Validade de peso e estatura informados e índice de massa corporal: estudo pró-saúde

OBJECTIVE: Evaluate the validity of self-reported weight and height and the body mass index (BMI). METHODS: A study was made of 3,713 employees of a public university in Rio de Janeiro, in which they were participants in Phase 1 of a longitudinal study. Information was obtained through a self-administered questionnaire, and measurements were carried out after its application. Student's paired t-test, Bland & Altman's graphs and the intraclass correlation coefficient (ICC) were utilized to evaluate the differences between the measured and the reported parameters. The sensitivity and specificity of the various BMI categories were estimated. RESULTS: There was high agreement between the measured and reported weights (ICC=0.977) and heights (ICC=0.943). The BMI sensitivity, in its various categories, was around 80%, and the specificity was close to 92%. There was a slight and uniform tendency toward self-reported weight underestimation and self-reported height overestimation in both sexes. CONCLUSIONS: Self-reported and measured weight and height information had good agreement and validity. In similar populations, when few resources are available, it is possible to use self-reported data instead of actual measurements.OBJETIVO: Avaliar a validade do peso e da estatura informados e do índice de massa corporal (IMC). MÉTODOS: Foram estudados 3.713 funcionários públicos de uma universidade no Rio de Janeiro, participantes da Fase 1 de um estudo longitudinal. As informações foram obtidas por meio de questionário auto-preenchível; as aferições foram realizadas após a aplicação. Para avaliar as diferenças entre os parâmetros aferidos e informados, utilizou-se o teste t pareado de Student, gráficos de Bland & Altman e o coeficiente de correlação intraclasse (CCIC). Estimou-se a sensibilidade e a especificidade das várias categorias do IMC. RESULTADOS: Houve alta concordância entre a aferição e a informação do peso (CCIC=0,977) e da estatura (CCIC=0,943). A sensibilidade do IMC, em suas várias categorias, variou em torno de 80%, e a especificidade foi próxima de 92%. Houve tendência leve e uniforme à subestimação do peso informado e à superestimação da estatura informada em ambos os sexos. CONCLUSÕES: As informações relatadas e aferidas de peso e estatura apresentaram boa concordância e validade; em populações similares, que disponham de recursos escassos, é possível utilizar dados informados ao invés de valores aferidos

Optimal cut-off points for waist circumference in the definition of metabolic syndrome in Brazilian adults : baseline analyses of the Longitudinal Study of Adult Health (ELSA-Brasil)

Background: Waist circumference (WC) has been incorporated in the definition of the metabolic syndrome (MetS) but the exact WC cut-off points across populations are not clear. The Joint Interim Statement (JIS) suggested possible cut-offs to different populations and ethnic groups. However, the adequacy of these cut-offs to Brazilian adults has been scarcely investigated. The objective of the study is to evaluate possible WC thresholds to be used in the definition of MetS using data from the Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of civil servants (35–74 years old) of six Brazilian cities. Methods: We analyzed baseline data from 14,893 participants (6772 men and 8121 women). A MetS was defined according to the JIS criteria, but excluding WC and thus requiring 2 of the 4 remaining elements. We used restricted cubic spline regression to graph the relationship between WC and MetS. We identified optimal cut-off points which maximized joint sensitivity and specificity (Youden’s index) from Receiver Operator Characteristic Curves. We also estimated the C-statistics using logistic regression. Results: We found no apparent threshold for WC in restricted cubic spline plots. Optimal cut-off for men was 92 cm (2 cm lower than that recommended by JIS for Caucasian/Europids or Sub-Saharan African men), but 2 cm higher than that recommended for ethnic Central and South American. For women, optimal cut-off was 86, 6 cm higher than that recommended for Caucasian/Europids and ethnic Central and South American. Optimal cut-offs did not very across age groups and most common race/color categories (except for Asian men, 87 cm). Conclusions: Sex-specific cut-offs for WC recommended by JIS differ from optimal cut-offs we found for adult men and women of Brazil´s most common ethnic groups

Fenotipo de cintura hipertrigliceridémica : factores asociados y comparación con otros indicadores de riesgo cardiovascular y metabólico en el ELSA-Brasil

