Ines Lessa

[Anthropometric indexes of obesity as an instrument of screening for high coronary risk in adults in the city of Salvador--Bahia].

OBJECTIVE To compare some anthropometric indexes of obesity and identify among them which one best discriminates the high coronary risk (HCR). METHODS A cross-section study, with sample consisting of 968 adults, between 30 and 74 years old, being 391 (40.4%) men. Many Receiver Operating Characteristic (ROC) curves were obtained and compared to areas under them among the conicity index (C index), body mass index (BMI), waist-hip circumference ratio (WHCR), waist circumference (WC) and HCR. The sensitivity and specificity to identify and compare the best cut-off point among the many indexes of obesity to discriminate the HCR were also identified. A confidence interval of 95% was used. RESULTS The largest area under ROC curve was found between the C index and the HCR, in individuals of male sex, 0.80 (0.74-0.85), significantly differing from the other indexes of obesity. In women, the largest area found under the ROC curve was 0.76 (0.71-0.81), being equal between C, WHCR and HCR indexes. CONCLUSION Those results show that C and WHCR indexes are the best indexes of obesity to discriminate HCR. WC has intermediate discriminatory power and the BMI was the least suitable anthropometric index of obesity to discriminate HCR. Those data suggest that the indexes of abdominal obesity are better to discriminate HCR than the indexes of general obesity.

Alcohol drinking patterns by gender, ethnicity, and social class in Bahia, Brazil

OBJETIVOS: Investigar padroes de consumo de alcool e prevalencia de consumo de alto risco. METODOS: Inquerito domiciliar realizado no municipio de Salvador, Bahia, com amostra de 2.302 adultos. Casos de consumo de alto risco foram definidos como sujeitos que referiram uso diario ou semanal mais episodios de embriaguez, alem daqueles que informaram qualquer uso de bebidas alcoolicas com embriaguez frequente (pelo menos uma vez por semana). RESULTADOS: Cinquenta e seis por cento da amostra referiram consumo atual de bebidas alcoolicas. Consumo global estava significantemente associado a genero (homens), estado civil (solteiros), migracao (nao-migrantes), educacao (nivel superior) e classe social (alta). Nenhuma diferenca significante foi encontrada com relacao a etnicidade, com excecao de cachaca e outras bebidas destiladas. A prevalencia anual de consumo de alto risco foi 7%, seis vezes mais prevalente entre homens que entre mulheres (quase 13% comparado a 2,4%). Foi encontrada uma associacao positiva de prevalencia de consumo de alto risco com educacao e classe social. Nenhuma relacao global foi encontrada entre etnicidade e consumo de alto risco. Genero masculino e niveis socioeconomicos mais altos foram associados ao aumento de consumo de alto risco. Analises estratificadas revelaram um efeito consistente de genero, atraves de todos os estratos de variaveis independentes. CONCLUSOES: Os resultados sugerem que elementos sociais e culturais determinam padroes locais de consumo de bebidas alcoolicas. Pesquisas adicionais sobre efeitos de longo prazo de etnicidade, classe social e genero sobre consumo de alcool sao necessarias, visando a explicar o seu papel como fontes de desigualdades sociais em saude.OBJECTIVE To study patterns of alcohol consumption and prevalence of high-risk drinking. METHODS A household survey was carried out in a sample of 2,302 adults in Salvador, Brazil. Cases of High-Risk Drinking (HRD) were defined as those subjects who referred daily or weekly binge drinking plus episodes of drunkenness and those who reported any use of alcoholic beverages but with frequent drunkenness (at least once a week). RESULTS Fifty-six per cent of the sample acknowledged drinking alcoholic beverages. Overall consumption was significantly related with gender (male), marital status (single), migration (non-migrant), better educated (college level), and social class (upper). No significant differences were found regarding ethnicity, except for cachaça (Brazilian sugarcane liquor) and other distilled beverages. Overall 12-month prevalence of high-risk drinking was 7%, six times more prevalent among males than females (almost 13% compared to 2.4%). A positive association of HRD prevalence with education and social class was found. No overall relationship was found between ethnicity and HRD. Male gender and higher socioeconomic status were associated with increased odds of HRD. Two-way stratified analyses yielded consistent gender effects throughout all strata of independent variables. CONCLUSIONS The findings suggest that social and cultural elements determine local patterns of alcohol-drinking behavior. Additional research on long-term and differential effects of gender, ethnicity, and social class on alcohol use and misuse is needed in order to explain their role as sources of social health inequities.

