Burden of disease and direct costs to the health system attributable to high body mass index in Brazil.

OBJECTIVES: Excess weight, measured by a high body mass index (BMI), is associated with the onset of many diseases, which can, in turn, lead to disability and premature death, subsequently placing a significant burden on healthcare services. This study analysed the burden of disease and the direct costs to the Brazilian Unified Health System (Sistema Único de Saúde [SUS]) attributable to high BMI in the Brazilian population. STUDY DESIGN: Ecological study. METHODS: This ecological study had two components: (1) a time-series assessment to analyse the burden of diseases attributable to high BMI from 1990 to 2019 in Brazil; and (2) a cross-sectional design to estimate the direct costs of SUS hospitalisations and outpatient procedures attributable to high BMI in 2019. Estimates from the Global Burden of Disease study and the costs of hospital admissions and outpatient procedures from the Department of Informatics of the Brazilian Unified Health System were used. Deaths, years of life lost to premature death (YLLs), years lived with disability (YLDs), and years of life lost adjusted for disability (DALYs) were analysed. The direct health cost was obtained in Brazilian Real (R$) and converted in international Dollars (INT$). RESULTS: The current study found a reduction in the number of DALYs, YLLs, and deaths per 100,000 population of cardiovascular disease (CVD) attributable to high BMI and an increase in YLD due to diabetes and cardiovascular disease attributable to high BMI from 1990 to 2019. In 2019, high BMI resulted in 2404 DALYs, 658 YLDs, 1746 YLLs, and 76 deaths per 100,000 inhabitants. In the same year, INT$377.30 million was spent on hospitalisations and high- and medium-complexity procedures to control non-communicable diseases attributable to high BMI. The states in the South and Southeast regions of Brazil presented the highest total cost per 10,000 inhabitants. CVDs and chronic kidney disease showed the highest costs per hospital admission, whereas neoplasms and CVDs presented the highest costs for outpatient procedures. CONCLUSIONS: High BMI causes significant disease burden and financial costs. The highest expenses observed were not in locations with the highest burden of disease attributable to high BMI. These findings highlight the need to improve current public policies and apply cost-effective intervention packages, focussing on equity and the promotion of healthier lifestyles to reduce overweight/obesity, especially in localities with low socioeconomic status.

Consumption of sugar-sweetened soft drinks and risk of metabolic syndrome and its components: results of the ELSA-Brasil study (2008-2010 and 2012-2014).

AIM: To estimate the association between consumption of sugar-sweetened soft drinks and unsweetened fruit juice with metabolic syndrome (MetS) and its components in participants of the Brazilian Longitudinal Adult Health Study (ELSA-Brasil) after 4 years of follow-up. METHODS: We used data from ELSA-Brasil cohort (N = 15,105). The sample consisted of 6,124 civil servants free of the MetS at baseline (35 to 74 years, both sexes). The consumption of sugar-sweetened soft drinks and unsweetened fruit juice was estimated by a food frequency questionnaire previously validated. The outcome was MetS and its components (Joint Interim Statement criteria). To test the association between beverage consumption at baseline (2008-2010) and MetS and its components at follow-up (2012-2014), we used Poisson regression models with robust variance adjusting for potential confounders. RESULTS: After 4-year follow-up, the higher consumption of sugar-sweetened soft drinks (≥ 1 serving/day = 250 mL/day) increased the relative risk of MetS (RR = 1.22; 95% CI 1.04-1.45), high fasting glucose (RR = 1.23; 95% CI 1.01-1.48), and high blood pressure (RR = 1.23; 95% CI 1.00-1.54). Moderate consumption of this beverage (0.4 to < 1 serving/day) increased the relative risk of high waist circumference (WC) (RR = 1.21; 95% CI 1.02-1.42). After adjustment for confounding variables, the consumption of unsweetened fruit juice was not associated with the MetS and its components. CONCLUSION: Higher sugar-sweetened soft drinks consumption was associated with a higher risk relative of MetS, high fasting glucose, and high blood pressure, while moderate consumption of this beverage increased the relative risk of high WC in Brazilian adults.

[Factors associated with abdominal obesity among childbearing-age women]. / Fatores associados à obesidade abdominal em mulheres em idade reprodutiva.

