Laercio Joel Franco

Multicenter Study of the Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in the Urban Brazilian Population Aged 30–69 yr

OBJECTIVE To assess the prevalence of diabetes and IGT in the urban adult Brazilian population. RESEARCH DESIGN AND METHODS We used a two-stage, multicenter, cross-sectional survey in a random sample of 21,847 individuals aged 30–69 yr from nine large cities. Subjects were first screened by FCG. All positive screenees (FCG ≥ 5.6 mM/L) and every sixth consecutive negative screenee were administered a 75 g OGTT and classified as diabetic, IGT, or normal (nondiabetic) according to WHO recommendations. OGTT findings from the negative screenees were extrapolated to all negative screenees after adjustments for potential biases. RESULTS The overall rates were 7.6 and 7.8% for diabetes and IGT, respectively. Men (7.5%) and women (7.6%) had similar rates of diabetes. Similar rates resulted with whites (7.8%) and nonwhites (7.3%). Diabetes prevalence increased from 2.7% in the 30–39-yr age-group to 17.4% in the 60–69-yr age-group. Diabetes was more prevalent among less educated people, but this difference disappeared after adjusting for age. Family history of diabetes was associated with a twofold increase in diabetes prevalence (12.5 vs. 5.8%); the same increase occurred with obesity (11.6 vs. 5.2%). Undiagnosed diabetes accounted for 46% of the total prevalence. Among previously diagnosed cases, 22.3% were not under treatment, 7.9% were on insulin, 40.7% were on oral agents, and 29.1% were on dietary treatment only. Self-reported diabetes prevalence was 0.1, 3.2, and 11.6% in the age groups < 30, 30–69, and > 70 yr, respectively. CONCLUSIONS The prevalence of diabetes in Brazil is comparable with that of more developed countries, where it is considered a major health problem.

Relação entre hábitos bucais e má oclusão em pré-escolares

OBJECTIVEnTo evaluate the way oral habits and speech problems affect dental occlusion in preschool children.nnnMETHODSnA random sample of 2,139 boys and girls aged 3-5 years old was evaluated. The children were enrolled in private and state institutions in the city of Bauru, São Paulo State, Brazil. The cross-sectional study was developed in two steps: occlusion assessment, and a questionnaire about their social and economic status. The occlusal anatomical-functional characteristics assessment was done according to Angle classification. Additionally, overjet, overbite, crowding, anterior open bite, posterior crossbite, and anterior crossbite were evaluated. A sub-sample of 618 children filled out the questionnaire. The prevalence of malocclusion and some variables of exposure were tested by bivariate analysis.nnnRESULTSnThe prevalence of malocclusion was 51.3% for boys and 56.9% for girls. There was no difference related to gender. In regard to age, there was a higher prevalence of malocclusion in the 3 year-old group, which decreased significantly with age (p<0.05).nnnCONCLUSIONSnAmong the environmental factors evaluated, the habit of sucking a pacifier was the most important in the association with malocclusion (OR=5.46) followed by the habit of sucking fingers (OR=1.54). Speech problems did not show any influence in malocclusion occurrence.OBJETIVO: Avaliar como o desenvolvimento de habitos bucais deleterios e os problemas de fala afetam a oclusao dentaria em pre-escolares. METODOS: Foi constituida a amostra probabilistica por 2.139 criancas de ambos os sexos, na faixa etaria de 3 a 5 anos, matriculadas em instituicoes publicas ou privadas do Municipio de Bauru, SP, Brasil. Foi desenvolvido estudo transversal em duas etapas: exame de oclusao e questionario socioeconomico. A classificacao de Angle foi adotada para avaliacao de aspectos morfologicos da oclusao, observando-se tambem trespasse horizontal e vertical, espacamento/apinhamento, mordida aberta anterior, mordida cruzada total, mordida cruzada anterior e mordida cruzada posterior uni ou bilateral. Uma subamostra de 618 criancas apresentou resposta ao questionario sobre habitos bucais, saude infantil e informacoes sobre condicoes socioeconomicas. RESULTADOS: A prevalencia de ma oclusao foi de 51,3% para o sexo masculino e 56,9% para o sexo feminino, sem variacao quanto ao sexo. A maior prevalencia de ma oclusao foi verificada no grupo etario de tres anos, decrescendo significantemente com a idade (p<0,05). CONCLUSOES: Entre os fatores ambientais estudados, o habito de succao de chupeta foi o mais importante na associacao com ma oclusao (OR=5,46), seguido da succao digital (OR=1,54). Dificuldades na fala nao apresentaram relacao com a ma oclusao.

