Objectively Measured Physical Activity and Healthcare Expenditures Related to Arterial Hypertension and Diabetes Mellitus in Older Adults: SABE Study.

Research using questionnaires has shown that physical activity level (PAL) is associated with healthcare costs. The purpose of this study was to examine the association between objectively measured PAL and healthcare costs among hypertensive and diabetic noninstitutionalized Brazilian older people. The method consisted of a cross-sectional study forming part of the SABE Study, composed of 377 older people interviewed in 2010. Expenditures were estimated taking into account self-reported medicine prescription, outpatient service, and hospitalizations, with the highest quartile of expenditures considered as a risk category. PAL was estimated using an Actigraph accelerometer. Associations were expressed as odds ratios and 95% confidence intervals, adjusted for covariates. Overall expenditures were higher in the sedentary group. The insufficiently active group presented greater odds for higher total, outpatient, and hospitalization expenditure. It was concluded that healthcare expenditures were lower in more active hypertensive and diabetic older people. The promotion of physical activity could be relevant in the attenuation of the burden of chronic diseases in economic losses.

[Self-rated hypertension and anthropometric indicators of body fat in elderly]. / Hipertensão arterial referida e indicadores antropométricos de gordura em idosos.

OBJECTIVE: To investigate the association between self-rated hypertension (sf-H) and anthropometric indicators of body fat and abdominal fat, in elderly of São Paulo. METHODS: Data on 1894 elderly were obtained from the Survey on Aging, Health and Well-being (SABE), 2000. The anthropometric indicators used were: body mass index (BMI), waist circumference (WC), waist/ hip ratio (WHR) and waist/height ratio (WHR). Binary logistic regression analysis, stratified by gender was used. RESULTS: In the final model (adjusted for age, education, smoking, physical activity and diabetes), for both genders BMI had a greater statistical strength, despite the fact that, in women, it is similar to other indicators. With the exception of WHR, in men, sf-H was positively and independently associated with other indicators. CONCLUSION: Results suggest the relevance of those indicators for an early detection of risks for the development of this disease as well as to intervene in its prevention and control.

Obesity decreases time to claudication and delays post-exercise hemodynamic recovery in elderly peripheral arterial disease patients.

BACKGROUND: Althoughobesity is usually observed in peripheral arterial disease (PAD) patients, the effects of the association between these diseases on walking capacity are not well documented. OBJECTIVE: The main objectives of this study were to determine the effects of obesity on exercise tolerance and post-exercise hemodynamic recovery in elderly PAD patients. METHODS: 46 patients with stable symptoms of intermittent claudication were classified according to their body mass index (BMI) into normal group (NOR) = BMI <28.0 and obese or in risk of obesity group (OBE) = BMI >or=28.0. All patients performed a progressive graded treadmill test. During exercise, ventilatory responses were evaluated and pre- and post-exercise ankle and arm blood pressures were measured. RESULTS: Exercise tolerance and oxygen consumption at total walking time were similar between OBE and NOR. However, OBE showed a lower claudication time (309 +/- 151 vs. 459 +/- 272 s, p = 0.02) with a similar oxygen consumption at this time. In addition, OBE presented a longer time for ankle brachial index recovery after exercise (7.8 +/- 2.8 vs. 6.3 +/- 2.6 min, p = 0.02). CONCLUSION: Obesity in elderly PAD patients decreased time to claudication, and delayed post-exercise hemodynamic recovery. These results suggest that muscle metabolic demand, and not total workload, is responsible for the start of the claudication and maximal exercise tolerance in PAD patients. Moreover, claudication duration might be responsible for the time needed to a complete hemodynamic recovery after exercise.

Comparison of nutritional status and dietary intake self-reported by elderly people of different birth cohorts (1936 to 1940 and 1946 to 1950): Health, Wellbeing and Aging (SABE) Study. / Comparação do estado nutricional e da ingestão alimentar referida por idosos de diferentes coortes de nascimento (1936 a 1940 e 1946 a 1950): Estudo Saúde, Bem-Estar e Envelhecimento (SABE).

INTRODUCTION: The aging process is characterized by several changes in individuals' life, including his or her nutritional status and food intake. To understand the trends of these changes, studies with elderly people who were born at different times are necessary. OBJECTIVE: To compare the nutritional status and food intake of elderly people who participated in the Health, Well-being, and Aging study (SABE study), conducted in São Paulo, in 2000 and 2010. METHODS: The nutritional status was identified by means of the body mass index (BMI) and was classified as underweight (BMI < 23 kg/m²), adequate weight (23 ≤ BMI < 28 kg/m²), or overweight (BMI ≥ 28 kg/m). Food intake was self-reported and was classified as the number of meals (≥ 3/day), frequency of intake of dairy products (≥ 1 serving/day), eggs and beans (≥ 1 serving/week), fruits and vegetables (≥ 2 servings/day), meat (≥ 3 servings/week), and liquids (≥ 5 glasses/day). The prevalence ratio was calculated to compare the variables of the cohorts, using Poisson regression. RESULTS: A total of 755 individuals of both the genders aged 60 to 64 years and who were born between 1936 and 1940 and between 1946 and 1950 participated in this study. Elderly people who were born between 1946 and 1950 presented higher prevalence ratio of overweight (PR = 1.19), number of meals (PR = 1.34), and liquids intake (PR = 1.18), but presented lower prevalence of intake of dairy products (PR = 0.87), meats (PR = 0.93), and fruits and vegetables (PR = 0.83). CONCLUSION: These results showed concerning scenarios of nutritional status and food intake for the most recent cohort (1946 - 1950).

