Erly Catarina de Moura

Socioeconomic status and obesity in adult populations of developing countries: a review

A landmark review of studies published prior to 1989 on socioeconomic status (SES) and obesity supported the view that obesity in the developing world would be essentially a disease of the socioeconomic elite. The present review, on studies conducted in adult populations from developing countries, published between 1989 and 2003, shows a different scenario for the relationship between SES and obesity. Although more studies are necessary to clarify the exact nature of this relationship, particularly among men, three main conclusions emerge from the studies reviewed: 1. Obesity in the developing world can no longer be considered solely a disease of groups with higher SES. 2. The burden of obesity in each developing country tends to shift towards the groups with lower SES as the countrys gross national product (GNP) increases. 3. The shift of obesity towards women with low SES apparently occurs at an earlier stage of economic development than it does for men. The crossover to higher rates of obesity among women of low SES is found at a GNP per capita of about US

Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989-2003)

2500, the mid-point value for lower-middle-income economies. The results of this review reinforce the urgent need to: include obesity prevention as a relevant topic on the public health agenda in developing countries; improve the access of all social classes in these countries to reliable information on the determinants and consequences of obesity; and design and implement consistent public actions on the physical, economic, and sociocultural environment that make healthier choices concerning diet and physical activity feasible for all. A significant step in this direction was taken with the approval of the Global Strategy on Diet, Physical Activity and Health by the World Health Assembly in May 2004.

Monitoramento de fatores de risco para doenças crônicas por entrevistas telefônicas

OBJECTIVE To evaluate the evolution in smoking indicators in the adult Brazilian population between 1989 and 2003. METHODS We compared age-adjusted prevalence ratios and means for smoking indicators, stratified by age, sex and sociodemographic variables, obtained from two comparable household surveys that used probabilistic sampling of the Brazilian population aged > 18 years (n = 34 808 in 1989 and n = 5000 in 2003). FINDINGS Between 1989 and 2003, there was a substantial decrease in the prevalence of smoking (from 34.8% to 22.4%; age-adjusted prevalence ratio, 0.65; 95% confidence interval, CI, 0.60-0.70) and a modest reduction in the mean number of cigarettes smoked per day (from 13.3 to 11.6; age-adjusted difference, -1.8; 95% CI, -2.6 - -1.0). Reductions in the prevalence and intensity of smoking were greater among males, younger age groups and higher socioeconomic strata. CONCLUSION The prevalence of smoking in the adult Brazilian population declined by 35% between 1989 and 2003, or an average of 2.5% per year. This exceptional reduction surpasses those seen in other countries that implemented wide-ranging and rigorous policies for controlling smoking during the same period. The more intense decline in smoking in younger age groups was consistent with the concentration of efforts of the Brazilian tobacco control programme to prevent the onset of smoking among youths and the total prohibition of cigarette advertising. We recommend the intensification of programme initiatives targeting women and less economically favoured population strata.

