The association between nutritional status and cognitive impairment in brazilian community-dwelling older adults assessed using a range of anthropometric measures - the Bambui study / Associação entre o estado nutricional avaliado por várias medidas antropométricas e o comprometimento cognitivo em idosos brasileiros vivendo em comunidade - projeto Bambuí

In most studies, body mass index (BMI) has been used as the main measurement of nutritional status. However, BMI does not differentiate between body fat and muscle mass. OBJECTIVE: To investigate the association between nutritional status and cognitive impairment in a population of Brazilian elderly. METHODS: Participants (n=1,496) from the Bambuí Cohort Study of Aging were selected based on the results for the two variables nutritional status and cognitive impairment (MMSE score). Gender, age, education, lifestyle, ApoE, chronic diseases, depressive symptoms, current use of hypnotic or sedative medication and functional disability were used as confounding factors for adjusting the logistic regression. RESULTS: Cognitive impairment was associated with lower BMI (OR: 0.91; CI: 0.86-0.95), waist circumference (OR: 0.97; CI: 0.95-0.99), triceps skinfold thickness (OR: 0.92; CI: 0.89-0.96) among the younger participants (60-69 years), while lower arm muscle circumference (OR: 0.88; CI: 0.80-0.98) and corrected arm muscle area (OR: 0.96; CI: 0.93-0.99) were associated with cognitive impairment among the older participants (70 years and over). CONCLUSION: There was a difference of association between anthropometric measures and cognitive impairment after stratifying by age group. In the group aged between 60 and 69, cognitive impairment was associated with measures related to fat mass, while in the group aged over 70, cognitive impairment was associated with measures related to muscle mass. This finding suggests that investigation of nutritional status in the elderly using anthropometric measures should not be restricted only to the use of BMI, and should also, differ according to age.

Na maioria dos estudos o índice de massa corporal (IMC) é usado como a principal medida de avaliação do estudo nutricional. Entretanto, o IMC não apresenta capacidade de diferenciar a gordura corporal da massa muscular. OBJETIVO: Investigar a associação do estado nutricional e o comprometimento cognitivo na população idosa de Bambuí. MÉTODOS: Participaram do estudo 1496 idosos que responderam simultaneamente as variáveis do estado nutricional e o comprometimento cognitivo (avaliado através do escore do MMSE). As seguintes variáveis: sexo, idade, educação, estilo de vida, ApoE, doenças crônicas, sintomas depressivos, uso de medicamentos hipnóticos e sedativos e incapacidade funcional foram utilizadas como fatores de confusão na regressão logística multivariada. RESULTADOS: O comprometimento cognitivo foi associado com os baixos valores de: IMC (OR: 0.91; CI: 0.86-0.95), circunferência da cintura (OR: 0.97; CI: 0.95-0.99), dobra cutânea triciptal (OR: 0.92; CI: 0.89-0.96) entre os idosos mais jovens (60-69 anos). Enquanto que baixos valores da circunferência (OR: 0.88; CI: 0.80-0.98) e da area muscular do braço corrigida (OR: 0.96; CI: 0.93-0.99) foram associados com o comprometimento cognitivo entre os idosos mais velhos (70 anos ou mais).CONCLUSÃO: Existe uma diferença entre a associação das medidas antropométricas e o comprometimento cognitivo após a estratificação por idade. Nos participantes entre 60 a 69 anos, o comprometimento cognitivo foi associado a medidas relacionadas com o tecido adiposo enquanto que no grupo com 70 anos ou mais, o comprometimento cognitivo foi associado a medidas relacionadas com a massa muscular. Esses achados sugerem que a investigação do estado nutricional dos idosos não se deve restringir somente ao IMC, sendo necessário variações devido a idade.

The association between nutritional status and cognitive impairment in brazilian community-dwelling older adults assessed using a range of anthropometric measures - the Bambui study.

