O consumo de alimentos ultraprocessados e a incidência de síndrome metabólica e de diabetes tipo II em adultos : Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)

Objetivos: O objetivo da tese é investigar a associação entre o consumo de alimentos ultraprocessados e a incidência de síndrome metabólica e diabetes tipo 2 no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Métodos: Partiu-se da linha de base do estudo de coorte ELSA-Brasil, que arrolou 15105 funcionários de instituições públicas de ensino/pesquisa em seis capitais brasileiras, com idades de 35 a 74 anos, entre agosto de 2008 e dezembro de 2010. Novas ondas de exames e entrevistas foram realizadas entre 2012 a 2014 e 2017 a 2019. Para a amostra analítica foram excluídos os participantes que foram a óbito ou que não retornaram para as ondas. Foram excluídos ainda aqueles com dados faltantes, ou com consumo energético diário 6000 kcal. Para investigar os casos novos de síndrome metabólica e de diabetes tipo 2 foram excluídos também aqueles que apresentavam o desfecho específico na linha de base. Além disso, para análises referentes ao diabetes foram excluídos também os que fizeram cirurgia bariátrica entre as ondas. O consumo de alimentos ou bebidas ultraprocessados (em incrementos de 150 gramas/dia e em quartis de gramas/dia) baseou-se em questionário de frequência alimentar. A síndrome metabólica foi definida pela presença de pelo menos três de cinco critérios: glicemia de jejum elevada, triglicerídeos elevados, colesterol HDL baixo, pressão arterial elevada e obesidade abdominal. O diabetes foi definido pelo relato de diagnóstico prévio (auto-relato ou uso de medicamentos para diabetes) ou por exames laboratoriais alterados durante as visitas. Casos incidentes foram definidos como casos novos detectados nas ondas ou, para a incidência de diabetes, também os detectados em duas entrevistas anuais de seguimento após a última visita ao centro de pesquisa. Modelos de regressão de Poisson robusta foram empregados para estimar os riscos relativos (RR) e seus intervalos de confiança de 95% (IC95%). Resultados: Para o desfecho síndrome metabólica, dos 8065 participantes analisados, 59% eram mulheres, 59% tinham ensino superior completo, a média de idade era de 49 anos e a mediana do consumo de ultraprocessados de 366g/d. Após oito anos de seguimento, detectaram-se 2508 (31%) casos incidentes de síndrome metabólica. Em regressão de Poisson robusta, ajustada para idade, sexo, centro, raça/cor, renda, escolaridade, tabagismo, atividade física, álcool, ingestão energética e índice de massa corporal, um incremento de 150g/d no consumo de ultraprocessados associou-se com um aumento de 4% no risco de desenvolvimento de síndrome metabólica (RR=1,04; IC95% 1,02-1,06). Aqueles no quarto quartil de consumo (>552 g/d), comparados aos do primeiro quartil (6000 kcal were excluded. For the outcome of type 2 diabetes, those who underwent bariatric surgery between visits were also excluded. Consumption of ultra-processed foods or drinks (in increments of 150 grams/day and in quartiles of grams/day) was based on a food frequency questionnaire. The metabolic syndrome was defined by the presence of at least three of five criteria: high fasting glucose, high triglycerides, low HDL cholesterol, high blood pressure, and abdominal obesity. Diabetes was defined by its ascertainment in one of the visits by self-report, use of medication or laboratory tests, or in the annual follow-up interview (on two occasions after the last clinic visit). Results: For the metabolic syndrome analyses, of the 8065 participants investigated, 59% were women, 59% had completed higher education, mean age was 49 years and median UPF consumption 366g/d. After eight years of follow-up, there were 2508 (31%) incident cases of metabolic syndrome. After eight years of follow-up, there were 2508 (31%) incident cases of metabolic syndrome. In robust Poisson regression adjusted for age, sex, center, race/color, income, education, smoking, physical activity, alcohol, energy intake and body mass index (BMI), an increase of 150g/d in UPF consumption was associated with a 4% increase risk of developing metabolic syndrome (RR=1.04; 95%CI 1.02-1.06). Those in the fourth quartile of consumption (>552 g/d), when compared to the first quartile (< 234 g/d), had a 19% increased risk (RR=1.19; 95%CI 1.07-1.32). For the type 2 diabetes analyses of the 10202 participants investigated, 57% were women, 55% were white, mean age was 51 years and mean UPF consumption 440 g/d. There were 1799 (18%) incident cases of type 2 diabetes. In robust Poisson regression with adjustment for age, sex, center, race/color, income, education, family history, energy intake, smoking, physical activity, alcohol, hypertension, red meat, saturated fats, sugar, fiber, BMI and waist circumference, UPF consumption predicted higher risk of incident diabetes (RR 1.05; 95%CI 1.02-1.08), for an increment of 150 g/d. When expressed in 13 quartiles, UPF consumption in the fourth quartile (≥ 566 g/d), compared to the first quartile (< 236 g/d), was associated with a 22% greater risk (RR 1.22; 95% CI 1.06-1.40). The addition of weight gain as a potential mediator did not alter the associations. Conclusion: The consumption of ultra-processed foods predicts a greater incidence of metabolic syndrome and type 2 diabetes, with implications for strategies for the prevention and management of these conditions

