Clinical biomarker-based biological age predicts deaths in Brazilian adults: the ELSA-Brasil study.

Biological age is a construct that seeks to evaluate the biological wear and tear process of the organism that cannot be observed by chronological age. We estimate individuals' biological age based on biomarkers from multiple systems and validate it through its association with mortality from natural causes. Biological age was estimated in 12,109 participants (6621 women and 5488 men) from the first visit of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) who had valid data for the biomarkers used in the analyses. Biological age was estimated using the Klemera and Doubal method. The difference between chronological age and biological age (Δage) was computed. Cox proportional hazard models stratified by sex were used to assess whether Δage was associated with mortality risk after a median follow-up of 9.1 years. The accuracy of the models was estimated by the area under the curve (AUC). Δage had equal mean for men and women, with greater variability for men. Cox models showed that every 1-year increase in Δage was associated with increased mortality in men (HR (95% CI) 1.21; 1.17-1.25) and women (HR (95% CI) 1.24; 1.15-1.34), independently of chronological age. Results of the AUC demonstrated that the predictive power of models that only included chronological age (AUC chronological age = 0.7396) or Δage (AUC Δage = 0.6842) was lower than those that included both, chronological age and Δage (AUC chronological age + Δage = 0.802), in men. This difference was not observed in women. We demonstrate that biological age is strongly related to mortality in both genders and is a valid predictor of death in Brazilian adults, especially among men.

Racial discrimination predicts the increase in body weight and BMI in Black individuals from ELSA-Brasil cohort / Discriminação racial prediz o aumento do peso corporal e do IMC em indivíduos pretos da coorte ELSA-Brasil

Abstract We investigated whether racial discrimination accelerates the weight and Body Mass Index (BMI) gain in Blacks and Browns participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) in four years of follow-up. We compared body weight and BMI between the 1st (2008-2010) and 2nd visit (2012-2014) of 5,983 Blacks and Browns participants. Exposure to racial discrimination and covariates (age, sex, education, and research center) were obtained at the 1st visit. Linear mixed effects models stratified by race/skin color were used. Report of racial discrimination was more frequent among Blacks (32.1%) than Browns (6.3%). During the follow-up period, Blacks and Browns gained an average of 1.4kg and 1.2kg, respectively. This increase was greater among those who reported discrimination when compared to those who did not, both in Blacks (2.1kg vs.1.0kg, p < 0.001) and Browns (1.9kg vs. 1.1kg, p < 0.05). The results of the interaction between racial discrimination and time showed that Blacks, but not Browns, who reported racial discrimination had greater weight and BMI gains between visits. Our results suggest that reducing racial discrimination would contribute to prevent and/or control obesity increase in the country.

Resumo Investigou-se se a discriminação racial acelera o ganho de peso corporal e o Índice de Massa Corporal (IMC) em pretos e pardos participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) em quatro anos de seguimento. Comparou-se o peso corporal e o IMC entre a 1ª (2008-2010) e a 2ª visita (2012-2014) de 5.983 participantes pretos e pardos. A exposição à discriminação racial e às covariáveis ​​(idade, sexo, escolaridade e centro de pesquisa) foram obtidas na 1ª visita. Foram utilizados modelos lineares de efeitos mistos estratificados por raça/cor da pele. O relato de discriminação racial foi mais frequente entre pretos (32,1%) do que em pardos (6,3%). Durante o período de acompanhamento, pretos e pardos ganharam uma média de 1,4kg e 1,2kg, respectivamente. Esse aumento foi maior entre os que relataram discriminação, quando comparados aos que não relataram, tanto em pretos (2,1 kg vs. 1,0 kg, p < 0,001) quanto em pardos (1,9kg vs. 1,1kg, p < 0,05). Após ajustes, os pretos, mas não os pardos, que relataram discriminação racial apresentaram maiores ganhos de peso e IMC entre as visitas. Nossos resultados sugerem que a redução da discriminação racial pode contribuir para prevenir e/ou controlar o aumento da obesidade no país.

Racial discrimination predicts the increase in body weight and BMI in Black individuals from ELSA-Brasil cohort.