OBJECTIVE: To investigate variables potentially associated with abdominal obesity among childbearing-age women. METHODS: A total of 781 women were studied based on data from the Nutrition and Health Survey conducted in 1996 in the municipality of Rio de Janeiro, Brazil. Abdominal obesity was defined as waist girth (WG) > 80 cm or waist:hips girth ratio (WHR) > 0.85. Statistical analysis involved calculation of central trend measures. Calculating the odds ratio using multivariate logistic regression tested the association between abdominal obesity and BMI, age, parity, and tobacco use. RESULTS: The highest frequencies of abdominal obesity were observed in women over 35 years of age and those with two or more children (50.7%). OR showed the effect of interaction between parity and age for WG>80 cm when only the effect of these two variables was controlled. Based on the logistic regression models, the study showed that when the population was categorized into women with and without overweight, schooling was the only factor associated with WHR, while the association with age and parity disappeared for WG>80 cm. CONCLUSIONS: Abdominal obesity in this population group is independent of age and parity when adjusted by relative weight, with overall adiposity and schooling as the greatest determinant. Having more schooling meant having a smaller WHR. It is crucial to implement strategies to prevent the development of obesity in childbearing-age women.

Frequency of food consumption and lipoprotein serum levels in the population of an urban area, Brazil.

OBJECTIVE: To identify the association between food group consumption frequency and serum lipoprotein levels among adults. METHODS: The observations were made during a cross-sectional survey of a representative sample of men and women over 20 years old living in Cotia county, S. Paulo, Brazil. Data on food frequency consumption, serum lipids, and other covariates were available for 1, 045 adults. Multivariate analyses adjusted by age, gender, body mass index, waist-to-hip ratio, educational level, family income, physical activity, smoking, and alcohol consumption were performed. RESULTS: Consumption of processed meat, chicken, red meat, eggs and dairy foods were each positively and significantly correlated with LDL-C, whereas the intake of vegetables and fruits showed an inverse correlation. Daily consumption of processed meat, chicken, red meat, eggs, and dairy foods were associated with 16.6 mg/dl, 14.5 mg/dl, 11.1 mg/dl, 5.8 mg/dl, and 4.6 mg/dl increase in blood LDL-C, respectively. Increases of daily consumption of fruit and vegetables were associated with 5.2 mg/dl and 5.5 mg/dl decreases in LDL-C, respectively. Alcohol beverage consumption showed a significant positive correlation with HDL-C. CONCLUSIONS: Dietary habits in the study population seem to contribute substantially to the variation in blood LDL and HDL concentrations. Substantially CHD risk reduction could be achieved with dietary changes.

Secular trend in age at menarche for women born between 1920 and 1979 in Rio de Janeiro, Brazil.

PRIMARY OBJECTIVE: This article presents data on the secular trend in age at menarche for 1955 women from 16 to 76 years of age born between 1920 and 1979 and studied under the Nutrition and Health Survey conducted in the municipality of Rio de Janeiro, Brazil, in 1996. METHODS AND PROCEDURES: Age at menarche was defined by the retrospective method. Women were grouped according to decade of birth, and the trend was estimated using simple linear regression between age at menarche and year of birth for the following specific periods: 1920-1940, 1920-1960, 1960-1979 and 1920-1979. MAIN OUTCOMES AND RESULTS: Mean age at menarche decreased from 13.07 to 12.40 years when comparing the group of women born in the 1920s with the 1970s birth cohort, corresponding to a mean rate of -0.0123 years per year (p < 0.001). The downward trend was -0.0120 years per year (p > 0.05) for the 1920s, 30s and 40s, -0.0093 years per year (p < 0.05) for the period from 1920 to 1960, and -0.0224 years per year (p < 0.01) for the 1960s/70s. CONCLUSIONS: The results suggest a secular trend in age at menarche. The literature points to such environmental variables as improved living conditions and expanded access to health services. Within this context, age at menarche could be used as a marker for social development.

[Physical growth of children from the Peruvian Amazon born in the eighties]. / Crescimento físico de crianças da Amazônia Peruana no final da década de 80.