INTRODUÇÃO: O processo de envelhecimento é caracterizado por várias alterações, incluindo do estado nutricional e da ingestão alimentar. Para compreender a tendência dessas alterações são necessários estudos com idosos de diferentes épocas de nascimento. OBJETIVO: Comparar o estado nutricional e a ingestão alimentar de idosos participantes do Estudo Saúde, Bem-Estar e Envelhecimento (SABE), realizado em São Paulo, em 2000 e 2010. MÉTODOS: O estado nutricional foi identificado pelo índice de massa corporal (IMC), considerando: baixo peso (IMC < 23 kg/m²); peso adequado (23 ≤ IMC < 28 kg/m²); excesso de peso (IMC ≥ 28 kg/m²); e a ingestão alimentar referida: número de refeições (≥ 3/dia), frequência de laticínios (≥ 1 porção/dia), de ovos e leguminosas (≥ 1 porção/semana), de frutas, legumes e verduras (≥ 2 porções/dia), de carnes (≥ 3 porções/semana) e de líquidos (≥ 5 copos/dia). A comparação foi realizada por razão de prevalência, utilizando regressão de Poisson. RESULTADOS: Participaram 755 indivíduos de ambos os sexos, de 60 a 64 anos, nascidos nos períodos de 1936 a 1940 e 1946 a 1950. Os idosos nascidos entre 1946 e 1950 apresentaram maior razão de prevalência para excesso de peso (RP = 1,19) e para número de refeições (RP = 1,34) e para líquidos (RP = 1,18), contudo menor razão de prevalência para laticínios (RP = 0,87), para carnes (RP = 0,93) e para frutas, legumes e verduras (RP = 0,83). CONCLUSÃO: Estes resultados mostram cenários alimentar e nutricional preocupantes para a coorte mais recente (1946 - 1950).

[Systematic review of nutritional screening methods for elderly Brazilians living at home]. / Revisão sistemática de métodos de triagem nutricionalpara idosos brasileiros domiciliados.

The scope of this article is to identify a specific method of nutritional screening for use on elderly Brazilians living at home. It is a systematic review article using the PubMed, LILACS and Web of Science databases. The eligibility criterion was articles about nutritional screening methods for the elderly. The articles were read by evaluators who selected the methods and classified them according to evidence of validity, reproducibility and acceptability. EndNote software was used for scrutiny of the articles. Twelve methods of nutritional screening were identified, 3 being developed for use in the US population (n = 4), though none for the Brazilian population. In seven methods, the forms were filled out by the elderly themselves, and 4 of these presented anthropometric measures. Only one method produced information on acceptability. Reproducibility and validity was identified in 1 and 8, respectively, however only the Determine Your Nutritional Health® - DNH method presented acceptability data, which is a fundamental aspect in the choice for adaptation and use of the method in another country. Among the methods studied, the DNH was the most appropriate for cross-cultural adaptation and use on elderly Brazilians living at home.

O objetivo deste artigo é identificar um método de triagem nutricional específico para utilização em idosos brasileiros domiciliados. Artigo de revisão sistemática utilizando as bases de dados PubMed, Lilacs e Web of Science para a obtenção de artigos. Os critérios de elegibilidade foram: artigos sobre métodos de triagem nutricional para idosos. Os artigos foram lidos por avaliadores que selecionaram os métodos de triagem e classificaram, segundo evidência de dados de validade, reprodutibilidade e aceitabilidade. O programa EndNote foi utilizado para gerenciamento dos artigos. Foram identificados 12 métodos de triagem nutricional, 3 desenvolvidos para população estadunidense e nenhum para população brasileira. Em 7 métodos o modo de preenchimento foi autorrespondido, sendo que 4 apresentavam dados antropométricos. A reprodutibilidade e a validade foram identificadas em 8 e em 1 método, respectivamente, contudo apenas o método Determine Your Nutritional Health® ­ DNH, apresentou dados de aceitabilidade, aspecto fundamental na escolha de método para adaptação e utilização em outro país. Dentre os métodos analisados, o DNH apresentou-se como o mais apropriado para adaptação transcultural e utilização em idosos brasileiros domiciliados.

[Factors associated with general obesity and the percentage of body fat of women during the menopause in the city of São Paulo, Brazil]. / Fatores associados à obesidade geral e ao percentual de gordura corporal em mulheres no climatério da cidade de São Paulo, Brasil.

To verify the association between obesity and demographic, clinical and lifestyle variables in climacteric women, a cross-sectional study was conducted in outpatient clinics, with 469 women aged 40 to 65 years in the city of São Paulo, Brazil. The dependent variables were: obesity according to body mass index (BMI) and obesity according to percentage of body fat (% BF). The main explanatory variable was: climacteric phase (pre or postmenopausal); and control variables were: age; years of formal study; parity; menopausal hormone therapy (MHT) use; physical activity practice and smoking habit. Multiple regression analysis was performed using the Stata 9.2 software. According to the BMI, obesity was positively associated with parity (RR = 1.62, 95% CI = 1.11-2.37) and, negatively, with years of formal study (RP = 0.71, CI 95% = 0.55-0.91) and with physical activity practice (PR = 0.45, 95% CI = 0.33-0.61). According to the % BF, obesity was positively associated with parity (PR = 1.60, 95% CI = 1.03-2.49) and negatively with physical activity practice (PR = 0.43; 95% CI = 0.29-0.63). While being active physically was protective, multiparity was a risk factor for developing obesity for women in this study.