In most studies, body mass index (BMI) has been used as the main measurement of nutritional status. However, BMI does not differentiate between body fat and muscle mass. OBJECTIVE: To investigate the association between nutritional status and cognitive impairment in a population of Brazilian elderly. METHODS: Participants (n=1,496) from the Bambuí Cohort Study of Aging were selected based on the results for the two variables nutritional status and cognitive impairment (MMSE score). Gender, age, education, lifestyle, ApoE, chronic diseases, depressive symptoms, current use of hypnotic or sedative medication and functional disability were used as confounding factors for adjusting the logistic regression. RESULTS: Cognitive impairment was associated with lower BMI (OR: 0.91; CI: 0.86-0.95), waist circumference (OR: 0.97; CI: 0.95-0.99), triceps skinfold thickness (OR: 0.92; CI: 0.89-0.96) among the younger participants (60-69 years), while lower arm muscle circumference (OR: 0.88; CI: 0.80-0.98) and corrected arm muscle area (OR: 0.96; CI: 0.93-0.99) were associated with cognitive impairment among the older participants (70 years and over). CONCLUSION: There was a difference of association between anthropometric measures and cognitive impairment after stratifying by age group. In the group aged between 60 and 69, cognitive impairment was associated with measures related to fat mass, while in the group aged over 70, cognitive impairment was associated with measures related to muscle mass. This finding suggests that investigation of nutritional status in the elderly using anthropometric measures should not be restricted only to the use of BMI, and should also, differ according to age.

Na maioria dos estudos o índice de massa corporal (IMC) é usado como a principal medida de avaliação do estudo nutricional. Entretanto, o IMC não apresenta capacidade de diferenciar a gordura corporal da massa muscular. OBJETIVO: Investigar a associação do estado nutricional e o comprometimento cognitivo na população idosa de Bambuí. MÉTODOS: Participaram do estudo 1496 idosos que responderam simultaneamente as variáveis do estado nutricional e o comprometimento cognitivo (avaliado através do escore do MMSE). As seguintes variáveis: sexo, idade, educação, estilo de vida, ApoE, doenças crônicas, sintomas depressivos, uso de medicamentos hipnóticos e sedativos e incapacidade funcional foram utilizadas como fatores de confusão na regressão logística multivariada. RESULTADOS: O comprometimento cognitivo foi associado com os baixos valores de: IMC (OR: 0.91; CI: 0.86-0.95), circunferência da cintura (OR: 0.97; CI: 0.95-0.99), dobra cutânea triciptal (OR: 0.92; CI: 0.89-0.96) entre os idosos mais jovens (60-69 anos). Enquanto que baixos valores da circunferência (OR: 0.88; CI: 0.80-0.98) e da area muscular do braço corrigida (OR: 0.96; CI: 0.93-0.99) foram associados com o comprometimento cognitivo entre os idosos mais velhos (70 anos ou mais). CONCLUSÃO: Existe uma diferença entre a associação das medidas antropométricas e o comprometimento cognitivo após a estratificação por idade. Nos participantes entre 60 a 69 anos, o comprometimento cognitivo foi associado a medidas relacionadas com o tecido adiposo enquanto que no grupo com 70 anos ou mais, o comprometimento cognitivo foi associado a medidas relacionadas com a massa muscular. Esses achados sugerem que a investigação do estado nutricional dos idosos não se deve restringir somente ao IMC, sendo necessário variações devido a idade.

Projeto Bambuí: a experiência do cuidado domiciliário por esposas de idosos dependentes / The Bambuí Health and Aging Study (BHAS): the experience with home care provided by wives of dependent elderly

O presente trabalho tem por objetivo investigar as características do processo de cuidar e a experiência de mulheres que cuidam de seus maridos idosos em Bambuí, Minas Gerais, Brasil. Entre os participantes do Projeto Bambuí, selecionaram-se dez idosos que necessitavam de cuidador e disseram ser cuidados por suas esposas. As dez esposas foram entrevistadas, utilizando-se de um roteiro de questões, com os grandes eixos temáticos sugeridos pela literatura. A análise dos dados inspirou-se na corrente interpretativa da antropologia e nos remete a uma cultura que define o papel, as responsabilidades e as obrigações da mulher, determina as regras que regem as relações conjugais, dita normas e modelos de comportamento e estabelece que cuidar de um idoso dependente é uma obrigação "natural" da mulher. Apesar de todas as evidências, as mulheres têm dificuldade em dissociar o cuidado de seu papel de esposas e em admitir o fardo. Cuidador e necessitados de cuidados vivem a dura realidade da incapacidade funcional, de modo integral, intuitivo e improvisado. Essa reflexão reforça a responsabilidade pela sistematização do cuidado domiciliário no nosso meio.

[The Bambuí Health and Aging Study (BHAS): the experience with home care provided by wives of dependent elderly]. / Projeto Bambuí: a experiência do cuidado domiciliário por esposas de idosos dependentes.