This paper presents data of physical growth for 673 children under 5 years born in the eighties in Iquitos and Punchana, Peruvian Amazon. The data were based on a clinical and nutritional research survey and a multiple stratified probability sample procedure was used. The statistical analysis were performed on EPI-INFO Version 6.04 and MULTLRM and included: prevalence of z-score under-2 standard deviation, means and standard deviation, ANOVA, t-test, relative risk and odds ratio. The results showed a high prevalence of low height/age (28.3%) and a relatively low for weight/age (12.5%). The final model obtained from the unconditional logistic regression included the following variables as independent factors significantly associated with low height/age: child age (RR = 1.05, CI 95%: 1.03-1.07); maternal education > 5 and < 10 years (RR = 0.48, IC 95%: 0.32-0.73), maternal education > 10 years (RR = 0.11, CI 95%: 0.01-0.89) and hygienic services with latrine (RR = 2.22, CI 95%: 1.46-3.37) and without WC (RR = 4.15, CI 95%: 1.56-10.99). These findings coroborate the influence of ecological factors on the determination of low height/age, and suggest that interventions should be centered on the enlargement of educational coverage and on improvements of hygienic conditions, as for this Peruvian school sample, both variables were defined as potential determinants for the low height/age.

Relationship between stature, overweight and central obesity in the adult population in São Paulo, Brazil.

OBJECTIVE: To test association between overweight, central obesity and stature. DESIGN: Cross-sectional study carried-out between 1990-1991. SUBJECTS: 951 adults (387 male and 564 female) aged 20-64 y, resident in the metropolitan area of São Paulo, Brazil. MEASUREMENTS: Anthropometry, blood lipid concentrations (total, high density lipoprotein (HDL) and low density lipoprotein (LDL)-cholesterol, triglycerides (TGs) and blood glucose. Body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference were used to identify overweight (BMI > 25 kg/m2), abdominal obesity (WHR tertile 3 and waist circumference tertile 3), respectively. The subjects were categorised as those of short stature (women < 150 cm, men < 162cm) and those of normal stature (women > or = 150 cm, men > or = 162 cm). RESULTS: Prevalence of short stature was 19.6% and 15.4% in men and women, respectively. Short stature women had higher serum concentrations of total cholesterol, LDL-cholesterol, TGs and glucose than those of normal stature. Among men, this difference was not observed, except for glucose concentrations. Short stature women had high BMI and WHR means in some age categories, compared with those of normal stature. Both overweight and high WHR frequencies were greater in short stature women than in those of normal ones. In multivariate analysis, adjusted by age, income, marital status, education, physical activity and tobacco use, only women group with short stature compared with normal stature had significantly risk of overweight an high WHR. In the same group there was no association with waist circumference. Among the men there was significant opposite association with waist circumference. CONCLUSION: Short stature in women can potentially be an independent risk factor for overweight and high WHR.

[Nutritional status of social groups in greater metropolitan São Paulo, Brazil]. / Estado Nutricional de grupamentos sociais da área metropolitana de São Paulo, Brasil.

This paper focuses on prevalence of nutritional status (Body Mass Index, BMI) in social groups in greater metropolitan São Paulo, in Southeastern Brazil. The population was stratified in four socioeconomic groups. Prevalence of malnutrition (BMI<18.5kg/m2), low body mass (BMI<20.0kg/m2), and overweight (BMI>25.0kg/m2) and obesity (BMI(30.0kg/m2) were calculated. Prevalence of malnutrition was 3.9% in men and 6.2% in women. Prevalence of overweight ranged from 27.5% to 34.1% in men and from 25.8% to 43.6% in women. Obesity ranged from 2.5% to 11.1% in men and from 7.1% to 20.5 in women. Prevalence of overweight and obesity was greater among women than men (p<0.01). In relation to excess weight (BMI>25.0kgm/2), the study showed that prevalence in men was 43, 51, 35, and 30% for strata I, II, III, and IV, respectively. Among women, prevalence was 12, 61, 55 and 46% for strata I, II, III, and IV, respectively. In women there were an abrupt increase in excess weight just before 40 years of age. A high percentage of overweight and obesity was observed in all population groups.

Mid-upper arm circumference in pregnant women and its relation to birth weight.