Consumo de alimentos ultraprocessados e incidência de sobrepeso e obesidade e alterações longitudinais no peso e na cintura no ELSA-Brasil

Objetivo: Avaliar a associação do consumo de alimentos ultraprocessados com elevados ganhos de peso e cintura e incidência de sobrepeso/obesidade. Desenho: Foram investigados 11.827 adultos (35-74 anos) no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil), um estudo de coorte realizado em seis instituições acadêmicas públicas brasileiras. Com base na classificação NOVA, foi criada a variável de consumo de ultraprocessados (em percentual do consumo energético diário), usada de forma contínua e categorizada. Foram medidos a altura, o peso e a circunferência da cintura na linha de base e novamente após 3,8 anos. Definimos um elevado ganho de peso (1,68 kg/ano) e um elevado ganho de circunferência da cintura (2,42 cm/ano) como ≥ ao percentil 90 da amostra. Resultados: Em média, 24,6% (9,6%) de energia foram provenientes de ultraprocessados. O ganho de peso médio foi de 0,3 (1,2) kg/ano e o ganho de circunferência da cintura foi de 0,7 (1,5) cm/ano. Em regressão logística ajustada para centro, idade, sexo, cor/raça, renda, escolaridade, tabagismo, atividade física e circunferência da cintura para desfecho de ganho de cintura e IMC para os demais desfechos, o consumo maior (4º versus 1º quartil) de ultraprocessados foi associado com chances 32% e 38% maiores de elevados ganhos de peso e cintura, respectivamente (OR= 1,32, IC95%: 1,09-1,60; OR= 1,38; IC95%: 1,14-1,67); chances 38% maiores (OR= 1,38; IC95%: 1,07-1,78) de sobrepeso/obesidade incidente entre aqueles com peso normal na linha de base; e chances 7% maiores, mas não significativas (OR= 1,07; IC95%: 0,81-1,42), de obesidade incidente entre aqueles com excesso de peso na linha de base. Entre os participantes do ELSA, 15% dos elevados ganhos de peso e cintura e, entre aqueles 9 com peso normal na linha de base, dos casos incidentes de sobrepeso/obesidade, podem ser atribuídos ao consumo de ultraprocessados maior do que o primeiro quartil. Conclusões: Maior consumo de ultraprocessados está associado a elevados ganhos em adiposidade geral e central e pode contribuir para o aumento da obesidade observado no mundo.Objective: To evaluate the association of ultra-processed food (UPF) consumption with large weight and waist gains, and incident overweight /obesity. Design: We investigated 11.827 adults (35-74 years) of the Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study conducted at six Brazilian public academic institutions. Based on the NOVA classification, we created a variable of ultraprocessed consumption (expressed in percentage of daily energetic intake), used continuously and categorized. We measured height, weight and waist circumference at baseline and again 3.8 years later. We defined a large weight gain (1.68kg/year) and a large waist circumference gain (2.42cm/year) as those ≥ 90 percentile of the sample. Results: On average, 24.6% (9.6%) of energy came from UPFs. Average weight gain was 0.3 (1.2) kg/year and waist circumference gain 0.7 (1.5) cm/year. In logistic regression analyses adjusting for center, age, sex, color/race, income, school achievement, smoking, physical activity, and waist circumference for waist gain outcome and BMI for the rest of outcomes, greater (4th vs. 1st quartile) consumption of UPFs was associated with 32% and 38% greater odds of having large weight and waist gains, respectively (OR=1.32, 95%CI 1.09-1.60; OR=1.38; 95%CI 1.14-1.67); a 38% greater odds (OR=1.38; 95%CI 1.07-1.78) of incident overweight/obesity among those normo-weight at baseline; and a non-significant 7% greater odds (OR=1.07; 95%CI 0.81-1.42) of incident obesity among those overweight at baseline. Among ELSA participants, 15% of large weight and waist gains, and, among those normo-weight, of incident cases of overweight/obesity, could be attributed to >1st quartile consumption of UPFs. Conclusions: Greater UPF consumption is associated with large gains in overall and central adiposity and may contribute to the rise in obesity seen worldwide

