Ignez Salas Martins

O potencial diagnóstico dos indicadores da obesidade centralizada

OBJETIVO: Tem sido sugerido que os indicadores da obesidade centralizada, representados pela relacao entre as medidas das circunferencias da cintura e do quadril e pela medida da circunferencia da cintura, expressam disturbios metabolicos diferentes. Assim, realizou-se estudo para verificar o potencial diagnostico da relacao circunferencia cintura/circunferencia do quadril com fatores sociais, comportamentais e biologicos, determinantes da obesidade centralizada. METODOS: Em uma amostra da populacao do Municipio de Sao Paulo, SP, composta por 1.042 pessoas, foram utilizados dois modelos de analise hierarquica de regressao multipla para se avaliar as relacoes entre os indicadores e os fatores determinantes da obesidade centralizada. Foram realizados tres inqueritos (clinico, bioquimico e laboratorial e comportamental), utilizando questionario padronizado. Para avaliacao, foram utilizados os instrumentos: pressao arterial, medidas antropometricas, medida de cintura e medida do quadril. RESULTADOS: A medida de circunferencia da cintura e do quadril (RCQ) mostrou associacao significativa com a baixa estatura e foi fortemente relacionada ao nivel socioeconomico, nao ocorrendo o mesmo com a CC. A RCQ e a medida de circunferencia da cintura (CC) foram fortemente associadas a idade, sexo e sedentarismo. As mulheres tem maior risco de apresentaram obesidade centralizada: OR=5,04 e 7,27, para a RCQ e CC, respectivamente. No que se refere aos disturbios metabolicos, a RCQ associou-se significativamente com as alteracoes indicativas da sindrome metabolica: hipertensao e baixos niveis de HDL-colesterol. A CC associou-se significativamente com a hipertensao isolada. Ambos os indicadores associaram-se intensamente com a presenca concomitante de duas ou mais alteracoes ligadas a sindrome metabolica. A CC associou-se a hipercolesterolemia, o que nao ocorreu com a RCQ. CONCLUSOES: A RCQ relacionou-se melhor com os fatores socioeconomicos, risco de desnutricao pregressa e com as alteracoes indicativas da sindrome metabolica do que a CC, mais associada aos fatores de risco para doencas cardiovasculares ateroscleroticas.

Consumo de fibras alimentares em população adulta

OBJETIVO: As fibras alimentares estao entre os principais fatores da alimentacao na prevencao de doencas cronicas. Por isso, objetivou-se estimar o consumo medio diario de fibras alimentares totais, insoluveis e soluveis, nas refeicoes de uma populacao de area metropolitana. METODOS: Foi estudada uma amostra da populacao do Municipio de Cotia, SP, composta por 559 individuos com mais de 20 anos. O consumo alimentar foi obtido pelo metodo de historia alimentar - dieta habitual. Foram identificadas as fontes de fibras nas refeicoes: desjejum, almoco e jantar. Com base na porcao media, os alimentos foram classificados quanto ao conteudo de fibras como: muito alto (7 g ou mais); alto (4,5 g a 6,9 g); moderado (2,4 g a 4,4 g) e baixo (< 2,4 g). RESULTADOS: O consumo medio diario da populacao foi de 24 g de fibras totais, sendo as quantidades medias de fibras insoluveis 17 g e, de soluveis, 7 g. O consumo de fibras alimentares entre mulheres e homens foi, respectivamente, 20 g e 29 g (p<0,01). A maioria dos alimentos presentes na dieta continha baixo teor de fibras. O feijao foi o unico alimento com alto teor de fibras na dieta habitual e, a principal fonte de fibra na alimentacao. O almoco e o jantar foram as refeicoes que forneceram maior quantidade de fibras. CONCLUSOES: Constatou-se baixo consumo de fibras alimentares, com diferencas estatisticamente significante entre os sexos. As praticas alimentares revelaram que a dieta e constituida por alimentos pobres em fibras alimentares.

Escores de consumo alimentar e níveis lipêmicos em população de São Paulo, Brasil

Descritores Consumo de alimentos. # Lipidios, sangue. # Colesterol, sangue. # Lipoproteinas. # Gorduras na dieta. # Abstract Objective To study food patterns assessed using scores of consumption and their relationship with serum total cholesterol (TOTAL-C), low density lipoprotein-cholesterol (LDL- C) and high density lipoproteins (HDL-C) concentration in the population of the metropolitan area of Sao Paulo, Brazil.

