Epidemiology of Abdominal Obesity

Abdominal obesity (AO) is associated with endothelial dysfunction, inflammation, insulin resistance, diabetes mellitus, hypercholesterolemia, metabolic syndrome, and cancer. AO is a multifactorial disorder arising from genetic, environmental, socioeconomic, and behavioral factors. Thus, in this chapter, we devote ourselves to the exercise of trying to explain the epidemiology of AO in adults. We showed the increasing prevalence of AO around the world, and a gender difference in this determination was observed. Among women, the population group who is the most affected by AO, a higher prevalence of AO is observed in individuals living in low- or middle-income countries (LMIC), who are older, multiparous, and in the menopausal transition, and who belong to the poorest strata and have lower educational level. While among men, the risk of AO is positively associated with socioeconomic status, particularly in LMIC. Regarding behavioral factors (eating frequency, sleep duration, physical activity, and smoking), gender differences are difficult to be detected due to the lack of studies investigating their association with AO according to sex. However, the current evidence suggests that men benefit more from consuming a greater number of meals a day and women are more affected by the harmful effects of physical inactivity. We argued AO, despite biological conditions associated with behavior factors, should be examined as an important issue of gender inequality in health, possibly mediated by socioeconomic and behavioral differences between men and women

Estudo de caso-controle sobre mortalidade infantil em Caxias do Sul

OBJECTIVE: To identify risk factors associated with infant mortality and, more specifically, with neonatal mortality. METHODS: A case-control study was carried out in the municipality of Caxias do Sul, Southern Brazil. Characteristics of prenatal care and causes of mortality were assessed for all live births in the 2001-2002 period with a completed live-birth certificate and whose mothers lived in the municipality. Cases were defined as all deaths within the first year of life. As controls, there were selected the two children born immediately after each case in the same hospital, who were of the same sex, and did not die within their first year of life. Multivariate analysis was performed using conditional logistic regression. RESULTS: There was a reduction in infant mortality, the greatest reduction was observed in the post-neonatal period. The variables gestational age (OBJETIVO: Identificar os fatores de risco associados à mortalidade infantil, especificamente à mortalidade neonatal. MÉTODOS: Foi realizado um estudo de caso-controle no município de Caxias do Sul, Estado do Rio Grande do Sul. Investigaram-se as características do pré-natal e parto e causas de morte, para todos os nascidos vivos entre o ano de 2001 e 2002, com Declaração de Nascidos preenchida, cujas mães residiam no município. Como casos, foram definidos todos os óbitos no primeiro ano de vida. Como controles foram selecionadas as duas crianças nascidas imediatamente após o caso, no mesmo hospital e mesmo sexo e que não faleceram até completar o seu primeiro ano de vida. A análise multivariada foi realizada por meio de regressão logística condicional. RESULTADOS: Houve queda da mortalidade infantil, com maior redução no seu componente pós-neonatal. As variáveis idade gestacional