We investigated whether racial discrimination accelerates the weight and Body Mass Index (BMI) gain in Blacks and Browns participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) in four years of follow-up. We compared body weight and BMI between the 1st (2008-2010) and 2nd visit (2012-2014) of 5,983 Blacks and Browns participants. Exposure to racial discrimination and covariates (age, sex, education, and research center) were obtained at the 1st visit. Linear mixed effects models stratified by race/skin color were used. Report of racial discrimination was more frequent among Blacks (32.1%) than Browns (6.3%). During the follow-up period, Blacks and Browns gained an average of 1.4kg and 1.2kg, respectively. This increase was greater among those who reported discrimination when compared to those who did not, both in Blacks (2.1kg vs.1.0kg, p < 0.001) and Browns (1.9kg vs. 1.1kg, p < 0.05). The results of the interaction between racial discrimination and time showed that Blacks, but not Browns, who reported racial discrimination had greater weight and BMI gains between visits. Our results suggest that reducing racial discrimination would contribute to prevent and/or control obesity increase in the country.

Racial discrimination is associated with greater arterial stiffness and carotid intima-media thickness: the ELSA-Brasil study.

PURPOSE: The association between racial discrimination and subclinical cardiovascular markers remains under-examined. We aimed to investigate the association of race/skin color and racial discrimination with pulse wave velocity (PWV) and carotid intima-media thickness (c-IMT) in the Brazilian context. METHODS: We used data from 13,284 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline with information of PWV and 9850 for c-IMT. Self-reported race/skin color and perceived racial discrimination were the exposures. PWV and c-IMT were used continuously and categorizing according to cutoff that indicates increased cardiovascular risk. Linear and logistic regression models were used. RESULTS: Experience of racial discrimination was reported by 7% of total participants, but this prevalence was much higher among Blacks than Browns (PWV sample: 31,9% vs. 6,1%; c-IMT sample: 33,7% vs. 6,8%). After adjustments for age, sex, and research center, Blacks and Browns presented higher means of PWV and c-IMT and had greater chances of PWV>10 m/s and c-IMT≥75th percentile than Whites. The magnitude of all these associations were higher among Blacks and Browns with racial discrimination. In final models adjusted for education this pattern of association remained the same, although an attenuation in the magnitude of the association has been observed. CONCLUSIONS: Blacks and Browns presented worse profiles of subclinical cardiovascular markers compared to Whites and those exposed to racial discrimination seem to have an additional cardiovascular risk.

Racial inequality, racial discrimination and obesity incidence in adults from the ELSA-Brasil cohort.

BACKGROUND: This study investigated whether self-reported race/skin colour and perceived racial discrimination predict higher obesity incidence after approximately 4-year follow-up of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We also investigated whether these associations are modified by educational level. METHODS: Following exclusion of individuals defined as obese (body mass index ≥30 kg/m2) at baseline, associations between race/skin colour and obesity incidence between the first (2008-2010) and second (2012-2014) visits were investigated in 10 130 participants. Next, associations between perceived racial discrimination and obesity incidence among black (n=1532) and brown (n=2958) individuals were investigated separately. Racial discrimination (yes/no) was assessed using the Lifetime Major Event Scale. Logistic regression models adjusted for age, sex and research site were used. All analyses were stratified for educational level. RESULTS: Obesity risk was higher in Blacks with high education compared with white individuals to the same education level (OR: 2.22; 95% CI 1.62 to 3.04) following adjustments. After adjustments, obesity incidence was higher among black individuals reporting racial discrimination compared with peers who did not report this experience, but only among the low education group (OR: 1.64; 95% CI 1.08 to 2.51). No statistical association with perceived discrimination was observed among brown individuals. CONCLUSION: Results are congruent with findings from other studies reporting associations between racial inequality and obesity incidence and also suggest racial discrimination may be one of the mechanisms leading to such inequalities. Also, it supports the paradox theory by which education modify the association in distinct directions.

