Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment

Background High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods We used data for exposure to risk factors by country, age group, and sex from pooled analyses of populationbased health surveys. We obtained relative risks for the eff ects of risk factors on cause-specifi c mortality from metaanalyses of large prospective studies. We calculated the population attributable fractions for- each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the eff ects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specifi c population attributable fractions by the number of disease-specifi c deaths. We obtained cause-specifi c mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the fi nal estimates. Findings In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10\ub78 million deaths, 95% CI 10\ub71\u201311\ub75) of deaths from these diseases in 2010 were attributable to the combined eff ect of these four metabolic risk factors, compared with 67% (7\ub71 million deaths, 6\ub76\u20137\ub76) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined eff ects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing eff ect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the globalresponse to non-communicable diseases

Níveis tensionais de adultos indígenas Suruí, Rondônia, Brasil

Os povos indígenas no Brasil vivenciam acelerado processo de transição nutricional e epidemiológica, verificando-se a emergência de doenças e agravos não transmissíveis, como hipertensão arterial (HA). Realizou-se, em 2005, um estudo transversal para descrever os níveis tensionais em adultos (> 20 anos) indígenas Suruí, Rondônia, e investigar sua relação com o estado nutricional e o nível socioeconômico (SSE). Foram visitadas 9 aldeias e avaliados 251 indivíduos (87,4% dos elegíveis). As médias de pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD) foram maiores no sexo masculino e superiores às verificadas em 1988, com incremento na média da PAS de 7,9 mmHg e de 1,4 mmHg, em mulheres e homens, respectivamente. A PAS correlacionou-se positivamente com a razão cintura quadril (RCQ) em ambos os sexos, e com a idade, no sexo feminino. A PAD apresentou correlações estatisticamente significativas com todas as variáveis antropométricas, exceto com estatura e área muscular do braço. A prevalência de HA foi de 2,8% (M: 2,4%; F: 3,1%). Essa prevalência foi maior nos indivíduos > 40 anos, com perímetro da cintura (PC) ou RCQ elevados, sobretudo no grupo feminino e também no grupo de mais baixo de SSE. A HA é um problema de saúde emergente entre os Suruí, devendo receber atenção do sistema de saúde e dos pesquisadores

Nutritional status and growth of indigenous Xavante children, Central Brazil

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to characterize the nutritional status of Xavante Indian children less than 10 years of age in Central Brazil and to evaluate the hypothesis of an association between child nutrition and socioeconomic differentiation in this population.</p> <p>Methods</p> <p>A cross-sectional study was conducted in July 2006 that included all children under the age of 10 from the Xavante village Pimentel Barbosa in Mato Grosso, Brazil. The data collected included weight, height, and sociodemographic information. Sociodemographic data were used to generate two indices ("income" and "wealth") and to determine the proportion of adults in each household. Descriptive analyses were performed for weight-for-age (W/A), height-for-age (H/A), and weight-for-height (W/H) using the NCHS and the WHO growth references. Univariate and multivariate analyses were conducted using H/A and W/A as a response variables.</p> <p>Results</p> <p>Of a total of 246 children under the age of ten residing in the village, 232 (94.3%) were evaluated. Following the NCHS reference, 5.6% of children under the age of ten presented low W/A and 14.7% presented low H/A. Among children under the age of five, deficit percentages for weight and height were 4.5% and 29.9%, respectively, following the WHO curves. Among children < 2 years of age, H/A index variability was found to be directly related to child's age and inversely related to the proportion of adults in the household. Maternal BMI was positively associated with growth for children from 2 to 4 years of age, explaining 11.5% of the z-score variability for the H/A index. For children 5 years of age and older, the wealth index and maternal height were positively associated with H/A. No significant associations were found using W/A as the dependent variable.</p> <p>Conclusion</p> <p>This study demonstrated that undernutrition, in particular linear growth deficit, is a notable health issue for Xavante children. These findings contrast with the nutritional profile observed among Brazilian children nationally, which is characterized by a sharp decline in child undernutrition in recent decades, even in the poorest regions of the country. This discrepancy calls attention to the persistent health disparities that exist between indigenous and non-indigenous people in Brazil.</p

Aspectos de la fecundidad de mujeres indígenas Suruí, Rondônia, Brasil: una aproximación

OBJETIVOS: caracterizar aspectos de la fecundidad de mujeres indígenas Suruí de la Amazonía brasilera. MÉTODOS: se levantaron y sistematizaron 88 historias reproductivas y de nacimientos, obtenidas a través de visitas domiciliarias en dos aldeas, realizadas en 2004. RESULTADOS: el promedio de edad de la menarquía fue 12 años; las edades medias de entrada a la primera unión y del nacimiento del primer hijo fueron, respectivamente, 13,8 y 15,7 años. El parto ocurrió en la aldea en su mayoría. Las mujeres Suruí presentan un intervalo intergenésico promedio próximo a los 22,8 meses. El promedio de amamantación fue 18,4 meses. El uso de contraceptivos es mínimo y el número de años de estudio de las mujeres es bajo. La tasa de fecundidad total fue de 6,3 hijos. CONCLUSIÓN: si se compara con resultados de otros estudios en pueblos indígenas, la demografía Suruí señala niveles de fecundidad entre moderados y elevados. Los autores argumentan que los hallazgos son relevantes para la prestación de servicios de salud culturalmente compatibles con la realidad Suruí.OBJECTIVES: to analyze female fertility among Suruí Indian women in the Brazilian Amazon. METHODS: a total of 88 reproductive and birth histories were collected by means of household interviews carried out in two Suruí villages in 2004. RESULTS: the average age of menarche was 12 years-old; the average ages of first marriage and of the delivering the first child were, respectively, 13.8 and 15.7 years-old. For most women, delivery took place in their own village. The average time between pregnancies was 22.8 months and the average breast feeding duration was 18.4 months. Very few Suruí women use contraceptives and most have attended school for only a couple of years. On average, the total fertility rate was of 6.3 children per woman. CONCLUSIONS: in comparison with other populations, Suruí's demography shows a moderately high fertility rate. The authors argue that the findings of this study can be of use to better plan health services that are more culturally compatible with the reality of Suruí women

Perspectivas culturais sobre transmissão e tratamento da tuberculose entre os Xavánte de Mato Grosso, Brasil

Esta nota tem por objetivo apresentar os resultados preliminares de uma pesquisa em andamento sobre as perspectivas Xavánte acerca da tuberculose (TB) e suas implicações para o tratamento e controle da endemia. Entrevistas na Terra Indígena Pimentel Barbosa, Mato Grosso, Brasil, revelaram a existência de múltiplos modelos explicativos para a doença. Os Xavánte destacam a feitiçaria (simi'õ ou abzé) e os micróbios como as principais causas de TB. Dessa forma, fazem uso de fitoterápicos assim como seguem a quimioterapia prescrita pela biomedicina. Entre os Xavánte, a cultura indígena não é impeditiva para a execução das medidas preconizadas pelo Programa Nacional de Controle da Tuberculose (PNCT), pois esta não conflita com a biomedicina. Pelo contrário, os Xavánte demonstram interesse nos exames, aceitam a vacinação com BCG, comparecem às consultas e seguem a quimioterapia prescrita. Como contraponto, importantes atividades previstas no PNCT não são realizadas pelos serviços locais, ou o são de forma incompleta, comprometendo as prioridades de detecção precoce e tratamento adequado de novos casos da doença