Síndrome metabólica em trabalhadores de turnos fixos

OBJECTIVE To analyze if metabolic syndrome and its altered components are associated with demographic, socioeconomic and behavioral factors in fixed-shift workers. METHODS A cross-sectional study was conducted on a sample of 902 shift workers of both sexes in a poultry processing plant in Southern Brazil in 2010. The diagnosis of metabolic syndrome was determined according to the recommendations from Harmonizing the Metabolic Syndrome. Its frequency was evaluated according to the demographic (sex, skin color, age and marital status), socioeconomic (educational level, income and work shift), and behavioral characteristics (smoking, alcohol intake, leisure time physical activity, number of meals and sleep duration) of the sample. The multivariate analysis followed a theoretical framework for identifying metabolic syndrome in fixed-shift workers. RESULTS The prevalence of metabolic syndrome in the sample was 9.3% (95%CI 7.4;11.2). The most frequently altered component was waist circumference (PR 48.4%; 95%CI 45.5;51.2), followed by high-density lipoprotein. Work shift was not associated with metabolic syndrome and its altered components. After adjustment, the prevalence of metabolic syndrome was positively associated with women (PR 2.16; 95%CI 1.28;3.64), workers aged over 40 years (PR 3.90; 95%CI 1.78;8.93) and those who reported sleeping five hours or less per day (PR 1.70; 95%CI 1.09;2.24). On the other hand, metabolic syndrome was inversely associated with educational level and having more than three meals per day (PR 0.43; 95%CI 0.26;0.73). CONCLUSIONS Being female, older and deprived of sleep are probable risk factors for metabolic syndrome, whereas higher educational level and higher number of meals per day are protective factors for metabolic syndrome in fixed-shift workers.OBJETIVO Analisar se síndrome metabólica e seus componentes alterados estão associados a fatores demográficos, socioeconômicos e comportamentais em trabalhadores de turnos fixos. MÉTODOS Estudo transversal com amostra de 902 trabalhadores de turnos, de ambos os sexos, de um frigorífico de frango do sul do Brasil, em 2010. O diagnóstico da síndrome metabólica foi determinado pelas recomendações do Harmonizing the Metabolic Syndrome; e sua frequência foi avaliada segundo características demográficas (sexo, cor de pele, idade e estado civil), socioeconômicas (escolaridade, renda e turno de trabalho) e comportamentais (tabagismo, consumo de álcool, atividade física de lazer, número de refeições/dia e duração do sono). A análise multivariada seguiu um modelo conceitual de determinação da síndrome metabólica em trabalhadores de turnos fixos. RESULTADOS A prevalência de síndrome metabólica foi 9,3% (IC95% 7,4;11,2). O componente mais frequentemente alterado foi a circunferência da cintura (RP 48,4%; IC95% 45,5;51,2), seguido pela lipoproteína de alta densidade. O turno de trabalho não esteve associado à síndrome metabólica e aos seus componentes alterados. Após ajustes, a prevalência da síndrome metabólica foi positivamente associada ao sexo feminino (RP 2,16; IC95% 1,28;3,64), a trabalhadores com 40 anos ou mais (RP 3,90; IC95% 1,78;8.93) e àqueles que reportaram dormir cinco horas ou menos por dia (RP 1,70; IC95% 1,09;2,24). Por outro lado, a síndrome metabólica esteve negativamente relacionada à escolaridade e a fazer mais do que três refeições por dia (RP 0,43 IC95% 0,26;0,73). CONCLUSÕES Ser mulher, possuir idade mais avançada e ter privação de sono mostraram-se potenciais fatores de risco para síndrome metabólica, enquanto ter maior escolaridade e realizar maior número de refeições/dia foram fatores de proteção para síndrome metabólica em trabalhadores de turnos fixos

Association between dietary patterns and mental disorders in pregnant women in Southern Brazil

To evaluate the association between dietary patterns and mental disorders among pregnant women in southern Brazil. Methods: Cross-sectional study with 712 pregnant women recruited from the Study of Food Intake and Eating Behaviors in Pregnancy (ECCAGe). Food intake assessment was performed using the Food Frequency Questionnaire. Dietary patterns were identified by cluster analysis. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to evaluate participants’ mental health. Poisson regression models with robust variance were fitted to estimate prevalence ratios (PR). Results: In the adjusted models, there was a high prevalence of major depressive disorder among women with low fruit intake (43%, PR 1.43, 95%CI 1.04-1.95) and high sweets and sugars intake (91%, PR 1.91, 95%CI 1.19-3.07). Women with a common-Brazilian dietary pattern had higher prevalence of major depressive disorder compared to those with a varied consumption pattern (PR 1.43, 95%CI 1.01-2.02). Low intake of beans was significantly associated with generalized anxiety disorder (PR 1.40, 95%CI 1.01-1.93). Conclusions: Low consumption of fruits and beans and intake of the common-Brazilian dietary pattern during pregnancy were associated with higher prevalence of mental disorders. These results reinforce the importance of an adequate dietary intake to ensure better mental health in pregnancy

Padrões alimentares e sua associação com fatores sociodemográficos e comportamentais : Pesquisa Saúde da Mulher 2015, São Leopoldo (RS)

