Márcia Gonçalves Ferreira

Epidemiological characteristics of diabetic patients within the public health system: an analysis of the HiperDia system

OBJECTIVE To describe epidemiological traits of diabetic patients attended in the public health network, enrolled in the HiperDia System between 2002 and 2006 and estimate the coverage of this System in the municipality. METHOD A cross-sectional study, with secondary data on 7.938 diabetic patients who live in Cuiabá/MT. Descriptive statistics for analysis of the data was used. RESULTS The HiperDia System coverage was of 58.8%. Most individuals presented type 2 diabetes diagnosis. Over 80% of patients were hypertensive. Among those enrolled, the majority was of women, of individuals born in the state, with low schooling and aged >40 years old. The main cardiovascular risk factors identified were overweight, sedentary lifestyle, and cardiovascular family history. Myocardial infarction was the most frequently observed complication. CONCLUSIONS Diabetic patients when enrolled in the HiperDia presented signs of advanced disease stage. Socio-demographic and clinical characteristics detected in these patients can lead to proper management and prevention actions of diabetes in primary health care.

Associação entre marcadores antropométricos de adiposidade corporal e hipertensão arterial na população adulta de Cuiabá, Mato Grosso

OBJECTIVE: To assess the association between the anthropometric indexes of body adiposity (body mass index - BMI and waist circumference) and hypertension. METHODS: This is a population-based cross-sectional study, carried out from 2003 to 2004, with 1,298 individuals between 20 and 59 years of age. Individuals with blood pressure > 140/90 mmHg using anti-hypertensive medication were considered hypertensive. The associations between anthropometric indexes and hypertension were analyzed through Poissons regression, adjusted for potential confounding factors (sex, age, schooling, smoking, alcohol consumption and physical activity during leisure time). The ROC curve was used to determine the best BMI cutoff point for detection of hypertension. RESULTS: The prevalence of hypertension was 28.3%, being 33.5% among males, and 23.5% among females. After adjustment for BMI and potential confounding factors, waist circumference lost its association with the evaluated outcomes, and BMI alone accounted for hypertension (PR = 1.05, p = 0.001). The best cutoff point for BMI for males was 25.6 Kg/m2, and for females, 25.7 Kg/m2. CONCLUSIONS: The association observed between waist circumference and hypertension in several studies may be related to the lack of control of potential confounding factors in analyses, and to the fact that the effect of total body adiposity was not eliminated. Further investigations should be conducted in the Brazilian population to check true associations among anthropometric indexes with several outcomes, also investigating the best cutoff points for such indexes.

Acurácia da circunferência da cintura e da relação cintura/quadril como preditores de dislipidemias em estudo transversal de doadores de sangue de Cuiabá, Mato Grosso, Brasil

This study evaluated the accuracy of anthropometric fat location indices (waist circumference and waist-to-hip ratio) as predictors of dyslipidemia, in addition to defining their respective cut-offs. The sample consisted of 416 healthy male blood donors from 20 to 58 years of age at the Blood Center in Cuiabá, capital of Mato Grosso State, Brazil. Serum lipids were determined through the enzymatic method. Data analysis through the ROC curve identified the best indicator and the cut-off with the largest statistically significant area under the ROC curve. The best cut-off points for waist-to-hip ratio and waist circumference were 0.90 and 85cm, respectively. The area under the ROC curve between waist circumference and high cholesterol/HDL relation included the 0.50 value, so waist circumference could not be considered a predictor of dyslipidemia. The best sensitivity and specificity were in the youngest group. Waist-to-hip ratio was a better predictor of dyslipidemia than waist circumference, although the latter showed better discriminating power to detect hypertriglyceridemia. The most accurate cut-off points were lower than those set by the World Health Organization.