OBJECTIVE: In order to determine the relationship between some maternal anthropometric indicators and birth weight, crown-heel length and newborn's head circumference, 92 pregnant women were followed through at the prenatal service of hospital in S. Paulo, Brazil. MATERIAL AND METHOD: The following variables were established for the mother: weight, height, mid-upper arm circumference, pre-pregnancy weight, gestational weight gain and Quetelet's index. For the newborn the following variables were recorded: birth weight, crown-heel length, head circumference and gestational age by Dubowitz's method. RESULTS: Significant associations were noted between gestational age and newborn variables. In addition, maternal mid-arm circumference (MUAC) and pre-pregnancy weight were found to be positively correlated to birth weight (r = 0.399; r = 0.378, respectively). The multivariate linear regression shows that gestational age, mother's arm circumference and pre-pregnancy weight continue to be significant predictors of birth weight. On the other hand, only gestational age and mother's age was associated with crown-heel length. Similarly MUAC was significantly associated with crown-heel length (r = 0.306; P = 0.0030). CONCLUSION: Maternal mid-upper arm circumference is a potential indicator of maternal nutritional status. It could be used in association with other anthropometric measurements, instead of pre-pregnancy weight, as an alternative indicator to assess women at risk of poor pregnancy outcome.

[Vitamin and mineral intake of adults living in a metropolitan area of São Paulo, Brazil]. / Consumo alimentar de vitaminas e minerais em adultos residentes em área metropolitana de São Paulo, Brasil.

OBJECTIVE: The objective of the study is to quantify mineral and vitamin concentration in habitual diet of adults of between 20 and 88 years of age. A dietary survey was carried out between 1990-1991 as a part of the cross-sectional study: "Atherosclerotic cardiovascular disease, lipemic disorders, hypertension, obesity and diabetes mellitus in a population of the metropolitan area of S. Paulo, Brazil". MATERIAL AND METHOD: The vitamin and mineral intake was examined in relation to age and sex using dietary intake based on the diet history method. Data were obtained from a sub-sample of 548 individuals. RESULTS AND CONCLUSION: In general, it was observed that the respective intakes of thiamin, riboflavin, niacin, calcium and iron were more concentrated in the men's diet than in that of the women (p < 0.001). There are no statistical differences in the intake of vitamin A and vitamin C by sex. Elderly persons presented a lower intake of vitamins and minerals than did younger people. The intake of vitamin C had no association with age. This cross-sectional study showed that the habitual diet of the residents in the study area has low intake and low density of vitamin A and calcium.

[Atherosclerotic cardiovascular disease, lipemic disorders, hypertension, obesity and diabetes mellitus in the population of a metropolitan area of southeastern Brazil. III--Hypertension]. / Doenças cardiovasculares ateroscleróticas, dislipidemias, hipertensão, obesidade e diabetes melito em população da área metropolitana da região sudeste do Brasil. III--Hipertensão.

OBJECTIVE: The prevalencies of hypertension are analysed by sex and age group, in social groupings established in accord with social criteria. With a view better to understanding the social dimension of the disease, prevalencies were characterised by type of occupation. MATERIAL AND METHODS: The sample consisted of 1,041 people and corresponds to the sum of the samples representing the "study areas" established by the use of socio-economic and geographical criteria. Four social strata were defined in obedience to a socioeconomic gradient. Hypertension was defined by the Joint National Committee (JNC), 140/90 mmHg, and of the World Health Organization (WHO), 160/95 mmHg, standard references. RESULTS: According to the JNC and WHO standard references the prevalencies of hypertension, age adjusted, were of approximately the following: stratum (I + II) 60 and 37%; stratum III 50 and 39%; stratum IV 55 e 46%. Among women the prevalencies were 40 and 38% (stratum I + II); 56 and 47% (stratum III) and 55 and 46% (stratum IV). For the men belonging to the economically active population, classified by occupation, it was showed that the freelance professionals, consisting of businessmen of small firms, small traders and liberal professionals, presented a prevalence of about 60 and 37%; the skilled workers, employed in factories of 35 and 14%; the daily freelance workers, unskilled laborers and unemployed, of 59 and 40%. The women were divided by occupation as belonging or not to the economically active population (EAP) and presented the following prevalencies: 39 and 47%, respectively, according to the JNC standard, and 27 and 45%, respectively, according to the WHO standard. Thus it may be seen that these results run counter to the hypothesis that women integrated into the labour market are more exposed to the risk factors for non-transmissible diseases. CONCLUSION: Thus it may be concluded that the categories most affected by the present economic were those most affected by hypertension. On the other hand the possibility of there being and a intense social determination in the etiology of hypertension in this population is demonstrated.

