Overweight and Class I Obesity Are Associated with Lower 10-Year Risk of Mortality in Brazilian Older Adults: The Bambuí Cohort Study of Ageing

Background: Prospective studies mostly with European and North-American populations have shown inconsistent results r

C-Reactive Protein and B-Type Natriuretic Peptide Yield Either a Non-Significant or a Modest Incremental Value to Traditional Risk Factors in Predicting Long-Term Overall Mortality in Older Adults

Background:New biomarkers may aid in preventive and end-of-life decisions in older adults if they enhance the prognostic ability of traditional risk factors. We investigated whether C-reactive protein (CRP) and/or B-type natriuretic peptide (BNP) improve the ability to predict overall mortality among the elderly of the Bambuí, Brazil Study of Aging when added to traditional risk factors.Methods:From 1997 to 2007, 1,470 community-dwelling individuals (≥60 years) were followed-up. Death was ascertained by continuous verification of death certificates. We calculated hazard ratios per 1 standard deviation change (HR) of death for traditional risk factors only (old model), and traditional risk factors plus CRP and/or BNP (new models) and assessed calibration of the models. Subsequently, we compared c-statistic of each of the new models to the old one, and calculated integrated discriminative improvement (IDI) and net reclassification improvement (NRI).Results:544 (37.0%) participants died in a mean follow-up time of 9.0 years. CRP (HR 1.28, 95% CI 1.17-1.40), BNP (HR 1.31 95% CI 1.19-1.45), and CRP plus BNP (HR 1.26, 95% CI 1.15-1.38, and HR 1.29, 95% CI 1.16-1.42, respectively) were independent determinants of mortality. All models were well-calibrated. Discrimination was similar among the old (c-statistic 0.78 [0.78-0.81]) and new models (p=0.43 for CRP; p=0.57 for BNP; and p=0.31 for CRP plus BNP). Compared to the old model, CRP, BNP, and CRP plus BNP models led to an IDI of 0.009 (p<0.001), -0.005 (p<0.001) and -0.003 (p=0.84), and a NRI of 0.04 (p=0.24), 0.07 (p=0.08) and 0.06 (p=0.10), respectively.Conclusions:Despite being independent predictors of long-term risk of death, compared to traditional risk factors CRP and/or BNP led to either a modest or non-significant improvement in the ability of predicting all-cause mortality in older adults

La asociación positiva entre ácido úrico sérico, glucosa alterada en ayunas, tolerancia a la glucosa alterada y diabetes mellitus en el estudio ELSA-Brasil

