Fernando Augusto Proietti

Genomic ancestry, Self-rated health and its association with mortality in an admixed population: 10 year follow-up of the Bambui-Epigen (Brazil) cohort study of ageing

Background Self-rated health (SRH) has strong predictive value for mortality in different contexts and cultures, but there is inconsistent evidence on ethnoracial disparities in SRH in Latin America, possibly due to the complexity surrounding ethnoracial self-classification. Materials/Methods We used 370,539 Single Nucleotide Polymorphisms (SNPs) to examine the association between individual genomic proportions of African, European and Native American ancestry, and ethnoracial self-classification, with baseline and 10-year SRH trajectories in 1,311 community dwelling older Brazilians. We also examined whether genomic ancestry and ethnoracial self-classification affect the predictive value of SRH for subsequent mortality. Results European ancestry predominated among participants, followed by African and Native American (median = 84.0%, 9.6% and 5.3%, respectively); the prevalence of Non-White (Mixed and Black) was 39.8%. Persons at higher levels of African and Native American genomic ancestry, and those self-identified as Non-White, were more likely to report poor health than other groups, even after controlling for socioeconomic conditions and an array of self-reported and objective physical health measures. Increased risks for mortality associated with worse SRH trajectories were strong and remarkably similar (hazard ratio ~3) across all genomic ancestry and ethno-racial groups. Conclusions Our results demonstrated for the first time that higher levels of African and Native American genomic ancestry—and the inverse for European ancestry—were strongly correlated with worse SRH in a Latin American admixed population. Both genomic ancestry and ethnoracial self-classification did not modify the strong association between baseline SRH or SRH trajectory, and subsequent mortality.

Association of socioeconomic factors with body mass index, obesity, physical activity, and dietary factors in Belo Horizonte, Minas Gerais State, Brazil: The BH Health Study

Obesity prevalence is rapidly increasing in developing countries. Existing research investigating social patterning of obesity and its risk factors in Latin American urban contexts has inconsistent findings. This study analyzed a multistage household survey in adults in Belo Horizonte, Minas Gerais State, Brazil. Marginal models were used to examine the association of education and household and neighborhood income with body mass index (BMI), obesity, physical inactivity, and low fruit and vegetable intake after adjusting for age and ethnicity and stratifying by sex. BMI and obesity were inversely associated with education in women. BMI was positively associated with household and neighborhood income in men. Additionally, physical inactivity and low fruit and vegetable intake were inversely associated with education and household income in both men and women, and physical inactivity was inversely associated with neighborhood income in men. Understanding the drivers of these patterns will allow for development of appropriate policy and interventions to reduce cardiovascular disease risk in large cities in Latin America.A prevalencia da obesidade esta aumentando nos paises em desenvolvimento. Estudos investigando os padroes sociais da obesidade e seus fatores de risco em areas urbanas da America Latina tem resultados inconsistentes. Neste estudo foram analisadas as informacoes provenientes de inquerito populacional sobre a saude de adultos residentes em Belo Horizonte, Minas Gerais, Brasil. Foram utilizados modelos marginais para examinar a associacao entre a escolaridade, a renda familiar e da vizinhanca com o IMC (indice de massa corporal), a obesidade, a atividade fisica e o consumo de frutas e verduras. O IMC e a obesidade se associaram inversamente a escolaridade entre as mulheres e o IMC positivamente a renda do domicilio e da vizinhanca entre os homens. O baixo consumo de frutas e verduras e a inatividade fisica foram inversamente associados a escolaridade e a renda familiar em ambos os sexos. A inatividade fisica se associou inversamente a renda da vizinhanca entre os homens. Compreender as causas da distribuicao social da obesidade e importante para reduzir o risco de doenca cardiovascular nos centros urbanos da America Latina.

Social context of neighborhood and socioeconomic status on leisure-time physical activity in a Brazilian urban center: The BH Health Study

