Vera Maria Freitas da Silveira

Major dietary patterns and cardiovascular risk factors among young Brazilian adults

PurposeDiet is one of the most important modifiable risk factors for cardiovascular diseases. The scientific literature has consistently shown the effects of certain diets on health; however, given the variety of cultures and dietary habits across the world, it is likely that much remains to be learned about dietary patterns and health outcomes. We assessed the associations between main dietary patterns and cardiovascular risk factors among 4,202 young Brazilian adults in a cross-sectional analysis.MethodsIn a principle components analysis, two main dietary patterns were identified: common Brazilian and processed food. As outcomes, we examined body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, HDL cholesterol (HDL-c), and LDL cholesterol (LDL-c). Means, crude, and adjusted β coefficients and 95% CIs were estimated according to quintiles of dietary patterns.ResultsCommon Brazilian scores were inversely associated with BMI, WC, LDL-c, HDL-c, and total cholesterol values among men. Among women, inverse association trends were observed with SBP, DBP, LDL-c, HDL-c, and total cholesterol. The processed food pattern was positively associated with LDL-c, HDL-c, total cholesterol, BMI, and WC values among the men. Among the women, the processed food pattern was not significantly associated with cardiovascular risk factors.ConclusionsIn conclusion, our findings confirm that diet has an important role on health during early adulthood. The common Brazilian pattern showed generally healthier trends regarding CVD risk factors, but the ultimate effects on risk of risk of disease are unclear because of the inverse relation with HDL-c levels.

Metabolic syndrome in the 1982 Pelotas cohort: effect of contemporary lifestyle and socioeconomic status

OBJECTIVES Describe the prevalence of metabolic syndrome, and its association with contemporary lifestyle factors. SUBJECTS AND METHODS In 2004-2005, 4,296 subjects of the 1982 Pelotas Birth Cohort were evaluated, and metabolic syndrome (MetS) was assessed in 3,599 according to the NCEP-ATP III and IDF criteria. RESULTS Prevalence of MetS was 5.9% and 6.7% for NCEP-ATPIII and IDF, respectively. Smoking, alcohol intake, and physical activity were not associated with MetS. Among men, the body mass index (BMI) was associated with MetS - overweight [RR: 3.14 (95% CI, 1.97-5.00)] and obese subjects [RR: 17.41 (95% CI, 11.85-25.60)]. In women, family income and schooling were inversely associated with MetS, overweight increased the risk of MetS 7.73 (95% CI, 3.65-16.38) times and obesity 40.67 (95% CI, 20.85-79.33) times. CONCLUSIONS MetS was more prevalent among men according to NCEP-ATP III criteria, and obesity was the main risk factor.

Maternal smoking during pregnancy and risk factors for cardiovascular disease in adulthood

Objective This study was aimed at assessing the effect of maternal smoking during pregnancy on metabolic cardiovascular risk factors in early adulthood in a Brazilian birth cohort, after controlling for possible confounding variables and health behaviors in early adulthood. Methods In 1982, the maternity hospitals in Pelotas, southern Brazil, were visited and all births were identified. Those livebirths whose family lived in the urban area of the city were studied prospectively. In 2004–2005, we attempted to follow the whole cohort, the subjects were interviewed, examined and blood sample was collected. The following outcomes were studied: blood pressure; HDL cholesterol; triglycerides; random blood glucose and C-reactive protein. To explore the effect of maternal smoking, we adjusted the coefficients for the following possible mediators: perinatal factors (low birthweight and preterm births); adult behavioral factors (physical activity, dietary pattern, intake of fat and fiber, and tobacco smoking) and adult anthropometry (body mass index and waist circumference). Results In 2004–2005, we interviewed 4297 subjects, with a follow-up rate of 77.4%. The only significant finding in the unadjusted analyses was lower HDL cholesterol among females. After adjustment for lifestyle variables in early adulthood, birthweight and waist circumference, the difference in HDL levels between offspring of smokers and non-smokers reduced from −2.10 mg/dL (95% confidence interval: −3.39; −0.80) to −1.03 mg/dL (−2.35; 0.30). Conclusion Evidence that maternal smoking during pregnancy programs offspring metabolic cardiovascular risk factors are scarce, and reported associations are likely due to postnatal exposure to lifestyle patterns.