Para verificar a associação entre obesidade e variáveis demográficas, clínicas e relacionadas ao estilo de vida em mulheres no climatério, foi realizado um estudo transversal com 469 mulheres de 40 a 65 anos em dois ambulatórios públicos da cidade de São Paulo. As variáveis dependentes foram: obesidade, segundo índice de massa corporal (IMC) e obesidade, segundo percentual de gordura corporal (%GC). A variável explanatória principal foi: fase do climatério (pré ou pós-menopausa); e as variáveis de controle foram: idade; anos de estudo; paridade; uso de terapia hormonal da menopausa; prática de atividade física e hábito de fumar. Realizou-se análise de regressão "glm" múltipla, utilizando para as análises o software Stata 9.2. Segundo o IMC, a obesidade associou-se positivamente, à paridade (RP = 1,62; IC 95% = 1,11-2,37) e, negativamente, aos anos de estudo (RP = 0,71; IC 95% = 0,55-0,91) e à prática de atividade física (RP = 0,45; IC 95% = 0,33-0,61). De acordo com o %GC, a obesidade associou-se positivamente à paridade (RP = 1,60; IC 95% = 1,03-2,49) e, negativamente, à prática de atividade física (RP = 0,43; IC 95% = 0,29-0,63). Enquanto a prática de atividade física foi um fator protetor, a multiparidade constituiu-se como fator de risco para a prevalência de obesidade no grupo de mulheres deste estudo.

Reported diabetes mellitus: incidence and determinants in cohort of community dwelling elderly people in São Paulo City, Brazil: SABE study, health, wellness and aging. / Diabetes mellitus referida: incidência e determinantes, em coorte de idosos do município de São Paulo, Brasil, Estudo SABE ­ Saúde, Bem-Estar e Envelhecimento.

To verify the association between the incidence of DM and predictors, in a cohort of elderly people. Elderly people (≥ 60 y) were analyzed, of both genders, participants of the SABE Survey, carried out in the city of São Paulo, Brazil, in 2000 (n = 2,143) and 2006 (n = 1,115). The study variables were: DM; demographic (gender, age group, education level, companionship in the residence), nutritional status (risk for obesity, body obesity, and high abdominal fat), clinical (number of reported diseases), and lifestyle (alcohol consumption, smoking, intake of meat and fruit and vegetables). Multiple logistic regression (p < 0.05) was used to verify the association between variables of this study, with the statistical software Stata/SE 10.1. In 2006, 914 subjects, survivors of 2000, were analyzed and 72 were identified as new cases of DM (7.7/1.000 person-years). It was found that body obesity (OR = 1.67, CI = 1.00 to 2.81) and high abdominal fat (OR = 2.32, CI = 1.47 to 3.67) were predictors of the incidence of DM in the elderly (p < 0.000). It was concluded that body obesity and abdominal fat are the variables which contribute to the development of DM in the elderly.

Verificar a associação da incidência de diabetes melito (DM) e variáveis determinantes em coorte de idosos. Foram analisados idosos, participantes do Estudo SABE ­ Saúde, Bem-Estar e Envelhecimento, realizado no município de São Paulo, em 2000 (2.143 idosos), e em 2006 (1.115 idosos). As variáveis de estudo foram: DM; sociodemográficas (sexo, grupo etário, escolaridade, companhia no domicílio), estado nutricional (risco para obesidade, obesidade e gordura abdominal), clínicas (número de doenças referidas) e de estilo de vida (ingestão de bebida alcoólica, hábito de fumar, ingestão de carnes e de frutas, legumes e verduras). Utilizou-se regressão logística múltipla para verificar a associação entre variáveis de estudo, utilizando o programa Stata/SE 10.0. Em 2006, 914 idosos, sobreviventes de 2000, foram analisados, dos quais 72 constituíram os novos casos de DM (incidência de 7,7/1.000 pessoas-ano). Verificou-se associação (p < 0,000) entre incidência de DM com obesidade corporal (OR = 1,67; IC = 1,00­2,81) e gordura abdominal elevada (OR = 2,32; IC = 1,47-3,67). Concluiu-se que a obesidade corporal e a gordura abdominal elevada foram as variáveis que contribuem para o desenvolvimento da DM em idosos.

[Trends in body fat and muscle mass among elderly individuals in Fortaleza, Ceará State, Brazil]. / Perfil dos indicadores de gordura e massa muscular corporal dos idosos de Fortaleza, Ceará, Brasil.

The aim of this study was to describe trends in body fat and muscle mass among elderly individuals in Fortaleza, Ceará State, Brazil. This was a population-based, cross-sectional, household survey of elderly individuals (> 60 years) (n = 483) in Fortaleza. The variables analyzed were: triceps skinfold thickness (TST), upper arm fat area (UFA), mid upper arm circumference (MAC), arm muscle circumference (AMC), arm muscle area (AMA), and corrected arm muscle area (CAMA). Mean TST and UFA were significantly higher in women than men (p < 0.05). Mean AMC, AMA, and CAMA were higher in men than women (p < 0.05). For all the variables, the mean and 50th percentile decreased with age, except the TST percentile for women. Anthropometric and body composition patterns in the elderly in this study showed similar trends to those of other studies, but with different values. The values could thus be useful as references for the elderly in Fortaleza.