Este estudo teve como objetivo estimar a prevalencia de atividade fisica de lazer e investigar sua associacao com caracteristicas contextuais do ambiente social e fisico, em diferentes niveis socioeconomicos, utilizando inquerito domiciliar realizado em Belo Horizonte, Minas Gerais, Brasil (2008-2009). A atividade fisica de lazer foi mensurada por meio do Questionario Internacional de Atividade Fisica, e o ambiente social e fisico por escalas originadas da percepcao dos atributos da vizinhanca. Foram realizadas analises de regressao logistica multinivel para cada estrato de niveis socioeconomicos. A prevalencia geral de atividade fisica de lazer foi de 30,2%, sendo 20,2% no nivel socioeconomico baixo, 25,4% no medio e 40,6% no nivel socioeconomico alto. Maior percepcao de coesao social na vizinhanca foi associada a atividade fisica de lazer apenas para o estrato socioeconomico mais baixo, mesmo apos o ajuste pelas caracteristicas individuais. Os resultados evidenciam a importância da coesao social para a promocao da pratica de atividade fisica de lazer em grupos economicamente mais desfavorecidos, reforcando a necessidade de se estimular acoes que possam incrementar as relacoes sociais nesta populacao.This study aimed to estimate the prevalence of leisure-time physical activity and investigate its association with contextual characteristics of the social and physical environment in different socioeconomic statuses, using a household survey in Belo Horizonte, Minas Gerais State, Brazil (2008-2009). Leisure-time physical activity was measured by the International Physical Activity Questionnaire; and the social and physical environment by scales arising from perception of neighborhood attributes. Multilevel logistic regression analysis was performed separately for each socioeconomic status stratum. The overall prevalence of leisure-time physical activity was 30.2%, being 20.2% amongst participants of low socioeconomic status, 25.4% in the medium and 40.6% in the high socioeconomic status group. A greater perception of social cohesion was associated with increased leisure-time physical activity only amongst participants of the lowest socioeconomic status even after adjusting for individual characteristics. The results demonstrate the importance of social cohesion for the promotion of leisure-time physical activity in economically disadvantaged groups, supporting the need to stimulate interventions for enhancing social relationships in this population.

Leisure-time physical activity in the vicinity of Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil: the impact of a health promotion program on the community

This study analyzed leisure-time physical activity among 1,621 adults who were non-users of the Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil, but who lived in the vicinity of a fitness center in operation (exposed Group I) or in the vicinity of two sites reserved for future installation of centers (control Groups II and III). The dependent variable was leisure-time physical activity, and linear distance from the households to the fitness centers was the exposure variable, categorized in radial buffers: < 500m; 500-1,000m; and 1,000-1,500m. Binary logistic regression was performed with the Generalized Estimation Equations method. Residents living within < 500m of the fitness center gave better ratings to the physical environment when compared to those living in the 1,000 and 1,500m buffers and showed higher odds of leisure-time physical activity (OR = 1.16; 95%CI: 1.03-1.30), independently of socio-demographic factors; the same was not observed in the control groups (II and III). The findings suggests the programs potential for influencing physical activity in the population living closer to the fitness center and thus provide a strategic alternative for mitigating inequalities in leisure-time physical activity.Abstract This study analyzed leisure-time physical activity among 1,621 adults who were non-users of the Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil, but who lived in the vicinity of a fitness center in operation (exposed Group I) or in the vicinity of two sites reserved for future installation of centers (control Groups II and III). The dependent variable was leisure-time physical activity, and linear distance from the households to the fitness centers was the exposure variable, categorized in radial buffers: < 500m; 500-1,000m; and 1,000-1,500m. Binary logistic regression was performed with the Generalized Estimation Equations method. Residents living within < 500m of the fitness center gave better ratings to the physical environment when compared to those living in the 1,000 and 1,500m buffers and showed higher odds of leisure-time physical activity (OR = 1.16; 95%CI: 1.03-1.30), independently of socio-demographic factors; the same was not observed in the control groups (II and III). The findings suggests the program’s potential for influencing physical activity in the population living closer to the fitness center and thus provide a strategic alternative for mitigating inequalities in leisure-time physical activity.

The place where you live and self-rated health in a large urban area

The aim of this study was to determine and quantify the association between ones perception of the place of residence and self-rated health. 4,048 adult residents of Belo Horizonte, Minas Gerais State, Brazil, participated in the study in 2008 and 2009. Ordinal logistic regression was used to estimate the magnitude of the association. Health was rated as good or very good, fair, or poor or very poor by 65.7%, 27.8%, and 6.5% of the subjects, respectively. Better self-rated health was associated with the following neighborhood characteristics: positive evaluation of aesthetics and mobility, better quality of public services, less physical and social disorder. The perception of violence had a borderline statistically significant association with worse self-rated health. These associations persisted after controlling for potential confounding demographic, socioeconomic, health, and health behavior variables. The results indicate that public and health policies should incorporate interventions that address the physical and social environment in addition to policies focused on individuals.O objetivo deste estudo foi determinar e quantificar a associacao entre autopercepcao do local de moradia e autoavaliacao da saude. Participaram da pesquisa 4.048 adultos residentes em Belo Horizonte, Minas Gerais, Brasil, de 2008 a 2009. Para estimar a magnitude das associacoes foi utilizada regressao logistica ordinal. Autoavaliacao da saude boa/muito boa, razoavel e ruim/muito ruim foi relatada por 65,7%, 27,8% e 6,5% dos participantes, respectivamente. Melhor autoavaliacao da saude foi associada as seguintes caracteristicas da vizinhanca: avaliacao positiva dos aspectos esteticos e da mobilidade, melhor qualidade dos servicos, menor desordem fisica e social. A percepcao da violencia apresentou associacao estatistica limitrofe com pior autoavaliacao da saude. As associacoes se mantiveram apos o controle para potenciais variaveis de confusao demograficas, socioeconomicas, de condicoes de saude e comportamentos em saude. Os resultados indicam que politicas publicas e de saude devem incorporar intervencoes sobre o entorno fisico e social em complemento as politicas individuais.