There is a conflict in the literature regarding the association between serum uric acid (SUA) levels and glycemic status. Therefore, we evaluated the association between SUA level and glycemic status – impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus – and insulin resistance, in a large Brazilian study. This is a cross-sectional, observational study with 13,207 participants aged 35-74 years, at baseline (2008-2010) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). A multinomial regression analysis was performed to test the association between SUA and glycemic status (IFG, IGT, and newly diagnosed type 2 diabetes at the cohort baseline) after adjustments by age, sex, skin color, body mass index, physical activity, smoking, alcohol consumption, comorbidities, and medicines use. Logistic regression model was used to evaluate the association between SUA and insulin resistance by HOMA-IR. Stratified analyses by sex were performed. The mean age (standard deviation) was 51.4 (8.9) years, 55.2% of participants were women. There were 1,439 newly diagnosed diabetes. After all adjustments, higher SUA was associated with IFG, IGT, and diabetes, with odds ratio (OR) = 1.15 (95%CI: 1.06; 1.25), 1.23 (95%CI: 1.14; 1.33), and 1.37 (95%CI: 1.24; 1.51), respectively. There was association between SUA levels and insulin resistance with OR = 1.24 (95%CI: 1.13; 1.36). In analysis stratified by sex, higher SUA persisted independently associated with impaired glycemic status. Our results suggest that a higher SUA levels were significantly associated with glycemic status in a large Latin American population, mainly among women.Há uma controvérsia na literatura a respeito da associação entre níveis de ácido úrico sérico (AUS) e glicemia. Portanto, avaliamos a associação entre AUS e glicemia (glicemia em jejum alterada, intolerância glicêmica e diabetes mellitus), além da resistência insulínica, em uma amostra grande no Brasil. O estudo transversal observacional incluiu 13.207 participantes com idade entre 35 e 74 anos na linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Foi realizada análise de regressão multivariada para testar a associação entre AUS e glicemia (glicemia em jejum alterada, intolerância glicêmica e diagnóstico novo de diabetes tipo 2 na linha de base da coorte) depois de ajustar para idade, sexo, cor, índice de massa corporal, atividade física, tabagismo, consumo de álcool, comorbidades e uso de medicação. O modelo de regressão logística foi usado para avaliar a associação entre AUS e resistência insulínica por HOMA-IR. Foram realizadas análises estratificadas por sexo. A média de idade (DP) foi 51,4 (8,9) anos, e 55,2% dos participantes eram mulheres. Houve 1.439 novos diagnósticos de diabetes. Depois de todos os ajustes, o AUS esteve associado à glicemia em jejum alterada, intolerância glicêmica e diabetes, com odds ratio (OR) = 1,15 (IC95%: 1,06; 1,25), 1,23 (IC95%: 1,14; 1,33) e 1,37 (IC95%: 1,24; 1,51), respectivamente. Houve uma associação entre níveis de AUS e resistência insulínica, com OR = 1,24 (IC95%: 1,13; 1,36). Na análise estratificada por sexo, persistiu a associação independente entre AUS elevado e glicemia. Os resultados sugerem que níveis elevados de AUS estão associados de maneira significativa com a glicemia em uma população latino-americana grande, sobretudo entre mulheres.Hay un conflicto en la literatura respecto a la asociación entre los niveles de ácido úrico sérico (AUS) y el estado glucémico. Por eso, evaluamos la asociación entre el nivel AUS y el estatus glucémico: glucosa alterada en ayunas (GAA), tolerancia a la glucosa alterada (TGA) y diabetes mellitus (diabetes), comparados con la resistencia a la insulina en un amplio estudio en Brasil. Se realizó un estudio transversal, observacional con 13.207 participantes, con edades comprendidas entre los 35-74 años, en la base de referencia del Estudio Longitudinal de Salud entre Adultos brasileños (2008-2010) (ELSA-Brasil). Se realizó un análisis de regresión multinomial para probar la asociación entre AUS y el estado glucémico (GAA, TGA y de nuevo la diabetes tipo 2, diagnosticada en la cohorte como base de referencia) tras los ajustes por edad, sexo, color de piel, índice de masa corporal, actividad física, fumar, consumo de alcohol, comorbilidades, uso de medicinas. Se usó el modelo de regresión logística para evaluar la asociación entre AUS y la resistencia a la insulina por el HOMA-IR. Se realizó también un análisis estratificado por sexo. La media de edad (desviación estándar) fue 51,4 (8,9) años, un 55,2% de los participantes eran mujeres. Hubo 1.439 nuevos casos de diabetes diagnosticados. Tras todos los ajustes, una AUS más alta estuvo asociada con GAA, TGA y diabetes, con odds ratio (OR) = 1,15 (IC95%: 1,06; 1,25), 1,23 (IC95%: 1,14; 1,33), y 1,37 (IC95%: 1,24; 1,51), respectivamente. Hubo asociación entre los niveles AUS y la resistencia a la insulina con OR = 1,24 (IC95%: 1,13; 1,36). En el análisis estratificado por sexo, una AUS más alta persistía independientemente asociada con un estado glucémico alterado. Nuestros resultados sugieren que unos niveles más altos de AUS estuvieron significativamente asociados con el estado glucémico en una amplia población latinoamericana, principalmente entre mujeres

Association between diabetes and cognitive function at baseline in the Brazilian Longitudinal Study of Adult Health (ELSA- Brasil)

