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To estimate the prevalence of self-reported high cholesterol diagnosis and to analyze the factors associated with the prevalence in the Brazilian adult population.Cross-sectional study, using data from the 2019 National Health Survey. The diagnosis of high cholesterol was self-reported. Poisson regression models yielded prevalence ratios (PR) and 95% confidence intervals (95%CI).In the 88,531 adults, the prevalence of high cholesterol was 14.6%. Positively associated: female sex (PR = 1.44; 95%CI 1.40;1.52), age ≥ 60 years (PR = 3.80; 95%CI 3.06;4.71), health insurance (PR = 1.33; 95%CI 1.24;1.42), poor or very poor self-rated health (PR = 1.75; 95%CI 1.60;1.90), hypertension (PR = 1.78; 95%CI 1.68;-1.89), diabetes (RP = 1.54; 95%CI 1.45;1.65), renal failure (PR = 1.33; 95%CI 1.15;1.53), obesity (PR = 1.27; 95%CI 1.18;1.36), former smoker (PR = 1.13; 95%CI 1.07;1.20), alcohol abuse (PR = 1.11; 95%CI 1.01;1.21), physically active during leisure time (PR = 1.22; 95%CI 1.15;1.30).High cholesterol was associated with sociodemographic characteristics, health condition and lifestyle.Estimar a prevalência de diagnóstico autorreferido de colesterol alto e analisar os fatores associados à prevalência na população adulta brasileira.Estudo transversal utilizando a Pesquisa Nacional de Saúde 2019. O diagnóstico de colesterol alto foi autorreferido. Modelos de regressão de Poisson originaram as razões de prevalência (RP) e intervalos de confiança de 95% (IC95%).Nos 88.531 adultos, a prevalência de colesterol alto foi de 14,6%. Associaram-se positivamente: sexo feminino (RP = 1,44; IC95% 1,40;1,52), idade ≥ 60 anos (RP = 3,80; IC95% 3,06;4,71), ter plano de saúde (RP = 1,33; IC95% 1,24;1,42), autoavaliação de saúde ruim ou muito ruim (RP = 1,75; IC95% 1,60;1,90), ter hipertensão (RP = 1,78; IC95% 1,68;1,89), ter diabetes (RP = 1,54; IC95% 1,45;1,65), ter insuficiência renal (RP = 1,33; IC95% 1,15;1,53), ter obesidade (RP = 1,27; IC95% 1,18;1,36), ser ex-fumante (RP = 1,13; IC95% 1,07;1,20), consumir álcool abusivamente (RP = 1,11; IC95% 1,01;1,21), ser ativo no lazer (RP = 1,22; IC95% 1,15;1,30).O colesterol alto associou-se a condições sociodemográficas, de saúde e estilo de vida.Estimar la prevalencia de colesterol alto autodeclarado y analizar factores asociados la prevalencia en adultos brasileños.Estudio transversal utilizando la Encuesta Nacional de Salud de 2019. El diagnóstico de colesterol alto fue autodeclarado. Los modelos de regresión de Poisson produjeron razón de prevalencia (RP) e intervalos de confianza del 95% (IC95%).En 88.531 adultos, la prevalencia fue 14,6%. Asociaron positivamente: sexo feminino (RP = 1,44; IC95% 1,40;1,52), edad ≥ 60 años (RP = 3,80; IC95% 3,06;4,71), seguro salud (RP = 1,33; IC95% 1,24;1,42), autoevaluación de salud mala o muy mala (RP = 1,75; IC95% 1,60;1,90), hipertensión (RP = 1,78; IC95% 1,68;1,89), diabetes (RP = 1,54; IC95% 1,45;1,65), insuficiencia renal (RP = 1,33; IC95% 1,15;1,53), obesidad (RP = 1,27; IC95% 1,18;1,36), exfumador (RP = 1,13; IC95% 1,07;1,20), abuso de alcohol (RP = 1,11; IC95% 1,01;1,21), estar activo en el tiempo libre (RP = 1,22; IC95% 1,15;1,30).Colesterol alto se asoció con condiciones sociodemográficas, de salud y estilo de vida.