The hypertriglyceridemic waist phenotype in young adults from the Southern Region of Brazil

The present study aimed to assess the prevalence of the hypertriglyceridemic waist phenotype and its associated factors among subjects that have been followed up from birth. In 1982, all maternity hospitals in the city of Pelotas, in the Southern Region of Brazil, were visited and all births were recorded. Babies whose parents lived in the urban area of Pelotas were subsequently followed up on several occasions. A 22 to 23-year follow-up of this birth cohort was carried out in 2004 and 2005. The presence of the hypertriglyceridemic waist phenotype was defined as waist circumference ≥ 90 cm and triglyceride levels ≥ 177 mg/dL for males, and waist circumference ≥ 85 cm and triglyceride levels ≥ 133 mg/dL for females. The prevalence of the hypertriglyceridemic waist phenotype was 5.9% and 4.5% among men and women, respectively. Among males, a sedentary lifestyle during leisure time, smoking and obesity were associated with the presence of the hypertriglyceridemic waist phenotype, whereas among females the condition was positively associated with skin color, family income, obesity and dietary fat intake.El presente estudio tuvo como objetivo determinar la prevalencia del fenotipo de la cintura hipertrigliceridemica y sus factores asociados entre individuos que fueron observados desde su nacimiento. En 1982, las maternidades de Pelotas, sur de Brasil, fueron visitadas y todos los nacimientos fueron identificados. En 2004-2005, se decidio realizar un seguimiento de toda la cohorte. La presencia del fenotipo de la cintura hipertrigliceridemica se definio como una circunferencia de la cintura ≥ 90cm y trigliceridos ≥ 177mg/dL para el sexo masculino y circunferencia de la cintura ≥ 85cm y trigliceridos ≥ 133mg/dL para las mujeres. La prevalencia del fenotipo de la cintura hipertrigliceridemica fue de un 5,9% y un 4,5% entre los hombres y mujeres, respectivamente. Para los hombres, el sedentarismo en el ocio, tabaquismo y obesidad estuvo asociado con el fenotipo de la cintura hipertrigliceridemica. Por otro lado, entre las mujeres, el fenotipo de la cintura hipertrigliceridemica fue positivamente asociado con el color de la piel, renta familiar, obesidad y consumo de grasa.

Prevalence of weight-loss strategies and use of substances for weight-loss among adults: a population study

This paper concerns a cross-sectional population-based study conducted with adults living in the city of Pelotas, Rio Grande do Sul State, Brazil. It aims to determine the prevalence of weight-loss practices and use of substances for weight-loss during the 12 months preceding the interview. The prevalence of weight-loss attempts was 26.6%. Although dietary control and regular physical exercise were the most commonly used strategies, the prevalence of the combined use of these methods was only 36% for individuals trying to lose weight. The prevalence of use of substances for weight-loss was 12.8% (48.4% of those who tried to lose weight). The use of dietary control and substances was more common among women, while men practiced physical exercise with greater frequency. Teas were the most frequently used substances for weight-loss. Multivariate analysis identified being female, excess weight and self-perception of excess weight as major associated factors for the use of substances for weight-loss. Finally, we found that, although weight-loss attempts are common, the majority of obese individuals do not make attempts to lose weight and only a minority follows the recommended practices.

Uma amostra de pacientes com diabetes tipo 1 no sul do Brasil

Objectives: To describe a type 1 diabetes mellitus (DM1) population with regard to demographic, socioeconomic, environmental and management aspects. Design: Series of cases. Participants: 126 DM1 patients, aged up to 30 yrs, with no more than 10 yrs of diagnosis, living in some cities of South Brazil. Results: The patients were 57 men and 69 women, being the age of onset mainly at 11-15 yrs (31%). There were seasonal presentations at diagnosis. The diagnosis of DM was done as outpatients, by symptoms in 61%, due to hospitalization in 22% and ketoacidosis in 18%. Forty-seven percent of the sample injected insulin once daily, 60% of patients performed some self monitoring, one third reused the same syringe six or more times and 50% of insulin was provided by public services. Regarding awareness of hypoglycaemia, 18% of the patients did not know any signal of alert. A significant part of the sample was seen by a specialist in DM (73%). Among the patients with five years or more of DM, 16% of them have never had their eyes examined and 17% had been examined at least two years ago. The onset of DM, assistance by a specialist and provision of insulin was associated with familiar income. Women were on diet more often (p= 0,05) and had more self-injection of insulin (p= 0,01) than men. Conclusions: In this study, socio-economic factors seem to influence the onset of DM, provision of insulin and assistance by a specialist doctor in DM. In general, patients did not have background and skills for self-management of DM.