Prevalência de excesso de peso e obesidade e fatores associados, Brasil, 2006

OBJETIVO: Descrever metodos e resultados iniciais de sistema de monitoramento de fatores de risco para doencas cronicas nao transmissiveis por meio de entrevistas telefonicas. METODOS: Estudou-se amostra probabilistica (n=2.122) da populacao adulta do Municipio de Sao Paulo residente em domicilios conectados a rede de telefonia fixa, com amostragem realizada em duas etapas: sorteio de linhas telefonicas e sorteio do morador do domicilio a ser entrevistado. Foi aplicado questionario para investigar caracteristicas demograficas e socioeconomicas, padrao de alimentacao e de atividade fisica, consumo de cigarros e de bebidas alcoolicas, peso e altura recordados e auto-referencia a diagnostico medico de hipertensao arterial e diabetes, entre outros quesitos. Foram calculadas estimativas sobre a prevalencia de fatores de risco selecionados para doencas cronicas nao transmissiveis para a populacao adulta com telefone e para a populacao adulta total do municipio. Neste ultimo caso, populacao total, foram aplicados a amostra fatores de ponderacao que levaram em conta diferencas demograficas e socioeconomicas entre a populacao com telefone e a populacao total do municipio. RESULTADOS: Foram observadas diferencas substanciais entre os sexos quanto a frequencia da maioria dos fatores de risco estudados, sendo significativamente mais frequentes em homens o consumo insuficiente de frutas e hortalicas, o consumo excessivo de bebidas alcoolicas e o excesso de peso; e nas mulheres foram mais frequentes o sedentarismo e a hipertensao. Possibilidades adicionais de estratificacao da prevalencia de fatores de risco permitidas pelo sistema de monitoramento foram ilustradas a partir de exemplos abrangendo faixa etaria, nivel de escolaridade e area de residencia na cidade dos entrevistados. CONCLUSOES: O desempenho do sistema de monitoramento, avaliado a partir da representatividade e confiabilidade das estimativas obtidas e do custo por entrevista realizada, mostrou-se adequado e, de modo geral, superior a sistemas equivalentes existentes em paises desenvolvidos. O custo por entrevista realizada foi oito vezes inferior ao custo estimado por sistemas semelhantes existentes em paises desenvolvidos e quatro a oito vezes inferior ao custo de inqueritos domiciliares tradicionais realizados no Municipio de Sao Paulo.OBJECTIVE To describe methods and initial findings of a surveillance system of risk factors for chronic non-communicable diseases (CNCDs) based on telephone interviews. METHODS Interviews undertaken in a random sample of the adult population of the Municipality of Sao Paulo living in households with telephone. Sampling was done in two steps and included the random selection of households and the random selection of the household member to be interviewed. The systems questionnaire investigated demographic and socioeconomic characteristics, food consumption and physical activity patterns, smoking, consumption of alcoholic beverages, recalled weight and height and reported medical diagnoses of hypertension and diabetes, among other topics. Prevalence estimates of selected risk factors for CNCDs were calculated for the adult population with telephone and for the citys entire adult population. In this last case, we applied sample weighting factors that took into account demographic and socioeconomic differences between the adult population with telephone and the entire adult population of the municipality. RESULTS Strong differences between sexes were found for most risk factors: low consumption of fruit and vegetables, high consumption of alcohol and overweight were more frequent among men while sedentary lifestyle and hypertension were more frequent among women. Additional possibilities of stratification of risk factor prevalences allowed by the surveillance system are illustrated using age groups, schooling, and place of residence in the city. CONCLUSIONS System performance was considered as good and was better than the performance observed in similar systems operating in developed countries when evaluated with basis on the representativeness and reliability of the estimates and on costs. The cost per concluded interview was eight times lower than the cost usually seen in similar systems in developed countries and four to eight times lower than the cost of traditional household surveys undertaken in the city of Sao Paulo.

Practice of physical activities and associated factors in adults, Brazil, 2006

OBJETIVO: Estimar a prevalencia de excesso de peso e obesidade e fatores associados. METODOS: Foram analisados dados referentes a individuos com idade >18 anos entrevistados pelo sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (VIGITEL), realizado nas capitais brasileiras e Distrito Federal em 2006. Para 49.395 individuos, o indice de massa corporal (IMC) foi utilizado para identificar excesso de peso (IMC 25-30 kg/m2) e obesidade (IMC >30 kg/m2). Prevalencia e razoes de prevalencia foram apresentadas segundo variaveis sociodemograficas, escolaridade e condicao de saude/comorbidades e auto-avaliacao da saude, estratificadas por sexo. Utilizou-se regressao de Poisson para analises brutas e ajustadas por idade. RESULTADOS: A prevalencia de excesso de peso foi de 47% para os homens e 39% para as mulheres, e de obesidade, 11% para ambos os sexos. Observou-se associacao direta entre excesso de peso e escolaridade entre homens, e associacao inversa entre mulheres. Obesidade foi mais frequente entre os homens que viviam com companheira e nao esteve associada com escolaridade ou cor da pele. As prevalencias de excesso de peso e obesidade foram mais altas entre mulheres negras e que viviam com companheiro. A presenca de diabetes, hipertensao arterial sistemica e dislipidemias, bem como considerar sua saude como regular ou ruim, tambem foram referidas pelos entrevistados com excesso de peso ou obesidade. CONCLUSOES: Enquanto cerca de um de cada dois entrevistados foram classificados com excesso de peso, obesidade foi referida por um de cada dez entrevistados. Variaveis socioeconomicas e demograficas, bem como morbidades referidas, foram associadas com excesso de peso e obesidade. Esses resultados foram similares aqueles encontrados em outros estudos brasileiros.OBJECTIVE To estimate the prevalence of overweight and obesity and factors associated. METHODS The study analyzed data referring to individuals aged 18 years or older interviewed through the system Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-based surveillance of risk and protective factors for chronic diseases), carried out in the Brazilian capitals and Federal District in 2006. For 49,395 individuals, the body mass index (BMI) was used to identify overweight (BMI > or = 25 kg/m2) and obesity (BMI > or = 30 kg/m2). Prevalence and prevalence ratios were presented according to sociodemographic variables, level of schooling, health condition/comorbidities, and self-evaluation of health, stratified by sex. Poisson regression was employed for crude and age-adjusted analyses. RESULTS The prevalence of overweight was of 47% for men and 39% for women, obesity was around 11% for both sexes. Direct association was observed between overweight and level of schooling among men and inverse association among women. Obesity was more frequent among men living with a partner and was associated neither with level of schooling nor skin color. The prevalence of overweight and obesity was higher among black women and women who lived with a partner. The presence of diabetes, systemic arterial hypertension and dyslipidemias, as well as the subject perceiving his/her health as regular or poor, were also reported by the interviewees with overweight or obesity. CONCLUSIONS While approximately one out of every two interviewees was classified as being overweight, obesity was reported by one out of every ten interviewed subjects. Socioeconomic and demographic variables, as well as reported morbidities, were associated with overweight and obesity. These results were similar to the ones found in other Brazilian studies.

