Obesity and its Association with Food Consumption, Diabetes Mellitus, and Acute Myocardial Infarction in the Elderly / Obesidade em Idosos e sua Associação com Consumo Alimentar, Diabetes Mellitus e Infarto Agudo do Miocárdio

Abstract Background: Obesity affects a large part of elderly individuals worldwide and is considered a risk predictor for the development of chronic diseases such as cardiac diseases, the leading causes of death in the elderly population. Objective: To investigate the prevalence of obesity and associated factors, with emphasis on the occurrence of other diseases and on food consumption in elderly individuals treated at the Brazilian Unified Health System (Sistema Único de Saúde, SUS). Methods: Cross-sectional sampling study performed in the city of Goiânia (Brazil) including elderly individuals (≥ 60 years) receiving primary care. During home visits, we performed anthropometric measurements and applied a structured, standardized, and pre-tested questionnaire assessing socioeconomic, demographic and lifestyle conditions, occurrence of diseases, and food consumption. We performed multiple Poisson regression analysis using a hierarchical model and adopting a significance level of 5%. Results: We evaluated 418 elderly patients with a mean age of 70.7 ± 7 years. Their body mass indices had a mean value of 27.0 kg/m2 and were higher in women than in men (27.4 kg/m2 versus 26.1 kg/m2, respectively, p = 0.017). Obesity had a prevalence of 49.0%, a risk 1.87 times higher between the ages of 60-69 years and 70-79 years, and a rate 1.4 times higher among individuals with more than four morbidities. On multivariate analysis, the factors associated with obesity were age 60-69 and 70-79 years, inadequate consumption of whole-wheat grains and adequate consumption of fruit, musculoskeletal diseases, diabetes mellitus, and acute myocardial infarction. Conclusions: Obesity had a high prevalence in the evaluated elderly population and was associated with food consumption, musculoskeletal disease, diabetes mellitus, and acute myocardial infarction.

Resumo Fundamento: A obesidade atinge uma grande parcela de idosos em todo o mundo e é considerada preditora de risco para o desenvolvimento de doenças crônicas, como as doenças cardíacas, as principais causas de óbito na população idosa. Objetivo: Investigar a prevalência de obesidade e fatores associados, com ênfase na presença de outras doenças e no consumo alimentar, em idosos usuários do Sistema Único de Saúde (SUS). Métodos: Estudo transversal, por amostragem, realizado no município de Goiânia, Brasil. Foram incluídos idosos (≥ 60 anos) atendidos na rede de atenção básica. Durante visitas domiciliares, foram realizadas medidas antropométricas e aplicação de questionário estruturado, padronizado e pré-testado sobre condições socioeconômicas, demográficas, estilo de vida, presença de doenças e consumo alimentar. Realizou-se regressão de Poisson múltipla a partir de um modelo hierárquico, adotando-se um nível de significância de 5%. Resultados: Foram avaliados 418 idosos com idade média de 70,7 ± 7 anos. O índice de massa corporal apresentou um valor médio de 27,0 kg/m2 e esteve mais elevado nas mulheres do que nos homens (27,4 kg/m2 x 26,1 kg/m2, respectivamente, p = 0,017). A obesidade teve prevalência de 49,0%, risco 1,87 vezes maior entre as idades de 60-69 anos e 70-79 anos, e taxa 1,4 vezes maior nos indivíduos com mais de quatro morbidades. Em análise multivariada, os fatores associados à obesidade foram idade de 60-69 e 70-79 anos, consumo inadequado de cereais integrais e adequado de frutas, doenças osteomusculares, diabetes mellitus e infarto agudo do miocárdio. Conclusões: A obesidade teve elevada prevalência na população idosa estudada e esteve associada com consumo alimentar, doença osteomuscular, diabetes mellitus e infarto agudo do miocárdio.

La obesidad en niños y adolescentes asocia cambios precoces en estructura y función arteriales / Obesity in children and adolescents associates early changes in structure and arterial function

Introducción: si bien se acepta que en adultos la obesidad asocia riesgo aumentado de enfermedades o eventos cardiovasculares, poco se conoce aún acerca de si la obesidad infantil asocia, y de ser así en qué magnitud, alteraciones arteriales precoces. El objetivo del trabajo fue caracterizar el estado funcional y estructural del sistema arterial de niños y adolescentes, y analizar los potenciales cambios arteriales asociados a la presencia de obesidad. Métodos: se seleccionaron 224 niños y adolescentes (93 de sexo femenino) asintomáticos (edad: 4-15 años), que presentasen normopeso (n = 142; percentil de índice de masa corporal (pIMC), 15 £ pIMC < 85) u obesidad (n = 82; pIMC ³ 97). Fueron criterios de exclusión: presentar comorbilidades crónicas (por ejemplo, cardiovasculares, renales), ser diabético, consumir fármacos cardioactivos y/o estar bajo tratamientos que afecten el sistema cardiovascular. Se realizó entrevista clínica, valoración antropométrica y evaluación arterial no invasiva que incluyó medición de: espesor íntima-media carotídeo (CIMT; ultrasonografía/software específico), presión arterial periférica y aórtica central (tonometría de aplanamiento), rigidez aórtica (velocidad de onda de pulso carótido-femoral, (VOP); tonometría de aplanamiento) y reactividad vascular (vasodilatación mediada por flujo). Se compararon los resultados de niños con normopeso y los de los obesos, para la población total y subgrupos sin dislipemia. Resultados: respecto de los niños con normopeso, con independencia de la presencia de dislipemia, los obesos presentaron mayor presión arterial sistólica y de pulso periférica y central, mayores diámetros carotídeos y CIMT, mayor rigidez aórtica y menor vasodilatación mediada por flujo. Conclusión: la obesidad en niños y adolescentes asocia aumento de espesor carotídeo, de rigidez y presión aórticas, y reducción de la reactividad vascular.

Introduction: while it is accepted that in adults the obesity is associated to an increased risk of disease or cardiovascular events, little is known yet if childhood obesity leads also, and if so in what magnitude, to early arterial changes. The objective of this work was to characterize the functional and structural state of the arterial system in children and adolescents, and analyze the potential arterial changes associated with the presence of obesity. Methods: 224 asymptomatic children and adolescents were selected (age: 4-15 years; 93 females), with normal weight (n= 142; body mass index percentile (p BMI), 15£ p IMC< 85) or obesity (n= 82, p BMI ³ 97). Inclusion criteria were: not to present chronic co-morbidities (such as cardiovascular and/or renal), not being diabetic, not being cardio-active drugs consumers or being under treatment that could affect cardiovascular system. Clinical interview, anthropometrical evaluation was assessed and non-invasive arterial evaluation was performed, in which carotid Intima-media thickness (CIMT; ultrasonography/specific software), arterial peripheral and central aortic pressures (applanation tonometry), aortic stiffness (Carotid-femoral Pulse Wave Velocity, PWV; applanation tonometry) and vascular reactivity (flow-mediated dilation) measurement were analyzed. The results of children with normal weight and obesity were compared for both total population and children without dyslipemia. Results: compared with children with normal weight, and with independence of the presence of dyslipidemia, obese children had higher systolic and pulse peripheral and aortic blood pressure, larger diameters and carotid CIMT, increased aortic stiffness, and reduced flow-mediated vasodilation. Conclusion: obesity in children and adolescents leads to arterial remodeling, increased carotid thickness, aortic stiffness, central aortic pressure and reduced vascular reactivity.