Associations of total legume, pulse, and soy consumption with incident type 2 diabetes : federated meta-analysis of 27 studies from diverse world regions

Background: The consumption of legumes is promoted as part of a healthy diet in many countries but associations of total and types of legume consumption with type 2 diabetes (T2D) are not well established. Analyses across diverse populations are lacking despite the availability of unpublished legume consumption data in prospective cohort studies. Objective: To examine the prospective associations of total and types of legume intake with the risk of incident T2D. Methods: Meta-analyses of associations between total legume, pulse, and soy consumption and T2D were conducted using a federated approach without physical data-pooling. Prospective cohorts were included if legume exposure and T2D outcome data were available and the cohort investigators agreed to participate. We estimated incidence rate ratios (IRRs) and CIs of associations using individual participant data including ≤42,473 incident cases among 807,785 adults without diabetes in 27 cohorts across the Americas, Eastern Mediterranean, Europe, and Western Pacific. Randomeffects meta-analysis was used to combine effect estimates and estimate heterogeneity. Results: Median total legume intake ranged from 0–140 g/d across cohorts. We observed a weak positive association between total legume consumption and T2D (IRR = 1.02, 95% CI: 1.01 to 1.04) per 20 g/d higher intake, with moderately high heterogeneity (I2 = 74%). Analysis by region showed no evidence of associations in the Americas, Eastern Mediterranean, andWestern Pacific. The positive association in Europe (IRR = 1.05, 95% CI: 1.01 to 1.10, I2 = 82%) was mainly driven by studies from Germany, UK, and Sweden. No evidence of associationswas observed for the consumption of pulses or soy. Conclusions: These findings suggest no evidence of an association of legume intakes with T2D in several world regions. The positive association observed in some European studies warrants further investigation relating to overall dietary contexts in which legumes are consumed, including accompanying foods which may be positively associated with T2D