Freqüência de hipertensão arterial e fatores associados: Brasil, 2006

OBJETIVO: Estimar a prevalencia da pratica de atividades fisicas por adultos e sua associacao com fatores sociodemograficos e ambientais. METODOS: Foram utilizados dados do Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico coletados em 2006. Os 54.369 adultos entrevistados residiam em domicilios com linha telefonica fixa nas capitais brasileiras e Distrito Federal. A pratica de atividades fisicas foi considerada nos dominios do lazer, trabalho, atividade domestica e deslocamento. As variaveis estudadas incluiram caracteristicas sociodemograficas dos individuos e ambientais das cidades; a associacao com as atividades fisicas foi analisada segundo sexo. RESULTADOS: As proporcoes de individuos ativos foram de 14,8% no lazer, 38,2% no trabalho, 11,7% no deslocamento e 48,5% nas atividades domesticas. Indices superiores a 60% de inativos no lazer foram observados em dez capitais. Os homens foram mais ativos que as mulheres em todos os dominios, exceto nas atividades domesticas. A proporcao de individuos ativos decresceu com o aumento da idade. A escolaridade associou-se diretamente com a atividade fisica no lazer. Os homens ativos no deslocamento tiveram maior chance de ser ativos no lazer, enquanto que as pessoas inativas no trabalho tiveram maior chance de serem ativas no lazer. A existencia de local para praticar atividades fisicas proximo a residencia associou-se a atividade fisica no lazer. CONCLUSOES: Os resultados obtidos sao importantes para o monitoramento dos niveis de atividades fisicas no Brasil. Para a promocao das atividades fisicas, deve-se considerar as diferencas entre homens e mulheres, as diferencas nas faixas etarias e nos niveis de escolaridade. Deve-se investir principalmente na promocao das atividades fisicas no lazer e como forma de deslocamento e em locais adequados para a pratica proximos as residencias.OBJECTIVE To estimate the prevalence of physical activity practice in adults and its association with sociodemographic and environmental factors. METHODS Data from the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases) were collected in 2006. All the 54,369 adults interviewed lived in households with a fixed telephone line, in the Brazilian state capitals and Federal District. Physical activity practice was considered in the leisure-time, occupational, transportation and household domains. Variables studied included sociodemographic characteristics of individuals and environmental characteristics of cities. Association with physical activities was analyzed according to sex. RESULTS Proportions of active individuals were 14.8% for leisure time, 38.2% for occupation, 11.7% for transportation, and 48.5% for household chores. Indices above 60% of inactive individuals in the leisure-time domain were observed in ten capitals. Men were more active than women in all domains, except for household chores. The proportion of active individuals decreased with age. Level of education was directly associated with physical activity in leisure time. Active men in the transportation domain were more likely to be active in their leisure time, while inactive people in the occupational domain were more likely to be active in their leisure time. The existence of places to perform physical activities near the home was associated with physical activity in leisure time. CONCLUSIONS Results obtained are important to monitor physical activity levels in Brazil. Differences between men and women and those in age groups and levels of education must be considered to promote physical activities. Promotion of physical activities in the leisure and transportation domains and in places that are adequate for physical activity practice and near the home should be encouraged.