Objective: To analyze the contextual factors associated with type II diabetes mellitus in Belo Horizonte City. Methods: Cross-sectional study with 5,779 adults living in Belo Horizonte City, participating in the Risk and Protection Factors Surveillance System for Chronic Diseases through Telephone Survey (Vigitel), in 2008, 2009, and 2010. Multilevel regression models were used to test the association between contextual indicators of physical and social environments, and self-reported diagnosis of diabetes, adjusted for individual sociodemographic and lifestyle factors. Descriptive analyzes and multilevel logistic regression models were used, considering a 5% significance level. Results: The prevalence of diabetes was 6.2% (95%CI 5.54 – 6.92), and 3.1% of the variability of chance of presenting diabetes were explained by contextual characteristics. Living in areas with high density of private places for physical activity and high income was associated with a lower chance of having diabetes. The areas with high level of social vulnerability were strongly associated with the chance of presenting diabetes, adjusted for individual characteristics. Conclusion: Characteristics of physical and social environments were associated with the chance of diabetes occurrence. Urban centers with opportunities to adopt healthy behaviors can help to reduce the occurrence of diabetes and its complications. RESUMO: Objetivo: Analisar os fatores contextuais associados ao diabetes mellitus tipo II em Belo Horizonte (MG). Métodos: Estudo transversal com 5.779 adultos residentes em Belo Horizonte, participantes do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico, nos anos de 2008, 2009 e 2010. Foram utilizados modelos de regressão multinível para testar a associação entre indicadores contextuais do ambiente físico e social e diagnóstico autorreferido de diabetes, ajustados por fatores individuais sociodemográficos e de estilo de vida. Utilizaram-se análises descritivas e modelos de regressão logística multinível, considerando um nível de significância de 5%. Resultados: A prevalência de diabetes foi de 6,2% (IC95% 5,54–6,92), e 3,1% da variabilidade da chance de diabetes nas áreas de abrangência estudadas foi explicada por características contextuais. Residir em áreas com alta densidade de locais privados para prática de atividade física e com alta renda associou-se a menor chance de ter diabetes. As áreas com alto índice de vulnerabilidade social foram fortemente associadas ao diabetes, independentemente de características individuais. Conclusão: A ocorrência de diabetes está associada com as características do ambiente físico e social. Centros urbanos com oportunidades para adoção de comportamentos saudáveis podem ajudar a reduzir a ocorrência de diabetes e as suas complicações.

Resumo: O objetivo do estudo foi estimar a prevalência da coocorrência de fatores de risco obesogênicos em adolescentes brasileiros e características sociodemográficas e familiares associadas. É um estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar, 2009 (n = 53.274). A variável resposta (coocorrência de fatores de risco obesogênicos) variou de zero a cinco e foi obtida com base no somatório dos comportamentos de risco: consumo diário de refrigerantes; consumo diário de guloseimas; consumo insuficiente de frutas; consumo insuficiente de hortaliças e atividade física insuficiente. As variáveis explicativas foram sexo, idade, cor da pele, região brasileira, escore de bens e serviços do domicílio, escolaridade materna, tipo de escola, composição familiar, monitoramento parental e realização de refeições principais com os responsáveis. Utilizou-se o diagrama de Venn para a análise exploratória e a regressão logística ordinal com modelo de odds proporcionais parciais para análise multivariada. Verificou-se maior chance de ocorrência simultânea dos fatores nos adolescentes do sexo feminino, naqueles que tinham menor monitoramento parental e que realizavam menor número de refeições com os responsáveis. Em contraste, adolescentes que residiam em regiões mais desenvolvidas do país e aqueles cujas mães possuíam maior escolaridade apresentaram menor chance de coocorrência de fatores de risco obesogênicos. Ações que estimulem mais envolvimento e supervisão familiar no comportamento alimentar podem promover impacto positivo na prevenção da obesidade em adolescentes brasileiros, principalmente em regiões menos desenvolvidas e em lares com mães de menor escolaridade. Abstract: The study aimed to estimate the prevalence of cooccurrence of obesogenic risk factors in Brazilian adolescents and associated sociodemographic and family characteristics. This is a cross-sectional study of data from the Brazilian National School Health Survey, 2009 (n = 53,274). The outcome variable (cooccurrence of obesogenic risk factors) varied from zero to five and was obtained as the sum of the risk behaviors: daily consumption of soft drinks; daily consumption of candy; insufficient consumption of fruits; insufficient consumption of vegetables; and insufficient physical activity. The explanatory variables were sex, age, skin color, region of Brazil, household goods and services score, maternal schooling, type of school, family composition, parental monitoring, and main meals shared with parents or guardians. A Venn diagram was used for exploratory analysis, plus ordinal logistic regression with partial proportional odds model for multivariate analysis. The results showed higher odds of simultaneous occurrence of the factors in adolescent girls, in teens with less parental supervision, and teens who shared fewer meals with their parents or guardians. Meanwhile, adolescents living in more developed regions of the country and those whose mothers had more schooling showed lower odds of cooccurrence of obesogenic risk factors. Actions that encourage greater family involvement and supervision in dietary behavior can have a positive impact on the prevention of obesity in Brazilian adolescents, especially in less developed regions and in homes where the mothers have less schooling. Resumen: El objetivo del estudio fue estimar la prevalencia de la coocurrencia de factores de riesgo obesogénicos en adolescentes brasileños, así como las características sociodemográficas y familiares asociadas. Se trata de un estudio transversal, con datos de la Encuesta Nacional de Salud del Escolar, 2009 (n = 53.274). La variable respuesta (coocurrencia de factores de riesgo obesogénicos) varió de cero a cinco, y se obtuvo a partir del sumatorio de los comportamientos de riesgo: consumo diario de refrescos; consumo diario de golosinas; consumo insuficiente de frutas; consumo insuficiente de hortalizas y actividad física insuficiente. Las variables explicativas fueron: sexo, edad, color de piel, región brasileña, marcador de bienes y servicios del domicilio, escolaridad materna, tipo de escuela, composición familiar, monitoreo parental y realización de comidas principales con los responsables. Se utilizó el diagrama de Venn para un análisis exploratorio y regresión logística ordinal con un modelo de odds proporcionales parciales para el análisis multivariado. Se verificó una mayor oportunidad de ocurrencia simultánea de los factores en adolescentes del sexo femenino, en aquellos que tenían un menor monitoreo parental y que realizaban un menor número de comidas con los responsables. En contraste, adolescentes que residían en regiones más desarrolladas del país, y aquellos cuyas madres poseían una mayor escolaridad, presentaron una menor oportunidad de coocurrencia de factores de riesgo obesogénicos. Acciones que estimulen más implicación y supervisión familiar en el comportamiento alimentario pueden promover un impacto positivo en la prevención de la obesidad en adolescentes brasileños, principalmente en regiones menos desarrolladas y en hogares con madres de menor escolaridad.