[The costs of physical inactivity in the world: a general review]. / Os custos da inatividade física no mundo: estudo de revisão.

There is convincing evidence in the scientific literature of the effectiveness of regular physical activity and physical exercise in the conservation of health and the prevention of various ailments. However, studies into the association between costs of medical services and physical inactivity have not been duly addressed. International studies have quantified these costs and revealed the association between physical activity and/or sedentary behavior. Therefore, this review sought to gather information available from several countries and analyze the global costs associated with physical inactivity over the past few decades. The results of twenty-four original and well-researched articles in nine countries, including Brazil, were analyzed. The results showed that physical inactivity, irrespective of the method of classification, is burdensome to the economy of health worldwide, and directly responsible for the high cost of medication, the incidence of hospitalization and the frequency of medical appointments. The costs of the group of the physically inactive population affected by chronic diseases feature among the major components of the total costs involved in public health.

[Calcium/protein relation of women on the climacteric]. / Relação cálcio/proteína da dieta de mulheres no climatério.

OBJECTIVE: To evaluate the calcium/protein relation of the diet of climacteric women. METHODS: In a transversal study the diet was evaluated of 154 women 35-65 years old and matriculated in the Health Clinic of the Climateric Woman of Health Center of Public Health College of the São Paulo University. The food intake of calcium and protein was investigated by "24 hours recall" method. The evaluation of calcium/protein relation was made according to Massey and Heaney (1998), that is 20/1 (mg/g). RESULTS: The mean of intake of calcium was 624.9 mg, the mean of intake of protein was 86.7 g and the calcium/protein relation was 7/1 (624.9 mg/86.7 g). CONCLUSION: The studied population presents inadequated consumation of the calcium and protein nutrients. It could result in serious risk for health.

[Nutritional status and food intake assessment of climacterics women]. / Avaliação do estado nutricional e do consumo alimentar de mulheres no climatério.

BACKGROUND: To evaluate the nutritional status and food intake of climacterics women. METHODS: In a transversal study were evaluated 154 women matriculated in the Clinic of the Climacteric Woman of the Health Center of Public Health College of the S o Paulo University, Brazil. The analyzed variables were body mass index (BMI) and food intake (energy, percentual distribution of macronutrients, A and C vitamins, calcium and iron minerals). To analyse food caloric value and calcium and iron minerals, were utilized two age groups (35-50 y and 51-65 y). To analyse BMI, macronutrients percentage and A and C vitamins were utilized the total population (35-65 years of age). In all variables were calculated mean and standard deviation. RESULTS: The mean BMI was 29.3 kg/m2; (+/- 6.2 kg/m2;), with 75% of population above normality. About the energy, the results indicated adequacy to two age groups; about the distribution percentual of macronutrients, all were inadequate. In relation to the vitamins and minerals, all were inadequates, with exception of iron. CONCLUSION: The population studied presents risks to health owing to high value of BMI and inadequate intake of macronutrients, calcium, A and C vitamins.

Revisão sistemática de métodos de triagem nutricionalpara idosos brasileiros domiciliados / Systematic review of nutritional screening methods for elderly Brazilians living at home

Resumo O objetivo deste artigo é identificar um método de triagem nutricional específico para utilização em idosos brasileiros domiciliados. Artigo de revisão sistemática utilizando as bases de dados PubMed, Lilacs e Web of Science para a obtenção de artigos. Os critérios de elegibilidade foram: artigos sobre métodos de triagem nutricional para idosos. Os artigos foram lidos por avaliadores que selecionaram os métodos de triagem e classificaram, segundo evidência de dados de validade, reprodutibilidade e aceitabilidade. O programa EndNote foi utilizado para gerenciamento dos artigos. Foram identificados 12 métodos de triagem nutricional, 3 desenvolvidos para população estadunidense e nenhum para população brasileira. Em 7 métodos o modo de preenchimento foi autorrespondido, sendo que 4 apresentavam dados antropométricos. A reprodutibilidade e a validade foram identificadas em 8 e em 1 método, respectivamente, contudo apenas o método Determine Your Nutritional Health® - DNH, apresentou dados de aceitabilidade, aspecto fundamental na escolha de método para adaptação e utilização em outro país. Dentre os métodos analisados, o DNH apresentou-se como o mais apropriado para adaptação transcultural e utilização em idosos brasileiros domiciliados.

Abstract The scope of this article is to identify a specific method of nutritional screening for use on elderly Brazilians living at home. It is a systematic review article using the PubMed, LILACS and Web of Science databases. The eligibility criterion was articles about nutritional screening methods for the elderly. The articles were read by evaluators who selected the methods and classified them according to evidence of validity, reproducibility and acceptability. EndNote software was used for scrutiny of the articles. Twelve methods of nutritional screening were identified, 3 being developed for use in the US population (n = 4), though none for the Brazilian population. In seven methods, the forms were filled out by the elderly themselves, and 4 of these presented anthropometric measures. Only one method produced information on acceptability. Reproducibility and validity was identified in 1 and 8, respectively, however only the Determine Your Nutritional Health® - DNH method presented acceptability data, which is a fundamental aspect in the choice for adaptation and use of the method in another country. Among the methods studied, the DNH was the most appropriate for cross-cultural adaptation and use on elderly Brazilians living at home.