Diabetes has been associated with cognitive changes and an increased risk of vascular dementia and Alzheimer’s disease, but it is unclear whether there are associations between diabetes and early alterations in cognitive performance. The present study consisted of a cross-section analysis of 14,444 participants aged 35–74 years and from a developing country at baseline in the Brazilian Longitudinal Study of Adult Health (ELSA–Brasil); these participants were recruited between 2008 and 2010. We investigated whether there was an association between diabetes and early changes in the cognitive performance of this Brazilian population. To assess cognitive domains, we used the word-list learning, word-list delayed recall and word recognition tests along. Phonemic verbal fuency tests included semantic phonemic test (animals) and a phonemic test (words beginning with the letter F). Executive functions associated with attention, concentration and psychomotor speed were evaluated using the Trail Making Test B. The exposure variable in the study was defned as diabetes. Multiple linear regression was used to estimate the association between diabetes and cognitive performance. The results were adjusted for age, sex, education, hypertension, coronary disease, depression, physical activity, smoking, alcohol consumption, and the cholesterol/HDL-C ratio. We found a signifcant association between diabetes and decreased memory, language and executive function (attention, concentration and psychomotor speed) performance in this population from a country with a distinct epidemiological profle, even after adjusting for the main intervening variables

Modelo homeostático para evaluar la resistencia a la insulina (HOMA-IR) y síndrome metabólico en la línea de base de una cohorte brasileña multicéntrica : estudio ELSA-Brasil

Homeostasis model assessment of insulin resistance (HOMA-IR) is a method to measure insulin resistance. HOMA-IR cut-offs for identifying metabolic syndrome might vary across populations and body mass index (BMI) levels. We aimed to investigate HOMA-insulin resistance cut-offs that best discriminate individuals with insulin resistance and with metabolic syndrome for each BMI category in a large sample of adults without diabetes in the baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Among the 12,313 participants with mean age of 51.2 (SD 8.9) years, the prevalence of metabolic syndrome was 34.6%, and 60.1% had overweight or obesity. The prevalence of metabolic syndrome among normal weight, overweight and obesity categories were, respectively, 13%, 43.2% and 60.7%. The point of maximum combined sensitivity and specificity of HOMA-IR to discriminate the metabolic syndrome was 2.35 in the whole sample, with increasing values at higher BMI categories. This investigation contributes to better understanding HOMA-IR values associated with insulin resistance and metabolic syndrome in a large Brazilian adult sample, and that use of cut-off points according to ROC curve may be the better strategy. It also suggests that different values might be appropriate across BMI categories

The STRATOB study: design of a randomized controlled clinical trial of Cognitive Behavioral Therapy and Brief Strategic Therapy with telecare in patients with obesity and binge-eating disorder referred to residential nutritional rehabilitation

bstract BACKGROUND: Overweight and obesity are linked with binge eating disorder (BED). Effective interventions to significantly reduce weight, maintain weight loss and manage associated pathologies like BED are typically combined treatment options (dietetic, nutritional, physical, behavioral, cognitive-behavioral, pharmacological, surgical). Significant difficulties with regard to availability, costs, treatment adherence and long-term efficacy are present. Particularly Cognitive Behavioral Therapy (CBT) is the therapeutic approach indicated both in in-patient and in out-patient settings for BED. In recent years systemic and systemic-strategic psychotherapies have been implemented to treat patients with obesity and BED involved in familiar problems. Particularly a brief protocol for the systemic-strategic treatment of BED, using overall the strategic dialogue, has been recently developed. Moreover telemedicine, a new promising low cost method, has been used for obesity with BED in out-patient settings in order to avoid relapse after the in-patient step of treatment and to keep on a continuity of care with the involvement of the same clinical in-patient team. METHODS: The comparison between CBT and Brief Strategic Therapy (BST) will be assessed in a two-arm randomized controlled clinical trial. Due to the novelty of the application of BST in BED treatment (no other RCTs including BST have been carried out), a pilot study will be carried out before conducting a large scale randomized controlled clinical trial (RCT). Both CBT and BST group will follow an in-hospital treatment (diet, physical activity, dietitian counseling, 8 psychological sessions) plus 8 out-patient telephone-based sessions of psychological support and monitoring with the same in-patient psychotherapists. Primary outcome measure of the randomized trial will be the change in the Global Index of the Outcome Questionnaire (OQ-45.2). Secondary outcome measures will be the percentage of BED patients remitted considering the number of weekly binge episodes and the weight loss. Data will be collected at baseline, at discharge from the hospital (c.a. 1 month after) and after 6-12-24 months from the end of the in-hospital treatment. Data at follow-up time points will be collected through tele-sessions. DISCUSSION: The STRATOB (Systemic and STRATegic psychotherapy for OBesity), a comprehensive two-phase stepped down program enhanced by telepsychology for the medium-term treatment of obese people with BED seeking intervention for weight loss, will shed light about the comparison of the effectiveness of the BST with the gold standard CBT and about the continuity of care at home using a low-level of telecare (mobile phones). TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT0109625

Eficiência dos contraventamentos horizontais em edifícios industriais de aço dotados de pontes rolantes.