Resumo O objetivo deste artigo é analisar a distribuição espacial da vacina contra Hepatite B (VCHB) de gestantes. Estudo transversal, realizado com 266 puérperas. O registro da VCHB foi obtido por meio da caderneta de pré-natal. Para a detecção do cluster de risco para presença de registro ou ausência de VCHB foi utilizada a técnica de varredura espacial. Posteriormente a esta identificação do cluster, procedeu-se à comparação das variáveis individuais e ambientais entre as Áreas de Abrangência da Unidade Básica de Saúde (AA-UBS). A prevalência média de não VCHB foi de 88,34%. A análise de varredura espacial Scan observou-se um cluster de alta prevalência de puérperas que apresentava o registro da VCHB em suas cadernetas. Análises comparativas demonstraram que trabalho remunerado e o número de consultas realizadas no pré-natal estão associados positivamente a VCHB. Este trabalho suscita uma reflexão de possíveis disparidades com as demais AA-UBS, além da perspectiva a nível ambiental. Ressalta-se que a situação vacinal sofre influência não somente de fatores intrínsecos aos indivíduos, entretanto, nesse estudo, os resultados apontam que as variáveis individuais são majoritariamente mandatórias na decisão das gestantes em vacinarem.

INTRODUCTION Chronic kidney disease (CKD) is a public health problem and it is associated with a high risk of mortality. Overweight and obesity are known as independent risk factors for CKD. OBJECTIVE To investigate the association between adiposity indexes and kidney disease. METHODS This study included 14,636 adults from ELSA-Brazil. Outcome variables: altered glomerular filtration rate (GFR), categorized as yes (GFR

Resumen: Objetivo: Determinar si la lactancia materna ≥ 6 meses se asocia con menor sobrepeso y obesidad en niños/as de 2 a 5 años de edad. Método: Análisis transversal de datos de encuestas nacionales de demografía y salud de Bolivia, Colombia y Perú. Se definieron sobrepeso y obesidad según los criterios de la Organización Mundial de la Salud. Se calculó la odds ratio (OR) utilizando regresión logística multinomial. Resultados: La prevalencia de obesidad en niños/as de 2 a 5 años fue del 10,4% (intervalo de confianza del 95% [IC95%]: 8,2-12,6) en Bolivia, del 4,9% (IC95%: 4,0-5,8) en Colombia y del 6,4% (IC95%: 5,2-8,0) en Perú. La lactancia materna ≥ 6 meses en la población estudiada fue del 89,9% (IC95%: 87,8-91,9) en Bolivia, del 73,9% (IC95%: 72,2-75,6) en Colombia y del 92,8% (IC95%: 91,2-94,4) en Perú. Se encontró evidencia de asociación entre lactancia materna ≥ 6 meses y menor posibilidad de obesidad en comparación con no lactancia o lactancia < 6 meses para Bolivia (OR = 0,30; IC95%: 0,16-0,57), y una asociación marginal para Colombia (OR = 0,71; IC95%: 0,47-1,06) y Perú (OR = 0,49; IC95%: 0,23-1,04). No hubo evidencia de asociación entre lactancia materna y sobrepeso. Conclusión: La lactancia materna ≥ 6 meses está asociada con una menor posibilidad de tener obesidad en niños/as de 2 a 5 años en Bolivia. Este patrón fue similar, pero marginal, para Colombia y Perú. Abstract: Objective: To determine if breastfeeding for at least the first six months of life is associated with overweight and obesity in children 2 to 5 years old. Method: Cross sectional analysis of data from national demographic and health surveys conducted in Bolivia, Colombia and Peru. Overweight and obesity were defined using World Health Organization standard definitions. Odds ratios (OR) were calculated using multinomial logistic regression. Results: The prevalence of obesity in children 2 to 5 years old was 10.4% (95% confidence interval [95%CI]: 8.2-12.6) in Bolivia, 4.9% in Colombia (95%CI: 4.0-5.8), and 6.4% (95%CI: 5.2-8.0) in Peru. Prevalence of exclusive breastfeeding for at least the first 6 months in the study population was 89.9% (95%CI: 87.8-91.9) in Bolivia, 73.9% (95%CI: 72.2-75.6) in Colombia, and 92.8% (95%CI: 91.2-92.4) in Peru. Exclusive breastfeeding was associated with a decreased risk of obesity in children as compared to no breastfeeding or breastfeeding for less than 6 months in Bolivia (OR = .30; 95%CI: .16-.57) and a marginal association in Colombia (OR = .71; 95%CI: .47-1.06) and Peru (OR = .49; 95%CI: 0.23-1.04). No association between breastfeeding and overweight was found. Conclusion: Exclusive breastfeeding for at least the first six months of life decreases the risk of obesity in children 2 to 5 years old in Bolivia. A similar but weaker pattern was observed for children in Colombia and Peru.