Fatores associados à obesidade geral e ao percentual de gordura corporal em mulheres no climatério da cidade de São Paulo, Brasil / Factors associated with general obesity and the percentage of body fat of women during the menopause in the city of São Paulo, Brazil

Resumo Para verificar a associação entre obesidade e variáveis demográficas, clínicas e relacionadas ao estilo de vida em mulheres no climatério, foi realizado um estudo transversal com 469 mulheres de 40 a 65 anos em dois ambulatórios públicos da cidade de São Paulo. As variáveis dependentes foram: obesidade, segundo índice de massa corporal (IMC) e obesidade, segundo percentual de gordura corporal (%GC). A variável explanatória principal foi: fase do climatério (pré ou pós-menopausa); e as variáveis de controle foram: idade; anos de estudo; paridade; uso de terapia hormonal da menopausa; prática de atividade física e hábito de fumar. Realizou-se análise de regressão "glm" múltipla, utilizando para as análises o software Stata 9.2. Segundo o IMC, a obesidade associou-se positivamente, à paridade (RP = 1,62; IC 95% = 1,11-2,37) e, negativamente, aos anos de estudo (RP = 0,71; IC 95% = 0,55-0,91) e à prática de atividade física (RP = 0,45; IC 95% = 0,33-0,61). De acordo com o %GC, a obesidade associou-se positivamente à paridade (RP = 1,60; IC 95% = 1,03-2,49) e, negativamente, à prática de atividade física (RP = 0,43; IC 95% = 0,29-0,63). Enquanto a prática de atividade física foi um fator protetor, a multiparidade constituiu-se como fator de risco para a prevalência de obesidade no grupo de mulheres deste estudo.

Abstract To verify the association between obesity and demographic, clinical and lifestyle variables in climacteric women, a cross-sectional study was conducted in outpatient clinics, with 469 women aged 40 to 65 years in the city of São Paulo, Brazil. The dependent variables were: obesity according to body mass index (BMI) and obesity according to percentage of body fat (% BF). The main explanatory variable was: climacteric phase (pre or postmenopausal); and control variables were: age; years of formal study; parity; menopausal hormone therapy (MHT) use; physical activity practice and smoking habit. Multiple regression analysis was performed using the Stata 9.2 software. According to the BMI, obesity was positively associated with parity (RR = 1.62, 95% CI = 1.11-2.37) and, negatively, with years of formal study (RP = 0.71, CI 95% = 0.55-0.91) and with physical activity practice (PR = 0.45, 95% CI = 0.33-0.61). According to the % BF, obesity was positively associated with parity (PR = 1.60, 95% CI = 1.03-2.49) and negatively with physical activity practice (PR = 0.43; 95% CI = 0.29-0.63). While being active physically was protective, multiparity was a risk factor for developing obesity for women in this study.

Comparação do estado nutricional e da ingestão alimentar referida por idosos de diferentes coortes de nascimento (1936 a 1940 e 1946 a 1950): Estudo Saúde, Bem-Estar e Envelhecimento (SABE) / Comparison of nutritional status and dietary intake self-reported by elderly people of different birth cohorts (1936 to 1940 and 1946 to 1950): Health, Wellbeing and Aging (SABE) Study

RESUMO: Introdução: O processo de envelhecimento é caracterizado por várias alterações, incluindo do estado nutricional e da ingestão alimentar. Para compreender a tendência dessas alterações são necessários estudos com idosos de diferentes épocas de nascimento. Objetivo: Comparar o estado nutricional e a ingestão alimentar de idosos participantes do Estudo Saúde, Bem-Estar e Envelhecimento (SABE), realizado em São Paulo, em 2000 e 2010. Métodos: O estado nutricional foi identificado pelo índice de massa corporal (IMC), considerando: baixo peso (IMC < 23 kg/m²); peso adequado (23 ≤ IMC < 28 kg/m²); excesso de peso (IMC ≥ 28 kg/m²); e a ingestão alimentar referida: número de refeições (≥ 3/dia), frequência de laticínios (≥ 1 porção/dia), de ovos e leguminosas (≥ 1 porção/semana), de frutas, legumes e verduras (≥ 2 porções/dia), de carnes (≥ 3 porções/semana) e de líquidos (≥ 5 copos/dia). A comparação foi realizada por razão de prevalência, utilizando regressão de Poisson. Resultados: Participaram 755 indivíduos de ambos os sexos, de 60 a 64 anos, nascidos nos períodos de 1936 a 1940 e 1946 a 1950. Os idosos nascidos entre 1946 e 1950 apresentaram maior razão de prevalência para excesso de peso (RP = 1,19) e para número de refeições (RP = 1,34) e para líquidos (RP = 1,18), contudo menor razão de prevalência para laticínios (RP = 0,87), para carnes (RP = 0,93) e para frutas, legumes e verduras (RP = 0,83). Conclusão: Estes resultados mostram cenários alimentar e nutricional preocupantes para a coorte mais recente (1946 - 1950).

