Predicting the prevalence of type 2 diabetes in Brazil: a modeling study

AimsWe adopted a modeling approach to predict the likely future prevalence of type 2 diabetes, taking into account demographic changes and trends in obesity and smoking in Brazil. We then used the model to estimate the likely future impact of different policy scenarios, such as policies to reduce obesity.MethodsThe IMPACT TYPE 2 DIABETES model uses a Markov approach to integrate population, obesity, and smoking trends to estimate future type 2 diabetes prevalence. We developed a model for the Brazilian population from 2006 to 2036. Data on the Brazilian population in relation to sex and age were collected from the Brazilian Institute of Geography and Statistics, and data on the prevalence of type 2 diabetes, obesity, and smoking were collected from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL).ResultsThe observed prevalence of type 2 diabetes among Brazilians aged over 25 years was 10.8% (5.2–14.3%) in 2006, increasing to 13.7% (6.9–18.4%) in 2020. Between 2006 and 2020, the observed prevalence in men increased from 11.0 to 19.1% and women from 10.6 to 21.3%. The model forecasts a dramatic rise in prevalence by 2036 (27.0% overall, 17.1% in men and 35.9% in women). However, if obesity prevalence declines by 1% per year from 2020 to 2036 (Scenario 1), the prevalence of diabetes decreases from 26.3 to 23.7, which represents approximately a 10.0% drop in 16 years. If obesity declined by 5% per year in 16 years as an optimistic target (Scenario 2), the prevalence of diabetes decreased from 26.3 to 21.2, representing a 19.4% drop in diabetes prevalence.ConclusionThe model predicts an increase in the prevalence of type 2 diabetes in Brazil. Even with ambitious targets to reduce obesity prevalence, type 2 diabetes in Brazil will continue to have a large impact on Brazilian public health

Reprodutibilidade, consistência interna e validade de construto do KIDSCREEN-27 em adolescentes brasileiros

Resumo: O objetivo deste trabalho foi estimar reprodutibilidade, consistência interna e validade de construto do KIDSCREEN-27, questionário para mensurar a qualidade de vida relacionada à saúde, em adolescentes brasileiros. Foi realizado um estudo para estimar a reprodutibilidade (176 adolescentes, 59,7% do sexo feminino, 64,7% de 10-12 anos de idade) e outro para estimar a consistência interna e a validade (1.321 adolescentes, 53,7% do sexo feminino, 56,9% de 10-12 anos de idade). Os estudos foram realizados com adolescentes de ambos os sexos, de escolas públicas, no Município de João Pessoa, Paraíba, Brasil. O KIDSCREEN-27 contém 27 itens distribuídos em cinco domínios (bem-estar físico, 5 itens; bem-estar psicológico, 7 itens; pais e suporte social, 7 itens; autonomia e relação com os pais, 4 itens; ambiente escolar, 4 itens). Para estimar a reprodutibilidade, recorreu-se ao coeficiente de correlação intraclasse - CCI. A análise fatorial confirmatória foi utilizada para avaliar a validade de construto, e o índice de fidedignidade combinada (IFC) para verificar a consistência interna do questionário. Os CCI foram iguais ou superiores a 0,70 (0,70-0,96). As cargas fatoriais foram superiores a 0,40, exceto para cinco itens (0,28-0,39). Os indicadores de qualidade de ajuste do modelo foram adequados (χ2/df = 2,79; RMR = 0,035; RMSEA = 0,037; GFI = 0,951; AGFI = 0,941; CFI = 0,908; TLI = 0,901). O IFC variou de 0,65 a 0,70 nos domínios e foi igual a 0,90 para o questionário. O KIDSCREEN-27 alcançou níveis satisfatórios de reprodutibilidade, consistência interna e validade de construto, podendo ser utilizado para avaliar a qualidade de vida relacionada à saúde em adolescentes de 10-15 anos de idade

Índice de conicidade como preditor de alterações no perfil lipídico em adolescentes de uma cidade do Nordeste do Brasil