Programa de Pós Graduação em Engenharia Civil. Departamento de Engenharia Civil, Escola de Minas, Universidade Federal de Ouro Preto.Os contraventamentos horizontais, nos planos dos banzos inferior ou superior das treliças ou no plano da cobertura em edifícios industriais são dimensionados de acordo com critérios práticos, considerando-se parcelas das ações verticais, do vento e do impacto lateral das pontes rolantes, admitindo-se que possam distribuir tais ações entre os pórticos adjacentes e produzir a estabilidade da estrutura como um todo, em seus respectivos planos. Neste trabalho, verifica-se a eficiência dos contraventamentos horizontais, analisando uma contribuição quanto à redução dos deslocamentos laterais dos pilares de edifícios industriais de aço dotados de pontes rolantes. A metodologia proposta corresponde à análise estrutural, utilizando-se o software Cypecad Metálicas 3D, de edifícios com vãos de 20m, 25m, 30m e altura de 6m, 8m e 10m; em combinação com espaçamentos entre pilares variáveis de 6m, 8m, 10m e 12m dotados de pontes rolantes com capacidade de 100kN, 160kN, 250kN e 500kN comparando-se os resultados dos deslocamentos com os valores limites recomendados pela norma brasileira.The horizontal bracings, in the plans of the inferior or superior line of the trusses or in the plan of the covering in industrial buildings are measured in agreement with practical criterions, being considered portions of the vertical actions, of the wind and of the lateral impact of the cranes, being admitted that we can distribute such actions among the adjacent porches and to produce the stability of the structure as a whole, in your respective plans. In this work, the efficiency of the horizontal bracing is verified, analyzing a contribution with relationship to the reduction of the lateral displacements of the pillars of industrial buildings of steel endowed with cranes. The adopted methodology corresponds to the structural analysis using the software Metallic Cypecad 3D of buildings with empty spaces of 20m, 25m and 30m in combination with spacings among variable pillars of 6m, 8m, 10m and 12m, endowed with cranes with different capacities of 100kN, 160kN, 250kN and 500kN, being compared the results with limits values of Brazilian

Avaliação dos níveis plasmáticos de peptídeo natriurético tipo B e relação com obesidade mórbida e comorbidades associadas

