Insulin resistance and associated factors: a cross-sectional study of bank employees

OBJECTIVE: Insulin resistance is characterized by the failure of target cells to respond to normal levels of circulating insulin, and this condition is related to cardiovascular disease. This study sought to evaluate the prevalence of insulin resistance and its association with markers of metabolic abnormalities and metabolic syndrome in bank employees. METHODS: A cross-sectional study was performed on 498 working men and women aged ≥20 years old. The Homeostasis Model Assessment (HOMA-IR) was used to determine the presence of insulin resistance based on cut-off values of ≤2.71 for normal insulin levels and >;2.71 for insulin resistance, as established for the adult Brazilian population. RESULTS: It was observed that the 52 (10.4%) overweight individuals with insulin resistance were 4.97 times (95%CI 1.31-18.83) more likely to have high HOMA-IR values than the normal-weight participants; among those who were obese, the likelihood increased to 17.87 (95%CI 4.36-73.21). Individuals with large waist circumferences were 3.27 times (95%CI 1.03-10.38) more likely to develop insulin resistance than those who were within normal parameters. The HOMA-IR values differed between subjects with and without metabolic syndrome, with values of 2.83±2.5 and 1.10±0.81 (p=0.001), respectively. The levels of insulin, ultrasensitive C-reactive protein and uric acid were also associated with insulin resistance. CONCLUSION: The prevalence of insulin resistance among bank employees is high, and insulin resistance is associated with and serves as a marker of metabolic syndrome. Cardiovascular disease and metabolic syndrome-associated metabolic abnormalities were observed, and insulin resistance may be a risk factor in this group of professionals

Adherence to physical activity in adults with chronic diseases: ELSA-Brasil

OBJECTIVE: The objective of this study is to investigate the adherence and the factors that influence adherence to physical activity in adults with dyslipidemia, hypertension, or diabetes. METHODS: The analyses were based on data collected at the baseline of the 14,521 participants from the study ELSA-Brasil aged between 35 and 74 years. The level of leisure time physical activity was determined using the International Physical Activity Questionnaire. Logistic regression analyses were performed to examine the influence of the demographic data, socioeconomic conditions, perceived health status, and access to exercise facilities in the neighborhood on adherence to physical activity. RESULTS: Men with hypertension and dyslipidemia were more active than women. The results show that 17.8%, 15.1%, and 13.9% of the subjects who reported dyslipidemia, hypertension, and diabetes, respectively, adhere to the physical activity recommendations. The factors positively associated with adherence were higher education and income. Older individuals who reported poor perceived health, were overweight and obese, regularly smoked, and had fewer opportunities to exercise in the neighborhood presented lower adherence. CONCLUSIONS: The number of adults with dyslipidemia, hypertension, and diabetes who adhere to the physical activity recommendations is very low. Higher education and income are positively associated with adherence, while age, excess body weight, negative perceived health, regular smoking, and lack of opportunity to exercise in the neighborhood were considered barriers to physical activity

Perspectiva de ciclo vital y de género en el estudio de la relación entre alimentación y salud cardiovascular. Lactancia materna vs artificial.

II Congreso de Alimentación, Nutrición y Dietética. Avances en Nutrición y Dietética Clínica: Prevención, Tratamiento y Gestión - Rol del Dietista-Nutricionist

Saúde coletiva : coletâneas

Rita de Cássia Duarte Lima, Elizabete Regina Araújo de Oliveira, Maria del Carmen Bisi Molina (organizadoras)