Excesso de peso e gordura abdominal para a síndrome metabólica em nipo-brasileiros

OBJECTIVE: Obesity, especially abdominal, has been associated with cardiovascular risk factors such as dyslipidemia, hypertension and diabetes mellitus (DM). The importance of these risk factors among Japanese-Brazilians was previously shown, although obesity is not a typical characteristic of Japanese migrants. In this study the prevalence of weight excess and central adiposity (CA) among Japanese-Brazilians and their association with metabolic disorders was evaluated. METHODS: A sample of 530 1st and 2nd generation Japanese-Brazilians (aged 40¾79 years) went through anthropometric and blood pressure measurements, lipid profile and oral glucose tolerance tests. The prevalence rate (point and confidence interval) of overweight was calculated using a cut-off value of >26.4 kg/m2. CA diagnosis was based on waist-to-hip circumference ratio (WHR): ³ 0.85 and 0.95 in women and men, respectively. RESULTS: The prevalence of weight excess was 22.4% (CI 95% 20.6¾28.1), and CA was 67.0% (95% CI 63.1¾70.9). In addition to higher prevalence of DM, hypertension and dyslipidemia, stratifying by BMI and WHR, people with weight excess and CA revealed a poorer metabolic profile: blood pressure levels were significantly higher among those with weight excess with or without CA; CA individuals had higher glucose, triglycerides, total and LDL cholesterol, and lower HDL than those without weight excess or CA; fasting insulinemia was significantly higher among subjects with weight excess (with or without CA) than among those without weight excess or CA. CONCLUSION: Comparing subgroups with and without CA supports the hypothesis that abdominal fat accumulation represents a risk factor for insulin resistance-related diseases, even among Japanese descendants. The increased prevalence of metabolic syndrome among Japanese migrants could be attributed to visceral fat deposition, which has been implicated in the genesis of insulin resistance.

Relação entre determinantes socioeconômicos e hábitos bucais de risco para más-oclusões em pré-escolares

Tendo por objetivo avaliar como determinantes socioeconomicos afetam a prevalencia de habitos bucais deleterios em pre-escolares, este estudo transversal foi desenvolvido. O inquerito epidemiologico foi realizado no periodo de outubro de 1994 a dezembro de 1995. A amostra probabilistica foi constituida por 2.139xa0criancas, de ambos os sexos, na faixa etaria de 3 a 5xa0anos, matriculadas em instituicoes publicas ou privadas do municipio de Bauru - SP - Brasil. Uma subamostra de 618 criancas apresentou resposta ao questionario socioeconomico. A partir da hipotese que determinantes socioeconomicos afetam o estado emocional da crianca e isto se manifesta atraves de habitos bucais, como succao de chupeta e succao digital, foram realizadas analises bivariadas envolvendo as respostas ao questionario socieconomico e algumas variaveis de exposicao. Alguns determinantes socioeconomicos, como o trabalho materno e ocupacao da pessoa de maior renda no domicilio estao relacionados com a maior prevalencia de habitos bucais (pxa0<xa00,05), que por sua vez estao positivamente associados com a ma-oclusao.

Diabetes in Japanese-Brazilians--influence of the acculturation process.

Epidemiologic studies of migrant populations provide very promising clues towards understanding the roles of genetics and environmental factors in the etiology of diabetes mellitus. Populations of Japanese ancestry are of particular interest due to marked differences in prevalence rates of non-insulin dependent diabetes (NIDDM) when comparing those living in Japan with those who migrated to western countries. Brazil offers very favorable conditions of the study of diabetes in the Japanese origin population. Presently, Brazil has the largest population of Japanese ancestry outside Japan. A cross-sectional study comparing first (Issei) and second (Nisei) generations of Japanese-Brazilians living in the city of Bauru, in the industrialized state of São Paulo, southeast of Brazil, was carried out between May and November 1993. The study sample consisted of all first generation (127 men and 111 women) and a random sample of second generation (136 men and 156 women) aged 40-79 years. Results show that: 1--The prevalence of diabetes in Japanese Brazilians (12.8 and 16.2% for first and second generations) are higher than the rates reported for Japan at comparable age-groups. 2--Comparing generations, the age-adjusted prevalence of diabetes was higher in the second generation only for men (men: 12.4 vs. 21.7%; women: 11.6 vs. 11.4%). 3--Obesity was more prevalent in the second generation among men (Men: 34.6 vs. 45.7% women, 39.6 vs. 40.8%).