Exportado OPUSMade available in DSpace on 2019-08-13T04:19:23Z (GMT). No. of bitstreams: 1 alline_maria_rezende_beleigoli.pdf: 1082462 bytes, checksum: 53dd48217a2a827e98540497532f7609 (MD5) Previous issue date: 8A obesidade mórbida (OM) apresenta níveis de crescimento mais importantes que qualquer outra forma da doença e está fortemente associada a comorbidades cardiovasculares. A insuficiência cardíaca (IC) é causa de elevadas morbidade e mortalidade e seu diagnóstico constitui verdadeiro desafio nessa população, devido à inespecificidade do quadro clínico e às limitações dos métodos diagnósticos existentes. Nesse contexto, o peptídeo natriurético tipo B (BNP) é potencialmente útil no diagnóstico de IC na OM. De acordo com as regras do Programa de Pós-Graduação em Saúde do Adulto, o presente estudo resultou em dois artigos. O primeiro é revisão publicada no periódico Obesity Reviews, em novembro de 2009. O segundo artigo descreve os resultados de estudo transversal, realizado de julho de 2008 a julho de 2009, com recrutamento consecutivo dos participantes no Grupo Multidisciplinar para Tratamento Cirúrgico da OM, no Hospital das Clínicas da UFMG e no ambulatório de obesidade do Centro de Especialidades Médicas da Santa Casa de Belo Horizonte. Revisão da literatura de língua inglesa mostrou que, além de ações hemodinâmicas, os peptídeos natriuréticos (PN) apresentam efeito lipolítico. Entre os 75 estudos selecionados, os que descreveram o comportamento dos PN em obesos, revelam, em sua maioria, níveis plasmáticos reduzidos em relação a indivíduos magros. Esse achado, aparentemente paradoxal, aponta para o papel dos PN na fisiopatologia da obesidade e de comorbidades, como hipertensão arterial e síndrome metabólica. Verificou-se grande heterogeneidade entre os estudos revisados, com diferenças importantes em relação à metodologia, seleção de pacientes e avaliação de obesidade e IC. Tais achados impossibilitam conclusões definitivas sobre o tema e indicam a necessidade de mais estudos na área. No estudo transversal, oitenta e nove obesos classe III foram submetidos à avaliação clínica, laboratorial, eletro e ecocardiográfica e dosagem de BNP, conforme protocolos padronizados, com os objetivos de descrever o comportamento do BNP e investigar sua utilidade na predição de disfunção ventricular. O BNP apresentou desde níveis inferiores ao limite de detecção do método (< 5,0 pg/mL) até 151,0 pg/mL. O BNP mostrou distribuição não-normal, com média de 19,5 ± 27,4 pg / mL e mediana de 9,5 pg / mL. Trinta porcento dos participantes apresentaram BNP abaixo do limite de detecção do método e seis por cento, níveis considerados diagnósticos de IC sistólica (= 100 pg/mL). Apenas quatro porcento tiveram diagnóstico de IC sistólica por avaliação clínica e ecocardiográfica. Análise de regressão logística ordinal, mostrou que, entre todas as variáveis clinica e/ou estatisticamente relevantes para entrada no modelo, apenas o volume do átrio esquerdo, marcador de disfunção diastólica, foi determinante dos valores de BNP (p=0,002). A partir dos resultados da revisão, conclui-se que os PN são agentes lipolíticos e seus níveis são diminuídos em obesos em relação a magros, refletindo a provável participação deles na fisiopatologia da obesidade. O estudo transversal mostra que obesos classe III apresentam níveis baixos de BNP, porém o peptídeo é útil na identificação de disfunção diastólica. Não foi possível estabelecer conclusões a respeito do comportamento do BNP em obesos mórbidos com disfunção sistólica.Following obesity epidemics, severe obesity has been increasing more importantly than any other form of obesity. Hence, morbid conditions associated to severe obesity, such as heart failure (HF), have had an impressive increase, as well. Diagnosing HF may be challenging, due to unspecific symptoms and signs, and limitations of diagnostic methods. In this context, brain natriuretic peptide (BNP) is a potential tool for identifying HF in the morbid obese population. Following the rules of the Adult Health Sciences Post-Graduation Program of the Medicine School of the Federal University of Minas Gerais, this study was composed by two phases. Each one resulted in a scientific article. The first one is a systematic review, published in Obesity Reviews, in November 2009. The second one is an original article, which displays the results of a cross- sectional study. The systematic review included seventy-five and revealed that natriuretic peptides (NP) have metabolic effects as potent lipolytic agents, in addition to cardiovascular actions. Most of the reviewed articles showed lower NP levels among obese subjects in relation to lean ones. This apparently paradoxical finding points to the potential role of NP in the physiopathological mechanisms of obesity, and obesity associated hypertension and metabolic syndrome. A critical analysis of the selected studies was performed as well. It revealed important heterogeinity among the studies in relation to methodology, participant´s selection criteria and criteria for diagnosing obesity and HF. Hence, definitive conclusions on NP behavior in obesity are not possible and we noticed the necessity for more studies on the subject. The cross-sectional study recruited participants from two obesity clinics in Hospital das Clínicas da UFMG and Centro de Especialidades Médicas da Santa Casa in Belo Horizonte, from July 2008 to July 2009. Its aim was to describe BNP behavior and investigate its utility in predicting ventricular dysfunction in class III obese patients. Clinical, laboratorial, electro and echocardiographic evaluation and BNP measures were performed in eighty-nine participants. BNP values varied from indetectable by the test (< 5.0 pg/mL) to 151.0 pg/mL. Thirty percent of the patients had values below 5.0 pg/mL and only six percent had values on the habitual range considered to diagnose heart failure (= 100 pg/mL). Multivariate ordinal logistic regression analysis verified that left atrial volume (LAV) was the only determinant of BNP levels among all the clinical, laboratorial and echocardiographic data considered relevant to enter the model (p=0.002). LAV is a marker of sustained left ventricular filling pressures and chronic diastolic dysfunction. Based on the systematic review results, it is possible to conclude that NP have important metabolic action as potent lipolytic agents. BNP levels are reduced in the obese subjects in relation to the lean ones. It probably has a role in obesity physiopathology. The second article showed low BNP levels, but the peptide was still able to identify diastolic dysfunction in severe obesity. It was not possible to determine the role of BNP in predicting systolic disfunction in class III obese patients