Background Monitoring and reducing premature mortality due to non-communicable diseases (NCDs) is a global priority of Agenda 2030. This study aimed to describe the mortality trends and disability-adjusted life years (DALYs) lost due to NCDs between 1990 and 2017 for Brazil and to project those for 2030 as well as the risk factors (RFs) attributed deaths according to estimates of the Global Burden of Disease Study. Methods We analyzed cardiovascular diseases, chronic respiratory diseases, neoplasms, and diabetes, and compared the mortality rates in 1990 and 2017 for all of Brazil and states. The study used the definition of premature mortality (30–69 years) that is used by the World Health Organization. The number of deaths, mortality rates, DALYs, and years of life lost (YLL) were used to compare 1990 and 2017. We analyzed the YLL for NCDs attributable to RFs. Results There was a reduction of 35.3% from 509.1 deaths/100,000 inhabitants (1990) to 329.6 deaths/100,000 inhabitants due to NCDs in 2017. The DALY rate decreased by 33.6%, and the YLL rate decreased by 36.0%. There were reductions in NCDs rates in all 27 states. The main RFs related to premature deaths by NCDs in 2017 among women were high body mass index (BMI), dietary risks, high systolic blood pressure, and among men, dietary risks, high systolic blood pressure, tobacco, and high BMI. Trends in mortality rates due to NCDs declined during the study period; however, after 2015, the curve reversed, and rates fluctuated and tended to increase. Conclusion Our findings highlighted a decline in premature mortality rates from NCDs nationwide and in all states. There was a greater reduction in deaths from cardiovascular diseases, followed by respiratory diseases, and we observed a minor reduction for those from diabetes and neoplasms. The observed fluctuations in mortality rates over the last 3 years indicate that if no further action is taken, we may not achieve the NCD Sustainable Development Goals. These findings draw attention to the consequences of austerity measures in a socially unequal setting with great regional disparities in which the majority of the population is dependent on state social policies.

Background The prevalence and burden of disease resulting from obesity have increased worldwide. In Brazil, more than half of the population is now overweight. However, the impact of this growing risk factor on disease burden remains inexact. Using the 2017 Global Burden of Disease (GBD) results, this study sought to estimate mortality and disability-adjusted life years (DALYs) lost to non-communicable diseases caused by high body mass index (BMI) in both sexes and across age categories. This study also aimed to describe the prevalence of overweight and obesity throughout the states of Brazil. Methods Age-standardized prevalence of overweight and obesity were estimated between 1990 and 2017. A comparative risk assessment was applied to estimate DALYs and deaths for non-communicable diseases and for all causes linked to high BMI. Results The prevalence of overweight and obesity increased during the period of analysis. Overall, age-standardized prevalence of obesity in Brazil was higher in females (29.8%) than in males (24.6%) in 2017; however, since 1990, males have presented greater rise in obesity (244.1%) than females (165.7%). Increases in prevalence burden were greatest in states from the North and Northeast regions of Brazil. Overall, burden due to high BMI also increased from 1990 to 2017. In 2017, high BMI was responsible for 12.3% (8.8–16.1%) of all deaths and 8.4% (6.3–10.7%) of total DALYs lost to non-communicable diseases, up from 7.2% (4.1–10.8%), and 4.6% (2.4-6.0%) in 1990, respectively. Change due to risk exposure is the leading contributor to the growth of BMI burden in Brazil. In 2017, high BMI was responsible for 165,954 deaths and 5,095,125 DALYs. Cardiovascular disease and diabetes have proven to be the most prevalent causes of deaths, along with DALYs caused by high BMI, regardless of sex or state. Conclusions This study demonstrates increasing age-standardized prevalence of obesity in all Brazilian states. High BMI plays an important role in disease burdens in terms of cardiovascular diseases, diabetes, and all causes of mortality. Assessing levels and trends in exposures to high BMI and the resulting disease burden highlights the current priority for primary prevention and public health action initiatives focused on obesity.