Dieta habitual e fatores de risco para doenças cardiovasculares

INTRODUCTION A survey by sampling in a county of the State of S. Paulo in 1990 sought, by means of home interviews, to analyse the habitual diet and risk factors for cardiovascular disease of people over 20 years of age. METHODOLOGY Of the sub-specimen of a comprehensive study population, 557 individuals, aged between 20 and 88, were interviewed. The habitual diet, characterized by the dietary history, was compared with the recommendations on energy and nutrients of the WHO and the risk factors (obesity, lipemic disorders and diabetes mellitus) diagnosed by the Body Mass Index and biochemical measurements. RESULTS AND CONCLUSIONS It was observed that 60% of the population consume a diet with total energy below the estimated need and that the caloric contribution of carbohydrates was of 56%, of the lipids 29% and of the proteins 15%. However, by percentile analysis, the caloric contribution of lipids and of proteins was far above the recommended levels to the detriment of the carbohydrates. Energy, caloric distribution and quantity of cholesterol were satisfactory in only 5% of diets. Among the risk factors for the cardiovascular disease studied, obesity was found to be present in 38% of individuals, lipemic disorders in 26% and diabetes mellitus in 5%. Preponderantly light physical activity together with unsatisfactory diet, both in qualitative as in quantitative terms, aggravated this scenario still further.INTRODUCAO: Estudo descritivo por amostragem em municipio do Estado de Sao Paulo, Brasil, em 1990, com objetivo de analisar, mediante entrevistas domiciliares, a dieta habitual e fatores de risco para doencas cardiovasculares em individuos maiores de 20 anos. METODOLOGIA: Foram entrevistados 557 individuos, de idade entre 20 e 88 anos, que fazem parte de subamostra de um estudo global na regiao. A dieta habitual, identificada pelo historico alimentar foi comparada as recomendacoes da OMS e os fatores de risco estudados (obesidade, dislipidemias, diabetes melito) diagnosticados pelo Indice de Massa Corporea e dosagens bioquimicas. RESULTADOS E CONCLUSOES: Observou-se que 60% da populacao consome dieta com energia total abaixo da estimativa das necessidades e que a contribuicao calorica dos carboidratos foi de 56%, dos lipidios de 29% e das proteinas de 15%. Entretanto, na analise por percentil, a contribuicao calorica dos lipidios e das proteinas encontra-se muito acima dos padroes recomendados em detrimento dos carboidratos. A energia, distribuicao calorica e quantidade de colesterol foi adequada em apenas 5% das dietas. Dentre os fatores de risco para doencas cardiovasculares estudados observou-se a prevalencia de obesidade em 38% dos individuos, de dislipidemias em 26% e de diabetes melito em 5%. A atividade fisica leve preponderante com dieta inadequada, tanto em termos de qualitativos quanto quantitativos, agravam ainda mais esse quadro.

Relationship between stature, overweight and central obesity in the adult population in São Paulo, Brazil

OBJECTIVE: To test association between overweight, central obesity and stature.DESIGN: Cross-sectional study carried-out between 1990–1991.SUBJECTS: 951 adults (387 male and 564 female) aged 20–64 y, resident in the metropolitan area of São Paulo, Brazil.MEASUREMENTS: Anthropometry, blood lipid concentrations (total, high density lipoprotein (HDL) and low density lipoprotein (LDL)-cholesterol, triglycerides (TGs) and blood glucose. Body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference were used to identify overweight (BMI >25 kg/m2), obdominal obesity (WHR tertile 3 and waist circumference tertile 3), respectively. The subjects were categorised as those of short stature (women <150 cm, men <162 cm) and those of normal stature (women ≥150 cm, men ≥162 cm).RESULTS: Prevalence of short stature was 19.6% and 15.4% in men and women, respectively. Short stature women had higher serum concentrations of total cholesterol, LDL-cholesterol, TGs and glucose than those of normal stature. Among men, this difference was not observed, except for glucose concentrations. Short stature women had high BMI and WHR means in some age categories, compared with those of normal stature. Both overweight and high WHR frequencies were greater in short stature women than in those of normal ones. In multivariate analysis, adjusted by age, income, marital status, education, physical activity and tobacco use, only women group with short stature compared with normal stature had significantly risk of overweight an high WHR. In the same group there was no association with waist circumference. Among the men there was significant opposite association with waist circumference.CONCLUSION: Short stature in women can potentially be an independent risk factor for overweight and high WHR.