Evaluation of Three Potential Screening Tests for Diabetes Mellitus in a Biethnic Population

We tested the ability of three potential screening tests for diabetes (fasting plasma glucose value ≥140 mg/dl, 1-h postglucose (PG) load value ≥200 mg/dl, and 2-h PG value ≥200 mg/dl) to detect non-insulin-dependent diabetes in 130 diabetic Mexican Americans (MAs) and 50 diabetic Anglo Americans (AA) usingthe National Diabetes Data Group criteria as the standard. The sensitivity of the fastingplasma glucose (FPG) cutpoint in detecting diabetes was low in both AAs (36.0%) and MAs (59.3%) and was related to the age-adjusted prevalence rates of diabetes in the two ethnic groups (AAs, 4.9% MAs, 10.9%). The 2-h PG load cutpoint had good sensitivity (> 93%) and specificity (> 99%) in both ethnic groups. The ethnic difference in the sensitivity of the FPG cutpoint appeared to be related to the greater hyperglycemia of diabetic MAs compared with diabetic AAs. Nearly 30% of diabetic MAs had FPG values ≥ 200 mg/dl as contrasted with only 10% of diabetic AAs. The difference in severity of hyperglycemia between the ethnic groups appears to be unrelated to ethnic differences in adiposity, pharmacologic treatment, or delay in diagnosis, although longer disease duration in MAs may explain part of the difference.

Disturbances of glucose and lipid metabolism in first and second generation Japanese-Brazilians

Increased prevalence of self-reported NIDDM in Japanese-Brazilians was reported when compared to Japan. This study aimed at determining the prevalence of NIDDM and IGT in Japanese-Brazilians living in the city of Bauru, São Paulo, Brazil. The impact of western environment on the frequency of obesity, dyslipidemia and hypertension was investigated. All Issei (first generation; n = 238) and a random sample of Nisei (second generation; n = 292), aged 40-79 years, were selected for clinical examination and OGTT (WHO criteria). Age-adjusted prevalence of NIDDM did not differ between men and women for Issei (12.4 vs. 11.6%, respectively), but it became different for Nisei (21.7 vs. 11.4%, P < 0.03) due to an increased rate among men. Increased IGT prevalence was also observed between Issei and Nisei men (8.5 vs. 19.3%, P < 0.03). Issei women had a higher IGT rate than Issei men (27. 3 vs. 8.5%, P < 0.0005). Body mass index (BMI) was higher in the second generation (24.1 +/- 3.6 vs. 23.3 +/- 3.1 kg/m2, P < 0.00005) and also the frequency of obesity, defined as BMI > 25 kg/m2. Comparison of waist/hip ratio by gender showed that only among women, Nisei had lower ratio than Issei (0.90 vs. 0.88, P < 0.05). Nisei had a lower total and LDL-cholesterol than Issei but triglyceride and HDL-cholesterol did not differ. Nisei women (younger than the Issei) had lower triglyceride and total cholesterol. This pattern was not seen between the two generations of men. Considering the mean blood pressure values, Issei and Nisei groups with normal glucose tolerance were not hypertensive. Systolic blood pressure was lower in Nisei and the inverse was found concerning diastolic levels. NIDDM prevalence in Japanese-Brazilians is higher than in Japan and in the general Brazilian population. Besides environment, genetic factors may confer susceptibility to NIDDM when they are exposed to a western environment. Before developing glucose intolerance, disturbances of lipid profile and blood pressure could be detected. Nisei may be more affected due to a longer exposure to an unfavorable environment and these changes seem to occur earlier among men than women.