Background Monitoring premature mortality due to noncommunicable diseases (NCDs) is a global priority, as part of the Agenda 2030. Objective The current study aims to describe the mortality trends and disability-adjusted life years (DALYs) lost due to NCDs between 1990 and 2017 for Brazil and states, projections for 2030. Methods We analyzed the following NCDs: cardiovascular diseases, chronic respiratory diseases, neoplasms, diabetes mellitus, comparing deaths and mortality rates between 1990 and 2017, for Brazil and states. The study used the concept of premature mortality used by the World Health Organization (30 to 69 years). The absolute number of deaths, mortality rates, DALYs, years of life lost (YLL), were used, comparing 1990 and 2017. We also analyzed the premature death fraction (YLL) for NCDs attributable to risk factors. Results There was a reduction of 35,3% from 509.1 deaths/100,000 inhabitants (1990) to 329.6 deaths/100,000 inhabitants due to NCD in 2017. DALYs rate decreased by 33.6% and the YLL rate by 36.0% in the same period. There was a reduction in the NCD rates in all 27 states. The main risk factors related to premature deaths by NCDs in 2017 among women were - high body mass index, diet risks, high systolic blood pressure, tobacco, and among men, diet risks, high systolic blood pressure, tobacco, high body mass index. Trends in mortality rates due to NCDs were declining in the period, however, after 2015, the curve reversed and fluctuation and tendency to increase rates were observed. Conclusions Trends of mortality rates by NCD were declining in the period, however, after 2015, the curve was inverted and the fluctuation and trend of increasing rates was observed, which can compromise the SDG goals in 2030. Key messages The austerity policies adopted and the economic crisis in Brazil after 2015, resulted in increased poverty and worsening NCD mortality indicators. With the NCD indicators worsening in 2015, SDG targets may not be achieved.

Background Given that sleep disturbances seem to be increasing in Brazil, this may have serious implications on Cardiovascular Health and mortality. Objective To examine the predicted probabilities of attained Lifés Simple 7 factors (LS7) in the presence of sleep problems among Brazilian adults. Methods We used data from the 2013 Brazilian National Health Survey (PNS), a nationally representative cross-sectional household survey of adults in Brazil. Cardiovascular Health was assessed by the sum of Lifés Simple 7 factors (LS7), which includes four behaviors (smoking, physical activity, body mass index and diet) and three biological factors (hypercholesterolemia, hypertension and diabetes). We analyzed self-reported data from 36,480 Brazilian adults aged 18 and over, including the sleep problems. We estimated predicted probabilities after multivariate Poisson regression. Results Mean CVH scores was higher among those who did not report sleep disturbances [4.2 (95% CI: 4.1; 4.2)], than those with sleep disturbances [3.8 (95% CI: 3.7; 3.8)]. Predicted probabilities of attained LS7 and CVH score was lower in the presence of sleep complaints, with a dose response for blood pressure, glucose, smoking and CVH score in both unadjusted and adjusted analyses, for age, sex, schooling, depression and night work shift. Conclusions Brazilian adults with sleep disturbances are less likely to achieve LS7 and consequently ideal cardiovascular health. Given that sleep disturbances seem to be increasingly more common in Brazil, recent gains in CVH mortality may be affected. Key messages Sleep disturbances may potentially affect metabolic outcomes and modifiable lifestyles behaviors as decreased physical activity and smoking. Sleep disturbances is novel risk factor for metabolic diseases.

We estimated the prevalence of the Metabolic Syndrome (MetS) and its components in the Brazilian population according to sociodemographic factors. This is a cross-sectional population-based study that used laboratory data from the National Health Survey. We estimated the prevalence of MetS and its components with 95% confidence intervals and the unadjusted and adjusted prevalence ratio (PR) with the Poisson regression. MetS prevalence ratio was 38.4%. High waist circumference (WC) (65.5%) and low HDL cholesterol (49.4%) were the most prevalent components, including in the youngest people. MetS and its components were more frequent among women (41.8%), individuals with low schooling (47.5%), and older adults (66.1%). In the adjusted analysis, females (PR = 1.16; 95% CI 1.08-1.24), older adults (PR = 3.69; 95% CI 3.26-4.17), and low schooling (PR = 1.32; 95% CI 1.17-1.49) were associated with MetS. MetS was prevalent in the Brazilian population, especially among women, individuals with low schooling, and older adults. High WC and low HDL cholesterol were the most prevalent components, with the aggravating high prevalence factor in young adults. These findings reveal the need to consider laboratory data for a more accurate analysis of this condition, which can be challenging at the national level.Estimou-se a prevalência de Síndrome Metabólica (SM) e seus componentes na população brasileira de acordo com fatores sociodemográficos. Estudo transversal, de base populacional, com dados laboratoriais da Pesquisa Nacional de Saúde. Estimou-se prevalência da SM e seus componentes com intervalos de 95% de confiança e Razão de Prevalência (RP) não ajustada e ajustada utilizando regressão de Poisson. A prevalência de SM foi de 38,4%. A circunferência da cintura (CC) alta (65,5%) e colesterol HDL baixo (49,4%) foram os componentes mais prevalentes, inclusive nos jovens. A ocorrência de SM foi maior entre mulheres (41,8%), indivíduos com baixa escolaridade (47,5%) e idosos (66,1%). Na análise ajustada, sexo feminino (RP = 1,16; IC95% 1,08-1,24), idade avançada (RP = 3,69; IC95% 3,26-4,17) e baixa escolaridade (RP = 1,32; IC95% 1,17-1,49) associaram-se à ocorrência de SM. A SM foi muito prevalente na população brasileira, principalmente entre mulheres, indivíduos com baixa escolaridade e idosos. A CC alta e o colesterol HDL baixo foram os componentes mais frequentes, com o agravante de prevalências altas em adultos jovens. Esses achados revelam a necessidade de considerar dados laboratoriais para uma análise mais precisa dessa condição, o que em âmbito nacional pode ser um desafio.

