Ludmila Correa Muniz

Clustering of risk factors for chronic diseases among adolescents from Southern Brazil.

Objective To investigate the clustering of risk behaviors for chronic non-communicable diseases and their associated factors among adolescents from Southern Brazil. Methods In 2008, a survey was conducted with 3990 adolescents aged 14–15 years (mean: 14.3; SD: 0.6) from the 1993 Pelotas Birth Cohort Study. Clustering was determined by comparing observed (O) and expected (E) prevalence of all possible combinations of the four risk factors investigated (smoking, alcohol intake, low fruit intake, and physical inactivity). We carried out Poisson regression to evaluate the effect of individual characteristics on the presence of at least three risk behaviors. Results All risk factors tended to cluster together (O/E prevalence = 3.0), especially smoking and alcohol intake (odds ratio to present on behavior in the presence of other > 5.0). Approximately 15% of adolescents displayed three or more risk behaviors. Females (adjusted OR = 1.55), people 15 years and older (OR = 1.47), with black skin color (OR = 1.23), and of low socioeconomic level (OR = 1.29) were more likely to display three or more risk factors. Conclusion These findings suggest that lifestyle-related risk factors tend to cluster among adolescents. Identifying subgroups at greater risk of simultaneously engaging in multiple risk behaviors may aid in the planning of preventive strategies.

Waist circumference and pulmonary function: a systematic review and meta-analysis

BackgroundStudies have reported an impact of central obesity on people’s health. The literature is scarce on the effects of waist circumference (WC) on pulmonary function. Our objective was to review the literature on the association between WC and pulmonary function.MethodsA systematic review was carried out in the PubMed, CINAHL, Web of Science and Scopus databases. The search included published, in press and online documents up to December 2011. A meta-analysis was carried out to obtain the pooled effect, and a meta-regression was performed to evaluate sources of heterogeneity.ResultsFrom the 547 studies identified, 10 were included. The meta-analysis revealed an inverse relationship between WC and pulmonary function parameters, indicating that the effect was greater among men (forced expiratory volume in 1 second (FEV1 β = −15.9 (95% confidence interval = −23.2, −8.5); forced vital capacity (FVC) β = −16.6 (95% confidence interval = −21.0, −12.2)) compared with women (FEV1 β = −5.6 (95% confidence interval = −9.1, −2.1); FVC β = −7.0 (95% confidence interval = −9.1, −4.8)). The meta-regression identified sex as the characteristic that most contributed to the heterogeneity (R2 = 54.8% for FEV1 and R2 = 85.7% for FVC).ConclusionsThere seems to be an inverse relationship between WC and pulmonary function, mainly in men. More population-based studies should be performed, especially among children and adolescents, to confirm these findings.

Fatores de risco comportamentais acumulados para doenças cardiovasculares no sul do Brasil