Evidence of bimodality of two hour plasma glucose concentrations in Mexican Americans: Results from the San Antonio heart study

Evidence for bimodality in the distribution of two hour post oral glucose challenge plasma glucose concentrations has come previously primarily from native American and Pacific Island populations having high non-insulin dependent diabetes mellitus (NIDDM) prevalence. Because the National Diabetes Data Group (NDDG) criteria for diagnosing NIDDM rely in part upon the assumption of bimodality, it is important to determine the generality of this phenomenon. We looked for bimodality among Mexican Americans in San Antonio, a population having greater than 50% Caucasian admixture. By fitting both a single normal distribution model and a mixture model of two normal distributions, for each age decade, we found that the mixture model was preferred to the single normal model (p less than 0.001) and that this model fit the data well. The proportion in the upper component (hyperglycemics) increased with each successive age decade. The minimum misclassification cutpoints decreased with age, but all were higher than the 200 mg/dl cutpoint recommended by the NDDG. Use of the NDDG cutpoint, however, improved sensitivity with only a minimal deterioration of specificity. Our findings further generalize the bimodality phenomenon and support the NDDG criteria.

Diabetes mellitus auto-referido no Município de São Paulo: prevalência e desigualdade

This report analyzes characteristics of self-reported diabetes mellitus in the city of Sao Paulo, Brazil. The data were obtained from the Brazilian Multicenter Study on Prevalence of Diabetes Mellitus, a household survey performed in 1986-88. The Sao Paulo sample consisted of 2,007 individuals aged 30-69 years, of both sexes, selected from three areas with distinct socio-economic levels. The estimated prevalence using a 75g glucose load and measurement of two-hour capillary glycemia was 9.7%. Prevalence of self-reported diabetes was 4.7% and increased with age and presence of family history of diabetes. There was a significant difference between sexes (3.5% in men and 5.7% in women), with higher rates of self-reported diabetes at higher economic levels among men and higher rates at lower socio-economic levels among women.

Prevalência de cárie dentária em crianças da faixa etária de 0 a 6 anos matriculadas em creches: importância de fatores socioeconômicos

Foi avaliada a prevalencia de carie na denticao decidua de criancas entre 0 e 6 anos, matriculadas em creches dos Municipios de Bauru e Sao Paulo, SP (Brasil). O primeiro grupo (Bauru) nao recebia cuidados sistematizados de saude na instituicao e o segundo (Sao Paulo) apresentava uma rotina de cuidados como norma institucional. Foram analisadas as variaveis relativas aos modos de viver desses grupos populacionais e sua associacao com a ocorrencia de carie, efetuando um estudo de caso para caracterizacao de fatores coletivos de risco a carie. Atraves de analise de regressao multipla, verificou-se a influencia da idade e frequencia de consultas odontologicas sobre a prevalencia de carie na amostra estudada (p<0,05). Na faixa etaria de 5-6 anos, 23,3% das criancas de Bauru e 9,3% de Sao Paulo estavam isentas de carie, contra a expectativa de 50% prevista na Meta n.o 1 da Organizacao Mundial da Saude para o ano 2000. A prevalencia de carie foi mais elevada em Bauru nas criancas de 3-4 e 5-6 anos, apresentando significância estatistica apenas para o grupo 3-4 anos (p<0,05). Nao foram observadas diferencas estatisticamente significantes entre os sexos quanto a ocorrencia de carie.Oral health condition in samples of children from zero to six years old, examined in day nurseries for children from Bauru and S. Paulo County (Brazil) by the caries indicator in primary dentition-dmfs, is assessed. The first group did not receive oral health care where any as the second group received the standard oral care provided by the institution. Variables related to way of life and their relationship to the presence of caries were evaluated. Multiple regression analysis showed a statistically significant association of age and frequency of dental visits with the prevalence of dental caries (p < 0.05). The data also showed that 23.3% of the children from Bauru, and 9.3% of those from S. Paulo were free of caries, numbers that are very far from the 50% proposed by WHO for the year 2000. The overall prevalence of dental caries was greater for the Bauru group than for the S. Paulo group; however, statistical significance was only found in the 3-4 age-group (p < 0.05). Sex differences in the occurrence of dental caries were not statistically significant.