ABSTRACT: Introduction: The aging process is characterized by several changes in individuals' life, including his or her nutritional status and food intake. To understand the trends of these changes, studies with elderly people who were born at different times are necessary. Objective: To compare the nutritional status and food intake of elderly people who participated in the Health, Well-being, and Aging study (SABE study), conducted in São Paulo, in 2000 and 2010. Methods: The nutritional status was identified by means of the body mass index (BMI) and was classified as underweight (BMI < 23 kg/m²), adequate weight (23 ≤ BMI < 28 kg/m²), or overweight (BMI ≥ 28 kg/m). Food intake was self-reported and was classified as the number of meals (≥ 3/day), frequency of intake of dairy products (≥ 1 serving/day), eggs and beans (≥ 1 serving/week), fruits and vegetables (≥ 2 servings/day), meat (≥ 3 servings/week), and liquids (≥ 5 glasses/day). The prevalence ratio was calculated to compare the variables of the cohorts, using Poisson regression. Results: A total of 755 individuals of both the genders aged 60 to 64 years and who were born between 1936 and 1940 and between 1946 and 1950 participated in this study. Elderly people who were born between 1946 and 1950 presented higher prevalence ratio of overweight (PR = 1.19), number of meals (PR = 1.34), and liquids intake (PR = 1.18), but presented lower prevalence of intake of dairy products (PR = 0.87), meats (PR = 0.93), and fruits and vegetables (PR = 0.83). Conclusion: These results showed concerning scenarios of nutritional status and food intake for the most recent cohort (1946 - 1950).

Dietary patterns of elderly persons from the city of São Paulo: evidence from the SABE (Health, Wellbeing and Aging) survey / Padrões alimentares de indivíduos idosos do município de São Paulo: evidências do estudo SABE (Saúde, Bem-estar e Envelhecimento)

Abstract Objective: to determine the dietary patterns of elderly persons in terms of sociodemographic, lifestyle and clinical aspects. Method: a cross-sectional study was conducted using the cohorts of the SABE (Health, Wellbeing and Aging) study. An epidemiological, home-based study representative of the city of São Paulo was carried out. The population of this study included 1,304 elderly persons (≥60 years), of both genders, selected by probabilistic stratified sampling, interviewed in 2010. Food intake data were obtained through a qualitative food frequency questionnaire. Dietary patterns were determined by exploratory factorial analysis by principal components. The Wald test was used for complex sampling. Results: four dietary patterns were identified: inadequate patterns, consisting of fried and canned food, sausages, sweets, tubers, industrialized sauces and eggs; modified pattern, skimmed milk, whole grain breads and cereals, light/diet/zero foods; beneficial pattern, fruits, vegetables and tubers; and traditional Brazilian pattern, vegetable oils, rice, refined cereals and white bread, meats and legumes (beans). The sociodemographic and lifestyle profile of the elderly persons who adopted each dietary pattern was different. Conclusion: healthier dietary patterns were associated with the female gender, older elderly persons, two or more chronic diseases, higher levels of schooling, a better lifestyle and a better self-perception of health. It is important to consider all these aspects as they are determinant in the type of diet adopted by this population.

Resumo Objetivo: determinar os padrões alimentares da população idosa, considerando aspectos sociodemográficos, de estilo de vida e clínicos. Método: foi realizada uma análise transversal nas coortes do Estudo SABE (Saúde, Bem-estar e Envelhecimento). Estudo de caráter epidemiológico, de base domiciliar, representativo do município de São Paulo. A população deste estudo incluiu 1.304 idosos (≥60 anos), de ambos os sexos, selecionados por amostragem probabilística estratificada, entrevistados em 2010. Os dados sobre alimentação foram obtidos por meio de questionário de frequência alimentar qualitativo. Os padrões alimentares foram determinados pela análise fatorial exploratória por componentes principais. Foram utilizados Teste de Wald para amostragem complexa. Resultados: quatro padrões alimentares foram identificados: padrão inadequado, composto por: frituras, embutidos, enlatados, doces, tubérculos, temperos e molhos industrializados e ovos; padrão modificado: laticínios desnatados, cereais e pães integrais e alimentos light/diet/zero; padrão benéfico: frutas, verduras e legumes e tubérculos; e padrão tradicional brasileiro: óleos vegetais, arroz, cereais refinados e pão branco, carnes e leguminosas. O perfil sociodemográfico e de estilo de vida dos idosos que adotam cada padrão alimentar é distinto. Conclusão: os padrões alimentares compostos por alimentos saudáveis estiveram associados ao sexo feminino, idosos com mais de 2 doenças crônicas, mais longevos, com maior escolaridade, melhor estilo de vida e autopercepção de saúde. Importante considerar estes aspectos, pois são determinantes no tipo de dieta adotado por esta população.

Anthropometric changes in the Brazilian cohort of older adults: SABE survey (health, well-being, and aging).

The aim of the present study was to analyze the anthropometric changes in a home-based cohort of Brazilian older adults who participated in the SABE Survey, conducted in 2000 and 2006. A total of 1030 men and women were examined by age group: 60-69, 70-79, and ≥80 years. This representative sample consists of the survivors of the 2000 cohort. The following anthropometric variables were assessed: body mass, arm muscle, waist and calf circumferences, triceps skinfold thickness, body mass index, waist-hip ratio, and arm muscle area according to mean values and percentile distribution. Except for body mass and body mass index, a significant difference (P < 0.05) was observed among the assessed anthropometric variables during the follow-up period. The older adults ≥80 years presented the lowest values. The reduction in the mean values of triceps skinfold thickness was greater (30%) than that of waist circumference (9%) and was more pronounced in women (21%) than in men (9%). Arm muscle circumference and area reduced by 8% and 19%, respectively, in men and 1% and 3%, correspondingly, in women. Our findings revealed reductions in the mean values for all anthropometric variables in the follow-up period from 2000 to 2006 among older adults.

