Obesogenic environment around schools is associated with atherogenic risk in Brazilian children.

INTRODUCTION: Cardiometabolic risk factors often emerge in childhood, increasing the risk of cardiovascular diseases in adulthood. The school environments represent an important active space in a child's routine and may influence their health status. METHODS: In this cross-sectional study, we aimed to evaluate the clustering of cardiometabolic risk factors and its association with the obesogenic and leptogenic environment around schools. A total of 378 children (181 boys; 197 girls) aged 8 and 9 years, enrolled in all urban schools of Viçosa, Minas Gerais, Brazil, were evaluated. Concentrations of high-density lipoprotein-cholesterol (HDL-c) and triglycerides (TG), and the insulin resistance (HOMA-IR), waist circumference (WC), and mean arterial pressure (MAP) were measured. The neighborhood income, walkability index, predominantly ultra-processed food stores, public spaces for leisure and/or physical activities, traffic accidents, crime and green spaces densities were assessed in 400 road network buffers around schools. To test association of the obesogenic and leptogenic environment around schools with cardiometabolic risk clustering, binary logistic regression models were performed with generalized estimating equations. RESULTS: "Obesogenic school environments" had greater densities of ultra-processed food stores, crime and traffic accidents, and higher walkability. The "↓ Atherogenic risk" cluster consisted of higher HDL-c values. There was an inverse association between the obesogenic environment around schools and a child's "↓ atherogenic risk" clustering (OR = 0.63; p < 0.001). CONCLUSION: We concluded that public policies aimed at modifying the environment around schools, by providing healthier food options and safe conditions for active mobility, are essential to prevent child's atherogenic risk.

Neighborhood obesogenic environment and cardiometabolic risk in Brazilian children: The mediation role of the mother's body mass index.

OBJECTIVE: We aimed to evaluate the association of neighborhood obesogenic and leptogenic environments with cardiometabolic risk clustering among Brazilian schoolchildren, mediated by child's ultra-processed food consumption and the mother's body mass index (BMI). METHODS: A total of 367 children aged 8-9 years, enrolled in urban schools of Viçosa, Minas Gerais, Brazil, were evaluated. Waist circumference, insulin resistance, blood pressure, high-density lipoprotein-cholesterol, and triglycerides concentrations were measured. The child's ultra-processed food consumption assessment was performed by applying three 24-hour dietary recall. The mother's weight and height values were used to calculate the BMI. The neighborhood income, walkability index, predominantly ultra-processed food stores, public spaces for leisure, and/or physical activities, traffic accidents, crime, and green spaces densities were assessed in four hundred road network buffers around households. From neighborhood and cardiometabolic risk variables, four latent variables were obtained from confirmatory factor analysis: neighborhood "obesogenic", and "leptogenic" environments; "high cardiometabolic risk," and "low atherogenic risk". A structural equation model was used to test the direct and indirect associations between neighborhood environment and cardiometabolic risk clusters. RESULTS: The neighborhood obesogenic environment had a significant total association (Standardized Coefficient = 0.172, p = .011) and was indirectly associated with the child's "high cardiometabolic risk" cluster, mediated by the mother's body mass index (Standardized Coefficient = 0.066, p = .049). CONCLUSIONS: Our results reinforce the role of the urban environment on maternal obesity and child's cardiometabolic risk and provide evidence for public health policies aimed to prevent such conditions.

Socioeconomic Disparities in the Community Food Environment of a Medium-Sized City of Brazil.

Objective: The purpose of this ecological study was to characterize the community food environment according to the socioeconomic condition of census tracts (CTs) in the urban area of a medium-sized city of southeastern Brazil in 2016.Method: Food establishments were identified on the streets covered by raters and information about type was collected through objective assessment. Geocoding was carried out from address observed by raters. Food establishments were categorized into establishments with predominant sale of natural or minimally processed foods, mixed establishments, and establishments with predominant sale of ultra-processed foods. The distribution of the number of establishments, by category, was evaluated according to tertiles of per capita income of the CT. The kernel estimation was used to analyze the density of establishments by category. The spatial pattern of the categories of establishments was investigated using the univariate Ripley's K-function.Results: A total of 656 establishments were evaluated. In all, 11.1% had predominant sale of natural or minimally processed foods, 44.5% were mixed, and 44.4% had predominant sale of ultra-processed foods. The average of establishments with predominant sale of natural or minimally processed foods, of ultra-processed foods, and all categories increased according to the income of the CT. There was a clustering of all categories of establishments in high-income CTs downtown. However, peripheral and low-income CTs were composed of a higher number of mixed establishments or those with predominant sale of ultra-processed foods than establishments with predominant sale of natural or minimally processed foods.Conclusions: On average, the number of all categories of establishments increased according to the per capita income of the CT and were clustered in central and higher-income regions of the city. These findings may have practical implications for the development of public policies to increase the availability of healthy foods and to reduce the sale of unhealthy foods.