Arterial hypertension in the adult population of Salvador (BA) - Brazil

OBJECTIVE To estimate the prevalence of hypertension (H) and its association with other cardiovascular risk factors in a highly multiracial population. METHODS A cross-sectional study carried out in Salvador, Brazil, in a population sample of 1439 adults > or = 20 years of age. All participants completed a questionnaire at home and had the following measurements taken: blood pressure, body weight, height, waist circumference (WC), and serum glucose and lipids. Hypertension was defined as mean SBP > or = 140 and/or DBP > or = 90 mmHg. Hypertension prevalence was estimated with a 95% confidence interval (CI). The associations were measured by the adjusted odds ratio (AOR), using regression analysis. RESULTS Overall prevalence of HA was 29.9%: 27.4% CI (23.9-31.2) in men and 31.7%, CI (28.5-34.9) in women. Among black men, this prevalence was 31.6%, and among black women, 41.1%. Among white men it was 25.8%, and among white women, 21.1%. Arterial hypertension was significantly associated with age > or = 40, overweight/obesity (aOR = 2.37[1.57-3.60]) for men and 1.62 (1.02-2.58) for women. Among men, HA was associated with a high level of education and among women, with dark brown and black skin, abdominal obesity, aOR = 2.05 CI (1.31-3.21), diabetes aOR = 2.16 CI (1.19-3.93), and menopause. CONCLUSION Arterial hypertension predominated among black people of both genders, and in women. Those variables that remained independently associated with AH differed in both genders, except overweight/obesity. Our results suggest the need for an in-depth study of AH among black people and early, continuing educational interventions.

Critério de obesidade Central em População Brasileira: impacto sobre a Síndrome metabólica

OBJECTIVE: To identify and propose the optimal waist circumference cut-off points (WCp) for the diagnosis of central obesity (CO) in a Brazilian population, so as to compare these cut-off points with those recommended by the ATPIII (WC-ATPIII), and to estimate the difference in prevalence rates of metabolic syndrome (MS) using the two criteria. METHODS: Cross-sectional study conducted in a population subgroup of 1439 adults in the city of Salvador, Brazil. ROC curves of waist circumference (WC) were plotted to identify diabetes mellitus (DM) and obesity. ROC curve sensitivity and specificity values >60% and the closest to each other were used to define WCp. The prevalence of MS was estimated using WCp and WC-ATPIII. RESULTS: Eight hundred and twenty nine women comprised 57.7% of the sample. The WCp selected were 84cm for women and 88cm for men. These cut-off points detected DM with a 68.7% and 70% sensitivity, and a 66.2% and 68.3% specificity, respectively. For obesity, sensitivity and specificity were 79.8% and 77.6% in women and 64.3% and 71.6% in men, respectively. Using WC-ATPIII, 88cm (for women) and 102cm (for men), the sensitivity was 53.3% and 26.5%, respectively, to diagnose DM. For obesity, sensitivity was 66.5% (for women) and 28.6% (for men). The prevalence of MS using WCp was 23.7%, 95%CI (21.6 - 25.9), whereas using WC-ATPIII it was 19.0%, 95%CI (17.1- 20.9), 1.2 times higher using WCp. CONCLUSION: WC-ATPIII were inappropriate and underestimated the prevalence of MS in the population studied, particularly among men. We suggest that the WC cut-off points > 84cm for women and > 88cm for men should be tested in other Brazilian populations.

Prevalência e fatores associados ao sedentarismo no lazer em adultos

This study focused on the prevalence and determinants of leisure-time sedentary lifestyle in the city of Salvador, Bahia, Brazil. A cross-sectional design was used in a sample of 2,292 adults > or = 20 years of age, of whom 1,271 (55.0%) were females. Leisure-time sedentary lifestyle was defined by individuals who, in a live interview, stated that they performed no physical activity during their leisure time in a normal week. Initially, total prevalence of leisure-time sedentary lifestyle in the study population was calculated by variables associated and stratified by sex. Then, the prevalence ratio between leisure-time sedentary lifestyle, age, schooling, and marital status stratified by sex was calculated. A 95% confidence interval was used. Prevalence of leisure-time sedentary lifestyle was 72.5% and was more frequent in women 40-50 years of age and men over 60, individuals with limited schooling, and married, separated, and widowed individuals. The findings are relevant for public health, since they can be used both to identify high levels of leisure-time sedentary lifestyle in the Brazilian population as well as the determinants, thus allowing new intervention strategies to be implemented.