Diabetes mellitus referida: incidência e determinantes, em coorte de idosos do município de São Paulo, Brasil, Estudo SABE - Saúde, Bem-Estar e Envelhecimento / Reported diabetes mellitus: incidence and determinants in cohort of community dwelling elderly people in São Paulo City, Brazil: SABE study, health, wellness and aging

Resumo Verificar a associação da incidência de diabetes melito (DM) e variáveis determinantes em coorte de idosos. Foram analisados idosos, participantes do Estudo SABE - Saúde, Bem-Estar e Envelhecimento, realizado no município de São Paulo, em 2000 (2.143 idosos), e em 2006 (1.115 idosos). As variáveis de estudo foram: DM; sociodemográficas (sexo, grupo etário, escolaridade, companhia no domicílio), estado nutricional (risco para obesidade, obesidade e gordura abdominal), clínicas (número de doenças referidas) e de estilo de vida (ingestão de bebida alcoólica, hábito de fumar, ingestão de carnes e de frutas, legumes e verduras). Utilizou-se regressão logística múltipla para verificar a associação entre variáveis de estudo, utilizando o programa Stata/SE 10.0. Em 2006, 914 idosos, sobreviventes de 2000, foram analisados, dos quais 72 constituíram os novos casos de DM (incidência de 7,7/1.000 pessoas-ano). Verificou-se associação (p < 0,000) entre incidência de DM com obesidade corporal (OR = 1,67; IC = 1,00-2,81) e gordura abdominal elevada (OR = 2,32; IC = 1,47-3,67). Concluiu-se que a obesidade corporal e a gordura abdominal elevada foram as variáveis que contribuem para o desenvolvimento da DM em idosos.

Abstract To verify the association between the incidence of DM and predictors, in a cohort of elderly people. Elderly people (≥ 60 y) were analyzed, of both genders, participants of the SABE Survey, carried out in the city of São Paulo, Brazil, in 2000 (n = 2,143) and 2006 (n = 1,115). The study variables were: DM; demographic (gender, age group, education level, companionship in the residence), nutritional status (risk for obesity, body obesity, and high abdominal fat), clinical (number of reported diseases), and lifestyle (alcohol consumption, smoking, intake of meat and fruit and vegetables). Multiple logistic regression (p < 0.05) was used to verify the association between variables of this study, with the statistical software Stata/SE 10.1. In 2006, 914 subjects, survivors of 2000, were analyzed and 72 were identified as new cases of DM (7.7/1.000 person-years). It was found that body obesity (OR = 1.67, CI = 1.00 to 2.81) and high abdominal fat (OR = 2.32, CI = 1.47 to 3.67) were predictors of the incidence of DM in the elderly (p < 0.000). It was concluded that body obesity and abdominal fat are the variables which contribute to the development of DM in the elderly.

Validation, reliability and operational equivalency of the nutritional screening method "Determine The Nutritional Health Of The Elderly" / Validação, confiabilidade e equivalência operacional do método de triagem nutricional "Verifique a condição nutricional do idoso"

Objective: To analyze the reliability, validity and operational equivalence of the nutritional screening method "Assessing The Nutritional Condition Of The Elderly". Method: This study was conducted with a subsample of 174 elderly persons from the Health, Welfare and Aging (SABE) study. The "Assessing The Nutritional Condition Of The Elderly" method consists of ten questions which classify individuals according to nutritional risk. Anthropometric and nutritional indicators were adopted as gold standard measures for comparison with the values of the method. Reliability was verified using the McNemar and Bland Altman tests, the validity of the discriminant type was assessed by the Mann-Whitney test and operational equivalence was identified through data relating to the time required to apply the method and the degree of understanding of the same using the Likert scale (1 to 5). Results: Of the 174 elderly persons interviewed, 63.8% were women and 52.3% were in the 60-74 years age group. It was found that 43.1% and 33.3% of the subjects had moderate to high nutritional risk, respectively, with a higher prevalence of high nutritional risk among women (33.3%) and those aged 60-74 years (43.4%). The method analyzed showed satisfactory results for reliability and discriminant validity. The average time required to apply this method was approximately seven minutes and the overall mean grade of understanding was 4.8. Conclusion: The method studied can be used by health professionals in epidemiological and clinical studies to identify the presence of nutritional risk in elderly persons living at home.