This paper investigates the characteristics of caregiving and the experience of women that care for their elderly husbands in Bambuí, Minas Gerais, Brazil. Among the elderly population in this community, the authors interviewed ten wives, using a survey exploring the main themes on the subject of caregiving. The data were interpreted based on an anthropological model of analysis. This model places the interaction between the individual and the context in the center of the interpretative process, underlying the construction and expression of diverse forms of human experience. The results of the survey highlighted the role, responsibilities, and obligations of women in Brazilian society with respect to caregiving for dependent elders. Women are seen as "natural" caregivers, whereby it is their given obligation to take care of their husbands, providing all kinds of support. Both the individual in need of care and the caregiver live the reality of functional disability in a society lacking the proper mechanisms to provide for the elderly population. The current study clearly shows the need to systematize home caregiving in Brazilian society.

Prevalence of excessive daytime sleepiness and associated factors in a Brazilian community: the Bambuí study.

BACKGROUND AND PURPOSE: Population-based studies of excessive daytime sleepiness (EDS) among adults residing in communities in developing countries are scarce. The objectives of the present study were to determine the prevalence of EDS in a Brazilian town with 15,000 inhabitants (Bambuí, MG), and the socio-demographic characteristics associated with it. PATIENTS AND METHODS: In this study, 87.3% of 1221 randomly selected individuals aged 18+ participated. EDS was defined as the presence of sleepiness during the previous month, occurring three or more times per week, with consequent impairment of daily activities. RESULTS: EDS was reported by 16.8% of the participants. There was no association with age groups (P=0.978). Higher prevalence of EDS was seen for women than for men in the following age groups: 18-29, 45-59 and 60+. After adjustment for gender, only family income was associated with EDS. Complaints of insomnia and the use of medicine to improve sleep during the previous month were more frequent among individuals with EDS than among those without it. Among those with EDS, 46.3% had been symptomatic for more than 1 year; 25 (2.34%) reported use of medication at some time in their lives to improve EDS. CONCLUSION: Social differences (represented by a lower family income) were an observed factor in the distribution of EDS, as were gender and insomnia. The high prevalence of EDS indicates that it is an important health problem, even in a small community of a developing country.

Obesity and underweight among Brazilian elderly: the Bambuí Health and Aging Study.

The coexistence of obesity (body mass index, BMI > or = 30kg/m ) and underweight (BMI <= 20kg/m ) and related factors were investigated among all residents aged 60+ years in Bambu , Minas Gerais State, using multinomial logistic regression. 1,451 (85.5%) of the town's elderly participated. Mean BMI was 25.0 (SD = 4.9kg/m ) and was higher for women and decreased with age. Prevalence of obesity was 12.5% and was positively associated with female gender, family income, hypertension, and diabetes and inversely related to physical activity. Underweight affected 14.8% of participants, increased with age, and was higher among men and low-income families. It was negatively associated with hypertension and diabetes and directly associated with Trypanosoma cruzi infection and > or = 2 hospitalizations in the previous 12 months. Both obesity and underweight were associated with increased morbidity. The association of underweight with T. cruzi infection, increased hospitalization, and low family income may reflect illness-related weight loss and social deprivation of elderly in this community. Aging in poverty may lead to an increase in nutritional deficiencies and health-related problems among the elderly.

Obesity and underweight among Brazilian elderly: the Bambuí Health and Aging Study

The coexistence of obesity (body mass index, BMI > or = 30kg/m²) and underweight (BMI <= 20kg/m²) and related factors were investigated among all residents aged 60+ years in Bambuí, Minas Gerais State, using multinomial logistic regression. 1,451 (85.5 percent) of the town's elderly participated. Mean BMI was 25.0 (SD = 4.9kg/m²) and was higher for women and decreased with age. Prevalence of obesity was 12.5 percent and was positively associated with female gender, family income, hypertension, and diabetes and inversely related to physical activity. Underweight affected 14.8 percent of participants, increased with age, and was higher among men and low-income families. It was negatively associated with hypertension and diabetes and directly associated with Trypanosoma cruzi infection and > or = 2 hospitalizations in the previous 12 months. Both obesity and underweight were associated with increased morbidity. The association of underweight with T. cruzi infection, increased hospitalization, and low family income may reflect illness-related weight loss and social deprivation of elderly in this community. Aging in poverty may lead to an increase in nutritional deficiencies and health-related problems among the elderly

Prevalência e características associadas à depressäo: revisäo de estudos epidemiológicos com base populacional / Prevalence and associated characteristics of depression: a review of population-based epidemiological studies

