Laura Augusta Barufaldi

The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study

BackgroundObesity is a major global epidemic and a burden to society and health systems. It is well known risk factor for a number of chronic medical conditions with high morbidity and mortality. This study aimed to provide an estimate of the direct costs associated to outpatient and inpatient care of overweight and obesity related diseases in the perspective of the Brazilian Health System (SUS).MethodsPopulation attributable risk (PAR) was calculated for selected diseases related to overweight and obesity and with the following parameters: Relative risk (RR) ≥ 1.20 or RR ≥1.10 and < 1.20, but important problem of public health due its high prevalence. After a broad search in the literature, two meta-analysis were selected to provide RR for PAR calculation. The prevalence rates of overweight and obesity in Brazilians with ≥18 years were obtained from large national survey. The national health database (DATASUS) was used to estimate the annual cost of the Brazilian Unified Health System (SUS) with the diseases included in the analysis. The extracted values were stratified by sex, type of service (inpatient or outpatient care) and year. Data were collected from 2008 to 2010 and the results reflect the average of 3 years. Brazilian costs were converted into US dollars during the analysis using a purchasing power parity basis (2010).ResultsThe estimated total costs in one year with all diseases related to overweight and obesity are US

Sampling design for the Study of Cardiovascular Risks in Adolescents (ERICA)

2,1 billion; US

Meta-analysis of the prevalence of physical inactivity among Brazilian adolescents

1,4 billion (68.4% of total costs) due to hospitalizations and US

Desenho da amostra do Estudo do Risco Cardiovascular em Adolescentes (ERICA)

679 million due to ambulatory procedures. Approximately 10% of these cost is attributable to overweight and obesity.ConclusionThe results confirm that overweight and obesity carry a great economic burden for Brazilian health system and for the society. The knowledge of these costs will be useful for future economic analysis of preventive and treatment interventions.

ERICA: prevalences of hypertension and obesity in Brazilian adolescents

O Estudo de Riscos Cardiovasculares em Adoles-centes (ERICA) objetiva estimar prevalencia de fatores de risco cardiovascular e da sindrome metabolica em adolescentes (12 a 17 anos) matriculados em escolas publicas e privadas dos 273 municipios com mais de 100 mil habitantes no Brasil. A populacao de pesquisa foi estratificada em 32 estratos geograficos (27 capitais e cinco conjuntos com os demais municipios de cada macrorregiao do pais) e uma amostra de 1.251 escolas foi selecionada com probabilidade proporcional ao tamanho. Em cada escola foram selecionadas tres combinacoes de turno (manha e da tarde) e ano (serie), e em cada uma destas combinacoes foi selecionada uma turma. Todos os alunos elegiveis das turmas selecionadas foram objeto de pesquisa. Os pesos amostrais do desenho foram calculados pelo produto dos inversos das probabilidades de inclusao em cada estagio da amostra e foram depois calibrados considerando as projecoes do numero de adolescentes matriculados em escolas localizadas nos estratos geograficos considerados por sexo e idade.The Study of Cardiovascular Risk in Adolescents (ERICA) aims to estimate the prevalence of cardiovascular risk factors and metabolic syndrome in adolescents (12-17 years) enrolled in public and private schools of the 273 municipalities with over 100,000 inhabitants in Brazil. The study population was stratified into 32 geographical strata (27 capitals and five sets with other municipalities in each macro-region of the country) and a sample of 1,251 schools was selected with probability proportional to size. In each school three combinations of shift (morning and afternoon) and grade were selected, and within each of these combinations, one class was selected. All eligible students in the selected classes were included in the study. The design sampling weights were calculated by the product of the reciprocals of the inclusion probabilities in each sampling stage, and were later calibrated considering the projections of the numbers of adolescents enrolled in schools located in the geographical strata by sex and age.

ERICA: prevalence of metabolic syndrome in Brazilian adolescents

A systematic review and meta-analysis were carried out to investigate the prevalence of physical inactivity among adolescents in Brazil. We identified articles that had been published up to August 2010 and the search was conducted using six electronic databases. We did not enforce any search limitations. Forest plot-type graphs were generated using the prevalence of physical inactivity stratified by region and sex. Meta-regression models were fitted to identify possible sources of heterogeneity in the prevalence estimates. Of the 1,496 articles initially identified, 37 were deemed appropriate for the systematic review. Prevalence rates ranged from 2% to 80% for male and from 14% to 91% for female subgroups. The lowest prevalence rates of physical inactivity were found to be for the Southern region, whereas the highest rates were observed in the North-Northeast. The methods employed to evaluate physical inactivity in Brazilian adolescents also differed among the studies. This variation demonstrates the need for standardised and validated methods of measuring physical activity in epidemiological investigation.