OBJECTIVES This study explores the association between socioeconomic position (SEP) and health-related quality of life (HRQoL) among Portuguese children according to their weight status. METHODS A total of 1215 primary school-aged children (mean age 8.78 years) from three Portuguese districts (Lisbon, Porto, Coimbra) were assessed during 2016/2017. Father and mother's education (low, medium, high) and work status (employed, unemployed/retired) were used as SEP indicators. Self-reported HRQoL was assessed with the KIDSCREEN-27. Height and weight were objectively measured and body mass index categorized in normal, overweight or obese. Age, sex, and district-adjusted linear regression models were fitted to estimate associations between SEP indicators and HRQoL dimensions, according to weight status. RESULTS We found that 24.9% of children were categorized as having overweight/obesity. The mean scores of the Physical Well-Being, and School Environment dimensions of HRQoL were lower among children classified with overweight/obesity compared to children with normal weight (57.21 vs 54.11, P

Objective: To describe the profile and evolution of the mortality rate due to motorcycle accidents in Belo Horizonte and its Metropolitan Region, from 2000 to 2012. Methods: A time series study with data extracted from the Mortality Information System (Sistema de Informacoes sobre Mortalidade, SIM) and from the IBGE. A linear regression model was used, with a 5% significance level. Results: From 2000 to 2012 there was a 278% increase in the number of deaths. The population most affected was that of male individuals, aged 20 to 29 years old, of black/brown skin, without partners, and with 8 to 11 years of schooling. The mortality rate increased from 1.7 to 3.58 deaths/100,000 inhabitants, with an increasing trend (β=0.25 per year; p

The study aimed to estimate the prevalence of cooccurrence of obesogenic risk factors in Brazilian adolescents and associated sociodemographic and family characteristics. This is a cross-sectional study of data from the Brazilian National School Health Survey, 2009 (n = 53,274). The outcome variable (cooccurrence of obesogenic risk factors) varied from zero to five and was obtained as the sum of the risk behaviors: daily consumption of soft drinks; daily consumption of candy; insufficient consumption of fruits; insufficient consumption of vegetables; and insufficient physical activity. The explanatory variables were sex, age, skin color, region of Brazil, household goods and services score, maternal schooling, type of school, family composition, parental monitoring, and main meals shared with parents or guardians. A Venn diagram was used for exploratory analysis, plus ordinal logistic regression with partial proportional odds model for multivariate analysis. The results showed higher odds of simultaneous occurrence of the factors in adolescent girls, in teens with less parental supervision, and teens who shared fewer meals with their parents or guardians. Meanwhile, adolescents living in more developed regions of the country and those whose mothers had more schooling showed lower odds of cooccurrence of obesogenic risk factors. Actions that encourage greater family involvement and supervision in dietary behavior can have a positive impact on the prevention of obesity in Brazilian adolescents, especially in less developed regions and in homes where the mothers have less schooling.O objetivo do estudo foi estimar a prevalência da coocorrência de fatores de risco obesogênicos em adolescentes brasileiros e características sociodemográficas e familiares associadas. É um estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar, 2009 (n = 53.274). A variável resposta (coocorrência de fatores de risco obesogênicos) variou de zero a cinco e foi obtida com base no somatório dos comportamentos de risco: consumo diário de refrigerantes; consumo diário de guloseimas; consumo insuficiente de frutas; consumo insuficiente de hortaliças e atividade física insuficiente. As variáveis explicativas foram sexo, idade, cor da pele, região brasileira, escore de bens e serviços do domicílio, escolaridade materna, tipo de escola, composição familiar, monitoramento parental e realização de refeições principais com os responsáveis. Utilizou-se o diagrama de Venn para a análise exploratória e a regressão logística ordinal com modelo de odds proporcionais parciais para análise multivariada. Verificou-se maior chance de ocorrência simultânea dos fatores nos adolescentes do sexo feminino, naqueles que tinham menor monitoramento parental e que realizavam menor número de refeições com os responsáveis. Em contraste, adolescentes que residiam em regiões mais desenvolvidas do país e aqueles cujas mães possuíam maior escolaridade apresentaram menor chance de coocorrência de fatores de risco obesogênicos. Ações que estimulem mais envolvimento e supervisão familiar no comportamento alimentar podem promover impacto positivo na prevenção da obesidade em adolescentes brasileiros, principalmente em regiões menos desenvolvidas e em lares com mães de menor escolaridade.El objetivo del estudio fue estimar la prevalencia de la coocurrencia de factores de riesgo obesogénicos en adolescentes brasileños, así como las características sociodemográficas y familiares asociadas. Se trata de un estudio transversal, con datos de la Encuesta Nacional de Salud del Escolar, 2009 (n = 53.274). La variable respuesta (coocurrencia de factores de riesgo obesogénicos) varió de cero a cinco, y se obtuvo a partir del sumatorio de los comportamientos de riesgo: consumo diario de refrescos; consumo diario de golosinas; consumo insuficiente de frutas; consumo insuficiente de hortalizas y actividad física insuficiente. Las variables explicativas fueron: sexo, edad, color de piel, región brasileña, marcador de bienes y servicios del domicilio, escolaridad materna, tipo de escuela, composición familiar, monitoreo parental y realización de comidas principales con los responsables. Se utilizó el diagrama de Venn para un análisis exploratorio y regresión logística ordinal con un modelo de odds proporcionales parciales para el análisis multivariado. Se verificó una mayor oportunidad de ocurrencia simultánea de los factores en adolescentes del sexo femenino, en aquellos que tenían un menor monitoreo parental y que realizaban un menor número de comidas con los responsables. En contraste, adolescentes que residían en regiones más desarrolladas del país, y aquellos cuyas madres poseían una mayor escolaridad, presentaron una menor oportunidad de coocurrencia de factores de riesgo obesogénicos. Acciones que estimulen más implicación y supervisión familiar en el comportamiento alimentario pueden promover un impacto positivo en la prevención de la obesidad en adolescentes brasileños, principalmente en regiones menos desarrolladas y en hogares con madres de menor escolaridad.