Early determinants of random blood glucose among adults of the 1982 birth cohort, Pelotas, Southern Brazil

OBJECTIVE To evaluate the effects of socioeconomic variables, birth weight, duration of breastfeeding and income changes on random blood glucose levels among young adults. METHODS This was a study on the birth cohort from 1982, when the 5,914 hospital births that occurred in the city of Pelotas (Southern Brazil) were identified and the mothers were interviewed. The children whose families lived in the urban area of the city were followed up several times. In 2004-5, 4,927 individuals of the cohort were interviewed and blood was collected from the fingertips of 3,730 of them for random blood glucose measurements. Associations between random blood glucose levels and skin color, family income at birth, maternal schooling, income change between 1982 and 2004-5, birth weight and duration of breastfeeding were evaluated. RESULTS The mean blood glucose level was 97.3 +/- 15.1mg/dL, and it was greater among the men. None of the variables studied was associated with the mens blood glucose level. Among the women, maternal schooling, family income at 23 years of age and birth weight were inversely associated with blood glucose levels. However, birth weight lost its statistical significance in the multivariable analysis. CONCLUSIONS Birth weight and duration of breastfeeding did not present any long-term effect on random blood glucose levels. Only maternal schooling level and present income presented associations with random blood glucose levels among the women.OBJETIVO: Avaliar o efeito de variaveis socioeconomicas, peso ao nascer, duracao da amamentacao e mudanca de renda sobre a glicemia ao acaso em jovens adultos. METODOS: Estudo sobre coorte de nascidos em 1982, quando os 5.914 nascimentos hospitalares ocorridos na cidade de Pelotas foram identificados e as maes entrevistadas. As criancas, cujas familias residiam na area urbana da cidade, foram acompanhadas diversas vezes. Em 2004-5, 4.927 individuos da coorte foram entrevistados e 3.730 tiveram sangue da polpa digital coletado para medida da glicemia casual. Foi avaliada a associacao entre glicemia casual e cor da pele, renda familiar ao nascer, escolaridade materna, mudanca de renda entre 1982 e 2004-5, peso ao nascer e duracao da amamentacao. RESULTADOS: A media da glicemia foi de 97,3±15,1mg/dL, sendo maior entre os homens. Nenhuma das variaveis estudadas esteve associada com a glicemia dos homens. Entre as mulheres, a escolaridade materna, a renda familiar aos 23 anos e o peso ao nascimento estiveram inversamente associados com a glicemia. Contudo, o efeito do peso ao nascer perdeu a significância estatistica na analise multivariavel. CONCLUSOES: O peso ao nascer e a duracao da amamentacao nao apresentaram efeito em longo prazo sobre a glicemia casual, apenas a escolaridade materna e a renda atual estiveram associados com a glicemia casual nas mulheres.

Determinantes precoces da glicemia casual em adultos da coorte de nascimentos de 1982, Pelotas, RS

OBJECTIVE To evaluate the effects of socioeconomic variables, birth weight, duration of breastfeeding and income changes on random blood glucose levels among young adults. METHODS This was a study on the birth cohort from 1982, when the 5,914 hospital births that occurred in the city of Pelotas (Southern Brazil) were identified and the mothers were interviewed. The children whose families lived in the urban area of the city were followed up several times. In 2004-5, 4,927 individuals of the cohort were interviewed and blood was collected from the fingertips of 3,730 of them for random blood glucose measurements. Associations between random blood glucose levels and skin color, family income at birth, maternal schooling, income change between 1982 and 2004-5, birth weight and duration of breastfeeding were evaluated. RESULTS The mean blood glucose level was 97.3 +/- 15.1mg/dL, and it was greater among the men. None of the variables studied was associated with the mens blood glucose level. Among the women, maternal schooling, family income at 23 years of age and birth weight were inversely associated with blood glucose levels. However, birth weight lost its statistical significance in the multivariable analysis. CONCLUSIONS Birth weight and duration of breastfeeding did not present any long-term effect on random blood glucose levels. Only maternal schooling level and present income presented associations with random blood glucose levels among the women.OBJETIVO: Avaliar o efeito de variaveis socioeconomicas, peso ao nascer, duracao da amamentacao e mudanca de renda sobre a glicemia ao acaso em jovens adultos. METODOS: Estudo sobre coorte de nascidos em 1982, quando os 5.914 nascimentos hospitalares ocorridos na cidade de Pelotas foram identificados e as maes entrevistadas. As criancas, cujas familias residiam na area urbana da cidade, foram acompanhadas diversas vezes. Em 2004-5, 4.927 individuos da coorte foram entrevistados e 3.730 tiveram sangue da polpa digital coletado para medida da glicemia casual. Foi avaliada a associacao entre glicemia casual e cor da pele, renda familiar ao nascer, escolaridade materna, mudanca de renda entre 1982 e 2004-5, peso ao nascer e duracao da amamentacao. RESULTADOS: A media da glicemia foi de 97,3±15,1mg/dL, sendo maior entre os homens. Nenhuma das variaveis estudadas esteve associada com a glicemia dos homens. Entre as mulheres, a escolaridade materna, a renda familiar aos 23 anos e o peso ao nascimento estiveram inversamente associados com a glicemia. Contudo, o efeito do peso ao nascer perdeu a significância estatistica na analise multivariavel. CONCLUSOES: O peso ao nascer e a duracao da amamentacao nao apresentaram efeito em longo prazo sobre a glicemia casual, apenas a escolaridade materna e a renda atual estiveram associados com a glicemia casual nas mulheres.

