Trajetória socioeconômica e obesidade em adultos residentes em Florianópolis, Santa Catarina

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, 2016.A obesidade é considerada um problema de saúde pública em razão desua alta prevalência e dos expressivos impactos negativos que produztanto em nível individual quanto coletivo. Estudos correlacionamcaracterísticas sociodemográficas e econômicas da infância e datrajetória da infância até a vida adulta com a obesidade em adultos,indicando que fatores do início da vida também influenciam o estadonutricional desta população, mas a maioria deles foram realizados empaíses de renda elevada. Destaca-se a importância da realização deestudos com esta temática em países de renda média ou baixa, visto queo perfil das associações encontradas difere de acordo com a renda médiado país cuja população está sendo avaliada. O objetivo deste estudo foiverificar a associação entre posição socioeconômica da infância e atrajetória socioeconômica da infância até a vida adulta com medidas deíndice de massa corporal (IMC), circunferência da cintura (CC) e apresença de obesidade geral e abdominal na vida adulta. Foi realizadaanálise transversal em estudo de coorte de base populacional, incluindoamostra de 1.222 adultos (22-63 anos) residentes em Florianópolis, suldo Brasil. A posição socioeconômica da infância e a trajetóriasocioeconômica foram analisadas utilizando dados da escolaridade dospais, mães e dos próprios participantes. Estatura, peso e CC foramaferidos por entrevistadores previamente treinados. Foram empregadasregressões linear e logística com ajuste para fatores confusão, eestratificação dos dados segundo sexo. Entre os avaliados, 20,4%(IC95%:18,1%-22,8%) apresentaram obesidade geral e 24,8% (IC95%:22,4%-27,4%) obesidade abdominal. As médias de IMC e CC entremulheres foram 1,2 kg/m2 (IC95%: -2,3;-0,04) e 2,8 cm (IC95%: -5,3;-0,2) menores, respectivamente, entre aquelas de maior posiçãosocioeconômica na infância. Entre os homens, a CC foi 3,9 cm (IC95%:1,0;6,8) maior nos indivíduos de maior posição socioeconômica nainfância. Em relação à trajetória socioeconômica, as médias de IMC eCC foram cerca de 2 kg/m2 (IC95%: -3,3;-0,7) e 6 cm (IC95%: -9,7;-2,9) menores nas mulheres que sempre tiveram alta posiçãosocioeconômica e nos homens a CC foi cerca de 4 cm maior (IC95%:0,1;7,5) que estiveram em alta posição socioeconômica durante a vida..Quanto à obesidade, mulheres de maior posição socioeconômica nainfância e que sempre se mantiveram em alta posição socioeconômicativeram menores chances de obesidade abdominal (OR= 0,56; IC95%:0,34-0,90 e OR= 0,38; IC95%: 0,20-0,76, respectivamente), não tendo10sido observada tal associação entre os homens. Em conclusão, tanto aposição socioeconômica na infância quanto a trajetória socioeconômicatem influência sobre IMC, CC e obesidade em adultos, com diferença nadireção da associação conforme o sexo. Nos homens, maior posiçãosocioeconômica na infância e nas mulheres menor posiçãosocioeconômica estiveram relacionadas a maior chance de obesidade.Dessa forma, políticas públicas devem desenvolver ações com foco nainfância e que se mantenham em longo prazo, tendendo a ser maisefetivas do que ações desenvolvidas em um curto período de tempo.Abstract : Obesity is a public health problem with high prevalence and negativeimpacts both individually and collectively. Studies associatedemographic and economic characteristics of childhood and of a lifecourse perspective with obesity in adults, indicating that early lifefactors also influence the nutritional status of this age group. Most of thestudies were performed in high-income countries, but it is important toconduct studies in middle or low income countries, as the associationsdiffers according to the average income of the country whose populationis being evaluated. The aim of this study was to investigate theassociation between socioeconomic position (SEP) in childhood and alife course socioeconomic position from childhood to adulthood withbody mass index (BMI) and waist circumference (WC) measurementsand the presence of overall and abdominal obesity in adults. Crosssectionalanalysis was performed in population-based study cohort,including sample of 1,222 adults (22-63 years) living in Florianópolis,southern Brazil. The SEP of childhood and the life course SEP wereanalyzed using data from the schooling of parents and the participantsthemselves. Height, weight and WC were measured by trainedinterviewers. Linear and logistics regressions were performed withadjusting for confusion variables, and stratification of data according tosex. The results show that 20.4% (95% CI: 18.1% -22.8%) of the samplehad overall obesity and 24.8% (95% CI: 22.4% -27.4%) abdominalobesity. The mean BMI and WC for women were 1.2 kg/m2 (95% CI: -2.3, -0.04) and 2.8 cm (95% CI: -5.3, -0.2) lower, respectively, amongthose of higher SEP in childhood. Among men, the WC was 3.9 cm(95% CI: 1.0, 6.8) higher in those of higher SEP in childhood.Regarding the life course SEP, the mean BMI and WC were about 2kg/m2 (95% CI: -3.3;-0.7) and 6 cm (95% CI: -9.7, -2.9) lower inwomen in the highest SEP in child and adulthood, and men WC wasabout 4 cm higher (95% CI: 0.1, 7.5) among those who with high SEP inlife. In relation to obesity, women of higher SEP in childhood andmaintained this SEP in adulthood had lower prevalence of abdominalobesity (OR = 0.56; 95% CI: 0.34 to 0.90 and OR = 0.38; 95% CI: 0.20to 0.76, respectively). No associations were found among men. Inconclusion, both the SES in childhood and in a life course perspectivehas influence on BMI, WC and obesity in adults, with difference in thedirection of the association according to sex. Men with highersocioeconomic position and women in lower socioeconomic position in12childhood had higher chance of obesity Thus, public policy should focuson actions on childhood that remain in a long term, tending to be moreeffective than actions developed in a short period of time