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

A suplementação de ômega 3 na doença de Alzheimer : uma revisão sistemática

Introdução: Conforme aumenta a expectativa de vida, aumentam também as doenças relacionadas ao envelhecimento, lideradas pelas demências. A prevalência da doença de Alzheimer, principal causa de demência, tem estimativas de quadriplicar até 2050. Os ácidos graxos ômega 3 parecem agir nos marcos patológicos cerebrais da doença de Alzheimer. Estudos observacionais têm investigado a relação entre a ingestão de ômega 3, ou suas fontes alimentares, e o desenvolvimento da doença de Alzheimer, sugerindo-o como um fator de proteção. Entretanto, o papel do ômega 3 no tratamento da doença de Alzheimer, quando já existente, não está bem esclarecido na literatura. Objetivo: Revisar, de forma sistemática, os resultados disponíveis na literatura envolvendo intervenções com ômega 3 e seus efeitos relacionados a desfechos na função cognitiva em indivíduos com doença de Alzheimer. Métodos: Foram seguidas as diretrizes estabelecidas pelo PRISMA e foi utilizada a base de dados Pubmed para a seleção de artigos. Foram incluídos estudos originais de intervenção, controlados por placebo, que avaliassem o impacto da suplementação de ácidos graxos ômega 3 em marcadores de função cognitiva, realizados em humanos, até março de 2015, sem limitação para data inicial de publicação, que relacionassem o uso de ômega 3, por suplementação ou ingestão, e o tratamento da doença de Alzheimer. Resultados: A estratégia de busca obteve como resultado um total de 211 artigos, dos quais 5 preencheram os critérios de inclusão. A maioria dos estudos não encontra resultados estatisticamente significativos com a suplementação de ômega 3, comparada ao placebo, e aqueles que demonstram algum benefício o encontram em apenas algumas das escalas avaliadas. Entretanto, os efeitos do ômega 3 parecem mais efetivos nas leves disfunções cognitivas, demonstrado em dois estudos em que houve análise de subgrupos. Conclusão: Os efeitos encontrados da suplementação no Alzheimer leve e nas leves disfunções cognitivas corroboram estudos epidemiológicos observacionais que apontam benefícios do ômega 3 nas fases iniciais da doença, quando ainda há apenas um leve comprometimento da função cerebral. Apesar de alguns estudos terem demonstrado alterações em algumas escalas de função cognitiva, ainda são insuficientes para recomendar a suplementação de ômega 3 no tratamento da doença de Alzheimer.Introduction: As life expectancy increases, there is also an increase in age related diseases, headed by dementias. Alzheimer’s disease prevalence, main cause of dementia, has estimatives to quadruple by 2050. Fatty acids omega 3 seems to act in brain pathologic hallmarks of Alzheimer’s disease. Observational studies have investigated the relation between the ingestion of omega 3, or its food sources, and the development of Alzheimer’s disease, suggesting it as a protection factor. However, the role of omega 3 in Alzheimer’s treatment, when the disease is already established, remains uncertain. Objective: To review, in a systematic way, the results available in the literature involving interventions with omega 3 and its effects related to cognitive function outcomes in Alzheimer’s disease subjects. Methods: The guidelines established by PRISMA were followed and the database Pubmed was used for article’s selection. Were included original intervention studies, controlled by placebo, that assessed the impact of omega 3 supplementation in cognitive function markers, performed in humans, until march 2015, without limitation for prime date of publication, who related the use of omega 3, through supplementation or ingestion, and the treatment of Alzheimer’s disease. Results: The search strategy had as result a total of 211 articles, from which 5 fulfil the inclusion criteria. Most studies do not find statistically significant results with omega 3 supplementation, compared to placebo, and those who demonstrate some benefit do it in only a few assessed scales. However, omega 3’s effects seems more effective in mild cognitive impairments, demonstrated in two studies were subgroups were analyzed. Conclusion: The effects founded from supplementation in mild Alzheimer’s and in mild cognitive impairments corroborates epidemiological observational studies that showed omega 3 benefits in initial phases of the disease, when there is only a mild cerebral function impairment. Despite some studies have demonstrated alterations in some cognitive function scales, they are not sufficient to recommend omega 3’s supplementation in Alzheimer’s disease treatment

Ultra-processed Foods Consumption and Increased Risk of Metabolic Syndrome in Adults – the ELSA-Brasil

   Objective: To investigate the association between ultra-processed food (UPF) consumption and the incidence of metabolic syndrome. Research Design and Methods: From 2008 to 2010, we enrolled 15105 adults, aged 35-74 years, employees from six public education/research institutions to assemble the Longitudinal Study of Adult Health (ELSA-Brasil). We used a food frequency questionnaire to assess UPF consumption (grams/day) at baseline. We then assessed the outcomes of those returning to visits between 2012-2014 and 2017-2019. We defined incident metabolic syndrome by the presence of at least three of the five abnormalities – high fasting glucose, high triglycerides, low HDL cholesterol, high blood pressure, and abdominal obesity, after excluding those meeting such criteria at baseline. We excluded additionally those who had missing data or an implausible energy intake, leaving 8065 participants. Results: The median age was 49, 59% were women, and the median consumption of UPFs was 366 g/day. After eight years, there were 2508 new cases of metabolic syndrome. In robust Poisson regression, adjusting for socio-demographics, behavioral factors, and energy intake, we found a 7% (RR=1.07, 95%CI 1.05-1.08) higher risk of incident metabolic syndrome for an increase of 150 g/day in UPF consumption. Similarly, those in the 4th quartile (compared to the 1st quartile) had a 33% increased risk (RR=1.33; 95%CI 1.20-1.47). Further adjustment for BMI attenuated these associations (respectively, RR=1.04; 95%CI 1.02-1.06; RR=1.19, 95%CI 1.07-1.32). Conclusions: Greater consumption of UPFs is associated with an increased risk of metabolic syndrome. These findings have important implications for diabetes and cardiovascular disease prevention and management.</p