OBJETIVO: Estimar la prevalencia e identificar factores asociados con la acumulacion de conductas de riesgo en enfermedades cardiovasculares entre adultos. METODOS: Estudio transversal de base poblacional con muestra representativa de 2.732 adultos de ambos sexos de Pelotas, Sur de Brasil, en 2010. Los factores de riesgo conductuales investigados fueron: tabaquismo; inactividad fisica en las horas de ocio; consumo habitual de grasa aparente de la carne, e consumo diario de embutidos, carne roja y leche integral. El desenlace del estudio fue el escore de aglomeracion de factores de riesgo conductuales, variando de cero a tres: ningun factor de riesgo conductual para enfermedades cardiovasculares o exposicion a 1, 2 o > 3 factores de riesgo conductuales. Se realizo regresion logistica multinomial para evaluar el efecto ajustado de las caracteristicas individuales sobre la acumulacion de factores de riesgo conductuales, teniendo como categoria de referencia individuos sin alguno de los factores. RESULTADOS: La inactividad fisica fue el factor de riesgo mas prevaleciente (75,6%), seguido del consumo habitual de grasa aparente de la carne (52,3%). Dos tercios de la poblacion presentaron dos o mas factores de riesgo conductuales. La combinacion de inactividad fisica y consumo habitual de grasa aparente de la carne ocurrio en 17,5% de la muestra; e inactividad fisica, consumo habitual de grasa aparente de la carne y tabaquismo, en 6,7%. Los odds ratios de acumulacion de dos o mas factores fueron mayores entre hombres y se asociaron inversamente con el indicador economico nacional. CONCLUSIONES: La acumulacion de factores de riesgo conductuales en enfermedades cardiovasculares es elevada en la poblacion estudiada. Son necesarias intervenciones publicas capaces de prevenir la ocurrencia simultanea de tales factores.OBJECTIVE To estimate the prevalence of, and identify factors associated with, accumulated risky behavior relating to cardiovascular diseases among adults. METHODS This was a population-based cross-sectional study on a representative sample of 2732 adults of both sexes in Pelotas, Southern Brazil, in 2010. The behavioral risk factors investigated were: smoking; leisure-time physical inactivity; habitual consumption of visible fat in meat; and daily consumption of processed meats, red meat and whole milk. The study outcome was the accumulated behavioral risk factors score, ranging from zero to three: no behavioral risk factor for cardiovascular diseases or exposure to 1, 2 or > 3 behavioral risk factors. Multinomial logistic regression was performed to evaluate the adjusted effect of individual characteristics on behavioral risk factors accumulation, taking individuals without any of these factors as the reference category. RESULTS Physical inactivity was the most prevalent risk factor (75.6%), followed by habitual consumption of visible fat in meat (52.3%). Two thirds of the population presented two or more behavioral risk factors. Combined physical inactivity and habitual consumption of visible fat in meat was observed in 17.5% of the sample; and combined physical inactivity, habitual consumption of visible fat in meat and smoking in 6.7%. The odds ratios for accumulation of two or more risk factors were higher among men and were inversely associated with a national economic indicator. CONCLUSIONS There was a high accumulation of behavioral risk factors for cardiovascular diseases among the study population. Public interventions with the capacity to prevent simultaneous occurrence of these factors are needed.OBJETIVO: Estimar a prevalencia e identificar fatores associados ao acumulo de comportamentos de risco para doencas cardiovasculares entre adultos. METODOS: Estudo transversal de base populacional com amostra representativa de 2.732 adultos de ambos os sexos de Pelotas, RS, em 2010. Os fatores de risco comportamentais investigados foram: tabagismo; inatividade fisica no lazer; consumo habitual de gordura aparente da carne; e consumo diario de embutidos, carne vermelha e leite integral. O desfecho do estudo foi o escore de aglomeracao de fatores de risco comportamentais, variando de zero a tres: nenhum fator de risco comportamental para doencas cardiovasculares ou exposicao a 1, 2 ou > 3 fatores de risco comportamentais. Realizou-se regressao logistica multinomial para avaliar o efeito ajustado das caracteristicas individuais sobre o acumulo de fatores de risco comportamentais, tendo como categoria de referencia individuos sem qualquer dos fatores. RESULTADOS: A inatividade fisica foi o fator de risco mais prevalente (75,6%), seguido do consumo habitual de gordura aparente da carne (52,3%). Dois tercos da populacao apresentaram dois ou mais fatores de risco comportamentais. A combinacao de inatividade fisica e consumo habitual de gordura aparente da carne ocorreu em 17,5% da amostra; e inatividade fisica, consumo habitual de gordura aparente da carne e tabagismo, em 6,7%. Os odds ratios de acumulo de dois ou mais fatores foram maiores entre homens e associaram-se inversamente com o indicador economico nacional. CONCLUSOES: O acumulo de fatores de risco comportamentais para doencas cardiovasculares e elevado na populacao estudada. Sao necessarias intervencoes publicas capazes de prevenir a ocorrencia simultânea desses fatores.