Effects of neighborhood socioeconomic status on blood pressure in older adults

OBJECTIVE To test if the neighborhood socioeconomic status is associated with systolic blood pressure and hypertension in older adults. METHODS A cross-sectional population-based study with a sample of 1,705 older adults from Florianópolis, SC, Southern Brazil. The contextual variable used was the average years of schooling of the head of the household in census tracts. Participants were considered hypertensive when the systolic blood pressure was ≥ 140 mmHg, diastolic ≥ 90 mmHg, or both. Additionally, the use of antihypertensive medication was also considered. Data were analyzed by using multilevel models of logistic and linear regression. RESULTS The average age of the sample was 70.7 years and the average of systolic and diastolic blood pressure was 133.5 mmHg (SD = 20.5 mmHg) and 81.9 mmHg (SD = 12.5 mmHg), respectively. The systolic blood pressure was 4.46 mmHg (95%CI 1.00–7.92) higher and the chance of hypertension was 1.80 (95%CI 1.26–2.57) among those who lived in census tracts with lower level of schooling. When the use of antihypertensive medication was combined with blood pressure levels, none association was found between the outcome and the level of schooling of the census tract. CONCLUSIONS Analytical models more robust (such as multilevel analysis) in Brazil are still little used, with a small number of articles published. Neighborhood socioeconomic status is associated with systolic blood pressure and the chance of hypertension, regardless of individual characteristics

Prevalência de consulta odontológica e fatores associados a sua realização durante o pré-natal: estudo transversal com puérperas em hospitais do Sistema Único de Saúde, Santa Catarina, 2019