Occupational accidents among middle and high school students of the state of São Paulo, Brazil

OBJECTIVES To estimate the prevalence of occupational injuries and identify their risk factors among students in two municipalities. METHODS A cross-sectional survey was conducted in public schools of the municipalities of Santo Antonio do Pinhal and Monteiro Lobato, Brazil. A stratified probabilistic sample was drawn from public middle and high schools of the study municipalities. A total of 781 students aged 11 to 19 years participated in the study. Students attending middle and high school answered a comprehensive questionnaire on living and working conditions, as well as aspects of work injuries, and health conditions. Multiple logistic regression models were fitted to estimate risk factors of previous and present occupational injuries. RESULTS Of 781 students, 604 previously had or currently have jobs and 47% reported previous injuries. Among current workers (n=555), 38% reported injuries on their current job. Risk factors for work injuries with statistically significant odds ratio >2.0 included attending evening school, working as a housekeeper, waiter or brickmaker, and with potentially dangerous machines. CONCLUSIONS The study results reinforce the need of restricting adolescent work and support communities to implement social promotion programs.

Food frequency consumption and lipoproteins serum levels in the population of an urban area, Brazil

OBJECTIVE: To identify the association between food group consumption frequency and serum lipoprotein levels among adults. METHODS: The observations were made during a cross-sectional survey of a representative sample of men and women over 20 years old living in Cotia county, S. Paulo, Brazil. Data on food frequency consumption, serum lipids, and other covariates were available for 1,045 adults. Multivariate analyses adjusted by age, gender, body mass index, waist-to-hip ratio, educational level, family income, physical activity, smoking, and alcohol consumption were performed. RESULTS: Consumption of processed meat, chicken, red meat, eggs and dairy foods were each positively and significantly correlated with LDL-C, whereas the intake of vegetables and fruits showed an inverse correlation. Daily consumption of processed meat, chicken, red meat, eggs, and dairy foods were associated with 16.6 mg/dl, 14.5 mg/dl, 11.1 mg/dl, 5.8 mg/dl, and 4.6 mg/dl increase in blood LDL-C, respectively. Increases of daily consumption of fruit and vegetables were associated with 5.2 mg/dl and 5.5 mg/dl decreases in LDL-C, respectively. Alcohol beverage consumption showed a significant positive correlation with HDL-C. CONCLUSIONS: Dietary habits in the study population seem to contribute substantially to the variation in blood LDL and HDL concentrations. Substantially CHD risk reduction could be achieved with dietary changes.

Estado nutricional de grupamentos sociais da área metropolitana de São Paulo, Brasil

This paper focuses on prevalence of nutritional status (Body Mass Index, BMI) in social groups in greater metropolitan São Paulo, in Southeastern Brazil. The population was stratified in four socioeconomic groups. Prevalence of malnutrition (BMI<18.5kg/m2), low body mass (BMI<20.0kg/m2), and overweight (BMI>25.0kg/m2) and obesity (BMI(30.0kg/m2) were calculated. Prevalence of malnutrition was 3.9% in men and 6.2% in women. Prevalence of overweight ranged from 27.5% to 34.1% in men and from 25.8% to 43.6% in women. Obesity ranged from 2.5% to 11.1% in men and from 7.1% to 20.5 in women. Prevalence of overweight and obesity was greater among women than men (p<0.01). In relation to excess weight (BMI>25.0kgm/2), the study showed that prevalence in men was 43, 51, 35, and 30% for strata I, II, III, and IV, respectively. Among women, prevalence was 12, 61, 55 and 46% for strata I, II, III, and IV, respectively. In women there were an abrupt increase in excess weight just before 40 years of age. A high percentage of overweight and obesity was observed in all population groups.