Objective: To investigate the prevalence of mammography screening and the association among socio-demographic, behavior factors and non-adherence to mammography screening among women between 50 and 69 years old, using data from Vigitel 2016. Method: Cross-sectional, population-based study with data from Vigitel including 12,740 women in the 50-69 age group. The variables were analyzed using logistic regression. Results: Among the women studied, 21.8% had not had a mammography in the past 2 years. The characteristics associated with non-adherence to the test were having less than 12 years of education (p

Made available in DSpace on 2022-04-28T19:28:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 National Cancer Institute National Institute of Mental Health National Heart, Lung, and Blood Institute Fogarty International Center Alliance for Health Policy and Systems Research Medical Research Council Background Describing the prevalence and trends of cardiometabolic risk factors that are associated with noncommunicable diseases (NCDs) is crucial for monitoring progress, planning prevention, and providing evidence to support policy efforts. We aimed to analyse the transition in body-mass index (BMI), obesity, blood pressure, raised blood pressure, and diabetes in the Americas, between 1980 and 2014. Methods We did a pooled analysis of population-based studies with data on anthropometric measurements, biomarkers for diabetes, and blood pressure from adults aged 18 years or older. A Bayesian model was used to estimate trends in BMI, raised blood pressure (systolic blood pressure =140 mm Hg or diastolic blood pressure =90 mm Hg), and diabetes (fasting plasma glucose =7.0 mmol/L, history of diabetes, or diabetes treatment) from 1980 to 2014, in 37 countries and six subregions of the Americas. Findings 389 population-based surveys from the Americas were available. Comparing prevalence estimates from 2014 with those of 1980, in the non-English speaking Caribbean subregion, the prevalence of obesity increased from 3.9% (95% CI 2.2-6.3) in 1980, to 18.6% (14.3-23.3) in 2014, in men; and from 12.2% (8.2-17.0) in 1980, to 30.5% (25.7-35.5) in 2014, in women. The English-speaking Caribbean subregion had the largest increase in the prevalence of diabetes, from 5.2% (2.1-10.4) in men and 6.4% (2.6-10.4) in women in 1980, to 11.1% (6.4-17.3) in men and 13.6% (8.2-21.0) in women in 2014). Conversely, the prevalence of raised blood pressure has decreased in all subregions; the largest decrease was found in North America from 27.6% (22.3-33.2) in men and 19.9% (15.8-24.4) in women in 1980, to 15.5% (11.1-20.9) in men and 10.7% (7.7-14.5) in women in 2014. Interpretation Despite the generally high prevalence of cardiometabolic risk factors across the Americas, estimates also showed a high level of heterogeneity in the transition between countries. The increasing prevalence of obesity and diabetes observed over time requires appropriate measures to deal with these public health challenges. Our results support a diversification of health interventions across subregions and countries. Universidad Peruana Cayetano Heredia Imperial College London Pontificia Universidad Catolica de Chile University of the West Indies University of Sao Paulo Miami Veterans Affairs Healthcare System University of Kent Cleveland Clinic Yale University Caja Costarricense de Seguro Social Instituto Mexicano Del Seguro Social Instituto Nacional de Ciencias Medicas y Nutricion Universidad de Cuenca Federal University of Pelotas Pan American Health Organization University of Pernambuco Dalhousie University Federal University of Maranhao CAFAM University Foundation University Medical Science Universidad de la Republica Centro de Educacion Medica e Investigaciones Clinicas University of Amsterdam Canadian Fitness and Lifestyle Research Institute Universidade Federal de Juiz de Fora Universidade Estadual Paulista Universidade Federal de Santa Catarina University of Montreal Universidade Do Vale Do Rio Dos Sinos National Council of Scientific and Technical Research Ministry of Health Instituto Nacional de Salud Publica Federal University of Sao Paulo