Eduardo Coelho Machado

Prevalência e fatores associados à doença do refluxo gastroesofágico

BACKGROUND O gastroesophageal reflux is a high prevalent disease with prevalence rates ranging from 21 to 56% in different countries. OBJECTIVE To study the epidemiology and the prevalence of gastroesophageal reflux disease among adult population (20 years and old) at the city of Pelotas, southern Brazil. METHODOLOGY A population-based cross-sectional study was conducted. Household interviews were done between October 1999 and January 2000. Association between gastroesophageal reflux disease and age, sex, skin color, years of formal education, income per capita, marital status, psychological variables (insomnia, stressful psychosocial events in the last year, psychological distress), body mass index, smoking and weekly consumption of alcoholic beverages was assessed through logistic regression. RESULTS Three thousands and nine-hundred thirty four (3,934) individuals were interviewed. A prevalence of 31,3% (CI 95% 29.9%-32.8%). After allowing for confounding gastroesophageal reflux disease was significantly associated with female sex, living without partner, low level of formal education, insomnia, psychological distress, reported stressful psychosocial events in the last year, obesity and overweight. CONCLUSION Gastroesophageal reflux disease is a high prevalent disease and its main associated factors are sex, anthropometric variables and psychological characteristics.

Prevalence of weight-loss strategies and use of substances for weight-loss among adults: a population study

This paper concerns a cross-sectional population-based study conducted with adults living in the city of Pelotas, Rio Grande do Sul State, Brazil. It aims to determine the prevalence of weight-loss practices and use of substances for weight-loss during the 12 months preceding the interview. The prevalence of weight-loss attempts was 26.6%. Although dietary control and regular physical exercise were the most commonly used strategies, the prevalence of the combined use of these methods was only 36% for individuals trying to lose weight. The prevalence of use of substances for weight-loss was 12.8% (48.4% of those who tried to lose weight). The use of dietary control and substances was more common among women, while men practiced physical exercise with greater frequency. Teas were the most frequently used substances for weight-loss. Multivariate analysis identified being female, excess weight and self-perception of excess weight as major associated factors for the use of substances for weight-loss. Finally, we found that, although weight-loss attempts are common, the majority of obese individuals do not make attempts to lose weight and only a minority follows the recommended practices.

Prevalência de dispepsia e fatores sociodemográficos

OBJETIVO: Medir a prevalencia e distribuicao de dispepsia e dispepsia frequente por subtipos na populacao com 20 anos ou mais segundo caracteristicas socioeconomicas e demograficas. METODOS: Estudo transversal, de base populacional, com 3.934 individuos moradores na cidade de Pelotas (RS), entrevistados em seus domicilios, de outubro de 1999 a janeiro de 2000. Dispepsia foi definida como dor ou desconforto no andar superior do abdome e/ou nauseas no ano anterior a entrevista (conforme criterios Roma I e II). Dispepsia frequente incluiu o registro de dispepsia mais de seis vezes e/ou nauseas, uma vez por mes ou mais. Esses desfechos foram analisados por idade, sexo, cor da pele, escolaridade, renda e estado civil. Os dados foram analisados por meio do teste qui-quadrado de Pearson de associacao para variaveis categoricas e teste de tendencia linear, quando aplicavel. RESULTADOS: A prevalencia de dispepsia foi de 44,4% e de dispepsia frequente, 27,4%. A prevalencia de dispepsia tipo refluxo, ulcera, dismotilidade e nao especificada foi, respectivamente, 19,4%, 6,3%, 13,9% e 16,6%; para dispepsia frequente foram 14,7%, 4,9%, 11,2% e 6,8%, respectivamente. As mulheres apresentaram cerca de 50% mais dispepsia frequente. Individuos mais jovens e de menor renda apresentaram maiores prevalencias de dispepsia e dispepsia frequente. Analise de acordo com criterios de Roma II mostrou prevalencias de 15,9% e 7,5% para dispepsia e dispepsia frequente, respectivamente. CONCLUSOES: A dispepsia constitui um problema prevalente na populacao estudada. A maioria dos individuos apresentaram mais de um subtipo de dispepsia.