Usefulness of the StrongKids Screening Tool in Detecting Anemia and Inflammation in Hospitalized Pediatric Patients.

Objective: To assess whether the nutritional risk classified by StrongKids is associated with anemia and inflammation (total leukocytes and C-reactive protein (CRP)), as well as to compare the ability of StrongKids with anthropometry in identifying these changes in hospitalized pediatric patients.Methods: Cross-sectional study with patients admitted to the pediatric ward of a public hospital in Brazil, from 2014 to 2018. The experimental protocol included: nutritional risk screening by StrongKids; weight and height measurements; and biochemical tests (complete blood count and C-reactive protein - CRP). Sensitivity, specificity, positive predictive value and negative predictive value were calculated to assess the ability of StrongKids and anthropometry to identify patients with the biochemical changes.Results: The study included 482 patients (54.2% male), with a median age of 2.7 years. The frequency of nutritional risk (medium or high) was 85.9% and the prevalence of malnutrition (acute and/or chronic) was 20.2%. Overall, of the patients evaluated, 40.2% had anemia, 28.2% leukocytosis, and 78.0% high CRP. Children and adolescents classified as at nutritional risk (moderate/high) had lower levels of hemoglobin and higher levels of CRP and total leukocytes, as well as a higher frequency of leukocytosis, high CRP and the three alterations combined when compared with individuals at low risk. No association was found between anthropometric variables and biochemical alterations. The sensitivity of nutritional screening was high to detect all biochemical alterations and was superior to the anthropometric assessment.Conclusion: StrongKids was associated with alterations in biochemical parameters with a better performance than anthropometry.

Coffee and Tea Group Contribute the Most to the Dietary Total Antioxidant Capacity of Older Adults: A Population Study in a Medium-Sized Brazilian City.

OBJECTIVE: The dietary total antioxidant capacity (TAC) has been proposed as a suitable tool to estimate the dietary antioxidant intake. However, the main foods/groups that contribute to the dietary TAC of older adults are poorly studied. We aimed to estimate the dietary TAC and to identify the main foods/groups that contribute to the dietary TAC of older adults in a medium-sized Brazilian city. METHODS: A cross-sectional population-based survey with older adults (≥60 years old) was conducted in Viçosa, Brazil. The assessment tool for food consumption was the recall of habitual consumption. A database with ferric reducing antioxidant power (FRAP) values for foods to evaluate the dietary TAC was used. RESULTS: We evaluated 620 older adults in which the majority were women. The dietary TAC mean was 11.9 (7.1) mmol/d (food only) adjusted by energy. Besides, when supplements were considered the dietary TAC increased to 35.2 (215.9) mmol/d. The food groups that contributed the most to the dietary TAC were coffee and tea, vegetables, and fruits and juices. The coffee and tea group explained most of the variability of dietary TAC (58.3%). CONCLUSIONS: We concluded that the older adults studied had a relatively low dietary TAC consumption. The coffee and tea were the food group that contribute the most to the dietary TAC. Our data show the need to implement national strategies aimed at improving the quality of the diet of older adults. We highlight the need to increase the consumption of different food groups and, consequently, the intake of different compounds with antioxidant capacity, which will contribute to a better dietary TAC with possible positive health effects.

Skeletal mass indices are inversely associated with metabolically unhealthy phenotype in overweight/obese and normal-weight men: a population-based cross-sectional study.