Resumo: O objetivo foi avaliar o indice de conicidade (Índice C) como preditor de alterações no perfil lipídico em adolescentes e estabelecer seus pontos de corte. Estudo transversal com 774 adolescentes de ambos os sexos (55% do sexo feminino), de 10 a 14 anos de idade. O Índice C foi calculado de acordo com a fórmula proposta por Valdez, considerando as medidas de massa corporal, estatura e circunferência da cintura (CC). As alterações no perfil lipídico dos adolescentes foram definidas segundo uma das seguintes condições: elevados níveis de colesterol total, lipoproteína de alta densidade (LDL), triglicerídeos e níveis baixos de lipoproteína de baixa densidade (HDL). O poder preditivo do Índice C para alterações no perfil lipídico, assim como seus pontos de corte, foi determinado por meio das curvas ROC (Receiver Operating Characteristic). O Índice C foi um bom preditor para alterações lipídicas em adolescentes, com destaque para os níveis de triglicerídeos em adolescentes do sexo masculino de 10 a 11 anos (ROC = 0,67; IC95%: 0,50-0,85) e de 12 a 14 anos (ROC = 0,69; IC95%: 0,59-0,80), assim como em adolescentes do sexo feminino de 10 a 11 anos (ROC = 0,65; IC95%: 0,50-0,79); e LDL em adolescentes do sexo feminino de 10 a 11 anos (ROC = 0,70; IC95%: 0,59-0,80) e adolescentes do sexo masculino (ROC = 0,65; IC95%: 0,55-0,75) e adolescentes do sexo feminino (ROC = 0,62; IC95%: 0,50-0,75) de 12 a 14 anos. Os pontos de corte do Índice C variaram de 1,12 a 1,16 entre meninos e meninas. O Índice C pode ser utilizado para predizer alterações lipídicas, bem como seus pontos de corte podem ser utilizados para triagem de adolescentes em risco de alterações no perfil lipídico

Association between sedentary behavior, diet and nutritional status in adolescents: baseline results from the LONCAAFS Study

The aim of the present study was to analyze the relationship between time spent engaged in sedentary behaviors, type of diet, and overweight in adolescents. A cross-sectional study using data from the Longitudinal Study on Sedentary Behavior, Physical Activity, Eating Habits, and Health of Adolescents - LONCAAFS Study. A total of 1,438 adolescents (10 to 14 years old) from public schools in the city of João Pessoa, Brazil, participated in the study. To evaluate the combined effects of excessive time in sedentary behavior and consumption from two food groups: Convenience and Prudent on overweight, we performed multiple logistic regression analyses, adjusted for energy, level of physical activity, sex, and age. Excessive time in sedentary behavior increased the chance of adolescents being overweight by 37% (OR = 1.37; 95%CI: 1.04-1.80). This chance increased to 43% when the adolescents were simultaneously engaged in excessive sedentary behavior and had high consumption of the Convenience food group (OR = 1.43; 95%CI: 1.05-1.94) and increased to 39% on those who engaged in excessive sedentary behavior and had low consumption of foods from the Prudent (OR = 1.39; 95%CI: 1.04-1.84). Excessive sedentary behavior is associated with being overweight and the chance increases with the consumption of convenient foods

Costs of obesity attributable to the consumption of sugar-sweetened beverages in Brazil

Abstract Excess sugar is considered one of the primary factors contributing to overweight status. In Brazil, sugar-sweetened beverages (SSBs) contain a significant amount of this nutrient and are consumed excessively. These beverages are associated with adverse health outcomes and impose costs on the healthcare system. The literature currently lacks studies that aim to attribute specific nutrients or foods as causes of diseases and also evaluate their economic impact, especially in middle- and low-income countries. This study aims to estimate the direct and indirect costs of obesity, stratified by sex and age group, resulting from the excessive consumption of sugar-sweetened beverages in Brazil from 2008 to 2020, and to project these costs for the year 2036. The estimation of obesity costs attributable to excessive consumption of SSBs was based on relative risks and the population prevalence of obesity, considering expenditures on hospitalizations and outpatient procedures in the Unified Health System (SUS). Cost information was obtained from the health information systems available at SUS. The highest burden attributable to the consumption of SSBs was observed among younger individuals and progressively decreased with advancing age. The total direct costs in the period between 2008 and 2020 amounted to approximately US$6.33 million, 87$ 40 million due to the premature loss of productivity. The total costs of obesity attributable to the consumption of SSBs are substantial, impacting public spending and generating social and productivity losses that burden the economy. It is crucial to develop and implement cost-effective fiscal and regulatory policies aimed at preventing and combating obesity