Raça/cor da pele, discriminação racial e obesidade entre adultos do ELSA-Brasil / Race/skin color, racial discrimination and obesity among adults in the ELSA-Brasil

Estudos norte-americanos demonstram que a raça/cor da pele e a exposição à discriminação racial são potenciais fatores de risco para o ganho de peso corporal e desenvolvimento da obesidade. Devido a isso, os objetivos desta dissertação foram: 1) investigar a associação da discriminação racial com o aumento do peso corporal e do Índice de Massa Corporal (IMC) entre pretos e pardos (Artigo 1); 2) investigar se a raça/cor da pele e a discriminação racial estão associadas à incidência de obesidade; (Artigo 2); e 3) verificar se a associação entre a raça/cor da pele e a discriminação racial com a incidência de obesidade é modificado pela escolaridade (Artigo 2). Foram utilizados dados de peso e índice de massa corporal (IMC) obtidos na 1ª visita (2008-2010) e na 2ª visita (2012-2014) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). A raça/cor da pele autorreferida, a exposição à discriminação racial e as covariáveis foram aferidas na 1ª visita. Para verificar a associação entre a discriminação racial e aumento de peso corporal ao longo do tempo entre indivíduos pretos e pardos (N=5.983), utilizamos modelos de regressão de efeitos mistos estratificados pela raça/cor da pele. Já para verificar se raça/cor da pele e a discriminação racial estão associadas à incidência de obesidade em brancos, pretos e pardos (N=10.130), utilizamos modelos de regressão logística estratificados pela escolaridade. Indivíduos pretos que reportaram discriminação racial tiveram um aumento de peso e de IMC maior e mais acelerado ao longo do tempo quando comparados aos que não reportaram discriminação racial em ambos os sexos. A incidência de obesidade em 4 anos de seguimento foi maior em pretos e pardos do que em brancos (11,3%, 8,5 e 7,4% respectivamente). A raça/cor da pele preta foi associada ao maior risco de obesidade apenas entre os indivíduos de maior escolaridade (OR: 2,22, IC: 1,62 a 3,04). A exposição à discriminação racial foi associada ao maior risco de obesidade apenas em indivíduos pretos de baixa escolaridade (OR: 1,64, IC: 1,08 a 2,51). Não houve associação entre a raça/cor da pele e a discriminação racial com a incidência de obesidade entre pardos. Nossos achados sugerem que a raça/cor da pele e a discriminação racial podem predizer um maior ganho de peso corporal e um maior risco de obesidade, reforçando as evidências já existentes sobre a associação entre a raça/cor da pele e a discriminação racial com desfechos relacionados à obesidade. Além disso, nossos resultados sugerem que a associação entre a raça/cor da pele e a discriminação racial são modificadas pela escolaridade em direções distintas. Tais resultados podem embasar políticas públicas voltadas para a redução das desigualdades raciais em saúde.

North American studies demonstrate that race/skin color and exposure to racial discrimination are potential risk factors for body weight gain and the development of obesity. Because of this, the objectives of this dissertation were: 1) to investigate the association of racial discrimination with increased body weight and body mass index (BMI) in black and brown individuals (Article 1); 2) investigate whether race/skin color and racial discriminationare associated with the incidence of obesity (Article 2); and 3) to verify if the association between race/skin color and racial discrimination with the incidence of obesity is modified by education (Article 2). Weight and body mass index (BMI) data obtained at the first visit (2008-2010) and the second visit (2012-2014) of the Longitudinal Adult Health Study (ELSA-Brazil) were used. Self-reported race/skin color, exposure to racial discrimination, and covariates were measured at the first visit. To verify the association between racial discrimination and body weight gain over time in black and brown individuals (N = 5.983), we used mixed-effect regression models stratified by race/skin color. To verify whether race/skin color and racial discrimination are associated with the incidence of obesity in whites, blacks and browns (N = 10.130), we used logistic regression models stratified by education. Black individuals who reported racial discrimination had a greater and faster weight and BMI increase over time compared to those who did not report racial discrimination in either sex. The obesity incidence in 4 years of follow-up was higher in blacks and browns than in whites (11.3%, 8.5 and 7.4% respectively). Black race/skin color was associated with a higher risk of obesity only among individuals with higher education (OR: 2.22, CI: 1.62 to 3.04). Exposure to racial discrimination was associated with a higher risk of obesity only in black individuals with low education (OR: 1.64, CI: 1.08 to 2.51). There was no association between race/skin color and racial discrimination with the incidence of obesity among browns. Our findings suggest that race/skin color and racial discrimination may predict greater body weight gain and increased risk of obesity, reinforcing existing evidence on the association between race/skin color and racial discrimination with outcomes related to obesity. In addition, our results suggest that the association between race/skin color and racial discrimination is modified by education in different directions. Such results can support public policies aimed at reducing racial inequalities in health.