O objetivo deste estudo foi estimar a prevalência do fenótipo cintura hipertrigliceridêmica (FCH) em participantes do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil), identificar fatores de risco associados e comparar com outros indicadores de risco cardiovascular e metabólico. Trata-se de um estudo transversal com dados da linha de base de uma coorte de servidores públicos. O FCH é definido pela presença simultânea de circunferência da cintura (CC) aumentada (≥ 80cm para mulheres, ≥ 90cm para homens de acordo com a Federação Internacional de Diabetes – IDF; e ≥ 88cm para mulheres, ≥ 102cm para homens de acordo com o Programa Nacional de Educação sobre o Colesterol dos Estados Unidos – NCEP) e hipertrigliceridemia. A associação entre as variáveis independentes e FCH foi testada por meio de modelos de regressão logística multivariada. O FCH foi comparado também com outros indicadores de risco cardiovascular e metabólico por meio de testes de correlação, índice kappa, sensibilidade e especificidade. Após exclusões, foram analisados 12.811 participantes. A prevalência do FCH variou de 24,7% (IDF) a 13,3% (NCEP). FCH foi associado a ter idade mais avançada, ao consumo excessivo de álcool, ser ex-fumante, apresentar HDL baixo, não-HDL alto e PCR aumentado, independente do sexo ou critério de definição. FCH associou-se a indicadores de risco cardiovascular, especialmente à síndrome metabólica. A elevada prevalência de FCH e sua associação com indicadores de risco cardiovascular, especialmente com a síndrome metabólica, apoia sua utilização como ferramenta de triagem de risco cardiometabólico na prática clínica.This study’s objectives were to estimate the prevalence of hypertriglyceridemic waist (HTW) phenotype in participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), identify associated risk factors, and compare with other cardiovascular and metabolic risk indicators. This was a cross-sectional study with baseline data from a cohort of public employees. HTW is defined as the simultaneous presence of increased waist circumference (WC) (≥ 80cm for women, ≥ 90cm for men according to the International Diabetes Federation – IDF; and ≥ 88cm for women, ≥ 102cm for men according to the U.S. National Cholesterol Education Program – NCEP) and hypertriglyceridemia. Associations between independent variables and HTW were tested with multivariate logistic regression models. HTW was also compared to other cardiovascular and metabolic risk indicators by means of correlation tests, kappa index, sensitivity, and specificity. After exclusions, 12,811 participants were analyzed. Prevalence of HTW ranged from 24.7% (IDF) to 13.3% (NCEP). HTW was associated with age, excessive alcohol consumption, former smoking, low HDL, nonhigh HDL, and increased C-reactive protein, independently of gender or the criterion used to define HTW. HTW was associated with cardiovascular risk indicators, especially metabolic syndrome. The high prevalence of HTW and its association with cardiovascular risk indicators, especially metabolic syndrome, supports its use as a cardiometabolic risk screening tool in clinical practice.El objetivo de este estudio fue estimar la prevalencia del fenotipo cintura hipertrigliceridémica (FCH), en participantes del Estudio Longitudinal de la Salud del Adulto (ELSA-Brasil), identificar factores de riesgo asociados, y compararlo con otros indicadores de riesgo cardiovascular y metabólico. Se trata de un estudio transversal con datos de la línea de referencia de una cohorte de empleados públicos. El FCH se define por la presencia simultánea de circunferencia de la cintura (CC) aumentada (≥ 80cm para mujeres, ≥ 90cm para hombres de acuerdo con la Federación Internacional de Diabetes – IDF; y ≥ 88cm para mujeres, ≥ 102cm para hombres de acuerdo con el Programa National de Educación sobre el colesterol de los EE.UU. – NCEP) e hipertrigliceridemia. La asociación entre las variables independientes y FCH fue probada mediante modelos de regresión logística multivariada. El FCH se comparó también con otros indicadores de riesgo cardiovascular y metabólico, mediante pruebas de correlación, índice kappa, sensibilidad y especificidad. Tras las exclusiones, se analizaron a 12.811 participantes. La prevalencia del FCH varió de un 24,7% (IDF) a un 13,3% (NCEP). El FCH se asoció a tener una edad más avanzada, al consumo excesivo de alcohol, ser ex-fumador, presentar HDL bajo, no-HDL alto y PCR aumentado, independiente del sexo o criterio de definición. FCH se asoció a indicadores de riesgo cardiovascular, especialmente al síndrome metabólico. La elevada prevalencia de FHC y su asociación con indicadores de riesgo cardiovascular, especialmente con el síndrome metabólico, apoya su utilización como herramienta de clasificación de riesgo cardiometabólico en la práctica clínica

Multinomial model and zero-inflated gamma model to study time spent on leisure time physical activity: an example of ELSA-Brasil