Hypertension and salt intake in an urban population

OBJECTIVE: To evaluate the salt intake and urinary Na+/K+ ratio in a randomized sample from an ethnically mixed urban population. METHODS: A randomized residential sample of 2,268 individuals aged 25-64 in Vitória, ES, was selected, of whom 1,663 (73.3%) reported to the hospital for standardized tests. Salt, Na+ and K+ intake was estimated from 12-hour urine excretion (7 p.m. to 7 a.m.) and from the monthly salt consumption at home reported in the interview. Clinic arterial pressure was measured twice under standard conditions by two trained investigators, using mercury sphygmomanometry. The Student t and Tukey tests were utilized for statistical analysis. RESULTS: Urinary Na+ excretion was higher in men and individuals of lower socioeconomic level (POBJETIVO: Avaliar o consumo de sal e a relação sódio/potássio urinário em amostra randomizada de população urbana etnicamente miscigenada. MÉTODOS: Foi selecionada uma amostra randômica de 2.268 residentes de Vitória, ES, entre 25 e 64 anos de idade. Os indivíduos foram escolhidos por amostragem domiciliar realizada em 1999/2000, dos quais 1.663 (73,3%) compareceram ao hospital para a realização de exames padronizados. O consumo estimado de sal, Na+ e K+ foi determinado por meio da coleta de urina de 12h no período noturno (19h às 7h) e do gasto mensal de sal domiciliar referido durante a entrevista. A pressão arterial clínica foi medida duas vezes por diferentes pesquisadores treinados em condições padronizadas, usando esfignomamômetro de mercúrio. Para análise estatística foram utilizados o teste de Student e o teste de Tukey. RESULTADOS: A excreção urinária de Na+ foi mais alta em homens e em indivíduos de menores condições socioeconômicas (

Sensibilidade e especificidade no diagnóstico de hipertensão por diferentes métodos

OBJECTIVE: To evaluate sensitivity and specificity of different protocols for blood pressure measurement for the diagnosis of hypertension in adults. METHODS: Cross-sectional study conducted in a non-probabilistic sample of 250 public servants of both sexes aged 35 to 74 years in Vitória, southeastern Brazil, between 2008 and 2010. The participants had their blood pressure measured using three different methods: clinic measurement, self-measured and 24-hour ambulatory measurement. They were all interviewed to obtain sociodemographic information and had their anthropometric data (weight, height, waist circumference) collected. Clinic measurement and self-measured were analyzed against the gold standard ambulatory measurement. Measures of diagnostic performance (sensitivity, specificity, accuracy and positive and negative predictive values) were calculated. The Bland & Altman method was used to evaluate agreement between ambulatory measurement (standard deviation for daytime measurements) and self-measured (standard deviation of four measurements). A 5% significance level was used for all analyses. RESULTS: Self-measured blood pressure showed higher sensitivity (S=84%, 95%CI 75;93) and overall accuracy (0.817, pOBJETIVO: Evaluar la sensibilidad y la especificidad de diferentes protocolos de medida de la presión arterial para el diagnóstico de la hipertensión en adultos. MÉTODOS: Estudio transversal con muestra no probabilística de 250 funcionarios de ambos sexos de institución pública en el grupo etáreo de 35 a 74 años en Vitoria, Sureste de Brasil, entre 2008 y 2010. Los participantes tuvieron sus presiones arteriales medidas por tres métodos: medida clínica, automedida y medida por ambulatorio por 24 horas. Se colectaron datos antropométricos (peso, estatura y circunferencias) y se realizó entrevista. Los métodos fueron confrontados y analizados con relación a la medida por ambulatorio 24h (patrón-oro). Se calcularon las medidas de desempeño diagnóstico: sensibilidad, especificidad, valores predictivos positivos y negativos y precisión. La metodología de Bland & Altman fue utilizada para verificar la concordancia entre la variable presórica en la automedida (desviación estándar de las cuatro medidas). Se adoptó nivel de 5% de significancia para todas las pruebas. RESULTADOS: La automedida presentó mayor sensibilidad (S=84%; IC95%: 75;93) y precisión global (0,817; pOBJETIVO: Avaliar a sensibilidade e a especificidade de diferentes protocolos de medida da pressão arterial para o diagnóstico da hipertensão em adultos. MÉTODOS: Estudo transversal com amostra não probabilística de 250 funcionários de ambos os sexos de instituição pública na faixa etária de 35 a 74 anos em Vitória, ES, entre 2008 e 2010. Os participantes tiveram suas pressões arteriais aferidas por três métodos: medida clínica, automedida e medida ambulatorial por 24 horas. Foram coletados dados antropométricos (peso, estatura e circunferências) e realizada entrevista. Os métodos foram confrontados e analisados em relação à medida ambulatorial 24 h (padrão-ouro). Foram calculadas as medidas de desempenho diagnóstico: sensibilidade, especificidade, valores preditivos positivos e negativos e acurácia. A metodologia de Bland & Altman foi utilizada para verificar a concordância entre a variabilidade pressórica na medida ambulatorial (desvio-padrão relativo ao período diurno) e a variabilidade pressórica na automedida (desvio-padrão das quatro medidas). Adotou-se nível de significância de 5% para todos os testes. RESULTADOS: A automedida apresentou maior sensibilidade (S = 84%; IC95%: 75;93) e acurácia global (0,817; p < 0,001) no diagnóstico da hipertensão que a medida clínica (S = 79%; IC95%: 73;86 e AG = 0,815; p < 0,001). Apesar da forte correlação com o método de medida ambulatorial durante a vigília (r = 0,843; p = 0,000), a automedida não mostrou boa concordância com o referido método para a medida sistólica (viés = 5,82; IC95%: 4,49;7,15). Foram identificados sete (2,8%) indivíduos com hipertensão do avental branco, 26 (10,4%) com hipertensão mascarada e 46 (18,4%) com efeito do avental branco. CONCLUSÕES: Os resultados sugerem que a automedida apresenta sensibilidade superior à medida clínica para identificar verdadeiros hipertensos na população. Os valores de predição negativa encontrados confirmam a superioridade da automedida em relação à medida clínica no que tange à capacidade do teste em apontar os indivíduos verdadeiramente normotensos. Contudo, não pode substituir a medida clínica, que ainda é o método mais fidedigno