Simultaneidade de fatores de risco cardiovascular modificáveis na população adulta de Salvador (BA), Brasil

OBJETIVO: Estimar a frequencia da simultaneidade de fatores de risco cardiovascular modificaveis, com e sem inclusao da hipertensao arterial, em uma populacao miscigenada. METODO: Estudo transversal realizado em 1 298 adultos com idade > 20 anos na Cidade de Salvador, Brasil, em 2000. Foram incluidos oito fatores de risco cardiovascular modificaveis, considerados em qualquer combinacao: colesterol total > 240 mg/dL; colesterol das lipoproteinas de alta densidade (HDL-c) 200 mg/dL; glicemia > 126 mg/dL + diabetes controlado; indice de massa corporal > 25 kg/m², cintura > 102 cm (homens) e > 88 cm (mulheres), tabagismo e alcoolismo. Os resultados foram estratificados de acordo com o numero de fatores de risco simultâneos (de zero a cinco ou mais; e dois ou mais). Os dados foram analisados em termos de proporcoes estimadas e intervalo de confianca de 95% (IC95%), com e sem inclusao da hipertensao arterial (criterio JNC-VI), razoes entre proporcoes e qui-quadrado para proporcoes como medida de associacao. RESULTADOS: Entre os homens (41,4% dos participantes), 7,5% (IC95%: 2,5 a 9,7) nao apresentaram fatores de risco; 68,8% (IC95%: 65,0 a 72,8) apresentaram dois ou mais fatores de risco, excluida a hipertensao. Quando a hipertensao foi incluida, 73,4% (IC95%: 69,7 a 77,1) apresentaram dois ou mais fatores de risco. Entre as mulheres, 11,6% nao apresentaram fatores de risco. A presenca de dois ou mais fatores de risco, excluida a hipertensao, foi observada em 67,7% (IC95%: 64,8 a 71,4). Apos inclusao da hipertensao, 71,7% (IC95%: 68,5 a 74,9) das mulheres apresentaram dois ou mais fatores de risco. Foram observadas diferencas significativas entre presenca de dois ou mais fatores de risco para homens com ate 4 anos de estudo versus homens com 5 a menos de 11 anos de estudo (P <0,05); mulheres com ate 4 anos de estudo versus 5 a menos de 11 anos de estudo; mulheres com ate 4 anos de estudo versus 11 ou mais anos de estudo (P <0,01); e para mulheres negras versus brancas (P <0,01). CONCLUSAO: A elevada proporcao de multiplos fatores de risco cardiovascular em Salvador, incluindo-se ou nao a hipertensao, especialmente na populacao de baixa escolaridade e em pessoas negras, sugere a necessidade de estrategias sociais abrangentes para reduzir as desigualdades sociais, promover a saude, e facilitar o tratamento de fatores de risco cardiovascular.

Razão cintura-estatura como discriminador do risco coronariano de adultos

OBJETIVO: Selecionar, por meio da sensibilidade e especificidade, os melhores pontos de coorte para a razao cintura-estatura (RCEst) como discriminador de risco coronariano elevado (RCE). METODOS: O desenho foi transversal com amostra composta por 968 adultos de 30-74 anos de idade, sendo 391 (40,4%) do sexo masculino. A analise foi feita por curva Receiver Operating Characteristic (ROC) para identificar a sensibilidade e especificidade do melhor ponto de coorte da RCEst como discriminador de RCE. Verificou-se tambem a significância estatistica da area sob a curva ROC. Foi utilizado intervalo de confianca (IC) a 95%. RESULTADOS: A area total sob a curva ROC entre RCEst e RCE foi de 0,75, IC 95% (0,70-0,81) para homens e 0,69, IC 95% (0,64-0,75) para mulheres. Os melhores pontos de coorte para discriminar o RCE foram para homens e mulheres, respectivamente: 0,52 (sensibilidade de 68% e especificidade de 64%) e 0,53 (sensibilidade de 67% e especificidade de 58%). CONCLUSAO: Os resultados do estudo sugerem que a RCEst deve ser comparada aos demais indicadores antropometricos de obesidade e pode vir a ser utilizada para discriminar RCE.

Prevalência de dor lombar crônica na população da cidade de Salvador

INTRODUCTION: Chronic low back pain has epidemic levels in the general population and profiling the individuals affected may help directing investments to control the problem. OBJECTIVE: To estimate the prevalence of chronic low back pain in the population and to identify associated factors. METHODS: Transversal study based on a population survey carried out in the sectors classified by the census in the city of Salvador according to socio-economic level. 2,297 individuals were interviewed in whom low back pain was evaluated through a bodily map. Exploratory analysis of associated factors was performed by logistic regression. RESULTS: Chronic low back pain prevalence in the population was 14.7%, with higher incidence among former smokers (19.7%), people with belly circumference above the range of normality (16.8%), and individuals with low level of schooling (17.4%) when compared to the other categories. Factors such as physical activity, social class, excessive alcohol intake, race, gender, and occupation at the time of the interview were not associated to low back pain. In the multiple regression analysis, being single was negatively associated to chronic low back pain, whereas positive and statistically significant associations were observed between current smoking or smoking in the past and low back pain (OR 1.47; IC95%; 1.11-1.96; p < 0.000). CONCLUSION: The population in Salvador shows high prevalence of chronic low back pain associated to smoking.