OBJECTIVE To compare two methodological approaches: the multinomial model and the zero-inflated gamma model, evaluating the factors associated with the practice and amount of time spent on leisure time physical activity. METHODS Data collected from 14,823 baseline participants in the Longitudinal Study of Adult Health (ELSA-Brasil – Estudo Longitudinal de Saúde do Adulto ) have been analysed. Regular leisure time physical activity has been measured using the leisure time physical activity module of the International Physical Activity Questionnaire. The explanatory variables considered were gender, age, education level, and annual per capita family income. RESULTS The main advantage of the zero-inflated gamma model over the multinomial model is that it estimates mean time (minutes per week) spent on leisure time physical activity. For example, on average, men spent 28 minutes/week longer on leisure time physical activity than women did. The most sedentary groups were young women with low education level and income CONCLUSIONS The zero-inflated gamma model, which is rarely used in epidemiological studies, can give more appropriate answers in several situations. In our case, we have obtained important information on the main determinants of the duration of leisure time physical activity. This information can help guide efforts towards the most vulnerable groups since physical inactivity is associated with different diseases and even premature death

Optimizing strategies to identify high risk of developing type 2 diabetes

Introduction: The success of diabetes prevention based on early treatment depends on high-quality screening. This study compared the diagnostic properties of currently recommended screening strategies against alternative score-based rules to identify those at high risk of developing diabetes. Methods: The study used data from ELSA-Brasil, a contemporary cohort followed up for a mean (standard deviation) of 7.4 (0.54) years, to develop risk functions with logistic regression to predict incident diabetes based on socioeconomic, lifestyle, clinical, and laboratory variables. We compared the predictive capacity of these functions against traditional pre-diabetes cutoffs of fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), and glycated hemoglobin (HbA1c) alone or combined with recommended screening questionnaires. Results: Presenting FPG > 100 mg/dl predicted 76.6% of future cases of diabetes in the cohort at the cost of labeling 40.6% of the sample as high risk. If FPG testing was performed only in those with a positive American Diabetes Association (ADA) questionnaire, labeling was reduced to 12.2%, but only 33% of future cases were identified. Scores using continuously expressed clinical and laboratory variables produced a better balance between detecting more cases and labeling fewer false positives. They consistently outperformed strategies based on categorical cutoffs. For example, a score composed of both clinical and laboratory data, calibrated to detect a risk of future diabetes ≥20%, predicted 54% of future diabetes cases, labeled only 15.3% as high risk, and, compared to the FPG ≥ 100 mg/dl strategy, nearly doubled the probability of future diabetes among screen positives. Discussion: Currently recommended screening strategies are inferior to alternatives based on continuous clinical and laboratory variables

Adaptação transcultural de escalas de discriminação e vigilância no ELSA-Brasil

OBJECTIVE: To describe the process of cross-cultural adaptation for the use in Brazil of the Everyday Discrimination Scale (EDS) and the Heightened Vigilance Scale (HVS) applied in the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: Conceptual, item and semantic equivalence analyses were conducted by a group of four epidemiologists; evaluation of measurement equivalence (factorial analysis of configural, metric and scalar structures, according to sociodemographic characteristics) and reliability. A total of 11,987 participants responded to the discrimination scale, and a subsample of 260 people participated in the test-retest study. In the case of HVS, 8,916 people responded, while 149 individuals did so in the test-retest study. RESULTS: The scales presented conceptual, item and semantic equivalence pertinent in the Brazilian context, in addition to adequate correspondence of referential/denotative meaning of terms and also of the general/connotative of the items. The confirmatory factor analysis of EDS revealed a unidimensional structure, with residual correlations between two pairs of items, presenting configural and metric invariance among the four subgroups evaluated. Scalar invariance was identified according to sex and age group, but it was not observed for race/color and education. Heightened vigilance showed low loads and high residuals, with inadequate adjustment indicators. For the items of the discrimination scale the weighted kappa coefficient (Kp) ranged from 0.44 to 0.78, and the intraclass correlation coefficient (ICC) was 0.87. For HVS items, the Kp ranged from 0.47 to 0.59 and the ICC was 0.83. CONCLUSIONS: Although there are correlated items, it was concluded that the EDS is a promising scale to evaluate experiences of perceived discrimination in Brazilian daily life. However, the heightened vigilance scale did not present equivalence of measurement in the current format.OBJETIVO: Descrever o processo de adaptação transcultural para o uso no Brasil das escalas de discriminação no dia a dia (EDD) e vigilância intensificada (EVI), aplicadas no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). MÉTODOS: Foram realizadas análises das equivalências conceitual, de itens e semântica conduzidas por um grupo de quatro epidemiologistas; avaliação da equivalência de mensuração (análise fatorial das estruturas configural, métrica e escalares, segundo características sociodemográficas) e a confiabilidade. Responderam à escala de escala de discriminação 11.987 participantes e uma subamostra de 260 pessoas participaram do estudo teste-reteste. No caso da EVI, 8.916 pessoas responderam e 149 indivíduos no estudo teste-reteste. RESULTADOS: As escalas apresentaram equivalências conceitual, de itens e semântica pertinentes no contexto brasileiro, além de adequada correspondência de significado referencial/denotativa de termos e também da geral/conotativa dos itens. A análise fatorial confirmatória da EDD revelou estrutura unidimensional, com correlações residuais entre dois pares de itens, apresentando invariância configural e métrica entre os quatro subgrupos avaliados. Identificou-se invariância escalar segundo sexo e faixa etária, mas não foi observada para recortes de raça/cor e escolaridade. A vigilância intensificada apresentou cargas baixas e resíduos altos, com indicadores de ajuste inadequados. Para os itens da escala de discriminação o coeficiente de concordância kappa ponderado (Kp) variou de 0,44 a 0,78, e o Coeficiente de Correlação Intraclasse (CCI) foi 0,87. Para os itens da EVI, o Kp variou de 0,47 a 0,59 e o CCI foi 0,83. CONCLUSÕES: Embora haja itens correlacionados, concluiu-se que a EDD é uma escala promissora para avaliar experiências de discriminação percebidas no cotidiano brasileiro. Entretanto, a escala de vigilância intensificada não apresentou equivalência de mensuração no formato atual