Muscle mass may play an important role in the metabolic profile of individuals with or without excess weight. Metabolic phenotypes classify individuals as healthy or unhealthy based on certain metabolic conditions. We investigated the association between skeletal mass indices (SMI) and the metabolically unhealthy phenotype in normal-weight and overweight/obese adults. A total of 660 adults aged 20 to 59 years were assessed by a population-based cross-sectional study. Muscle mass of the limbs or appendicular lean mass (ALM) adjusted for weight (SMIweight) and BMI (SMIBMI) was used to evaluate SMI. Logistic regression was employed to estimate the association between SMIweight, SMIBMI and metabolic phenotypes of normal-weight and overweight/obese individuals. Metabolically unhealthy individuals were older in both sexes. Metabolically unhealthy men had lower SMI values and higher fat percentage than metabolically healthy men. SMIweight was inversely associated with the metabolically unhealthy phenotype, both in normal-weight men (OR 0·49, 95 % CI 0·24, 0·99, P = 0·04) and in overweight/obese men (OR 0·32, 95 % CI 0·16, 0·64, P = 0·001). SMIBMI was inversely associated with the metabolically unhealthy phenotype in overweight/obese men (OR 0·36, 95 % CI 0·18, 0·72, P = 0·004), but not in normal-weight men (OR 0·70, 95 % CI 0·34, 1·43, P = 0·33). Among women, SMI showed no significant association with the phenotypes. In conclusion, the SMI are inversely associated with the metabolically unhealthy phenotype in men, especially among overweight/obese men.

Association between Skeletal Mass Indices and Metabolic Syndrome in Brazilian Adults.

INTRODUCTION: Skeletal muscle is the primary site of glucose uptake and its reduction would increase insulin resistance, which is a determinant factor for diseases such as type 2 diabetes mellitus, hypertension, and metabolic syndrome. However, the role of low skeletal muscle mass as a risk factor for metabolic syndrome and its association with cardiometabolic risk is still uncertain. We aimed to investigate the association between muscle mass (determined by different skeletal mass indices) and metabolic syndrome in Brazilian adults. METHODOLOGY: We conducted a cross-sectional population-based study with 689 adults of both sexes aged between 20 and 59 years. Data were collected through questionnaires and assessment of body composition through dual-energy X-ray absorptiometry and anthropometric, clinical, and biochemical measurements. RESULTS: Older individuals, obese and those with metabolic syndrome predominated in the highest tertile of skeletal mass index adjusted by height (SMIheight), whereas using skeletal mass index adjusted by weight (SMIweight) and skeletal mass index adjusted by body mass index (SMIBMI) these individuals were the majority in the lowest tertile of these indices. In men and women, the adjusted logistic regression model revealed that the highest tertile of SMIweight (odds ratio [OR]: 0.06; 95% confidence interval [CI]: 0.02-0.21 and OR: 0.27, 95% CI: 0.10-0.74) and SMIBMI (OR: 0.14, 95% CI: 0.05-0.37 and OR: 0.34, 95% CI: 0.12-0.94) were negatively associated with metabolic syndrome. On the other hand, the highest tertile of SMIheight was positively associated with metabolic syndrome in both sexes (OR: 4.17, 95% CI: 1.80-9.66 and OR: 6.15, 95% CI: 2.31-16.37, respectively in men and women). CONCLUSION: In adults, the muscle mass assessed from the skeletal mass index adjusted for body weight and body mass index is inversely associated with metabolic syndrome in both sexes.

Fruit and vegetable consumption among older adults: influence of urban food environment in a medium-sized Brazilian city.

OBJECTIVE: To examine the association between urban food environment and regular consumption of fruits and vegetables (FV) by older adults from a medium-sized Brazilian city. DESIGN: Cross-sectional study based on data related to (1) objective assessment of establishments with predominant sale of unprocessed/minimally processed foods, mixed establishments and establishments with predominant sale of ultra-processed foods; (2) regular consumption of FV (≥ 5 times/week), health and socio-demographic variables of community-dwelling older adults. Tertiles of proximity between food establishments and older adults' residence were calculated. Poisson generalised estimating equations with robust variance, adjusted for individual and contextual variables, were used to estimate the independent association between the proximity of establishments and regular consumption of FV. SETTING: Medium-sized Brazilian city. SUBJECTS: Representative sample of community-dwelling older adults (n 549). RESULTS: Older adults travelled the longest distances to establishments with predominant sale of unprocessed/minimally processed foods. The longer the distance to establishments with predominant sale of unprocessed/minimally processed foods, the lower the prevalence of regular consumption of FV (tertile 2: prevalence ratio (PR) = 0·86; 95 % CI = 0·74, 0·99; tertile 3: PR = 0·84; 95 % CI = 0·72, 0·97). Older adults living larger distance tertiles from establishments with predominant sale of ultra-processed foods, mixed establishments or all categories of establishments had 16 % (PR = 0·84; 95 % CI = 0·73, 0·96), 19 % (PR = 0·81; 95 % CI = 0·71, 0·93) and 19 % (PR = 0·81; 95 % CI = 0·70, 0·94) lower prevalence of regular consumption of FV, respectively. CONCLUSION: The food environment is associated with regular consumption of FV among older adults. Longer distances from the residence of older adults to food establishments are independently associated with lower prevalence of regular consumption of FV.