Neste trabalho é apresentada uma revisäo da prevalência e dos fatores associados à depressäo observados em estudos epidemiológicos de base populacional. Os artigos foram obtidos a partir de pesquisas na Medline e Lilacs, nos últimos cinco anos, nas línguas inglesa, portuguesa e espanhola. Também foram utilizados artitos referenciados. As principais palavras-chave utilizads na pesquisa foram: epidemiologia, distribuiçäo, prevalência, depressäo maior, transtorno depressivo, transtornos afetivos, transtornos de humor, estudo populacional, estudo de comunidade e CIDI (Composite International Diagnostic Interview). Foram considerados para o presente trabalho os artigos relativos a estudos que investigaram amostras da populaçäo geral e que utilizaram critérios diagnósticos padronizados, assim como as classificações diagnósticas da CID ou do DSM. Os aspectos enfatizados säo a prevalência da depressäo e as características associadas à mesma, a saber: sexo, idade, estado civil, escolaridade, raça/etnia, trabalho, renda e status socioeconômico, urbanizaçäo, tabagismo e outros fatores, incluindo-se o uso de serviços de saúde, e suicídio. Os episódios depressivos e o transtorno depressivo recorrente tiveram prevalências significativas em todos os países ocidentais. Nestes países, as prevalências de episódios depressivos nos últimos 30 dias, no último ano e durante a vida, de acordo com o DSM (III a IV), variaram de 2,2 por cento a 5,4 por cento, 3,5 por cento a 10,3 por cento e 3,7 por cento a 15,7 por cento, respectivamente. O fator descrito como mais consistentemente associado à depressäo foi o sexo feminino. Associações entre depressäo e os demais fatores acima mencionados foram encontrados em alguns trabalhos, mas näo em todos. Na presente revisäo ficou evidente a carência de estudos epidemiológicos sobre depressäo em países menos desenvolvidos. Estes estudos säo importantes para se estabelecer a carga da depressäo na comunidade e os seus determinantes e, desta forma, subsidiar políticas e programas de saúde pública

The Bambuí Health and Aging Study (BHAS): private health plan and medical care utilization by older adults.

The aim of this cross sectional study was to investigate whether holding a private health plan affects the consumption of medical services (hospitalization and visits to a doctor) and use of medications by older adults. All residents in Bambuí town (Minas Gerais, Brazil) aged >/= 60 years (n = 1,742) were selected. From these, 92.2% were interviewed and 85.9% were examined (blood tests and physical measurements). After adjustments for worse health status, reported less visits to a doctor, and used a small number of prescribed medications. The main explanation for the aged holding a private health plan was economic, not health. Even though those who had only public health coverage complained more in relation to medical care (70.9%), an important proportion of the aged with a private health care plan presented some kind of complaint (45.2%). Another worrying factor was the difficulty to acquire medication because of financial problems (47.2 and 25.2% reported, respectively). Further investigations are needed to verify whether our results can be generalized to other communities of the country.

Prevalence of insomnia and associated socio-demographic factors in a Brazilian community: the Bambuí study.

BACKGROUND: Population-based studies of insomnia among adults residing in communities in developing countries are rare. The objectives of this population-based study were to determine the prevalence and factors associated with insomnia among adults (18 years and over) living in a Brazilian town with 15,000 inhabitants (Bambuí MG) and to determine how the use of different definitions of insomnia affect its prevalence. METHODS: A total of 87.3% of 1221 randomly selected individuals aged 18+ participated. Prevalences were estimated based on different definitions. To determine the associated characteristics, insomnia was defined as a complaint in the last month, occurring at least three times a week, causing distress. RESULTS: (1) Prevalence ranged from 12.0 to 76.3%; (2) prevalence of insomnia, as defined above, was 35.4%; (3) prevalence among women increased with age and was higher than that of men; (4) insomnia was independently associated with less education in both sexes, and among females it was associated with older age (60+ years). CONCLUSIONS: The prevalence of insomnia in Bambuí was high, similar to that of urban centers of developed countries; this investigation substantiated the importance of operational criteria in studies of insomnia.

Envelhecimento e saúde: experiência e construçäo cultural / Aging and health: experience and cultural building

Estudos antropológicos tornam-se imprescindíveis para investigar as condições de vida dos idosos e identificar os fatores sociais, culturais e econômicos que intervêm positiva ou negativamente na qualidade de vida desta populaçäo. Aqui, a abordagem antropológica foi utilizada para investigar os problemas encontrados por mulheres idosas vivendo na cidade de Bambuí (MG), assim como as estratégias por elas desenvolvidas para tentar enfrentá-los