Objective: to analyze the prevalence and associated factors of dental consultation during prenatal care. Methods: cross-sectional study based on interviews with puerperal women in 31 hospitals in the Unified Health System (SUS) in Santa Catarina, 2019.Sociodemographic,economic and prenatal related data were collected. Multivariate analyzes were performed using logistic regression to calculate the odds ratios (OR, odds ratio). Results: 3,580 puerperal women were included and 41.4% [95% confidence interval (95%CI) 39.7;43.0] underwent dental consultations during prenatal care. Higher chance of consultation was observed with higher education (OR=1.35 – 95%CI 1.06;1.71) and greater number of medical/nursing consultations (OR=1.97 – 95%CI 1.47;2.65) and the chance of not having paid work decreased (OR=0.82 – 95%CI 0.70;0.96) and of not participating in an educational activity at SUS (OR=0.63 – 95%CI 0.52;0.77). Conclusion: Factors related to education, employment, prenatal consultations and educational activities increased the chance of dental consultations during pregnancy in Santa Catarina.Objetivo: Analizar la prevalencia y los factores asociados de la consultan odontológica durante la atención prenatal. Métodos: Estudio transversal a partir de entrevistas a puérperas de 31 hospitales del Sistema Único de Salud (SUS) de Santa Catarina, Brasil, 2019. Se recolectaron datos sociodemográficos, económicos y prenatales. Se realizaron análisis multivariados mediante regresión logística para calcular las razones de probabilidades (OR, razón de probabilidades). Resultados: Se incluyeron 3.580 puérperas y el 41,4% [intervalo de confianza del 95% (IC 95% ) 39,7;43,0] se sometieron a consultas dentales durante la atención prenatal. Se observó una mayor probabilidad de consulta con mayor escolaridad (OR=1,35 – IC 95% 1,06;1,71) y un mayor número de consultas médicas / de enfermería (OR=1,97 – IC 95% 1,47;2,65) y la posibilidad de no tener trabajo remunerado disminuyó (OR=0,82 – IC 95% 0,70;0,96) y de no participar en una actividad educativa en el SUS (OR=0,63 – IC 95% 0,52;0,77). Conclusión: Los factores relacionados con la educación, el empleo, las consultas prenatales y las actividades educativas aumentaron la posibilidad de consultas dentales durante el embarazo en Santa Catarina.Objetivo: Analisar a prevalência de consulta odontológica e fatores associados a sua realização durante o pré-natal. Métodos: Estudo transversal, baseado em entrevistas com puérperas em 31 hospitais do Sistema Único de Saúde (SUS) de Santa Catarina, Brasil, 2019. Foram coletados dados sociodemográficos, econômicos e relacionados ao pré-natal. Foram realizadas análises multivariadas, mediante regressão logística, para calcular razões de chances (odds ratio, OR). Resultados: Foram incluídas 3.580 puérperas e 41,4% (intervalo de confiança de 95% [IC95%] 39,7;43,0) realizaram consulta odontológica durante o pré-natal. Maior chance de consulta odontológica foi associada a maior escolaridade (OR=1,35 – IC95% 1,06;1,71) e maior número de consultas médicas/de enfermagem (OR=1,97 – IC95% 1,47;2,65); diminuiu essa chance não ter trabalho remunerado (OR=0,82 – IC95% 0,70;0,96) e não participar de atividade educativa no SUS (OR=0,63 – IC95% 0,52;0,77). Conclusão: Fatores relacionados a escolaridade, emprego, consultas de pré-natal e atividades educativas aumentaram a chance da consulta odontológica na gravidez em Santa Catarina

Socioeconomic status in childhood and obesity in adults : a population-based study