Determinants of high blood pressure in children: a case-control study in a rural area of the Espírito Santo State / Determinantes da pressão arterial elevada em crianças: um estudo caso-controle em área rural do Espírito Santo

Objetivo: Identificar e analisar os fatores preditores da ocorrência da pressão arterial elevada em crianças de 7 a 10 anos de um município rural no Espírito Santo. Métodos: Foram constituídos dois grupos de estudo: os casos (PAS ou PAD ≥ P95) e os controles (PA &lt;P90). Houve pareamento por sexo e idade. A amostra foi composta por sorteio sistemático e foram avaliadas 395 crianças, 79 casos e 316 controles. Resultados: A prevalência de excesso de peso nos casos foi de 8,9% e nos controles de 11,1%, o sedentarismo esteve presente em 88,1% dos casos e em 87,9% dos controles e a média do tempo de tela foi de 97,7 minutos e 106,6 minutos por dia nos casos e controles respectivamente. Conclusão: Observou-se a necessidade da criação de políticas públicas que visam promoção da saúde para que os grupos vulneráveis recebam assistência desde a infância. Descritores: Criança, Pressão alta, Hipertensão

Reproducibility of arterial pressure measured in the ELSA-Brasil with 24-hour pressure monitoring

OBJETIVO: Determinar a reprodutibilidade da pressão arterial casual de participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) e confirmar o diagnóstico pressórico pela monitorização. MÉTODOS: A pressão arterial casual foi medida em aparelho oscilométrico. Uma subamostra dos participantes do estado do Espírito Santo (N = 255) foi reavaliada com igual metodologia de uma a dez semanas após; além disso, foi realizada monitorização. O diagnóstico de hipertensão seguiu os pontos de corte de 140/90 mmHg ou 130/80 mmHg para a pressão casual e na monitorização, respectivamente. A hipertensão do jaleco branco foi definida pela presença hipertensão na medida casual e normotensão na monitorização e o inverso para a hipertensão mascarada. RESULTADOS: Os dados referem-se a 230 participantes que nas duas ocasiões estavam sem medicação (N1 = 153) ou sob a mesma medicação anti-hipertensiva (N2 = 77). No N1, a normotensão casual foi confirmada em 120 dos 134 pela monitorização. No N2, a monitorização confirmou o controle pressórico em 43 dos 54 participantes com pressão controlada pela medida casual. A concordância geral de diagnósticos entre a pressão casual e monitorada foi de 78% (kappa = 0,44). No grupo N1, seis indivíduos (4%) apresentaram hipertensão do jaleco branco e 23 (25%), mascarada. CONCLUSÕES: A concordância de diagnósticos entre a pressão arterial casual e a monitorada foi moderada. A padronização rigorosa da medida casual adotada no ELSA-Brasil foi capaz de reduzir a hipertensão do jaleco branco. A alta frequência de hipertensão mascarada sugere que a medida pressórica da monitorização indique grau elevado de estresse no trabalho.OBJECTIVE: To determine the reproducibility of casual arterial pressure measurement and to confirm pressure diagnosis by monitoring of participants in the ELSA-Brasil (Estudo Longitudinal de Saúde do Adulto - Brazilian Longitudinal Study for Adult Health). METHODS: Casual blood pressure was measured with an oscilometric device. A sub-sample of participants (N = 255) from Espírito Santo state (Southeastern Brazil) was reevaluated using the same methodology following one to ten weeks and, in addition, underwent arterial blood pressure monitoring. Diagnosis of hypertension used cut off points of 140/90 mmHg for casual pressure and 130/80 mmHg for arterial blood pressure monitoring. White coat hypertension was defined as the presence of hypertension in casual blood pressure and normal arterial blood pressure monitoring, and converse findings characterized masked