Distribution of Glycated Haemoglobin According to Early-Life and Contemporary Characteristics in Adolescents and Adults without Diabetes: The 1982 and 1993 Pelotas Birth Cohorts.

Aim Glycated haemoglobin (HbA1c), a marker of glucose control in individuals with diabetes mellitus, is also related with the incidence of cardiometabolic risk in populations free of disease. The aim of this study was to describe the distribution of HbA1c levels according to early-life and contemporary factors in adolescents and adults without diabetes mellitus. Methods HbA1c was measured in adults aged 30 years and adolescents aged 18 years who are participants in the 1982 and 1993 Pelotas Birth Cohorts, respectively. Bivariate and multivariate analyses were performed to describe the HbA1c mean values according to early-life and contemporary characteristics collected prospectively since birth. Results The distribution of the HbA1c was approximately normal in both cohorts, with a mean (SD) 5.10% (0.43) in the 1982 cohort, and 4.89% (0.50) in the 1993 cohort. HbA1c mean levels were significantly higher in individuals self-reported as black/brown skin color compared to those self-reported as white in both cohorts. Parental history of diabetes was associated with higher HbA1c mean in adults, while stunting at one year old presented an inverse relation with the outcome in adolescents. No other early and contemporary factors were associated with HbA1c levels in adults or adolescents. Conclusions We found a consistent relationship between HbA1c and skin color in both cohorts. Further research is needed to understand the role of genomic ancestry on levels of HbA1c concentrations which may inform policies and preventive actions for diabetes mellitus and cardiometabolic risk.

Hypertriglyceridemic Waist Phenotype: Effect of Birthweight and Weight Gain in Childhood at 23 years old.

Objective To evaluate the association of birthweight and weight gain during different periods in childhood with the prevalence of hypertriglyceridemic waist phenotype (HWP). Methods In 1982, all hospitals births in Pelotas, South Brazil, were identified, and the 5914 liveborn were examined and their mothers interviewed. This population has been followed for several times. In 2004–05, we tried to follow the whole cohort and the subjects were interviewed, examined, and a blood sample was collected. HWP was defined as a triglycerides ≥ 2 mmol/L and a waist circumference ≥ 90 cm for men, and triglycerides ≥ 1.5 mmol/L and waist circumference ≥ 85 cm for woman. Poisson regression with robust adjustment of the variance was used to obtain adjusted estimates of the prevalence ratio. Results Subjects whose weight-for-age z-score at mean age of 42 months was one or more standard deviation above the mean, according to gender and age, were 8.77 (95% confidence interval: 2.60; 29.64) times more likely of presenting the HWP than those subjects whose weight-for-age z-score at 42 months was more than one standard deviation below the mean. Among those subjects whose birthweight was adequate-for-gestational age (AGA), conditional weight at 20 months was positively associated to the risk of HWP [relative risk: 1.59 (95%: confidence interval: 1.32; 1.92)], whereas for small for gestational age (SGA) subjects conditional weight was not associated with HWP [relative risk: 1.05 (95% confidence interval: 0.77; 1.43)], p-value for interaction 0.08. Conclusion Early weight gain among SGA infants, did not increase the risk of HWP in early adulthood, whereas among those who were AGA, early weight gain increased the risk of the having the phenotype in early adulthood.