Altres ajuts: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq - Process 485327/2007-4 and 477061/20109).To test whether there is an association between socioeconomic status in childhood and measures of body mass index, waist circumference and the presence of overall and abdominal obesity in adult life. A cross-sectional analysis of a population-based cohort study, including a sample of adults (22-63 years old) living in Florianópolis, Southern Brazil. The socioeconomic status in childhood was analyzed through the education level of the participant's parents. Height, weight and waist circumference were measured by previously trained interviewers. Linear and logistic regressions with adjustment for confounding factors and stratification of data according to gender were used. Of the 1,222 adults evaluated, 20.4% (95%CI 18.1-22.8) presented overall obesity and 24.8% (95%CI 22.4-27.4), abdominal obesity. The body mass index and waist circumference averages among women were, respectively, 1.2 kg/m 2 (95%CI -2.3- -0.04) and 2.8 cm (95%CI -5.3- -0.2) lower among those with higher socioeconomic status in childhood. Among men, waist circumference was 3.9 cm (95%CI 1.0-6.8) higher in individuals with higher socioeconomic status in childhood. Regarding obesity, women of higher socioeconomic status in childhood had lower odds of abdominal obesity (OR = 0.56, 95%CI 0.34-0.90), and no such association was observed among men. The socioeconomic status in childhood influences body mass index, waist circumference and obesity in adults, with a difference in the direction of association according to gender. The higher socioeconomic status among men and the lower socioeconomic status among women were associated with higher adiposity indicators

Posição socioeconômica na infância e obesidade em adultos: estudo de base populacional

OBJETIVO: Testar se há associação entre posição socioeconômica da infância e medidas de índice de massa corporal, circunferência da cintura e presença de obesidade geral e abdominal na vida adulta. MÉTODOS: Análise transversal em estudo de coorte de base populacional, incluindo amostra de adultos (22–63 anos) residentes em Florianópolis, Sul do Brasil. A posição socioeconômica da infância foi analisada por meio da escolaridade dos pais e mães dos participantes. Estatura, peso e circunferência da cintura foram aferidos por entrevistadores previamente treinados. Foram empregadas regressões linear e logística com ajuste para fatores de confusão, e estratificação dos dados segundo sexo. RESULTADOS: Dos 1.222 adultos avaliados, 20,4% (IC95% 18,1–22,8) apresentaram obesidade geral e 24,8% (IC95% 22,4–27,4), obesidade abdominal. As médias de índice de massa corporal e circunferência da cintura entre mulheres foram, respectivamente, 1,2 kg/m2 (IC95% -2,3– -0,04) e 2,8 cm (IC95% -5,3– -0,2) menores entre aquelas de maior posição socioeconômica na infância. Entre os homens, a circunferência da cintura foi 3,9 cm (IC95% 1,0–6,8) maior nos indivíduos de maior posição socioeconômica na infância. Em relação à obesidade, mulheres de maior posição socioeconômica na infância tiveram menores chances de obesidade abdominal (OR = 0,56; IC95% 0,34–0,90), não tendo sido observada tal associação entre os homens. CONCLUSÕES: A posição socioeconômica na infância tem influência sobre índice de massa corporal, circunferência da cintura e obesidade em adultos, com diferença na direção da associação conforme o sexo. A maior posição socioeconômica entre os homens e a menor posição socioeconômica entre as mulheres estiveram associadas aos maiores indicadores de adiposidade.OBJECTIVE: To test whether there is an association between socioeconomic status in childhood and measures of body mass index, waist circumference and the presence of overall and abdominal obesity in adult life. METHODS: A cross-sectional analysis of a population-based cohort study, including a sample of adults (22–63 years old) living in Florianópolis, Southern Brazil. The socioeconomic status in childhood was analyzed through the education level of the participant’s parents. Height, weight and waist circumference were measured by previously trained interviewers. Linear and logistic regressions with adjustment for confounding factors and stratification of data according to gender were used. RESULTS: Of the 1,222 adults evaluated, 20.4% (95%CI 18.1–22.8) presented overall obesity and 24.8% (95%CI 22.4–27.4), abdominal obesity. The body mass index and waist circumference averages among women were, respectively, 1.2 kg/m2 (95%CI -2.3– -0.04) and 2.8 cm (95%CI -5.3– -0.2) lower among those with higher socioeconomic status in childhood. Among men, waist circumference was 3.9 cm (95%CI 1.0–6.8) higher in individuals with higher socioeconomic status in childhood. Regarding obesity, women of higher socioeconomic status in childhood had lower odds of abdominal obesity (OR = 0.56, 95%CI 0.34–0.90), and no such association was observed among men. CONCLUSIONS: The socioeconomic status in childhood influences body mass index, waist circumference and obesity in adults, with a difference in the direction of association according to gender. The higher socioeconomic status among men and the lower socioeconomic status among women were associated with higher adiposity indicators

