American admixed population. Both genomic ancestry and ethnoracial self-classification did not modify the strong association between baseline SRH or SRH trajectory, and subsequent mortality.


Assuntos
Envelhecimento/fisiologia , Genoma Humano , Nível de Saúde , Autoavaliação , Brasil/epidemiologia , Estudos de Coortes , Seguimentos , Humanos
9.
Proc Natl Acad Sci U S A ; 112(28): 8696-701, 2015 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-26124090

RESUMO

While South Americans are underrepresented in human genomic diversity studies, Brazil has been a classical model for population genetics studies on admixture. We present the results of the EPIGEN Brazil Initiative, the most comprehensive up-to-date genomic analysis of any Latin-American population. A population-based genome-wide analysis of 6,487 individuals was performed in the context of worldwide genomic diversity to elucidate how ancestry, kinship, and inbreeding interact in three populations with different histories from the Northeast (African ancestry: 50%), Southeast, and South (both with European ancestry >70%) of Brazil. We showed that ancestry-positive assortative mating permeated Brazilian history. We traced European ancestry in the Southeast/South to a wider European/Middle Eastern region with respect to the Northeast, where ancestry seems restricted to Iberia. By developing an approximate Bayesian computation framework, we infer more recent European immigration to the Southeast/South than to the Northeast. Also, the observed low Native-American ancestry (6-8%) was mostly introduced in different regions of Brazil soon after the European Conquest. We broadened our understanding of the African diaspora, the major destination of which was Brazil, by revealing that Brazilians display two within-Africa ancestry components: one associated with non-Bantu/western Africans (more evident in the Northeast and African Americans) and one associated with Bantu/eastern Africans (more present in the Southeast/South). Furthermore, the whole-genome analysis of 30 individuals (42-fold deep coverage) shows that continental admixture rather than local post-Columbian history is the main and complex determinant of the individual amount of deleterious genotypes.


Assuntos
Genética Populacional , Mutação , Grupo com Ancestrais do Continente Africano/genética , Brasil , Grupo com Ancestrais do Continente Europeu/genética , Humanos
10.
Sci Rep ; 5: 9812, 2015 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-25913126

RESUMO

Brazil never had segregation laws defining membership of an ethnoracial group. Thus, the composition of the Brazilian population is mixed, and its ethnoracial classification is complex. Previous studies showed conflicting results on the correlation between genome ancestry and ethnoracial classification in Brazilians. We used 370,539 Single Nucleotide Polymorphisms to quantify this correlation in 5,851 community-dwelling individuals in the South (Pelotas), Southeast (Bambui) and Northeast (Salvador) Brazil. European ancestry was predominant in Pelotas and Bambui (median = 85.3% and 83.8%, respectively). African ancestry was highest in Salvador (median = 50.5%). The strength of the association between the phenotype and median proportion of African ancestry varied largely across populations, with pseudo R(2) values of 0.50 in Pelotas, 0.22 in Bambui and 0.13 in Salvador. The continuous proportion of African genomic ancestry showed a significant S-shape positive association with self-reported Blacks in the three sites, and the reverse trend was found for self reported Whites, with most consistent classifications in the extremes of the high and low proportion of African ancestry. In self-classified Mixed individuals, the predicted probability of having African ancestry was bell-shaped. Our results support the view that ethnoracial self-classification is affected by both genome ancestry and non-biological factors.


Assuntos
Epigen/genética , Grupos Étnicos/genética , Adulto , Grupo com Ancestrais do Continente Africano/genética , Brasil , Criança , Pré-Escolar , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/genética , Genética Populacional/métodos , Genômica/métodos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Fenótipo , Polimorfismo de Nucleotídeo Único/genética , Adulto Jovem
11.
Ann Epidemiol ; 22(9): 644-8, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22819435