Response rate in the Study of Cardiovascular Risks in Adolescents – ERICA

O Estudo de Riscos Cardiovasculares em Adoles-centes (ERICA) objetiva estimar prevalencia de fatores de risco cardiovascular e da sindrome metabolica em adolescentes (12 a 17 anos) matriculados em escolas publicas e privadas dos 273 municipios com mais de 100 mil habitantes no Brasil. A populacao de pesquisa foi estratificada em 32 estratos geograficos (27 capitais e cinco conjuntos com os demais municipios de cada macrorregiao do pais) e uma amostra de 1.251 escolas foi selecionada com probabilidade proporcional ao tamanho. Em cada escola foram selecionadas tres combinacoes de turno (manha e da tarde) e ano (serie), e em cada uma destas combinacoes foi selecionada uma turma. Todos os alunos elegiveis das turmas selecionadas foram objeto de pesquisa. Os pesos amostrais do desenho foram calculados pelo produto dos inversos das probabilidades de inclusao em cada estagio da amostra e foram depois calibrados considerando as projecoes do numero de adolescentes matriculados em escolas localizadas nos estratos geograficos considerados por sexo e idade.The Study of Cardiovascular Risk in Adolescents (ERICA) aims to estimate the prevalence of cardiovascular risk factors and metabolic syndrome in adolescents (12-17 years) enrolled in public and private schools of the 273 municipalities with over 100,000 inhabitants in Brazil. The study population was stratified into 32 geographical strata (27 capitals and five sets with other municipalities in each macro-region of the country) and a sample of 1,251 schools was selected with probability proportional to size. In each school three combinations of shift (morning and afternoon) and grade were selected, and within each of these combinations, one class was selected. All eligible students in the selected classes were included in the study. The design sampling weights were calculated by the product of the reciprocals of the inclusion probabilities in each sampling stage, and were later calibrated considering the projections of the numbers of adolescents enrolled in schools located in the geographical strata by sex and age.

ERICA: prevalence of healthy eating habits among Brazilian adolescents

ABSTRACT OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.

ERICA: patterns of alcohol consumption in Brazilian adolescents

ABSTRACT OBJECTIVE To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents. METHODS We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status. RESULTS Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95%CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95%CI 2.4-3.2]), when compared with private schools (1.9% [95%CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides. CONCLUSIONS ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome.

ERICA: use of screens and consumption of meals and snacks by Brazilian adolescents

ABSTRACT OBJECTIVE To describe the response rate and characteristics of people who either took part or not in from the Study of Cardiovascular Risks in Adolescents (ERICA) , according to information subsets. METHODS ERICA is a school-based, nation-wide investigation with a representative sample of 12 to 17-year-old adolescents attending public or private schools in municipalities with over 100,000 inhabitants in Brazil. Response rate of eligible subjects were calculated according to macro-regions, sex, age, and type of school (public or private). We also calculated the percentages of replacement schools in comparison with the ones originally selected as per the sample design, according to the types of schools in the macro-regions. The subjects and non-subjects were compared according to sex, age, and average body mass indices (kg/m2). RESULTS We had 102,327 eligible adolescents enrolled in the groups drawn. The highest percentage of complete information was obtained for the subset of the questionnaire (72.9%). Complete information regarding anthropometric measurements and the ones from the questionnaire were obtained for 72.0% of the adolescents, and the combination of these data with the 24-hour dietary recall were obtained for 70.3% of the adolescents. Complete information from the questionnaire plus biochemical blood evaluation data were obtained for 52.5% of the morning session adolescents (selected for blood tests). The response percentage in private schools was higher than the one in public schools for most of the combination of information. The ratio of older and male adolescents non-participants was higher than the ratio among participants. CONCLUSIONS The response rate for non-invasive procedures was high. The response rate for blood collection – an invasive procedure that requires a 12-hour fasting period and the informed consent form from legal guardians – was lower. The response rate observed in public schools was lower than in the private ones, and that may reflect lower school frequency of registered students.