Data_Sheet_1_Predicting the prevalence of type 2 diabetes in Brazil: a modeling study.PDF

AimsWe adopted a modeling approach to predict the likely future prevalence of type 2 diabetes, taking into account demographic changes and trends in obesity and smoking in Brazil. We then used the model to estimate the likely future impact of different policy scenarios, such as policies to reduce obesity.MethodsThe IMPACT TYPE 2 DIABETES model uses a Markov approach to integrate population, obesity, and smoking trends to estimate future type 2 diabetes prevalence. We developed a model for the Brazilian population from 2006 to 2036. Data on the Brazilian population in relation to sex and age were collected from the Brazilian Institute of Geography and Statistics, and data on the prevalence of type 2 diabetes, obesity, and smoking were collected from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL).ResultsThe observed prevalence of type 2 diabetes among Brazilians aged over 25 years was 10.8% (5.2–14.3%) in 2006, increasing to 13.7% (6.9–18.4%) in 2020. Between 2006 and 2020, the observed prevalence in men increased from 11.0 to 19.1% and women from 10.6 to 21.3%. The model forecasts a dramatic rise in prevalence by 2036 (27.0% overall, 17.1% in men and 35.9% in women). However, if obesity prevalence declines by 1% per year from 2020 to 2036 (Scenario 1), the prevalence of diabetes decreases from 26.3 to 23.7, which represents approximately a 10.0% drop in 16 years. If obesity declined by 5% per year in 16 years as an optimistic target (Scenario 2), the prevalence of diabetes decreased from 26.3 to 21.2, representing a 19.4% drop in diabetes prevalence.ConclusionThe model predicts an increase in the prevalence of type 2 diabetes in Brazil. Even with ambitious targets to reduce obesity prevalence, type 2 diabetes in Brazil will continue to have a large impact on Brazilian public health.</p

The direct correlation between oxidative stress and LDL-C levels in adults is maintained by the Friedewald and Martin equations, but the methylation levels in the MTHFR and ADRB3 genes differ.

Low-density lipoprotein (LDL-C) concentrations are a standard of care in the prevention of cardiovascular disease and are influenced by different factors. This study compared the LDL-C concentrations estimated by two different equations and determined their associations with inflammatory status, oxidative stress, anthropometric variables, food intake and DNA methylation levels in the LPL, ADRB3 and MTHFR genes. A cross-sectional population-based study was conducted with 236 adults (median age 37.5 years) of both sexes from the municipality of João Pessoa, Paraíba, Brazil. The LDL-C concentrations were estimated according to the Friedewald and Martin equations. LPL, ADRB3 and MTHFR gene methylation levels; malondialdehyde levels; total antioxidant capacity; ultra-sensitive C-reactive protein, alpha-1-acid glycoprotein, homocysteine, cobalamin, and folic acid levels; usual dietary intake; and epidemiological variables were also determined. For each unit increase in malondialdehyde concentration there was an increase in the LDL-C concentration from 6.25 to 10.29 mg/dL (p <0.000). Based on the Martin equation (≥70 mg/dL), there was a decrease in the DNA methylation levels in the ADRB3 gene and an increase in the DNA methylation levels in the MTHFR gene (p <0.05). There was a positive relation of homocysteine and cholesterol intake on LDL-C concentrations estimated according to the Friedewald equation and of waist circumference and age based on the two estimates. It is concluded the LDL-C concentrations estimated by the Friedewald and Martin equations were different, and the Friedewald equation values were significantly lower than those obtained by the Martin equation. MDA was the variable that was most positively associated with the estimated LDL-C levels in all multivariate models. Significant relationships were observed based on the two estimates and occurred for most variables. The methylation levels of the ADRB3 and MTHFR genes were different according to the Martin equation at low LDL-C concentrations (70 mg/dL)