Growth and work among elementary and high school students in São Paulo, Brazil

OBJECTIVE To assess risk factors for low height and students and working adolescents in cities of State of São Paulo, Brazil. METHODS A stratified sample, consisting of 50.0% of students from 5th grade to last year of high school, of State of São Paulo, Brazil, in 1999, was drawn from two largest schools of two different cities (urban and rural). A total of 756 individuals were studied. The height/age indicator, according to the 1977-NCHS (National Center for Health Statistics) standards, defined malnutrition. Height/age distribution and multivariate analyses were carried out using the stepwise method and low-height as the dependent variable. RESULTS Of the adolescents, 12.7% (96) fell below percentile 5; 24.4% (184) between percentiles 5 - 15; and 47.1% (356) between percentiles 15 - 50. Low height was associated with age: taking age-group 10-13 as reference, low-height was twice as likely in students aged 14-17 years (OR adj.=2.49). For those aged 17-19 years, low height was three times as likely (OR adj.=3.37). Being unemployed increases the risk for low-height (OR adj.=2.86) when compared to working adolescents. Also, low height is higher (OR adj.=1.81) among part-time workers. CONCLUSION Economical determinants contribute to the risks for chronic malnutrition among students, since these adolescents rely on work to live on. It is worth emphasizing that underage labor legislation should be enforced in conjunction with compensation public programs.

Hábitos alimentares aterogênicos de grupos populacionais em área metropolitana da região sudeste do Brasil

Em amostra representativa da populacao de duas areas de estudo (568 individuos), Municipio de Cotia, SP, Brasil, foi realizado inquerito alimentar, baseado na historia alimentar do individuo. Os objetivos foram: identificar o potencial aterogenico de dietas de diferentes agrupamentos humanos, estratificados em classes sociais e analisar diferenciais de consumo de alguns nutrientes, que conferem aterogenicidade a dieta entre esses agrupamentos. Foram analisados diferenciais de consumo, entre homens e mulheres, segundo classes sociais e tomando-se como referencia o percentil 50 (P50) da amostra, dos seguintes constituintes da dieta: energia, proteinas totais, proteinas de origem animal, percentagem de calorias proteicas (P%), acidos graxos, gorduras, carboidratos. Seguindo esse criterio, foram analisados perfis de dieta em relacao as recomendacoes do National Cholesterol Education Program (NEP) no que diz respeito as calorias fornecidas pelas gorduras (G >30%), ac. graxos saturados (AGS> 10%), carboidratos (HC>60%) e colesterol (>300mg/dia). Os resultados mostraram que os diferenciais de consumo foram mais pronunciados entre os homens do que entre as mulheres. As classes sociais, entre os homens, que apresentaram maiores percentuais acima do P50 da amostra, no que diz respeito a energia , proteinas totais, gorduras e carboidratos, foram as representadas pelos trabalhadores nao qualificados, que se dedicam a trabalhos bracais com alto consumo energetico e a dos pequenos proprietarios e comerciantes. A classe de maior poder aquisitivo e nivel educacional apresentou consumo moderado desses constituintes. O consumo de proteinas de origem animal, acima do P50, entre homens e mulheres, guardou relacao direta com o nivel socioeconomico da classe . A participacao calorica das gorduras (G%) e proteinas (P%) foi diretamente proporcional ao poder aquisitivo da classe, ao passo que a dos carboidratos (HC%) guardou relacao inversa. Por outro lado, o consumo de colesterol acima de 300mg/dia situou-se nas faixas de 37 a 50% e de 20 a 32% para os homens e mulheres, respectivamente. A percentagem de dietas com calorias provenientes das gorduras (G%) acima de 30% variou de 25 a 40%, para os homens e de 45 a 50% para as mulheres. A participacao dos acidos graxos saturados (AGS%) em proporcoes maiores ou iguais a 10 foi relativamente baixa para ambos os sexos: de 5 a 17% para os homens e menos de 10% para as mulheres. Os percentuais de casos em que a relacao acidos graxos saturados e insaturados (AGS/AGI) guardou valores menores ou iguais a 1, tambem foi baixa para a populacao em geral; situou-se entre 7 e 22% para os homens e em proporcoes abaixo de 10%, para as mulheres. Concluiu-se que a dieta se apresenta como provavel fator de risco de doencas cardiovasculares, dislipidemias, obesidade e hipertensao, para grande parte da populacao.