Introdução: Padrões alimentares parecem predizer melhor o risco de doenças do que nutrientes ou alimentos isoladamente. Objetivo: Identificar padrões alimentares e fatores associados em mulheres adultas. Método: Estudo transversal, de base populacional, com 1.128mulheres, de 20 a 69 anos de idade, de São Leopoldo, Rio Grande do Sul. O consumo alimentar foi avaliado por meio de um questionário de frequência. Utilizou-se análise de componentes principais para identificação dos padrões alimentares. Razõesde prevalências brutas e ajustadas foram estimadas por meio de regressão de Poisson com variância robusta. Resultados: Foram identificados três padrões alimentares que explicaram 25,8% da variância total: saudável (frutas, vegetais e alimentos integrais); de risco (alimentos ultraprocessados); e brasileiro (arroz e feijão). Opadrão saudável apresentou o maior percentual de variância explicada (11,62%). A probabilidade de adesão ao padrão saudável aumentou linearmente com a idade e a escolaridade e foi maior em ex-fumantes (razão de prevalência - RP = 1,22; intervalo de 95% de confiança (IC95%) 1,04 - 1,42). Já mulheres mais jovens e com maior escolaridade tinham maior probabilidade de aderir ao padrão de risco. A probabilidade de adesão ao padrão brasileiro aumentou à medida que diminuiu a escolaridade e foi maior em mulheres de cor de pele não branca (RP = 1,29; IC95% 1,04 - 1,59). Conclusões: Enquanto a adesão aos padrões saudável e de risco comportou-se distintamente segundo a idade das mulheres, ela foi semelhante para a escolaridade. Já a adesão ao padrão brasileiro foi definida pelas condições socioeconômicas.Introduction: Dietary patterns may be more predictive of disease risk than individual nutrients or foods. Objective: To identify dietary patterns and associated factors among adult women. Method: Population-based cross-sectional study with 1,128 women, aged 20 to 69 years, living in São Leopoldo, Rio Grande do Sul. Food intake was assessed with a frequency questionnaire. The principal component analysis identified dietary patterns. We estimated crude and adjusted prevalence ratios using Poisson regression with robust variance. Results: Threedietary patterns - responsible for 25.8% of the total variance - were identified: healthy (fruits, vegetables, and whole foods); risk (ultra-processed foods); and Brazilian (rice and beans). The healthy pattern showed the largest percentage of explained variation (11.62%). The probability of adherence to the healthy pattern increased linearly with age and schooling and was higher among ex-smokers [prevalence ratio (PR)=1.22; confidence interval of 95% (95%CI) 1.04 - 1.42]. Younger women and those with better schooling had more chances of adhering to the risk pattern. The probability of adherence to the Brazilian pattern increased as schooling decreased and was higher among non-white women (PR = 1.29; 95%CI 1.04- 1.59). Conclusions: While adherence to healthy and risk patterns behaved differently according to women’s age, it was similar regarding schooling. Socioeconomic conditions defined adherence to the Brazilian pattern

Uso de chupeta em crianças: contaminação fecal e associação com diarréia

A cross-sectional study of 354 children under two years of age was carried out in two periurban slums, with poor sanitary and socioeconomic conditions, located in Pelotas, southern Brazil. Most (79%) of the children studied were current users of pacifiers, 15% had never used one and the remaining 6% were ex-users. Among current users, 38% sucked a pacifier most of the time ("constant users"). Of the pacifiers in constant use, 93% were cultured for evidence of fecal contamination. Fecal coliforms were present in 49% of these. Diarrhoea was reported in 35% of all the children in the two weeks preceding the survey. Among constant pacifiers users, 40% had had diarrhoea in the preceding fortnight; this proportion was 32% for occasional users and 37% for non-users. These diferences were not statistically significant.Inexistem na literatura estudos sobre o possível papel das chupetas na transmissão da diarréia. Realizou-se um estudo transversal em 354 crianças menores de dois anos em duas vilas da periferia urbana de Pelotas, RS, Brasil, com precárias condições socioeconómicas. A maioria das crianças (79%) usava chupeta, 15% nunca as haviam utilizado e 6% já haviam abandonado o hábito. Dentre os usuários, 38% passavam a maior parte do tempo fazendo uso da chupeta (uso intenso). Foram realizadas culturas para coliformes fecais em 93% das chupetas em uso, indicando que 49% estavam contaminadas. Nas duas semanas anteriores à entrevista, 35% das crianças apresentaram diarréia - 40% entre as de uso intenso, 32% entre usuárias em tempo parcial e 37% entre não usuárias. Apesar da forte presença de coliformes fecais, parece não existir associação entre uso de chupeta e diarréia