Ultra-processed foods, incident overweight and obesity, and longitudinal changes in weight and waist circumference : the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Objective: To evaluate the association of ultra-processed food (UPF) consumption with gains in weight and waist circumference, and incident overweight/obesity, in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. Design: We applied FFQ at baseline and categorized energy intake by degree of processing using the NOVA classification. Height, weight and waist circumference were measured at baseline and after a mean 3·8-year follow-up. We assessed associations, through Poisson regression with robust variance, of UPF consumption with large weight gain (1·68 kg/year) and large waist gain (2·42 cm/year), both being defined as ≥90th percentile in the cohort, and with incident overweight/obesity. Setting: Brazil. Participants: Civil servants of Brazilian public academic institutions in six cities (n 11 827), aged 35–74 years at baseline (2008–2010). Results: UPF provided a mean 24·6 (SD 9·6) % of ingested energy. After adjustment for smoking, physical activity, adiposity and other factors, fourth (>30·8 %) v. first (17·8 % of energy as UPF. Conclusions: Greater UPF consumption predicts large gains in overall and central adiposity and may contribute to the inexorable rise in obesity seen worldwide

Cross-cultural adaptation of discrimination and vigilance scales in ELSA-Brasil

OBJECTIVE: To describe the process of cross-cultural adaptation for the use in Brazil of the everyday discrimination scale (EDS) and the heightened vigilance scale (HVS) applied in the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: Conceptual, item and semantic equivalence analyses were conducted by a group of four epidemiologists; evaluation of measurement equivalence (factorial analysis of configural, metric and scalar structures, according to sociodemographic characteristics) and reliability. A total of 11,987 participants responded to the discrimination scale, and a subsample of 260 people participated in the test-retest study. In the case of HVS, 8,916 people responded, while 149 individuals did so in the test-retest study. RESULTS: The scales presented conceptual, item and semantic equivalence pertinent in the Brazilian context, in addition to adequate correspondence of referential/denotative meaning of terms and also of the general/connotative of the items. The confirmatory factor analysis of EDS revealed a unidimensional structure, with residual correlations between two pairs of items, presenting configural and metric invariance among the four subgroups evaluated. Scalar invariance was identified according to sex and age group, but it was not observed for race/color and education. Heightened vigilance showed low loads and high residuals, with inadequate adjustment indicators. For the items of the discrimination scale the weighted kappa coefficient (Kp) ranged from 0.44 to 0.78, and the intraclass correlation coefficient (ICC) was 0.87. For HVS items, the Kp ranged from 0.47 to 0.59 and the ICC was 0.83. CONCLUSIONS: Although there are correlated items, it was concluded that the EDS is a promising scale to evaluate experiences of perceived discrimination in Brazilian daily life. However, the heightened vigilance scale did not present equivalence of measurement in the current format