Accumulated behavioral risk factors for cardiovascular diseases in Southern Brazil

OBJETIVO: Estimar la prevalencia e identificar factores asociados con la acumulacion de conductas de riesgo en enfermedades cardiovasculares entre adultos. METODOS: Estudio transversal de base poblacional con muestra representativa de 2.732 adultos de ambos sexos de Pelotas, Sur de Brasil, en 2010. Los factores de riesgo conductuales investigados fueron: tabaquismo; inactividad fisica en las horas de ocio; consumo habitual de grasa aparente de la carne, e consumo diario de embutidos, carne roja y leche integral. El desenlace del estudio fue el escore de aglomeracion de factores de riesgo conductuales, variando de cero a tres: ningun factor de riesgo conductual para enfermedades cardiovasculares o exposicion a 1, 2 o > 3 factores de riesgo conductuales. Se realizo regresion logistica multinomial para evaluar el efecto ajustado de las caracteristicas individuales sobre la acumulacion de factores de riesgo conductuales, teniendo como categoria de referencia individuos sin alguno de los factores. RESULTADOS: La inactividad fisica fue el factor de riesgo mas prevaleciente (75,6%), seguido del consumo habitual de grasa aparente de la carne (52,3%). Dos tercios de la poblacion presentaron dos o mas factores de riesgo conductuales. La combinacion de inactividad fisica y consumo habitual de grasa aparente de la carne ocurrio en 17,5% de la muestra; e inactividad fisica, consumo habitual de grasa aparente de la carne y tabaquismo, en 6,7%. Los odds ratios de acumulacion de dos o mas factores fueron mayores entre hombres y se asociaron inversamente con el indicador economico nacional. CONCLUSIONES: La acumulacion de factores de riesgo conductuales en enfermedades cardiovasculares es elevada en la poblacion estudiada. Son necesarias intervenciones publicas capaces de prevenir la ocurrencia simultanea de tales factores.OBJECTIVE To estimate the prevalence of, and identify factors associated with, accumulated risky behavior relating to cardiovascular diseases among adults. METHODS This was a population-based cross-sectional study on a representative sample of 2732 adults of both sexes in Pelotas, Southern Brazil, in 2010. The behavioral risk factors investigated were: smoking; leisure-time physical inactivity; habitual consumption of visible fat in meat; and daily consumption of processed meats, red meat and whole milk. The study outcome was the accumulated behavioral risk factors score, ranging from zero to three: no behavioral risk factor for cardiovascular diseases or exposure to 1, 2 or > 3 behavioral risk factors. Multinomial logistic regression was performed to evaluate the adjusted effect of individual characteristics on behavioral risk factors accumulation, taking individuals without any of these factors as the reference category. RESULTS Physical inactivity was the most prevalent risk factor (75.6%), followed by habitual consumption of visible fat in meat (52.3%). Two thirds of the population presented two or more behavioral risk factors. Combined physical inactivity and habitual consumption of visible fat in meat was observed in 17.5% of the sample; and combined physical inactivity, habitual consumption of visible fat in meat and smoking in 6.7%. The odds ratios for accumulation of two or more risk factors were higher among men and were inversely associated with a national economic indicator. CONCLUSIONS There was a high accumulation of behavioral risk factors for cardiovascular diseases among the study population. Public interventions with the capacity to prevent simultaneous occurrence of these factors are needed.OBJETIVO: Estimar a prevalencia e identificar fatores associados ao acumulo de comportamentos de risco para doencas cardiovasculares entre adultos. METODOS: Estudo transversal de base populacional com amostra representativa de 2.732 adultos de ambos os sexos de Pelotas, RS, em 2010. Os fatores de risco comportamentais investigados foram: tabagismo; inatividade fisica no lazer; consumo habitual de gordura aparente da carne; e consumo diario de embutidos, carne vermelha e leite integral. O desfecho do estudo foi o escore de aglomeracao de fatores de risco comportamentais, variando de zero a tres: nenhum fator de risco comportamental para doencas cardiovasculares ou exposicao a 1, 2 ou > 3 fatores de risco comportamentais. Realizou-se regressao logistica multinomial para avaliar o efeito ajustado das caracteristicas individuais sobre o acumulo de fatores de risco comportamentais, tendo como categoria de referencia individuos sem qualquer dos fatores. RESULTADOS: A inatividade fisica foi o fator de risco mais prevalente (75,6%), seguido do consumo habitual de gordura aparente da carne (52,3%). Dois tercos da populacao apresentaram dois ou mais fatores de risco comportamentais. A combinacao de inatividade fisica e consumo habitual de gordura aparente da carne ocorreu em 17,5% da amostra; e inatividade fisica, consumo habitual de gordura aparente da carne e tabagismo, em 6,7%. Os odds ratios de acumulo de dois ou mais fatores foram maiores entre homens e associaram-se inversamente com o indicador economico nacional. CONCLUSOES: O acumulo de fatores de risco comportamentais para doencas cardiovasculares e elevado na populacao estudada. Sao necessarias intervencoes publicas capazes de prevenir a ocorrencia simultânea desses fatores.