Insulin resistance and associated factors in female adolescents from two capital cities in the north and south of Brazil

Background: It has been described that physiological changes in glucose metabolism, represented by insulin resistance (IR), are predicted during pubertal evolution, and obesity may be associated with its persistence even at the end of puberty. The aim of this study was to investigate the prevalence of IR in female adolescents with possible associated factors and evaluate the relationship of time since menarche (< 2 vs. ≥ 2 years) in the occurrence of IR in two Brazilian capital cities: Porto Velho (RO) and Porto Alegre (RS). Methods: This is a cross-sectional school-based study, using information from the Study of Cardiovascular Risks (ERICA) database for adolescents aged 12–17 years, enrolled in public and private schools, in municipalities with more than 100,000 inhabitants in Brazil, between 2013 and 2014. The present study included 889 adolescents, 382 in Porto Velho (PVh) and 507 in Porto Alegre (PoA). The homeostasis model assessment for insulin resistance (HOMA-IR) ≥ 3.16 and fasting insulin ≥ 15 mU/L was used to determine the outcome variable of IR. Estimates of crude and adjusted prevalence ratios with confidence intervals of 95% were calculated using Poisson regression with robust variance. Sociodemographic, behavioral, reproductive and nutritional characteristics were considered as potential confounding factors in multivariable models based on a conceptual framework of IR determination. Results: In the total sample, the prevalence of IR was 22.03% (95% CI 17.84–26.89). After adjusting the models, age 15–17 years and time since menarche ≥ 2 years were found to act as protective factors for IR; in contrast, the highest probability of IR was observed in black adolescents, with increased waist circumference (WC) and overweight/obesity (Ow/Ob). The protective effect of two or more years since menarche (post-menarche) was observed for both higher HOMA-IR and fasting insulin in PVh; in PoA, such protection was maintained only for fasting insulin ≥ 15 mU/L after adjustments in the multivariate models

Prevalência de obesidade em mulheres na pós-menopausa atendidas em um ambulatório no sul do Brasil

Este estudo objetiva avaliar a prevalência de obesidade em mulheres na pós-menopausa atendidas no Ambulatório Central da Universidade de Caxias do Sul. Para isso, foram entrevistadas 201 mulheres de janeiro de 2010 a abril de 2011, na faixa etária de 44 a 65 anos completos. Das 201 mulheres investigadas 50,7% apresentavam obesidade. Foram encontradas diferenças estatisticamente significativas nas variáveis escolaridade, obesidade abdominal, Lipid Accumulation Product (LAP), glicemia elevada, HDL baixo e presença de síndrome metabólica. Em relação à escolaridade, observou-se que quanto maior o nível, maior o percentual de mulheres eutróficas (p=0,045). Entre aquelas com obesidade abdominal, observou-se que todas as obesas apresentaram circunferência da cintura acima de 88 cm (p&lt;0,001). Foi encontrado um LAP maior naquelas com sobrepeso (22,1%) e obesidade (36,6%), quando comparado com mulheres eutróficas (1,3%) (p&lt;0,001). Quanto à glicemia acima de 100 mg/dL ou uso de medicamento hipoglicemiante, observou-se um aumento quando comparadas às eutróficas, com sobrepeso e com obesidade (9,6%, 28,8%, 61,6%, respectivamente) (p=0,004). Em relação ao HDL, a tendência foi a mesma encontrada (9,4%, 33,0%, 57,5%) (p=0,001). A síndrome metabólica esteve presente em 5,8% das eutróficas, 26,4% das mulheres com sobrepeso e 67,8% entre as obesas (p=&lt;0,001). Após o levantamento de informações e análise das variáveis observadas, pode-se concluir que a maioria das mulheres na pós-menopausa são obesas, têm baixa escolaridade, tiveram mais de três gestações, possuem obesidade abdominal, tem LAP e glicemia elevada, síndrome metabólica e baixo colesterol HDL