General and Central Adiposity in Older Adults in Palmas (TO): Prevalence and Associated Factors.

Objectives: To evaluate the prevalence and associated factors with general and central adiposity in older adults in Palmas (TO).Methods: Cross-sectional study with older adults (≥60 years) of both sexes enrolled in the Family Health Strategy program in Palmas (TO). Sociodemographic aspects, health conditions, and functionality were evaluated as independent variables and Body Mass Index (BMI) for general adiposity and Waist Circumference (WC) for central adiposity as dependent variables. Descriptive analysis and hierarchical multiple Poisson regression with robust variance were performed.Results: A total of 449 seniors (50.6% women) from 60 to 92 years of age, average of 68.3 years, were evaluated. The prevalence of general adiposity was 46.8% (95% CI: 42.2%-51.4%) and central adiposity was 78.8% (95% CI: 74.7%-82.3%). The prevalence of both outcomes was significantly higher among women and the participants with a history of hypertension, diabetes, dyslipidemia, and rheumatic diseases and those dependent in activities of daily living (ADL) than among men. Lower frequency of adiposity (general and central) was found with increasing age. After adjustment, the prevalence of both outcomes was significantly higher in women aged 70-79 years and hypertensive.Conclusions: The results of this study confirm the need to establish nutritional status monitoring and direct obesity prevention and control interventions in programs to promote health and quality of life of older adults and those in the stages prior to old age.

Waist circumference, waist-to-height ratio and conicity index to evaluate android fat excess in Brazilian children.

OBJECTIVE: To evaluate the ability of anthropometric measurements to identify excess android fat and to propose cut-off points for excess central adiposity in children, according to age and sex. DESIGN: A cross-sectional study with children from a municipality of Minas Gerais, Brazil. Receiver-operating characteristic curve analyses were performed to evaluate waist circumference (WC), waist-to-height ratio (WHtR) and conicity index (C-index) in estimating excess android fat by dual energy X-ray absorptiometry (DXA). SETTING: Viçosa, Minas Gerais, Brazil. SUBJECTS: Children aged 4-9 years (n 788). RESULTS: Overweight prevalence was 29·1 % and android fat percentage was higher among girls. All central fat measurements were able to discriminate excess android fat in the age groups evaluated, especially WC and WHtR, with cut-off points showing good sensitivity and specificity overall. CONCLUSIONS: Because these methods are easy to obtain and inexpensive, it is possible to use WC, WHtR and C-index in population surveys to evaluate central obesity. The proposed cut-off points showed satisfactory values of sensitivity and specificity and can be used in epidemiological studies.

Agreement of body adiposity index (BAI) and paediatric body adiposity index (BAIp) in determining body fat in Brazilian children and adolescents.

OBJECTIVE: To evaluate agreement of the body adiposity index (BAI) and paediatric body adiposity index (BAIp) in estimating body fat compared with dual-energy X-ray absorptiometry (DXA) and to propose cut-off points for these indices to classify excess adiposity in Brazilian children and adolescents. DESIGN: Cross-sectional study. Measures of weight, height, hip circumference, BMI and body fat percentage (%BF) assessed by DXA were taken, and BAI and BAIp were calculated. The Bland-Altman plot was used to estimate agreement between the methods, and the receiver-operating characteristic curve to determine the cut-off points for BAI and BAIp per age and sex in comparison with DXA. SETTING: Viçosa, Minas Gerais, Brazil. SUBJECTS: Children and adolescents aged 8-19 years (n 1049). RESULTS: Of the children and adolescents, 52·4 % were girls. BAI and BAIp had satisfactory performance by the receiver-operating characteristic curve, except for the 18-19 years age group, whose BAIp had better predictive capacity than BAI. The agreement analysis showed that BAI overestimated %BF by 2·64 %, on average, using DXA; while BAIp underestimated %BF by 3·37 %. CONCLUSIONS: BAI and BAIp showed low agreement with the body fat obtained by DXA, requiring caution when interpreting body composition data in children and adolescents.