Socio-economic life course and obesity among adults in Florianopolis, southern Brazil

Objective: To estimate the association between socio-economic life course and body mass index (BMI), waist circumference (WC) and general and abdominal obesity in adults. Methods: A cross-sectional analysis of a population-based cohort study of 1,222 adults (aged 22-63) from Florianopolis, southern Brazil. The socio-economic life course was analysed using the educational level of participants and their parents. Height, weight and WC were measured by specially trained staff. Linear and logistic regressions were used with adjustment for confounding factors, and data were stratified according to sex. Results: Mean BMI and WC were about 2 kg/m (95% CI: −3.3 to −0.7) and 6 cm (95% CI: −9.7 to −2.9) lower in women with a high socio-economic position, while the association was reversed in men with a high socio-economic position, with WC being about 4 cm higher (95% CI: 0.1 to 7.5). In addition, women who had always been in a high socio-economic position were less likely to have abdominal obesity (OR: 0.38; 95% CI: 0.20 to 0.76) while no such association was found in men. Conclusion: Socio-economic life course influences BMI, WC and obesity, with differences between males and females, thereby indicating that public policies that contemplate a socio-economic life course approach can be effective for controlling obesity.Objetivo: Estimar la asociación entre trayectoria socioeconómica e índice de masa corporal (IMC), circunferencia de la cintura (CC) y obesidad general y abdominal en adultos. Métodos: Análisis transversal de un estudio de cohortes de base poblacional en 1222 adultos (22-63 años de edad) en Florianópolis, sur de Brasil. La trayectoria socioeconómica fue analizada mediante el nivel educativo de los padres y los propios participantes. La medición de altura, peso y CC fue realizada por personal especialmente entrenado. Se usaron modelos de regresión lineal y logística ajustando factores confusores y estratificando por sexo. Resultados: El promedio de IMC y CC fue de 2 kg/m2 (intervalo de confianza del [IC95%]: −3,3 a −0,7) y 6 cm (IC95%: −9,7 a −2,9), menor en las mujeres con mejor posición socioeconómica. Dicha asociación fue la contraria en el caso de los hombres, en los que el promedio de CC fue 4 cm mayor (IC95%: 0,1 a 7,5). Las mujeres que siempre permanecieron en mejor posición socioeconómica fueron menos propensas a tener obesidad abdominal (odds ratio: 0,38; IC95%: 0,20 a 0,76), mientras que en los hombres no se observó dicha asociación. Conclusiones: La trayectoria socioeconómica se asocia al IMC, la CC y la obesidad, con diferencias entre sexos, indicando que la aplicación de políticas públicas que contemplen la trayectoria socioeconómica puede ser efectiva para el control de la obesidad

Socio-economic life course and obesity among adults in Florianopolis, southern Brazil