Decrease of the DNA methylation levels of the ADRB3 gene in leukocytes is related with serum folate in eutrophic adults

Abstract Background DNA methylation has been evidenced as a potential epigenetic mechanism related to various candidate genes to development of obesity. Therefore, the objective of this study was to evaluate the DNA methylation levels of the ADRB3 gene by body mass index (BMI) in a representative adult population, besides characterizing this population as to the lipid profile, oxidative stress and food intake. Methods This was a cross-sectional population-based study, involving 262 adults aged 20–59 years, of both genders, representative of the East and West regions of the municipality of João Pessoa, Paraíba state, Brazil, in that were evaluated lifestyle variables and performed nutritional, biochemical evaluation and DNA methylation levels of the ADRB3 gene using high resolution melting method. The relationship between the study variables was performed using analyses of variance and multiple regression models. All results were obtained using the software R, 3.3.2. Results From the stratification of categories BMI, was observed a difference in the average variables values of age, waist-to-height ratio, waist-to-hip ratio, waist circumference, triglycerides and intake of trans fat, which occurred more frequently between the categories “eutrophic” and “obesity”. From the multiple regression analysis in the group of eutrophic adults, it was observed a negative relationship between methylation levels of the ADRB3 gene with serum levels of folic acid. However, no significant relation was observed among lipid profile, oxidative stress and food intake in individuals distributed in the three categories of BMI. Conclusions A negative relationship was demonstrated between methylation levels of the ADRB3 gene in eutrophic adults individuals with serum levels of folic acid, as well as with the independent gender of BMI, however, was not observed relation with lipid profile, oxidative stress and variables of food intake. Regarding the absence of relationship with methylation levels of the ADRB3 gene in the categories of overweight, mild and moderate obesity, the answer probably lies in the insufficient amount of body fat to initiate inflammatory processes and oxidative stress with a direct impact on methylation levels, what is differently is found most of the times in exacerbated levels in severe obesity

α-Tocopherol influences glycaemic control and miR-9-3 DNA methylation in overweight and obese women under an energy-restricted diet: a randomized, double-blind, exploratory, controlled clinical trial

Abstract Background Excess weight is a strong risk factor for the development of dysglycaemia. It has been suggested that changes in the metabolism microRNAs, small non-coding RNAs that regulate gene expression, could precede late glycaemic changes. Vitamin E in turn may exert important functions in methylation and gene expression processes. This study aimed to determine the effect of α-tocopherol on glycaemic variables and miR-9-1 and miR-9-3 promoter DNA methylation in overweight women. Methods A randomized, double-blind, exploratory, placebo-controlled study was conducted in overweight and obese adult women (n = 44) who ingested synthetic vitamin E (all-rac-α-tocopherol), natural source vitamin E (RRR-rac-α-tocopherol) or placebo capsules and were followed up for a period of 8 weeks. Supplemented groups also received dietary guidance for an energy-restricted diet. An additional group that received no supplementation and did not follow an energy-restricted diet was also followed up. The intervention effect was evaluated by DNA methylation levels (quantitative real-time PCR assay) and anthropometric and biochemical variables (fasting plasma glucose, haemoglobin A1C, insulin, and vitamin E). Results Increased methylation levels of the miR-9-3 promoter region (P < 0.001) and reduced haemoglobin A1C (P < 0.05) were observed in the natural source vitamin E group after intervention. Increased fasting plasma glucose was observed in the synthetic vitamin E group, despite the significant reduction of anthropometric variables compared to the other groups. Conclusions α-Tocopherol from natural sources increased methylation levels of the miR-9-3 promoter region and reduced haemoglobin A1C in overweight women following an energy-restricted diet. These results provide novel information about the influence of vitamin E on DNA methylation. Trial registration ClinicalTrials.gov, NCT02922491. Registered 4 October, 2016