Exclusive breast-feeding and sociodemographic characteristics are associated with dietary patterns in children aged 4-7 years.

OBJECTIVE: To identify the dietary patterns of children aged 4-7 years and verify their association with sociodemographic characteristics, lifestyle habits and exclusive breast-feeding (EBF). DESIGN: A cross-sectional study nested within a cohort, performed with Brazilian children aged 4-7 years. The children were re-evaluated at age 4 to 7 years and food patterns were identified a posteriori through principal component analysis. The predictive variables were related to socio-economic characteristics, lifestyle habits and duration of EBF. SETTING: Viçosa, Minas Gerais, Brazil.ParticipantsRepresentative sample of 403 children followed up by the Lactation Support Program from the Extension Program of the Universidade Federal de Viçosa during the first 6 months of life. RESULTS: Five dietary patterns were identified: 'Traditional', 'Unhealthy', 'Milk and chocolate', 'Snack' and 'Healthy'. Children who did not receive EBF until they were at least 4 months old had a higher adherence to the 'Unhealthy' and 'Snack' patterns, and older children also consumed more 'Unhealthy' foods. The highest income was associated with the highest consumption of foods of the patterns 'Unhealthy', 'Milk and chocolate' and 'Healthy'. CONCLUSIONS: In view of the results, we emphasize the importance of providing support and encouragement towards EBF in the first months of life, as it can positively influence lifelong eating habits.

Dietary total antioxidant capacity as a tool in health outcomes in middle-aged and older adults: A systematic review.

The dietary total antioxidant capacity (TAC) has been a useful tool in epidemiological studies. To assess whether the TAC is associated with chronic diseases in middle-aged and older adults carried out a systematic review of articles indexed in MEDLINE and Science Direct. Of the 104 articles found, nine were included to meet the inclusion criteria. There was variation among the items on the sample size, sample origin, use of statistical tests, analysis of different outcomes and the use of assays to evaluate the TAC, which brought limitations to the comparability of results on the association of TAC with the outcomes of interest. However, in six studies we found an inverse association between TAC and the risk of chronic diseases, showing that this method has great potential for clinical applications and public health.

Estimated dietary intake and major food sources of polyphenols in elderly of Viçosa, Brazil: a population-based study.

PURPOSE: Epidemiological studies have remarked the beneficial role that polyphenols may have in the elderly population such as cancer and cardiovascular disease prevention. This is particularly relevant considering the global tendency of population aging. Data on polyphenol intake in the elderly population are scarce and usually provide partial information-only for some polyphenol classes. The aim of this study was to estimate the intake of polyphenols and its major dietary contributors in the population of Viçosa. METHODS: A cross-sectional population-based survey including 620 elderly was conducted in Viçosa, Brazil. Food intake was estimated by recall of habitual consumption (RHC). Polyphenol intake was calculated by matching food consumption data from the RHC with the polyphenol content in foods listed in the Phenol-Explorer database. RESULTS: The average total polyphenol intake was 1198.6 mg/day (533.7 mg/day as aglycone). The main polyphenol classes were phenolic acids (729.5 mg/day) and flavonoids (444.7 mg/day). The main dietary contributors for total polyphenols were coffee (45.8%), beans (32.8%) and polenta (1.3%). A total of 292 polyphenols divided in 14 classes and 23 subclasses were found. The individual compounds with the highest intake were isomers of chlorogenic acid (i.e., 5-caffeoylquinic acid, 4-caffeoylquinic acid and 3-caffeoylquinic acid) among hydroxycinnamic acids that largely originated from coffee. CONCLUSIONS: The data reported here can be used to evaluate the association between the amount and type of ingested polyphenols and health outcomes in epidemiological studies in order to eventually establish nutritional recommendations.

Validity of body adiposity index in predicting body fat in Brazilians adults.