Fatores associados ao consumo de frutas e hortaliças no Brasil, 2006

OBJECTIVE To analyze the frequency of self-reported systemic arterial hypertension and associated factors. METHODS Study based on data provided by the system of Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-based surveillance of risk and protective factors for chronic diseases), collected in 2006 in Brazils capitals and Federal District. The frequency of systemic arterial hypertension was estimated in 54,369 adults, stratified by sex, geographic region, sociodemographic and behavioral variables and self-reported morbidities. Crude odds ratios of hypertension were calculated, as well as odds ratios adjusted for the studys variables. RESULTS The frequency of self-reported hypertension was 21.6%. It was higher among women (24.4% versus 18.4%), lower in the North and Central-West regions and higher in the Southeast region. The frequency of hypertension increased with age, decreased with level of schooling, was higher among blacks and widowed subjects, and lower among singles. The chance of hypertension, adjusted for confounding variables, was higher in subjects with overweight, diabetes, dyslipidemia and cardiovascular events. CONCLUSIONS Around one fifth of the population reported suffering from systemic arterial hypertension. The high frequencies of modifiable risk factors indicate the population segments on which intervention should be targeted, aiming to prevent and control hypertension.OBJETIVO: Analisar a frequencia de hipertensao arterial sistemica auto-referida e fatores associados. METODOS: Estudo baseado em dados do sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (VIGITEL), coletados em 2006 nas capitais brasileiras e Distrito Federal. Estimou-se a frequencia de hipertensao arterial sistemica entre 54.369 adultos, estratificada por sexo, regiao geografica, variaveis sociodemograficas e comportamentais e morbidades auto-referidas. Foram calculadas os odds ratios brutos de hipertensao e ajustados para variaveis do estudo. RESULTADOS: A frequencia de hipertensao auto-referida foi de 21,6%, maior entre mulheres (24,4% versus 18,4%), menor nas regioes Norte e Centro-Oeste e maior na Sudeste. A frequencia de hipertensao aumentou com a idade, diminuiu com a escolaridade, foi maior entre negros e viuvos e menor entre solteiros. A chance de hipertensao, ajustada para variaveis de confusao, foi maior para os individuos com excesso de peso, diabetes, dislipidemia e de eventos cardiovasculares. CONCLUSOES: Cerca de um quinto da populacao referiu ser portadora de hipertensao arterial sistemica. As altas frequencias de fatores de risco modificaveis indicam os segmentos populacionais alvos de intervencao, visando a prevencao e controle da hipertensao.

Prevalence of smoking among adults residing in the Federal District of Brasília and in the state capitals of Brazil, 2008

OBJECTIVE To estimate the frequency of fruit and vegetable consumption and associated factors. METHODS A total of 54,369 individuals aged > or = 18 years living in Brazilian state capitals and the Federal District in 2006 were interviewed through the system Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--telephone-based surveillance of risk and protective factors for chronic diseases). The food consumption indicators used were regular intake of fruits and vegetables (> or = 5 days/week) and adequate intake (> or = 5 times/day). The prevalence of the indicators and their confidence intervals, stratified according to sex, were calculated. To analyze associations between sociodemographic variables, crude odds ratios were calculated and then adjusted for sex, age, schooling level and marital status. RESULTS Less than half of the individuals said that they regularly consumed fruits (44.1%) or vegetables (43.8%), while 23.9% said they regularly consumed both fruits and vegetables. Adequate intake was reported by 7.3% of the interviewees. Fruit and vegetable consumption varied between the cities studied, was greater among women and increased with increasing age and schooling level. CONCLUSIONS Initiatives for promoting fruit and vegetable consumption need to address both the whole population and, especially, cities in the Northern and Northeastern regions of Brazil, young people, men and the population strata of low schooling level.OBJETIVO: Estimar a frequencia do consumo de frutas e hortalicas e fatores associados. METODOS: Foram estudados 54.369 individuos com idade >18 anos, entrevistados pelo sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (VIGITEL) nas capitais brasileiras e Distrito Federal, em 2006. Os indicadores do consumo alimentar foram: consumo regular (>5 dias/semana) de frutas e hortalicas e consumo adequado (>5 vezes/dia). Calculou-se a prevalencia dos indicadores e intervalos de confianca, estratificada por sexo. Para analisar a associacao das variaveis sociodemograficas foram calculados odds ratio bruta e ajustada por sexo, idade, escolaridade e estado civil. RESULTADOS: Menos da metade dos individuos referiu consumo regular de fruta (44,1%) ou hortalicas (43,8%), enquanto 23,9% referiram consumo regular de frutas e hortalicas em conjunto; o consumo adequado foi referido por 7,3% dos entrevistados. O consumo de frutas e hortalicas variou entre as cidades estudadas, foi maior entre as mulheres e aumentou com a idade e escolaridade. CONCLUSOES: Iniciativas de promocao do consumo de frutas e hortalicas devem atender a populacao como um todo, especialmente as cidades das regioes Norte e Nordeste, aos jovens, aos homens e aos estratos populacionais com baixa escolaridade.