Relationship between acute diarrhoea and low plasma levels of vitamin A and retinol binding protein.

The objective of this study was to assess vitamin A status and association between acute diarrhoea and plasma levels of vitamin A through cross-sectional comparison in children. Plasma vitamin A was measured by colorimetric method of Neeld & Pearson and RBP by radial immunodiffusion technique. Seventy eight children (aged 18-119 months), 26 with current history of diarrhoea and 52 children as controls (outpatient from the Santa Casa de Misericórdia Hospital in metropolitan area of São Paulo City, Brazil) were studied. Children with history of diarrhoea showed significant low levels (mean +/- s.e.) as compared to controls, vitamin A (15.87 +/- 1.4 micrograms/dl vs. 21.14 +/- 1.15 micrograms/dl, p < 0.007) and RBP (1.70 +/- 0.2 mg/dl vs. 2.52 +/- 0.11 mg/dl). Multivariate logistic regression adjusted by sex, age, nutritional status and mother education revealed association between diarrhoea and inadequate levels of vitamin A and RBP.

Vitamin A status in children with pneumonia.

OBJECTIVE: To assess vitamin A status in children with pneumonia. INTERVENTIONS: Thirty-four hospitalised patients with pneumonia were randomly allocated into two groups: the study group, besides the routine treatment, received a high dose of aqueous retinyl palmitate oral solution; the control group received only the routine treatment. METHODS: The concentrations of plasma vitamin A and carotenoids were determined by colorimetric method. Retinol binding protein (RBP) was determined by the radial immunodiffusion technique. RESULTS: After 1 week of treatment there was a statistically significant (P < 0.05) increase in the levels (mean +/- s.e.) of vitamin A (study group: 14.1 +/- 1.6 to 26.5 +/- 5.8 micrograms/dl; control group: 16.1 +/- 3.3 to 24.1 +/- 2.3 micrograms/dl) and RBP (study group: 0.8 +/- 0.2 to 2.2 +/- 0.6 mg/dl; control group: 0.6 +/- 0.2 to 3.0 +/- 0.5 mg/dl) in both groups as compared to the baseline. On day 7 of treatment when the average levels of vitamin A (26.5 +/- 5.8 and 24.1 +/- 2.3 micrograms/dl) were compared, there was no statistically significant difference between the groups. CONCLUSION: This study suggests that low levels of circulating plasma vitamin A in child with pneumonia may be a consequence of acute phase of infectious disease.

[Plasma levels of vitamin A, carotenoids and retinol binding protein in children with acute respiratory infections and diarrheal diseases]. / Níveis plasmáticos de vitamina A, carotenóides e proteína ligadora de retinol em crianças com infecções respiratórias agudas e doenças diarréicas.

The present study was carried out in order to assess the plasma levels of vitamin A, carotenoids and retinol binding protein (RBP) of three-hundred and eleven children aged from seven months to eleven years, who had a history of upper respiratory infection (URI), pneumonia and diarrhoea. The children were resident in the urban area of the Municipality of S. Paulo, Brazil, and were seen at the pediatric service of the one school-hospital. The data show that plasma vitamin A (microgram/dl) and RBP (mg/dl) levels in the diarrhoea (15.2 micrograms/dl; 1.7 mg/dl) and pneumonia (15.2 micrograms/dl; 0.7 mg/dl) groups were lower (p < 0.05) than those observed in the control (18.8 micrograms/dl; 2.6 mg/dl) and URI (19.0 micrograms/dl; 2.4 mg/dl) groups. The plasma carotenoid levels were lower in all groups than in the control group (p < 0.05). These findings corroborate the results that show low levels of vitamin A in circulation during period of infection.