hypertension. RESULTS: Data are from 230 participants that on the two occasions were free from antihypertensive medication (N1 = 153) or under the same antihypertensive regimen (N2 = 77). Normotension was confirmed by arterial blood pressure monitoring in120 out of 134 participants of the N1 group. In N2, blood pressure control was confirmed by arterial blood pressure monitoring in 43 of 54 participants with controlled hypertension per casual blood pressure. Overall diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was 78% (kappa = 0.44). In the N1 group, six subjects (4%) presented white coat hypertension, and 23 subjects (25%) presented with masked hypertension. CONCLUSIONS: Diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was moderate. The rigorous standardization of casual blood pressure measurement adopted in the ELSA-Brasil study was able to reduce white coat hypertension. The high frequency of masked hypertension may suggest that pressure values obtained by arterial blood pressure monitoring indicate an elevated degree of stress at work

Brazilian dietary patterns and the dietary approaches to stop hypertension (DASH) diet-relationship with metabolic syndrome and newly diagnosed diabetes in the ELSA-Brasil study

Background: Studies evaluating dietary patterns, including the DASH diet, and their relationship with the metabolic syndrome and diabetes may help to understand the role of dairy products (low fat or full fat) in these conditions. Our aim is to identify dietary patterns in Brazilian adults and compare them with the (DASH) diet quality score in terms of their associations with metabolic syndrome and newly diagnosed diabetes in the Brazilian Longitudinal Study of Adult Health-the ELSA-Brasil study. Methods: The ELSA-Brasil is a multicenter cohort study comprising 15,105 civil servants, aged 35–74 years at baseline (2008–2010). Standardized interviews and exams were carried out, including an OGTT. We analyzed baseline data for 10,010 subjects. Dietary patterns were derived by principal component analysis. Multivariable logistic regression investigated associations of dietary patterns with metabolic syndrome and newly diagnosed diabetes and multivariable linear regression with components of metabolic syndrome. Results: After controlling for potential confounders, we observed that greater adherence to the Common Brazilian meal pattern (white rice, beans, beer, processed and fresh meats), was associated with higher frequencies of newly diagnosed diabetes, metabolic syndrome and all of its components, except HDL-C. Participants with greater intake of a Common Brazilian fast foods/full fat dairy/milk based desserts pattern presented less newly diagnosed diabetes. An inverse association was also seen between the DASH Diet pattern and the metabolic syndrome, blood pressure and waist circumference. Diet, light foods and beverages/low fat dairy pattern was associated with more prevalence of both outcomes, and higher fasting glucose, HDL-C, waist circumference (among men) and lower blood pressure. Vegetables/fruit dietary pattern did not protect against metabolic syndrome and newly diagnosed diabetes but was associated with lower waist circumference. Conclusions: The inverse associations found for the dietary pattern characterizing Brazilian fast foods and desserts, typically containing dairy products, with newly diagnosed diabetes, and for the DASH diet with metabolic syndrome, support previously demonstrated beneficial effects of dairy products in metabolism. The positive association with metabolic syndrome and newly diagnosed diabetes found for the pattern characterizing a typical Brazilian meal deserves further investigation, particularly since it is frequently accompanied by processed meat