Self-rated health in urban adults, perceptions of the physical and social environment, and reported comorbidities: The BH Health Study

Abstract This study assesses the prevalence of poor self-rated health and investigates its association with individual and environmental characteristics in adults with and without reported morbidity. A household survey assessed 4,048 adults in two districts of Belo Horizonte, Minas Gerais State, Brazil. We used Poisson regression with robust variance stratified by the presence of reported morbidity. Prevalence of poor self-rated health was 29.9% (42.6% in those with morbidity and 13.1% in the group without morbidity). All assessed domains were associated with self-rated health in subjects with reported morbidity. In the group without reported morbidity, the following were associated with self-rated health: social environment, socio-demographic factors, lifestyle, and psychological health. Perceived problems in the environment were associated with poor self-rated health in both groups, even after hierarchical adjustment. The results suggest the importance of investigating self-rated health stratified by reported morbidity and reinforce the need to include variables that characterize the physical and social environment.Health Status; Morbidity; Urban HealthThis study assesses the prevalence of poor self-rated health and investigates its association with individual and environmental characteristics in adults with and without reported morbidity. A household survey assessed 4,048 adults in two districts of Belo Horizonte, Minas Gerais State, Brazil. We used Poisson regression with robust variance stratified by the presence of reported morbidity. Prevalence of poor self-rated health was 29.9% (42.6% in those with morbidity and 13.1% in the group without morbidity). All assessed domains were associated with self-rated health in subjects with reported morbidity. In the group without reported morbidity, the following were associated with self-rated health: social environment, socio-demographic factors, lifestyle, and psychological health. Perceived problems in the environment were associated with poor self-rated health in both groups, even after hierarchical adjustment. The results suggest the importance of investigating self-rated health stratified by reported morbidity and reinforce the need to include variables that characterize the physical and social environment.

Overweight in men and women among urban area residents: individual factors and socioeconomic context

Abstract The present study aimed to evaluate factors associated with overweight among adults living in urban areas, with the income of the census tract as a context variable. The survey assessed individuals from two health districts of Belo Horizonte, Minas Gerais State, Brazil. Excess weight was determined by body mass index > 25kg/m2. Multilevel logistic regression was used. The sample comprised 2,935 individuals aged 20 to 60 years. The prevalence of overweight was 52.3% (95%CI: 49.9-54.8), similar between men and women. Higher schooling proved to be protective against overweight in women and a risk for men. Living in census tracts with higher income was associated with excess weight only in males. Report of the consumption of diet soft drinks was positively associated with overweight in both sexes. The occurrence of this event seems to be influenced by different factors or to interrelate differently in men and women.The present study aimed to evaluate factors associated with overweight among adults living in urban areas, with the income of the census tract as a context variable. The survey assessed individuals from two health districts of Belo Horizonte, Minas Gerais State, Brazil. Excess weight was determined by body mass index > 25kg/m2. Multilevel logistic regression was used. The sample comprised 2,935 individuals aged 20 to 60 years. The prevalence of overweight was 52.3% (95%CI: 49.9-54.8), similar between men and women. Higher schooling proved to be protective against overweight in women and a risk for men. Living in census tracts with higher income was associated with excess weight only in males. Report of the consumption of diet soft drinks was positively associated with overweight in both sexes. The occurrence of this event seems to be influenced by different factors or to interrelate differently in men and women.

Características individuais associadas à autopercepção da extensão territorial da vizinhança

There is a growing interest in evaluating the impact of neighborhood characteristics on health. The definition of neighborhood involves two main strategies, one using artificial boundaries, usually created for administrative purposes, and the other based on the individual’s definition, namely the perceived neighborhood. The aim of this study was to identify factors associated with heterogeneity in the perceived neighborhood among participants in a health survey in Belo Horizonte, Minas Gerais State, Brazil. Ordinal logistic regression was used to determine and quantify this association. Larger size of the perceived neighborhood was associated with better socioeconomic status, positive employment status, positive assessment of aesthetic aspects and mobility within the neighborhood, active identification of problems in the neighborhood, less involvement in sports/leisure activities, and knowing more neighbors. The study’s results can help produce more significant neighborhood definitions that are more consistent with residents’ own perceptions, thereby favoring more accurate estimates of neighborhood impact on health.