RESUMO

PURPOSE: There is mixed evidence that socioeconomic status (SES) affects the predictive power of self-rated health (SRH) for mortality. We sought to compare the predictive value of SRH for 6-year mortality in English and Brazilian older adults, and to assess whether this association varies by SES in these populations. METHODS: Data came from the English and the Bambui (Brazil) cohort studies of aging. Potential confounding variables included sociodemographic characteristics, lifestyle, self-reported diseases, physical functioning, mental symptoms, and selected biomarker measures. RESULTS: Participants were 5183 English and 1499 Brazilians aged 60 years and over. Low health ratings were independently associated with subsequent mortality in both populations. However, the predictive power of poor SRH for death was much higher for English (a population with higher SES level) than for Brazilians (adjusted hazard ratios 4.45 [95% confidence interval, 3.04-6.51] and 1.88 [1.25-2.81], respectively). In both populations, the predictive value of SRH for mortality was higher among those in the highest income tertile. CONCLUSIONS: Our results suggest that the association between SRH and mortality is underestimated in populations and in subgroups of population with low SES level. Further international research is needed to examine the generalizability of this pattern.


Assuntos
Disparidades nos Níveis de Saúde , Mortalidade/tendências , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos de Coortes , Inglaterra/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Autorrelato , Classe Social , Análise de Sobrevida
12.
Am J Public Health ; 102(8): 1535-41, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22698020

RESUMO

OBJECTIVES: We examined socioeconomic inequalities in health among older adults in England and Brazil. METHODS: We analyzed nationally representative samples of residents aged 50 years and older in 2008 data from the Brazilian National Household Survey (n = 75,527) and the English Longitudinal Study of Ageing (n = 9589). We estimated prevalence ratios for self-rated health, functional limitations, and reported chronic diseases, by education level and household income tertiles. RESULTS: Brazilians reported worse health than did English respondents. Country-specific differences were higher among the poorest, but also affected the wealthiest persons. We observed a strong inverse gradient of similar magnitude across education and household income levels for most health indicators in each country. Prevalence ratios (lowest vs highest education level) of poor self-rated health were 3.24 in Brazil and 3.50 in England; having 2 or more functional limitations, 1.81 in Brazil and 1.96 in England; and having 1 or more diseases, 1.14 in Brazil and 1.36 in England. CONCLUSIONS: Socioeconomic inequalities in health affect both populations, despite a less pronounced absolute difference in household income and education in Brazil than in England.


Assuntos
Nível de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Classe Social , Idoso , Brasil/epidemiologia , Doença Crônica/epidemiologia , Escolaridade , Inglaterra/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Renda/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Prevalência
13.
Neuroepidemiology ; 32(2): 122-8, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19088484

RESUMO

BACKGROUND: Limited clinical data suggest that chronic Trypanosoma cruzi infection, which causes Chagas' disease (ChD), is associated with cognitive impairment. This study investigated this association in a large population-based sample of older adults. METHODS: Participants in this cross-sectional study comprised 1,449 persons aged > or = 60 years from a Brazilian endemic area (Bambuí). Cognitive functioning was ascertained by the Mini-Mental State Examination (MMSE), considering its score in percentiles [< or =14 (<5th percentile), 15-22 (5th to <25th) and > or =23]. Hypothesized risk factors were T. cruzi infection, ChD-related electrocardiographic (ECG) abnormalities and use of digoxin medication. Potential confounders included depressive symptoms, smoking, stroke, hemoglobin, HDL cholesterol, blood glucose, systolic blood pressure, and use of psychoactive medication. RESULTS: The prevalence of T. cruzi infection was 37.6%. There was a graded and independent association between infection and the MMSE score (adjusted odds ratios estimated by ordinal logistic regression = 1.99; 95% CI 1.43-2.76). No significant associations between the MMSE score and ECG abnormalities or digoxin medication use were found. CONCLUSIONS: This study provides for the first time epidemiological evidence of an association between T. cruzi infection and cognitive impairment which was not mediated by either ChD-related ECG abnormalities or digoxin medication use.


Assuntos
Doença de Chagas/epidemiologia , Doença de Chagas/psicologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/psicologia , Trypanosoma cruzi , Fatores Etários , Idoso , Animais , Brasil/epidemiologia , Doença de Chagas/complicações , Transtornos Cognitivos/etiologia , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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