Objetivo: Analisar a confiablidade, a validade e a equivalência operacional do método de triagem nutricional "Verifique a condição nutricional do idoso". Método: Este estudo foi realizado com subamostra de 174 idosos do Estudo Saúde, Bem-estar e Envelhecimento (SABE). O método "Verifique a condição nutricional do idoso", consiste de 10 perguntas, que classifica os indivíduos, segundo risco nutricional. Adotou-se a antropometria e indicadores nutricionais, como medidas padrão-ouro para comparação com os valores desse método. A confiabilidade foi verificada pelo teste de McNemar e gráficos de Bland Altman, a validade do tipo discriminante foi avaliada por meio do teste Mann-Whitney e a equivalência operacional do método foi identificada pelos dados referentes à duração de realização do método e pelo grau de entendimento do mesmo pela escala Likert (entre 1 e 5). Resultados: Dos 174 idosos entrevistados, 63,8% eram mulheres e 52,3% eram do grupo etário de 60 a 74 anos. Constatou-se que 43,1% e 33,3% dos indivíduos apresentavam risco nutricional moderado e alto, respectivamente, sendo maior a prevalência de risco nutricional alto nas mulheres (33,3%) e naqueles do grupo de 60 a 74 anos (43,4%). O método analisado apresentou resultados satisfatórios para confiabilidade e validade discriminante. A duração média de realização do método foi de aproximadamente sete minutos e nota média geral de entendimento foi de 4,8. Conclusão: O método estudado pode ser utilizado em estudos epidemiológicos e clínicos, por profissionais de saúde, para identificar a presença de risco nutricional em idosos domiciliados.

[Total energy value and percentage contribution of calories from macronutrients in the diet of elderly individuals from Fortaleza, state of Ceará, Brazil]. / Valor energético total e contribuição percentual de calorias por macronutrientes da alimentação de idosos domiciliados em Fortaleza--CE.

OBJECTIVE: Describe the total energy value and percentage contribution of calories from macronutrients in the diet of elderly individuals living in Fortaleza/CE. METHODS: This is a population-based, cross-sectional domiciliary study, which included 458 elderly individuals (66.6% women). The variables evaluated were total energy value (TEV) and the percentage contribution of calories from proteins, carbohydrates, and lipids. The results are shown as mean, standard deviation, and percentile distribution (P5, P10, P25, P50, P75, P90, P95). The Student's t-test and analysis of variance (one-way ANOVA) with LSD post-hoc tests were used to determine the statistical significance of means between two groups and among three or more groups, respectively. RESULTS: When comparing the mean values of TEV among categories of socioeconomic and demographic variables, statistically significant differences were found between women for ethnicity, years of schooling and socioeconomic level. Among men, differences were found for years of schooling and socioeconomic level. The mean energy value of men's diet was significantly higher than that of women (1475.8 kcal and 1236.4 kcal, respectively). The mean values of calorie percentage contribution from proteins, carbohydrates, and lipids were similar between men and women. CONCLUSION: The elderly of this study showed significant differences in mean values of TEV between sexes and between the categories years of schooling and socioeconomic level. Women also showed significant differences between the ethnic categories. The mean relative contribution of macronutrients in TEV was similar between genders and age groups.

Abdominal obesity and healthcare costs related to hypertension and diabetes in older adults / Obesidade abdominal e custos com saúde relacionados à hipertensão e diabetes em idosos

ABSTRACT Objective: To analyze the association between excess abdominal fat and healthcare costs related to hypertension and diabetes Mellitus in older adults. Methods: These cross-sectional analyses are part of the Health, Wellbeing and Aging Study conducted in São Paulo, Brazil, with 806 older adults with self-reported hypertension and diabetes Mellitus. The study included the annual costs with medicines, hospital admissions, and outpatient services for hypertension and diabetes Mellitus control. Excess abdominal fat was diagnosed based on waist circumference. Level of physical activity, age, and gender were considered covariates. The sample was divided into two groups according to waist circumference. Multiple logistic regression analyzed the associations between annual costs and waist circumference. Results: The cost of services and hospitalizations (R$551.05; 95%CI=418.27-683.83) and total costs (R$817.77; 95%CI=669.21-966.33) were higher in the excess abdominal fat group. Older adults with high waist circumference had higher odds of increasing annual costs due to medicines (OR=2.6; 95%CI=1.13-3.77), regardless of gender, age, and level of physical activity. Conclusion: Healthcare costs for treating hypertension and diabetes Mellitus in older adults are higher in the presence of excess abdominal fat.

RESUMO Objetivo: Analisar a associação entre excesso de gordura abdominal e custos com saúde relacionados à hipertensão arterial sistêmica e ao diabetes Mellitus em idosos. Métodos: Estudo transversal que faz parte do Estudo Saúde, Bem-estar e Envelhecimento realizado em São Paulo, São Paulo, incluindo 806 idosos com autorreferência à hipertensão arterial sistêmica e ao diabetes Mellitus. Os custos anuais com medicamentos, internações e serviços ambulatoriais para o controle dessas patologias foram considerados. O excesso de gordura abdominal foi diagnosticado segundo os valores de circunferência da cintura. Nível de atividade física, sexo e idade foram considerados como covariáveis. Os idosos foram divididos em dois grupos segundo a circunferência da cintura, sendo que a análise de regressão logística múltipla verificou associações entre essa medida e custos anuais. Resultados: Os custos com serviços e hospitalizações (R$551,05; IC95%=418,27-683,83) e custos totais (R$817,77; IC95%=669,21-966,33) foram maiores no grupo de idosos com excesso de gordura abdominal. Os idosos com maior circunferência da cintura apresentaram maior risco para custos anuais superiores devido ao uso de medicamentos (OR=2.06; IC95%=1.13-3.77), independentemente do sexo, idade ou nível de atividade física. Conclusão: Os custos com saúde para hipertensão arterial sistêmica e diabetes Mellitus em idosos são superiores quando existe excesso de gordura abdominal.