OBJECTIVES: The aim of this study was to compare various methods of assessing body compositions with body adiposity index (BAI) and to identify the validity of BAI as a predictor of body fat in Brazilian adults. METHODS: This study included 706 individuals (average age 37.3 years, SD = 12.1). Anthropometric data included percent body fat obtained by skinfold thicknesses, bioelectrical impedance analysis and DXA. Body mass index (BMI), waist/hip ratio, and BAI were calculated. The correlation between variables was assessed by Pearson's correlation coefficient, and the Bland-Altman and Kaplan Meier graphic approaches were used to verify the agreement between BAI and DXA. RESULTS: There was a strong correlation between BAI and BMI (r = 0.84 in men and r = 0.86 in women, P < .001), waist circumference (r = 0.77 in men and r = 0.75 in women, P < .001) percent fat by skinfold thicknesses (r = 0.71 in men and r = 0.71 in women, P < .001) and by DXA (r = 0.72 in men and r = 0.78 in women, P < .001). The Bland-Altman approach showed an overestimation of BAI in males and an underestimation in women using DXA as the reference method. The agreement between BAI and DXA through the Kaplan-Meier analysis was 41%. CONCLUSIONS: It was found that BAI does not replace other measurements of body fat, but compared with more complex methods can be an alternative for estimating the body fat in the absence of these methods.

Influence of weight gain rate on early life nutritional status and body composition of children.

OBJECTIVE: To evaluate the influence of the weight gain rate at 4-6 months on nutritional status and body composition in children between 4 and 7 years of age. METHODS: Retrospective cohort study, sample of 257 children. Data collection was performed in two stages, with the first relating to retrospective data of weight gain from birth to the first 4-6 months of life in the patient records. Measurements of weight, height, waist circumference, and body composition in children between ages 4 and 7 years were obtained. Nutritional status was assessed by the BMI/age. Control variables, such as pregnancy, breastfeeding, lifestyle, and sociodemographics, were studied. Descriptive analysis and multiple linear regression were performed. RESULTS: In the nutritional status assessment, the prevalence of overweight observed was 24.9%. After adjusting for control variables, it was found that the increase of the WGR at 4-6 months of age explained the occurrence of higher BMI/age, percentage of total body fat, body fat percentage in the android region, and waist circumference in children between 4 and 7 years of age. CONCLUSION: The increase of the WGR in the first months of life can lead to the occurrence of higher values of parameters of nutritional status and body composition in later life.

Noninvasive body contouring: biological and aesthetic effects of low-frequency, low-intensity ultrasound device.

BACKGROUND: Recent advancements in body-contouring techniques have prompted the investigation of ultrasound (US) technology as a potential noninvasive alternative for nonobese subjects for lifting, tightening, and reducing small areas of unwanted fat. This prospective study aimed to evaluate the biological and aesthetic effects of a low-frequency, low-intensity US device in reducing localized fat deposits for improving the body contours. METHODS: A total of 20 female subjects included in this study were subjected to low-frequency US in the abdomen area. The effectiveness of this technique was determined by measuring changes in the anthropometric measurements and body composition, photographs, and a Client Satisfaction Questionnaire. The safety of the technique for application was determined by assessing the clinical features and biochemical tests results. RESULTS: After five US sessions, a significant mean reduction of 1.5, 2.1, and 1.9 cm was noted in the waist, abdominal, and umbilical circumferences, respectively. No significant changes were noted in the levels of free fatty acids, insulin, liver enzymes, or lipid profile. However, a significant increase in the fasting glucose level was noted. However, four adverse side effects were reported: mild burning or discomfort, tingling or unilateral numbness in the lower limbs, pain around the bony areas, and soreness in the abdomen. CONCLUSION: The low-frequency, low-intensity US device provides reduction in the abdominal region with a moderate level of satisfaction. However, more studies are required to assess the effectiveness of US for body contouring and its effect on glucose metabolism.

Quality of life of older adults in Family Health Strategy: a cross-sectional study.

BACKGROUND: With the increase in the older adult population, it is essential to identify the living and health conditions that can impact the quality of life of these individuals. OBJECTIVES: To identify the domains and factors associated with the quality of life of older adults under the Family Health Strategy program. DESIGN AND SETTING: This was a cross-sectional analytical study was conducted in the municipality of Palmas, Tocantins, Brazil. METHODS: We assessed 449 older adults enrolled in the Family Health Strategy program. Data were collected between April and July, 2018. World Health Organization Quality of Life Assessment (WHOQOL-OLD) was used to assess the quality of life (QoL) and multiple linear regression was used to estimate the factors associated with QoL. RESULTS: The QoL domain with the highest score was death and dying (mean = 70.4), and the lowest score was for sensory functions (mean = 61.0 points). The factors associated with QoL were single marital status (ß = -4.55; P = 0.014), level of independence for daily living activities (ß = 4.92; P < 0.001), self-assessment of regular health (ß = 5.35; P < 0.001), and poor health (ß = -8.67; P < 0.001). CONCLUSION: The death and dying domain of QoL presented the highest score. Marital status, impairment in daily activities, and health self-assessment were associated with QoL.