Relações entre medidas antropométricas, peptídeo natriurético tipo B e mortalidade em dez anos de idosos do estudo de Bambuí sobre saúde e envelhecimento

Exportado OPUSMade available in DSpace on 2019-08-12T10:29:31Z (GMT). No. of bitstreams: 1 tese_alline_maria_rezende_beleigoli.pdf: 1827884 bytes, checksum: 3ef5f1b154aa0a007bcacfc93e59a2fc (MD5) Previous issue date: 17Os fenômenos de transição demográfica, nutricional e tecnológica, que ocorreram no Brasil de forma marcante nos últimos 20 anos, levaram a aumento importante do número de indivíduos com excesso de peso entre os idosos. O impacto da obesidade sobre a morbimortalidade de idosos é questão de interesse tanto na prática clínica quanto noplanejamento em saúde pública. Adicionalmente, esta é a faixa da população em que há maior prevalência de doenças cardiovasculares. Biomarcadores, como o peptídeo natriurético tipo B (BNP), veem sendo estudados amplamente estudados em populações de idosos com o intuito de diagnosticar, estratificar o risco e avaliar resposta a tratamento em pacientes com doenças cardiovasculares. BNP é um peptídeo secretado pelos cardiomiócitos em resposta à sobrecarga hemodinâmica de pressão e/ou volume. Embora a obesidade esteja associada a condições que geram esse tipo de sobrecarga, estudos prévios mostraram níveis reduzidos de BNP em obesos em comparação a indivíduos magros. Esses achados paradoxais associados aevidências recentes de efeito lipolítico dos peptídeos natriuréticos chamam atenção para o papel dos peptídeos na fisiopatologia da obesidade e levantam questões quanto à aplicabilidade do BNP como biomarcador em obesos. A presente tese teve dois objetivosprincipais: investigar o impacto de sobrepeso/obesidade, medidos através do índice de massa corporal (IMC) e da circunferência abdominal (CA), sobre a mortalidade em longo prazo em idosos brasileiros; e estudar as relações entre BNP e medidas antropométricas nesses idosos. A população do estudo foi constituída pelos adultos com idade igual ou superior a 60 anos do Estudo de Bambuí sobre Saúde e Envelhecimento. Trata-se de estudo de coorte prospectiva que está em andamento na cidade de Bambuí, Minas Gerais, Brasil, desde janeiro de 1997. A cidade de Bambuí era região endêmica de Doença de Chagas e, apesar da interrupção da transmissão vetorial na região desde a década de 1970, há elevada prevalência em idosos devido à infecção desses indivíduos quando eram jovens. O estudo de Bambuí tem como principal objetivo investigar efeitos isolados e conjuntos da infecção por Trypanosoma cruzi e de doenças não comunicantes sobre a saúde de adultos com idade igual ou superior a 60 anos. Peso, altura, IMC, CA e espessura da prega tricipital foram medidas antropométricas aferidas à linha de base e no terceiro e quinto anos de seguimento do estudo e que foram usadas na presente análise. O evento morte foi confirmado, em quase sua totalidade (98,9%), por certificados de óbito e para esta análise foram usados dados até 31 de dezembro de 2007. BNP plasmático foi dosado em amostras de sangue coletadas à linha de base e, posteriormente, estocadas sob refrigeração. Os resultados foram organizados no formato de dois artigos científicos, de acordo com as normas do Programa de Pós Graduação em Ciências Saúde do Adulto da Faculdade de Medicina da UFMG. No primeiro artigo, observou-se que valores de IMC, nas faixas de sobrepeso e obesidade classe I, segundo a classificação da Organização Mundial de Saúde, foram associados a menores taxas de morte em dez anos em idosos da coorte de Bambuí. Além disso, a CA isoladamente não apresentou efeito significativo sobre a mortalidade em dez anos. Apenas quando analisada em conjunto com o IMC, o aumento dos valores de CA foi associado a aumento discreto do risco de morte. Os achados apresentados no segundo artigo revelaram que níveis de BNP foram inversamente relacionados a IMC, CA e prega tricipital à linha de base, independentemente da infecção por Trypanossoma cruzi. Tais resultados sugerem que os valores de IMC e CA utilizados como pontos de corte para indicar intervenções para controle e perda de peso na população adulta em geral não refletem adequadamente o risco de morte entre idosos brasileiros. Em relação ao uso do BNP em idosos, concluiu-se que é possível que os níveis plasmáticos do peptídeo não reflitam adequadamente a sobrecarga hemodinâmica e o risco