Prevalência e fatores associados ao consumo de frutas, legumes e verduras entre adolescentes de escolas públicas de Caruaru, PE

This is a cross-sectional school-based study that evaluated the prevalence and associated factors of the daily intake of fruit and vegetables by adolescents at public schools in Caruaru, Pernambuco. Poisson regression with a hierarchical model, including sociodemographic variables in the first hierarchical level, behavioral variables in the second and diet-related variables in the third was used to assess the factors associated with fruit and vegetable intake. The results showed that of the 600 adolescents interviewed, 10% reported never eating fruit and 30.7% mentioned not eating vegetables. Prevalence of fruit intake was 32.9% and vegetables 29.0%. Only 6.5% reported eating both kinds of food daily. Merely the daily vegetable intake showed a significant difference according to sex (higher among girls). Daily fruit intake was 63% higher among adolescents living in urban areas. Not consuming alcohol was associated with higher fruit intake, though not to vegetable intake. Daily intake of fruits and vegetables was 2.4 times higher among adolescents who consumed rice and beans daily. Daily fruit and vegetable intake among adolescents in Caruaru is below the recommendations, and was associated with gender, residence area, consumption of alcoholic beverages and consumption of rice and beans.

Consumo alimentar entre crianças brasileiras de dois a cinco anos de idade: Pesquisa Nacional de Demografia e Saúde (PNDS), 2006

O objetivo deste estudo foi analisar a mortalidade por doencas circulatorias paralelamente a evolucao da Estrategia Saude da Familia no Brasil. Estudo ecologico, retrospectivo, baseado na evolucao temporal da ESF e nas taxas de mortalidade por doencas circulatorias no Brasil. Foi realizada uma descricao da razao de cobertura habitante x ESF e dos indicadores de saude relacionados a mortalidade por doencas circulatorias. Para a associacao estatistica utilizou-se o teste de Correlacao de Spearman. Houve aumento populacional no Brasil em 15%, evolucao de 761% no numero de ESF e 5% de aumento na mortalidade por doencas circulatorias. A razao populacao x ESF passou de 52.838 (1998) para 7.084 (2006) pessoas assistidas por ESF. As regioes norte e nordeste apresentaram crescimento nas taxas de mortalidade por doencas circulatorias e em 21 (81%) estados houve correlacao positiva entre mortalidade por doencas circulatorias e ESF (r: > 0,7; p < 0,01). Por fim, considera-se a ESF uma importante politica publica de saude, tendo obtido resultados exitosos no Brasil desde a sua implementacao. Entretanto, em um contexto geral, sua expansao nao influenciou a reducao da mortalidade por doencas circulatorias, tendo apresentado aumento deste indicador no pais.

Physical activity and lung function in adolescents: the 1993 Pelotas (Brazil) birth cohort study.

Purpose To evaluate the association between physical activity changes in those aged 11 to 15 years and lung function at age 15 years. Methods The original cohort comprised 5,249 hospital-born children during the calendar year of 1993 in Pelotas, Brazil. In 2004–2005 and 2008–2009, all cohort members were sought for follow-up visits. Self-reported physical activity was measured at ages 11 and 15 years. At the 2008–2009 visit, when participants were 15 years old, spirometry was performed. Linear regression was used, and all analyses were stratified by sex. Results Of the 5,249 original members of the cohort, 4,325 were located at 15 years of age, and spirometry was performed on 4,010 members. Forced expiratory volume in 1 second was not associated with physical activity. In girls, those who were active in leisure time in both periods have better percent-predicted forced vital capacity (β = 3.573 [95% confidence interval {CI}: 1.015, 6.130]) and forced expiratory volume in the 6 seconds (β = .095 [95% CI: .021, .168]) than those who were inactive in the two periods. Also in girls, those who became active at 15 years of age had higher peak expiratory flow than those who were inactive at 11 and 15 years of age. In boys, only those who became inactive in leisure time had worse peak expiratory flow (β = −.180 [95% CI: −.339, −.021]) than boys who were inactive at ages 11 and 15 years. Conclusions Self-reported leisure-time physical activity was associated with better effort-dependent lung function parameters, particularly among girls.