Hipertensão arterial e estilo de vida em Sinop, Município da Amazônia Legal

BACKGROUND Hypertension is highly prevalent and is an important cardiovascular risk factor. OBJECTIVE To estimate the prevalence of hypertension and its association with lifestyle. METHODS This was a cross-sectional population-based study conducted through a household survey in Sinop-MT (n = 690). The study sample was obtained by simple sampling in two steps. Blood pressure was measured three times and, for the analysis, the average of the last two measures was taken into account. The individuals who had BP > 140/90 mmHg and/or reported use of antihypertensive drugs were considered hypertense. The analysis of hierarchical multiple logistic regression was used to test the association between hypertension and independent variables. RESULTS The prevalence of hypertension was 23.2% (95% CI: 20.1 - 26.6). The only variable related to lifestyle associated with hypertension was the consumption of alcoholic beverages, and this variable was protective for women who consumed up to 15g ethanol/day (OR = 0.49, 95% CI: 0.26-0.93), and deleterious for men who consumed more than 30g ethanol/day (OR = 2.94, 95% CI: 1.28 to 6.77). CONCLUSION Hypertension was independently associated with alcohol consumption among men and women.FUNDAMENTO: La hipertension arterial presenta alta prevalencia y es un importante factor de riesgo cardiovascular. OBJETIVO: Estimar la prevalencia de la hipertension arterial y su asociacion con el estilo de vida. METODOS: Estudio transversal, de base poblacional, por medio de encuesta domiciliaria llevada a cabo en Sinop-MT (n = 690). La muestra de la investigacion se obtuvo por muestreo simple en dos etapas. La presion arterial se tomo tres veces y para el analisis, el promedio de las dos ultimas mediciones. Se considero como hipertensos aquellos que presentaron PA > 140/90 mmHg y/o que refirieron uso de farmacos antihipertensivos. El analisis de regresion logistica multiple jerarquizada se utilizo para probar la asociacion entre la hipertension y las variables independientes. RESULTADOS: La prevalencia de hipertension arterial fue de un 23,2% (IC 95%: 20,1 - 26,6). La unica variable relacionada al estilo de vida asociada a la hipertension arterial fue el consumo de bebidas alcoholicas, siendo protector para las mujeres que consumian hasta 15 g de etanol/dia (OR=0,49;IC 95%: 0,26 - 0,93) y deletereo para los varones que consumian mas de 30 g de etanol/dia (OR=2,94;IC 95%: 1,28 - 6,77). CONCLUSION: La hipertension arterial se asocio independientemente al consumo de bebidas alcoholicas, entre varones y mujeres.

Consumo de bebida alcoólica e adiposidade abdominal em doadores de sangue

OBJECTIVE To evaluate the association between alcohol consumption and abdominal fat. METHODS Cross-sectional study carried out in a sample of male blood donors (n=1,235), aged 20-59 years, in the city of Cuiabá, Central-West Brazil, between August 1999 and January 2000. Waist circumference and waist-to-hip ratio were indicators of abdominal fat, adjusted for total adiposity. Weight, height, waist and hip circumferences were measured. Alcohol consumption was evaluated using a questionnaire collecting information on type, frequency, and amount of consumption. The association between alcohol consumption and abdominal fat was assessed through multiple linear regression models adjusted for age, physical activity, smoking, and percent of body fat. RESULTS After adjustment, waist circumference and waist-to-hip ratio were positively associated with beer (p=0.02) and total alcohol consumption (p=0.01; p=0.03, respectively). Waist circumference was positively associated with spirit consumption (p=0.04). CONCLUSIONS Alcohol intake, particularly beer, was positively associated to abdominal fat.OBJETIVO: Analisar a associacao entre o consumo de bebidas alcoolicas e adiposidade abdominal. METODOS: Estudo transversal com uma amostra de homens doadores de sangue (N=1.235), de 20 a 59 anos, em Cuiaba (MT), realizado de agosto/1999 a janeiro/2000. Os indicadores de adiposidade abdominal foram circunferencia da cintura e relacao cintura/quadril, ajustados pela adiposidade total. As medidas aferidas foram: peso, estatura, circunferencias da cintura e do quadril. O consumo de alcool foi avaliado utilizando-se um questionario sobre tipo, frequencia e quantidade da bebida consumida. A associacao entre o consumo de alcool e adiposidade abdominal foi analisada por regressao linear multipla, com os modelos ajustados para idade, atividade fisica, tabagismo e adiposidade total. RESULTADOS: Apos ajuste, a circunferencia da cintura e a relacao cintura quadril mantiveram-se associadas positivamente ao consumo de cerveja (p=0,02) e ao total de alcool consumido (p=0,01 e 0,03, respectivamente). O consumo de aguardente mostrou associacao somente com a circunferencia da cintura (p=0,04). CONCLUSOES: O consumo de alcool, particularmente de cerveja, associou-se com a localizacao abdominal de gordura.