Central adiposity as a predictor of mortality in older adults: Identification of cutoffs using generalized additive models.

Background: Obesity is associated with premature mortality in adults; however, this association has been inconsistent in the older adult population. In addition, there is a lack of specific cutoff points for indicators of negative health outcomes in older adults. Methods: This is a prospective study with 796 non-institutionalized older adults. Data on sociodemographic characteristics, lifestyle, food consumption, and nutritional status were obtained at baseline. Generalized additive models were used to identify cutoff points for the waist circumference (WC) and waist-to-height ratio (WHtR) and Cox proportional hazards models to assess the independent association between adiposity and mortality. Results: Over the 9 years of follow-up, 197 deaths (24.7%) occurred, of which 51.8% were men, with a mean age of 76.1 ± 9.0 years. Older adults at higher risk of death had WHtR of <0.52 or ≥0.63 and WC of <83 cm or ≥101 cm. An increased risk of death was observed in older adults with high WC (HR: 2.03 95% CI: 1.20-3.41) and high WHtR (HR: 1.51 95% CI: 1.01-2.26) in the adjusted models, and an increase in WC was a risk factor for higher CVD mortality (HR: 2.09, 95% CI: 1.12-3.88) in the adjusted models. Conclusion: Adiposity was associated with an increased risk of death in older adults. In view of these results and considering the lack of cutoff points for anthropometric indices in Brazilian older adults, further studies are needed to confirm the WC and WHtR cutoff values found in this study.

COVID-19 Infodemic and Impacts on the Mental Health of Older People: Cross-sectional Multicenter Survey Study.

BACKGROUND: The COVID-19 pandemic received widespread media coverage due to its novelty, an early lack of data, and the rapid rise in deaths and cases. This excessive coverage created a secondary "infodemic" that was considered to be a serious public and mental health problem by the World Health Organization and the international scientific community. The infodemic particularly affected older individuals, specifically those who are vulnerable to misinformation due to political positions, low interpretive and critical analysis capacity, and limited technical-scientific knowledge. Thus, it is important to understand older people's reaction to COVID-19 information disseminated by the media and the effect on their lives and mental health. OBJECTIVE: We aimed to describe the profile of exposure to COVID-19 information among older Brazilian individuals and the impact on their mental health, perceived stress, and the presence of generalized anxiety disorder (GAD). METHODS: This cross-sectional, exploratory study surveyed 3307 older Brazilians via the web, social networks, and email between July 2020 and March 2021. Descriptive analysis and bivariate analysis were performed to estimate associations of interest. RESULTS: Major proportions of the 3307 participants were aged 60 to 64 years (n=1285, 38.9%), female (n=2250, 68.4%), and married (n=1835, 55.5%) and self-identified as White (n=2364, 71.5%). Only 295 (8.9%) had never started or completed a basic education. COVID-19 information was mainly accessed on television (n=2680, 81.1%) and social networks (n=1943, 58.8%). Television exposure was ≥3 hours in 1301 (39.3%) participants, social network use was 2 to 5 hours in 1084 (32.8%) participants, and radio exposure was ≥1 hour in 1223 (37%) participants. Frequency of exposure to social networks was significantly associated with perceived stress (P=.04) and GAD (P=.01). A Bonferroni post hoc test revealed significantly different perceived stress in participants who were exposed to social networks for 1 hour (P=.04) and those who had no exposure (P=.04). A crude linear regression showed that "some" social media use (P=.02) and 1 hour of exposure to social media (P<.001) were associated with perceived stress. Adjusting for sociodemographic variables revealed no associations with this outcome variable. In a crude logistic regression, some social media use (P<.001) and 2 to 5 hours of exposure to social media (P=.03) were associated with GAD. Adjusting for the indicated variables showed that some social network use (P<.001) and 1 hour (P=.04) and 2 to 5 hours (P=.03) of exposure to social media were associated with GAD. CONCLUSIONS: Older people, especially women, were often exposed to COVID-19-related information through television and social networks; this affected their mental health, specifically GAD and stress. Thus, the impact of the infodemic should be considered during anamnesis for older people, so that they can share their feelings about it and receive appropriate psychosocial care.