Prática de atividades físicas e fatores associados em adultos, Brasil, 2006

OBJECTIVE To determine the prevalence of smoking in the adult population of Brazil, in order to propose recommendations for the reduction of tobacco use. METHODS This was a population-based, cross-sectional study including a sample composed of residents (> 18 years of age) of the capital cities of 26 Brazilian states and in the Federal District of Brasília, Brazil. For the determination of sample size, a 95% confidence interval and a 2% sample error were defined. The participants were selected and interviewed by means of the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL, Telephone-based System for the Surveillance of Risk and Protective Factors for Chronic Diseases).The proportion of smokers and the number of cigarettes smoked per day were estimated and stratified according to sociodemographic variables. In addition, the male/female ratio was estimated for the prevalence of smoking. RESULTS The prevalence of smoking was 16.1% (20.5% among males and 12.4% among females). The proportion of adults that reported smoking > 20 cigarettes a day was 4.9%, being greater in males (6.5% vs. 3.6%). The prevalence of smoking was greater among individuals with a lower level of education (< 8 years of schooling). The number of cigarettes smoked per day by males was approximately the double that smoked by females. CONCLUSIONS The VIGITEL estimates indicate a reduction in the prevalence of smoking, which was, however, still greater among males than among females. The VIGITEL has been fundamental to monitoring smoking, as well as to informing decisions regarding public policies for health promotion and the prevention of chronic nontransmissible diseases.

Auto-avaliação da saúde e fatores associados, Brasil, 2006

OBJETIVO: Estimar a prevalencia da pratica de atividades fisicas por adultos e sua associacao com fatores sociodemograficos e ambientais. METODOS: Foram utilizados dados do Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico coletados em 2006. Os 54.369 adultos entrevistados residiam em domicilios com linha telefonica fixa nas capitais brasileiras e Distrito Federal. A pratica de atividades fisicas foi considerada nos dominios do lazer, trabalho, atividade domestica e deslocamento. As variaveis estudadas incluiram caracteristicas sociodemograficas dos individuos e ambientais das cidades; a associacao com as atividades fisicas foi analisada segundo sexo. RESULTADOS: As proporcoes de individuos ativos foram de 14,8% no lazer, 38,2% no trabalho, 11,7% no deslocamento e 48,5% nas atividades domesticas. Indices superiores a 60% de inativos no lazer foram observados em dez capitais. Os homens foram mais ativos que as mulheres em todos os dominios, exceto nas atividades domesticas. A proporcao de individuos ativos decresceu com o aumento da idade. A escolaridade associou-se diretamente com a atividade fisica no lazer. Os homens ativos no deslocamento tiveram maior chance de ser ativos no lazer, enquanto que as pessoas inativas no trabalho tiveram maior chance de serem ativas no lazer. A existencia de local para praticar atividades fisicas proximo a residencia associou-se a atividade fisica no lazer. CONCLUSOES: Os resultados obtidos sao importantes para o monitoramento dos niveis de atividades fisicas no Brasil. Para a promocao das atividades fisicas, deve-se considerar as diferencas entre homens e mulheres, as diferencas nas faixas etarias e nos niveis de escolaridade. Deve-se investir principalmente na promocao das atividades fisicas no lazer e como forma de deslocamento e em locais adequados para a pratica proximos as residencias.OBJECTIVE To estimate the prevalence of physical activity practice in adults and its association with sociodemographic and environmental factors. METHODS Data from the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases) were collected in 2006. All the 54,369 adults interviewed lived in households with a fixed telephone line, in the Brazilian state capitals and Federal District. Physical activity practice was considered in the leisure-time, occupational, transportation and household domains. Variables studied included sociodemographic characteristics of individuals and environmental characteristics of cities. Association with physical activities was analyzed according to sex. RESULTS Proportions of active individuals were 14.8% for leisure time, 38.2% for occupation, 11.7% for transportation, and 48.5% for household chores. Indices above 60% of inactive individuals in the leisure-time domain were observed in ten capitals. Men were more active than women in all domains, except for household chores. The proportion of active individuals decreased with age. Level of education was directly associated with physical activity in leisure time. Active men in the transportation domain were more likely to be active in their leisure time, while inactive people in the occupational domain were more likely to be active in their leisure time. The existence of places to perform physical activities near the home was associated with physical activity in leisure time. CONCLUSIONS Results obtained are important to monitor physical activity levels in Brazil. Differences between men and women and those in age groups and levels of education must be considered to promote physical activities. Promotion of physical activities in the leisure and transportation domains and in places that are adequate for physical activity practice and near the home should be encouraged.