Prevalência e fatores associados aos comportamentos sedentários em adolescentes

OBJECTIVE To analyze the prevalence of sedentary behavior and associated factors in adolescents. METHODS A cross-sectional study with adolescents aged 10 to 17 years, of both sexes, belonging to a 1994-1999 birth cohort in the city of Cuiabá, MT, Central Western Brazil. Data were collected using a questionnaire containing sociodemographic, economic, lifestyle and anthropometric variables. Sedentary behavior was determined as using television and/or computer/video games for a time greater than or equal to 4 hours/day. Associations with sedentary behavior were evaluated using body mass index in childhood and adolescence and sociodemographic and behavioral variables using hierarchical logistic regression. RESULTS The overall prevalence of sedentary behavior was 58.1%. Of the 1,716 adolescents evaluated, 50.7% (n = 870) were male. In multivariate analysis, after adjustment for confounding factors, the variables that remained associated with sedentary behavior were: age (14 and over) (OR = 3.51, 95%CI 2.19;5.60); higher socioeconomic class (OR = 3.83, 95%CI 2.10;7.01), higher level of maternal education (OR = 1.81, 95%CI 1.09;3.01); living in the country (OR = 0.49, 95%CI 0.30;0.81); insufficient physical activity (OR = 1.25, 95%CI 1.02;1.53); experimentation with alcoholic beverages (OR = 1.34, 95%CI 1.08;1.66) and being overweight in adolescence (OR = 1.33, 95%CI 1.06;1.68). CONCLUSIONS The high proportion of adolescents in sedentary activities and the lack of association with being overweight in childhood, indicates the need for educational initiatives to reduce multiple risk behaviors. Encouraging physical activity in young people as a way of reducing sedentary behavior and, consequently, being overweight is fundamental.OBJECTIVE To analyze the prevalence of sedentary behavior and associated factors in adolescents. METHODS A cross-sectional study with adolescents aged 10 to 17 years, of both sexes, belonging to a 1994-1999 birth cohort in the city of Cuiaba, MT, Central Western Brazil. Data were collected using a questionnaire containing sociodemographic, economic, lifestyle and anthropometric variables. Sedentary behavior was determined as using television and/or computer/video games for a time greater than or equal to 4 hours/day. Associations with sedentary behavior were evaluated using body mass index in childhood and adolescence and sociodemographic and behavioral variables using hierarchical logistic regression. RESULTS The overall prevalence of sedentary behavior was 58.1%. Of the 1,716 adolescents evaluated, 50.7% (n = 870) were male. In multivariate analysis, after adjustment for confounding factors, the variables that remained associated with sedentary behavior were: age (14 and over) (OR = 3.51, 95%CI 2.19;5.60); higher socioeconomic class (OR = 3.83, 95%CI 2.10;7.01), higher level of maternal education (OR = 1.81, 95%CI 1.09;3.01); living in the country (OR = 0.49, 95%CI 0.30;0.81); insufficient physical activity (OR = 1.25, 95%CI 1.02;1.53); experimentation with alcoholic beverages (OR = 1.34, 95%CI 1.08;1.66) and being overweight in adolescence (OR = 1.33, 95%CI 1.06;1.68). CONCLUSIONS The high proportion of adolescents in sedentary activities and the lack of association with being overweight in childhood, indicates the need for educational initiatives to reduce multiple risk behaviors. Encouraging physical activity in young people as a way of reducing sedentary behavior and, consequently, being overweight is fundamental.

Obesidade: principal fator de risco para hipertensão arterial sistêmica em adolescentes brasileiros participantes de um estudo de coorte

OBJECTIVE: To identify the prevalence and factors associated with hypertension in adolescents. SUBJECTS AND METHODS: Cross-sectional study of 1,716 adolescents of a cohort study, aged from 10 to 16 years old sociodemographic, economic, and lifestyle characteristics were obtained from an interview, and birth weight from hospital records. Hypertension was defined as systolic or diastolic blood pressure above the 95th percentile according to the classification recommended by the Second Task Force High Blood Pressure in Children and Adolescents. Nutritional status was diagnosed by body mass index (BMI), according to the z score from curves published by the World Health Organization. Waist circumference was measured at the natural waist. The association between hypertension and the explanatory variables was measured using logistic regression. RESULTS: The adolescents interviewed represent 71.4% of the baseline, and 50.7% of them were males. The prevalence of hypertension was 11.7%. In the multivariate analysis, after adjustment for age sex and skin color, hypertension was associated with obesity [OR = 2.27, (95%) CI = 1.64 to 3.14] but not associated with waist circumference after adjusting for BMI. Early life factors were not associated with hypertension in adolescence. CONCLUSION: The results show an association between obesity and hypertension among adolescents.