Uma amostra de pacientes com diabetes tipo 1 no sul do Brasil

Objectives: To describe a type 1 diabetes mellitus (DM1) population with regard to demographic, socioeconomic, environmental and management aspects. Design: Series of cases. Participants: 126 DM1 patients, aged up to 30 yrs, with no more than 10 yrs of diagnosis, living in some cities of South Brazil. Results: The patients were 57 men and 69 women, being the age of onset mainly at 11-15 yrs (31%). There were seasonal presentations at diagnosis. The diagnosis of DM was done as outpatients, by symptoms in 61%, due to hospitalization in 22% and ketoacidosis in 18%. Forty-seven percent of the sample injected insulin once daily, 60% of patients performed some self monitoring, one third reused the same syringe six or more times and 50% of insulin was provided by public services. Regarding awareness of hypoglycaemia, 18% of the patients did not know any signal of alert. A significant part of the sample was seen by a specialist in DM (73%). Among the patients with five years or more of DM, 16% of them have never had their eyes examined and 17% had been examined at least two years ago. The onset of DM, assistance by a specialist and provision of insulin was associated with familiar income. Women were on diet more often (p= 0,05) and had more self-injection of insulin (p= 0,01) than men. Conclusions: In this study, socio-economic factors seem to influence the onset of DM, provision of insulin and assistance by a specialist doctor in DM. In general, patients did not have background and skills for self-management of DM.

Accuracy and adequacy of waist circumference cut-off points currently recommended in Brazilian adults

OBJECTIVE To evaluate the adequacy and accuracy of cut-off values currently recommended by the WHO for assessment of cardiovascular risk in southern Brazil. DESIGN Population-based study aimed at determining the predictive ability of waist circumference for cardiovascular risk based on the use of previous medical diagnosis for hypertension, diabetes mellitus and/or dyslipidaemia. Descriptive analysis was used for the adequacy of current cut-off values of waist circumference, receiver operating characteristic curves were constructed and the most accurate criteria according to the Youden index and points of optimal sensitivity and specificity were identified. SETTING Pelotas, southern Brazil. SUBJECTS Individuals (n 2112) aged ≥20 years living in the city were selected by multistage sampling, since these individuals did not report the presence of previous myocardial infarction, angina pectoris or stroke. RESULTS The cut-off values currently recommended by WHO were more appropriate in men than women, with overestimation of cardiovascular risk in women. The area under the receiver operating characteristic curve showed moderate predictive ability of waist circumference in men (0.74, 95% CI 0.71, 0.76) and women (0.75, 95% CI 0.73, 0.77). The method of optimal sensitivity and specificity showed better performance in assessing the accuracy, identifying the values of 95 cm in men and 87 cm in women as the best cut-off values of waist circumference to assess cardiovascular risk. CONCLUSIONS The cut-off values currently recommended for waist circumference are not suitable for women. Longitudinal studies should be conducted to evaluate the consistency of the findings.

Consumo de carnes por adolescentes do Sul do Brasil

OBJETIVO: Descrever a frequencia de consumo de diferentes tipos de carnes conforme variaveis sociodemograficas e nutricionais, e analisar o consumo, em adolescentes do Sul do Brasil, de dieta rica em gordura conforme os tipos de carne consumidos. METODOS: Estudo transversal realizado com adolescentes pertencentes a coorte de nascimentos de 1993, em Pelotas (RS). A frequencia de consumo de carnes vermelhas, brancas, visceras e embutidos foi avaliada por um Questionario de Frequencia de Consumo Alimentar, adaptado para este estudo. A ingestao de dieta rica em gordura foi avaliada a partir do instrumento proposto por Block. As variaveis independentes foram sexo, cor da pele, nivel socioeconomico, escolaridade materna e estado nutricional. Nas analises estatisticas, foram utilizados testes Qui-quadrado de heterogeneidade e de tendencia linear. RESULTADOS: Foram avaliados 4.325 adolescentes com idade media de 14,7, DP=0,3 anos, dos quais 51,2% eram do sexo feminino. A frequencia de consumo diario de carnes vermelhas foi maior do que a de carnes brancas (43,0% e 9,7%, respectivamente). O consumo de embutidos por mais do que quatro vezes por semana foi referido por 48,5% dos individuos, e 81,4% relataram consumir visceras raramente ou nunca. Adolescentes de maior nivel socioeconomico e filhos de maes com maior escolaridade apresentaram maior consumo de carnes vermelhas e embutidos, enquanto aqueles em situacao oposta apresentaram maior consumo de carnes brancas. Adolescentes que consomem carnes com maior frequencia tambem consomem dieta rica em gordura. CONCLUSAO: As carnes consumidas com maior frequencia pelos adolescentes foram as vermelhas e os embutidos. No entanto, adolescentes de maior nivel socioeconomico consomem carnes vermelhas com maior frequencia, enquanto adolescentes menos favorecidos economicamente consomem mais carnes brancas.