Predictors of Body Mass Index Change From 11 to 15 Years of Age: The 1993 Pelotas (Brazil) Birth Cohort Study

Purpose We explored predictors of nutritional status change from 11 to 15 years of age by analyzing prospective data. Methods We collected data at 11 and 15 years of age from individuals born in 1993 in Pelotas, Brazil. We assessed nutritional status using body mass index (BMI) for age in z-score according to the World Health Organization 2007 standards. Independent variables collected at 11 years of age were socioeconomic position, adolescents perception of own weight, body dissatisfaction, and weight loss dieting. Results Of the 4,032 adolescents whose nutritional status could be evaluated in the two follow-ups, 93% maintained their nutritional status classification from 11 to 15 years. A total of 102 (2.8%) became obese and 181 (4.5%) ceased to be obese in the 4-year period. The prevalence of obesity decreased from 11 to 15 years of age in both boys and girls. Low-income girls were more likely to become obese from 11 to 15 years of age compared with high-income ones. Among boys, those with high income were more likely to cease being obese compared those with low income. Those who perceived themselves to be obese, who wished to have a smaller silhouette, and who were on diets to lose weight were more likely to become obese or to achieve a normal BMI category at 15 years of age. Conclusions BMI tracks strongly in early adolescence. This finding suggests that interventions to more effectively change nutritional status should be implemented in childhood and should consider emotional aspects as well as social and biological ones.

Trends in self-reported arterial hypertension in Brazilian adults: an analysis of data from the Brazilian National Household Sample Survey, 1998-2008

This study investigated the time trend in self-reported arterial hypertension from 1998 to 2008 in individuals older than 20 years in Brazil. Data were analyzed on prevalence of hypertension from the National Household Sample Survey (PNAD) for the years 1998, 2003, and 2008. The analysis considered the sampling complexity and included 203,419, 238,591, and 257,816 individuals in the years 1998, 2003, and 2008, respectively. The time trend in hypertension was analyzed by sex, family income, geographic regions of Brazil, and area of residence (urban versus rural), and the prevalence rates were adjusted for age. Prevalence of self-reported hypertension was 12.5% in 1998, 13% in 2003, and 13.9% in 2008, with an annual increase of 1.07%. The highest increases occurred in the Southeast Region (1.41%), in men (1.82%), and in urban areas (1.15%). The study showed a rise in the prevalence of self-reported hypertension in all income brackets and with increasing age. Knowledge of the prevalence of hypertension is essential for backing activities to prevent and control the problem, especially among the more vulnerable subgroups.

Consumo de leite e derivados entre adultos e idosos no Sul do Brasil: um estudo de base populacional

This is a population-based cross-sectional study to evaluate the frequency of consumption of dairy products by adults and the elderly in Pelotas in the state of Rio Grande do Sul, in accordance with demographic, social and economic characteristics. Frequency of dairy product consumption was obtained by means of a questionnaire containing short, straightforward questions. Information about the type of milk (cows milk, soy, other) and the fat contained in the milk consumed (full-cream, semi-skimmed and skimmed) was also investigated. Heterogeneity, linear trend and chi-square tests were used for the statistical analysis. The prevalence of regular dairy product consumption was 45.9%, and was 1.7 times higher among the elderly compared with 20 to 29-year-olds. Dairy product consumption frequency was higher among women, Caucasians and those with tertiary education. The economic level was significantly and inversely associated with the outcome. Nearly 98% of the sample drink cows milk and 75.5% drink full-fat milk. About 26% of the adults do not drink milk and of these less than 20% consume dairy products daily. Dairy product consumption, especially low-fat products, should be encouraged among adults. Special attention should be given to younger individuals, males, and groups with less education and income.