Objective: To estimate the association between socio-economic life course and body mass index (BMI), waist circumference (WC) and general and abdominal obesity in adults. Methods: A cross-sectional analysis of a population-based cohort study of 1,222 adults (aged 22–63) from Florianopolis, southern Brazil. The socio-economic life course was analysed using the educational level of participants and their parents. Height, weight and WC were measured by specially trained staff. Linear and logistic regressions were used with adjustment for confounding factors, and data were stratified according to sex. Results: Mean BMI and WC were about 2 kg/m2 (95% CI: −3.3 to −0.7) and 6 cm (95% CI: −9.7 to −2.9) lower in women with a high socio-economic position, while the association was reversed in men with a high socio-economic position, with WC being about 4 cm higher (95% CI: 0.1 to 7.5). In addition, women who had always been in a high socio-economic position were less likely to have abdominal obesity (OR: 0.38; 95% CI: 0.20 to 0.76) while no such association was found in men. Conclusion: Socio-economic life course influences BMI, WC and obesity, with differences between males and females, thereby indicating that public policies that contemplate a socio-economic life course approach can be effective for controlling obesity. Resumen: Objetivo: Estimar la asociación entre trayectoria socioeconómica e índice de masa corporal (IMC), circunferencia de la cintura (CC) y obesidad general y abdominal en adultos. Métodos: Análisis transversal de un estudio de cohortes de base poblacional en 1222 adultos (22-63 años de edad) en Florianópolis, sur de Brasil. La trayectoria socioeconómica fue analizada mediante el nivel educativo de los padres y los propios participantes. La medición de altura, peso y CC fue realizada por personal especialmente entrenado. Se usaron modelos de regresión lineal y logística ajustando factores confusores y estratificando por sexo. Resultados: El promedio de IMC y CC fue de 2 kg/m2 (intervalo de confianza del [IC95%]: −3,3 a −0,7) y 6 cm (IC95%: −9,7 a −2,9), menor en las mujeres con mejor posición socioeconómica. Dicha asociación fue la contraria en el caso de los hombres, en los que el promedio de CC fue 4 cm mayor (IC95%: 0,1 a 7,5). Las mujeres que siempre permanecieron en mejor posición socioeconómica fueron menos propensas a tener obesidad abdominal (odds ratio: 0,38; IC95%: 0,20 a 0,76), mientras que en los hombres no se observó dicha asociación. Conclusiones: La trayectoria socioeconómica se asocia al IMC, la CC y la obesidad, con diferencias entre sexos, indicando que la aplicación de políticas públicas que contemplen la trayectoria socioeconómica puede ser efectiva para el control de la obesidad. Keywords: Socio-economic life course, Socio-economic factors, Obesity, Adults, Cross-sectional study, Palabras clave: Trayectoria socioeconómica, Factores socioeconómicos, Obesidad, Adultos, Estudio transversa

Is cognitive decline in the elderly associated with contextual income? Results of a population-based study in southern Brazil

Abstract: The aim of this study was to estimate the association between contextual income and cognitive decline in the elderly in Florianópolis, a medium-sized city in southern Brazil. A nested cross-sectional study was performed in a cohort of elderly ≥ 60 years (n = 1,197), interviewed in the second wave (2013/2014) of the EpiFloripa cohort. Cognitive decline was assessed with the Mini Mental State Examination (MMSE) and contextual income was measured as the mean monthly income of the heads of households. Individual adjustment variables were sex, age, skin color, per capita household income, years of schooling, and time living in the neighborhood. The data were analyzed using multilevel logistic regression. The odds of cognitive decline were twice as high (OR = 1.99; 95%CI: 1.03; 3.87) in elderly living in census tracts with the lowest income quintile compared to those in the highest quintile, independently of individual characteristics. In conclusion, the socioeconomic environment is related to cognitive decline and should be considered in public policies with a focus on health of the elderly

Conceito de Risco e Princípio da Precaução na Vigilância à Saúde: A Vigilância Sanitária de Alimentos Como Cenário de Prática

Este ensaio teórico procura levantar elementos de discussão a respeito do conceito de risco e princípio da precaução no contexto das práticas da vigilância sanitária de alimentos. A reflexão tem a expectativa de produzir o desenvolvimento e aprofundamento acerca desses conceitos aplicados à prática da vigilância sanitária de alimentos, com a finalidade de contribuir para o incremento do debate em torno deste tema e subsidiar o aprimoramento das políticas e práticas de saúde pública relacionadas à vigilância sanitária, com ênfase na área de alimentos