Weight excess in adolescents in Belo Horizonte? population-based household survey

Introduction: Weight excess rates have had an alarming growth among adolescents. Of complex and multifactor origins, weight excess is influenced by genetic and contextual factors. Objective: To assess individual factors related to weight excess among adolescents in a large urban center. Methods: A cross-sectional study with data from a population-based household survey conducted in two districts of Belo Horizonte, between 2008 and 2009. Data were collected through confidential self-administered questionnaires and anthropometric measurements. The final sample consisted of 1,030 adolescents aged 11-17 years. We evaluated excess weight, as defined by body mass index, and its association with sociodemographic variables, habits and lifestyles, body satisfaction and self-rated health. Descriptive analysis of the data, including frequency distributions and differences between proportions and means with the Pearson chi-square test were conducted. Results: 21.9% of adolescents were overweight, with a higher prevalence among females (54.2%, p <0.05). The following aspects were significantly associated with weight excess: not eating breakfast, body dissatisfaction and worse self-rated health status. Males were more active compared to females, however without significant differences in nutritional status classifications. Conclusion: This study reinforces the multifactor aspects of exWeight excess in adolescents in Belo Horizonte? population-based household survey Stephanie Bispo1, Adriana Lúcia Meireles2, Marcela Guimarães Côrtes3, César Coelho Xavier4, Fernando Augusto Proietti5, Waleska Teixeira Caiaffa6 1 Nutricionista. Mestranda em Ciências da Saúde: Saúde da Criança e do Adolescente – Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG). Observatório de Saúde Urbana. Belo Horizonte, MG – Brasil. 2 Nutricionista. Doutoranda em Saúde Pública – Faculdade de Medicina da UFMG. Observatório de Saúde Urbana. Belo Horizonte, MG – Brasil. 3 Fonoaudióloga. Doutoranda em Saúde Pública – Faculdade de Medicina da UFMG. Observatório de Saúde Urbana. Belo Horizonte, MG – Brasil. 4 Médico. Professor Associado do Departamento de Pediatria da Faculdade de Medicina da UFMG. Observatório de Saúde Urbana. Belo Horizonte, MG – Brasil. Professor da Faculdade de Saúde e Ecologia Humana (FASEH). Vespasiano, MG – Brasil 5 Médico. Professor Associado do Departamento de Medicina Preventiva e Social da Faculdade de Medicina da UFMG. Observatório de Saúde Urbana, Belo Horizonte, MG – Brasil. Professor da Faculdade de Saúde e Ecologia Humana (FASEH). Vespasiano, MG – Brasil 6 Médica. Professora Titular de Epidemiologia – Departamento de Medicina Preventiva da Faculdade de Medicina da UFMG. Observatório de Saúde Urbana. Belo Horizonte, MG – Brasil. Excesso de peso em adolescentes de Belo Horizonte: inquérito domiciliar de base populacional DOI: 10.5935/2238-3182.20130003

Atividade física de lazer no território das Academias da Cidade, Belo Horizonte, Minas Gerais, Brasil: o efeito da presença de um programa de promoção da saúde na comunidade

This study analyzed leisure-time physical activity among 1,621 adults who were non-users of the Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil, but who lived in the vicinity of a fitness center in operation (exposed Group I) or in the vicinity of two sites reserved for future installation of centers (control Groups II and III). The dependent variable was leisure-time physical activity, and linear distance from the households to the fitness centers was the exposure variable, categorized in radial buffers: < 500m; 500-1,000m; and 1,000-1,500m. Binary logistic regression was performed with the Generalized Estimation Equations method. Residents living within < 500m of the fitness center gave better ratings to the physical environment when compared to those living in the 1,000 and 1,500m buffers and showed higher odds of leisure-time physical activity (OR = 1.16; 95%CI: 1.03-1.30), independently of socio-demographic factors; the same was not observed in the control groups (II and III). The findings suggests the programs potential for influencing physical activity in the population living closer to the fitness center and thus provide a strategic alternative for mitigating inequalities in leisure-time physical activity.Abstract This study analyzed leisure-time physical activity among 1,621 adults who were non-users of the Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil, but who lived in the vicinity of a fitness center in operation (exposed Group I) or in the vicinity of two sites reserved for future installation of centers (control Groups II and III). The dependent variable was leisure-time physical activity, and linear distance from the households to the fitness centers was the exposure variable, categorized in radial buffers: < 500m; 500-1,000m; and 1,000-1,500m. Binary logistic regression was performed with the Generalized Estimation Equations method. Residents living within < 500m of the fitness center gave better ratings to the physical environment when compared to those living in the 1,000 and 1,500m buffers and showed higher odds of leisure-time physical activity (OR = 1.16; 95%CI: 1.03-1.30), independently of socio-demographic factors; the same was not observed in the control groups (II and III). The findings suggests the program’s potential for influencing physical activity in the population living closer to the fitness center and thus provide a strategic alternative for mitigating inequalities in leisure-time physical activity.