Dietary patterns associated with anthropometric indicators of abdominal fat in adults

This study aimed to identify dietary patterns and assess their association with abdominal fat. A cross-sectional study was conducted in the Central West Region of Brazil with a probabilistic sample of 208 adults of both sexes. Data on food intake was obtained using a food frequency questionnaire and factor analysis (principal components) was conducted to identify dietary patterns. Waist circumference (WC) and waist-to-hip ratio (WHR) were used to assess abdominal fat. The association between dietary patterns and body fat distribution was examined using multiple linear regression analysis adjusted for confounders. Three dietary patterns were identified: Western, regional traditional, and prudent. A positive association was found between the Western pattern and WC (p = 0.04) and WHR (p = 0.001) and between the regional traditional pattern and WHR (p = 0.05) among women. A slight association was also found between the latter pattern and WC (p = 0.07) also among women. An association was found between the Western and regional traditional dietary patterns and a larger concentration of abdominal fat among women.Este estudo teve o objetivo identificar padroes alimentares e analisar a associacao com a adiposidade abdominal. Estudo transversal, realizado na Regiao Centro-Oeste do Brasil, com amostra probabilistica de 208 adultos, de ambos os sexos. O consumo alimentar foi obtido por questionario de frequencia alimentar e aplicada analise fatorial (componentes principais) para identificar padroes alimentares. A circunferencia da cintura (CC) e a relacao cintura quadril (RCQ) foram indicadores de adiposidade abdominal. A associacao dos padroes alimentares com adiposidade abdominal foi analisada em modelos de regressao linear multipla ajustados por fatores de confusao. Identificaram-se tres padroes alimentares: ocidental, tradicional regional e prudente. O padrao ocidental associou-se positivamente com CC (p = 0,04) e RCQ (p = 0,001) e o padrao tradicional regional associou-se tambem com RCQ (p = 0,05), e marginal a associacao com a CC (p = 0,07) somente em mulheres. Os padroes ocidental e tradicional regional associaram a maior adiposidade abdominal em mulheres.

O censo escolar como estratégia de busca de crianças e adolescentes em estudos epidemiológicos

Low-cost alternatives that allow for the monitoring of population groups are important strategies in conducting cohort studies. This paper presents the procedures for the use of the National School Census as a search tool for children and adolescents in follow-up studies. The study was conducted among adolescent students who took vaccinations in clinics in Cuiaba, Mato Grosso State, Brazil in 1999. A total of 86.8% were identified in the census and 0.2% in the Mortality Information System. Of those identified, 1,716 were interviewed, representing a follow-up rate of 71.4%. In this study, the school census proved to be an effective method for finding students.

Effect of tobacco smoke exposure during pregnancy and preschool age on growth from birth to adolescence: a cohort study

BackgroundThere is strong evidence of an association between maternal smoking during pregnancy and restriction of intrauterine growth, but the effects of this exposure on postnatal linear growth are not well defined. Furthermore, few studies have investigated the role of tobacco smoke exposure also after pregnancy on linear growth until adolescence. In this study we investigated the effect of maternal smoking exposure during pregnancy and preschool age on linear growth from birth to adolescence.MethodsWe evaluated a cohort of children born between 1994 and 1999 in Cuiabá, Brazil, who attended primary health clinics for vaccination between the years 1999 and 2000 (at preschool age) and followed-up after approximately ten years. Individuals were located in public and private schools throughout the country using the national school census. Height/length was measured, and length at birth was collected at maternity departments. Stature in childhood and adolescence was assessed using the height-for-age index sex-specific expressed as z-score from curves published by the World Health Organization. Linear mixed effects models were used to estimate the association between exposure to maternal smoking, during pregnancy and preschool age, and height of children assessed at birth, preschool and school age, adjusted for age of the children.ResultsWe evaluated 2405 children in 1999–2000, length at birth was obtained from 2394 (99.5%), and 1716 at follow-up (71.4% of baseline), 50.7% of the adolescents were male. The z-score of height-for-age was lower among adolescents exposed to maternal smoking both during pregnancy and childhood (p < 0.01). Adjusting for age, sex, maternal height, maternal schooling, socioeconomic position at preschool age, and breastfeeding, children exposed to maternal smoking both during pregnancy and preschool age showed persistent lower height-for-age since birth to adolescence (coefficient: −0.32, p < 0.001) compared to non-exposed. Paternal smoking at preschool age was not associated with growth after adjustment for confounders.ConclusionExposure to maternal smoking not only during pregnancy, but also at early childhood, showed long-term negative effect on height of children until adolescence.