de morte em idosos obesos. Tal questão é clinicamente relevante e deve ser mais detalhadamente investigada em estudos futuros.The demographic, nutritional and technological transition phenomena that have been taking place in Brazil in the last two decades led to a dramatic increase in the number of older adults with excessive weight. The impact of obesity on the health conditions of the elderly is animportant issue both in clinical practice and in public health. Additionally, the elderly are the age group with the highest prevalence of cardiovascular diseases. Biomarkers, such as the Btype natriuretic peptide, have been studied with the aim to diagnose cardiovascular diseases, stratify the risk of subjects with these diseases and evaluate the response to treatment. The Btype natriuretic peptide (BNP), which is secreted by the cardiomyocites under hemodynamic (pressure or volume) overload, is among these biomarkers. Although obesity is associated with hemodynamic overload, low BNP levels have been described in obese subjects. Combined with evidence of lipolytic and metabolic action of the natriuretic peptides, the role of these peptides on the biological mechanisms of obesity and the usefulness of BNP as abiomarker in obese individuals are put into question. The aims of this thesis were to investigate the impact of overweight and obesity on mortality and also the relationship between BNP and anthropometric measures in Brazilian elderly. These issues were investigated in the Bambuí (Brazil) Cohort Study of Ageing, which is a ongoing cohort study in Bambuí, Minas Gerais, Brazil, since 1997. The region was endemicfor Chagas disease, despite the interruption of the vectorial transmission by 1970, there is a high prevalence of elderly who were infected at young ages. The Bambuí Study was designed to study the isolated and combinated consequences of Trypanossoma cruzi infection ndnoncommunicable diseases on the health of adults aged 60 or older. Weight, height, body mass índex (BMI), waist circumference and triceps skinfold thickness were some of the anthropometric measures assessed at baseline and repeated in the third and fifth years offollow-up. The outcome studied in this thesis was death until the 31st December 2007, which was ascertained by death certificates in the majority (98.9%) of the cases. Plasmatic BNP was measured in blood samples colected at baseline and stored under -80ºC. We found that overweight and class I obesity, as measured by BMI and defined according to WHO criteria, were associated with the lowest rates of death in the follow-up of 10 years of the elderly of the BHAS. This suggests that the cut-off points used to indicate weight control and loss interventions in adults do not grade appropriately the risk of death in Brazilian elderly individuals. Additionally, we found that BNP levels were inversely associated with the anthropometric measures at baseline regardless of Trypanossoma cruzi infection status. This finding is probably related to BNP metabolic actions and suggests that neither BNP might reflect the hemodynamic burden nor predict adequately the risk of death in elderly obese individuals. This is an issue of great clinical importance, which needs to be clarified by further prospective studies

Overweight and Class I Obesity Are Associated with Lower 10-Year Risk of Mortality in Brazilian Older Adults: The Bambui Cohort Study of Ageing

Background: Prospective studies mostly with European and North-American populations have shown inconsistent results regarding the association of overweight/obesity and mortality in older adults. Our aim was to investigate the relationship between overweight/obesity and mortality in an elderly Brazilian population. Methods and Findings: Participants were 1,450 (90.2% from total) individuals aged 60 years and over from the community-based Bambui (Brazil) Cohort Study of Ageing. From 1997 to 2007, 521 participants died and 89 were lost, leading to 12,905 person-years of observation. Body mass index (BMI) and waist circumference (WC) were assessed at baseline and at the 3rd and 5th years of follow-up. Multiple imputation was performed to deal with missing values. Hazard ratios (HR) of mortality for BMI or WC Conclusions: The usual BMI and WC cut-off points should not be used to guide public health and clinical weight control interventions in elderly in Brazil