Doenças crônicas não-transmissíveis no Brasil: um desafio para a complexa tarefa da vigilância

A literatura na area da saude publica e pobre em textos sobre vigilância epidemiologica (VE) para DCNT, mas contem varias propostas de programas e varias redes em andamento nos 5 continentes. O tema encontra-se em destaque mundial, nao so pela lideranca das doencas cardiovasculares na mortalidade na grande maioria dos paises, como pela ja considerada pandemia da obesidade, inclusive em criancas e adolescentes. A endemia do diabetes e esperada. No Brasil a situacao e grave. O envelhecimento populacional e rapido, com expectativa de aumento real das frequencias da obesidade e o diabetes como problema populacional sem concomitantes estrategias de protecao e promocao da saude no contexto das DCNT. Predomina macicamente a pratica clinica, mas sem assegurar o tratamento ininterrupto para as DCNT na rede basica de saude. O texto apresentado aborda sumariamente a VE para DCNT de modo geral e comenta o Metodo Progressivo de VE para DCNT proposto pela OMS, no caso do Brasil. Para aceita-la e imprescindivel uma analise critica dos dados secundarios nacionais disponiveis e mencionados na proposta. E tambem necessario produzir, a curto prazo, dados primarios metodologicamente padronizados com enfoque para fatores de risco.

Sensibilidade e especificidade do índice de conicidade como discriminador do risco coronariano de adultos em Salvador, Brasil

Abstract ObjectiveObjective: In the early nineties, the conicityindex was proposed for the assessment ofbody fat distribution based on weight, heightand waist circumference measurements.The goal of this study was to identify the sen-sitivity, specificity and the best cut-off pointfor the conicity index as a predictor of highcoronary risk. MethodsMethods: This is a cross-sec-tional study whose population comprised968 adults between 30-74 years, of which 391(40.4%) were males. Receiver OperatingCharacteristic (ROC) curves were employedto identify the sensitivity and specificity ofthe best cut-off point of the conicity index asa predictor of high coronary risk. The statis-tical significance of the area under the ROCcurve between the conicity index and a highcoronary risk was also verified and a 95%confidence interval (CI) was utilized. Results:The total area under the ROC curve betweenthe conicity index and the coronary risk was0.80, CI 95% (0.74-0.85) in males and 0.75, CI95% (0.70-0.80) in females. The best cut-offpoints to discriminate high coronary risk inmen and women were, respectively, 1.25(73.91% sensitivity and 74.92% specificity)and 1.18 (73.39% sensitivity and 61.15% speci-ficity). Conclusion: Results suggest that theconicity index may be used to identify highcoronary risk, and must be compared toother anthropometric indicators of obesity.Key Words:Key Words: Obesity. Conicity index. Coro-nary risk.OBJETIVO: No inicio da decada de 90, foi proposto o indice de conicidade para avaliacao da distribuicao da gordura corporal, com base nas medidas de peso, estatura e circunferencia da cintura. Este estudo teve como objetivo selecionar atraves da sensibilidade e especificidade os melhores pontos de corte para o indice de conicidade como discriminador de risco coronariano elevado. METODOS: Estudo de corte transversal, com amostra composta por 968 adultos de 30-74 anos de idade, sendo 391 (40,4%) do sexo masculino. A analise foi feita por curva Receiver Operating Characteristic (ROC) para identificar a sensibilidade e especificidade do melhor ponto de corte do indice de conicidade como discriminador de risco coronariano elevado. Verificou-se tambem a significância estatistica da area sob a curva ROC entre o indice de conicidade e risco coronariano elevado. Foi utilizado intervalo de confianca (IC) a 95%. RESULTADOS: A area total sob a curva ROC entre o indice de conicidade e risco coronariano foi de 0,80, IC 95% (0,74-0,85) para homens e 0,75, IC 95% (0,70-0,80) para mulheres. Os melhores pontos de corte para discriminar o risco coronariano elevado foram, para homens e mulheres, respectivamente, 1,25 (sensibilidade de 73,91% e especificidade de 74,92%) e 1,18 (sensibilidade de 73.39% e especificidade de 61,15%). CONCLUSOES: Os resultados encontrados neste estudo sugerem que o indice de conicidade deve ser comparado aos demais indicadores antropometricos de obesidade e pode vir a ser utilizado para discriminar risco coronariano elevado.