Hospital de Clinicas de Porto Alegre Universidade Federal Do Rio Grande Do sul McGill University Andes Clinic of Cardio-Metabolic Studies National Institute of Hygiene Epidemiology and Microbiology Universidad Icesi State University of Montes Claros King's College London Institute for Clinical Effectiveness and Health Policy National Institute of Public Health Universidad Autonoma de Bucaramanga Kingston General Hospital Heart Institute Fundacion Oftalmologica de Santander Simon Fraser University Institute of Tropical Medicine Ministerio de Salud Publica Harvard TH Chan School of Public Health West Virginia University Oswaldo Cruz Foundation Rene Rachou Research Institute Universidade Federal de Ouro Preto Hospital Israelita Albert Einstein Emory University Gorgas Memorial Institute of Health Studies Statistics Canada Gorgas Memorial Institute of Public Health University of Vale Do Rio Dos Sinos University of Puerto Rico Medical Sciences Campus University of Wisconsin-Madison Minas Gerais State Secretariat for Health Universidade Nove de Julho Public Health Agency of Canada Universidad Industrial de Santander National Institute of Health University of Sao Paulo Clinics Hospital Hospital Italiano de Buenos Aires Federal University of Santa Catarina Universidad Centro-Occidental Lisandro Alvarado Epidemiology and Microbiology Institute Universidade Federal de Minas Gerais World Health Organization Middlesex University Universidade Estadual Paulista National Cancer Institute: 1P20CA217231 National Institute of Mental Health: 1U19MH098780 National Heart, Lung, and Blood Institute: 1UM1HL134590 National Heart, Lung, and Blood Institute: 5U01HL114180 Fogarty International Center: D71TW010877 National Heart, Lung, and Blood Institute: HHSN268200900033C Alliance for Health Policy and Systems Research: HQHSR1206660 Medical Research Council: MR/P008984/1 Medical Research Council: MR/P02386X/1 Medical Research Council: MR/P024408/1 Fogarty International Center: R21TW009982

Objectives: to analyze the association of socioeconomic level and obstetric characteristics with vaccine registration of pregnant women. Methods: cross-sectional study, performed with 480 women in puerperal. Vaccination of pregnant women was considered a dependent variable and as independent variables were age, skin color, education, steady union, paid work, and number of prenatal consultations. Association between variables was verified by the Poisson’s regression model. Results: from 480 pregnant women’s health cards, 10.63% had information on hepatitis B vaccination; 31.46% for tetanus; and 90% of the health cards had not register for influenza. There was an association of paid work and number of prenatal consultations with hepatitis B vaccination. Conclusions: lower percentages in absence of vaccination occurred in women who were in the job market and had a higher number of prenatal consultations. This suggests that socioeconomic inequalities may interfere with the vaccination of pregnant women in health services. RESUMEN Objetivos: analizar la relación del nivel socioeconómico y características obstétricas con registro de vacunación de gestantes. Métodos: estudio transversal, realizado con 480 puérperas. Ha sido considerada, como variable dependiente, la vacunación de gestantes; y como variables independientes: edad, color de piel, escolaridad, unión estable, trabajo remunerado y número de consultas en el prenatal. Relación entre las variables ha sido verificada por medio de modelo de regresión de Poisson. Resultados: de las 480 libretas de gestantes, 10,63% poseían informaciones de la vacunación contra hepatitis B; 31,46% para el tétanos; y, para influenza, se observó ausencia de registro en 90% de las libretas. Hubo relación de trabajo remunerado y número de consultas realizadas en el prenatal con vacunación contra hepatitis B. Conclusiones: menores proporciones de ausencia de vacunación ocurrieron en mujeres que estaban en el mercado de trabajo y que realizaron mayor número de consultas de prenatal. Eso sugiere que desigualdades socioeconómicas pueden interferir en la vacunación de gestantes en los servicios de salud. RESUMO Objetivos: analisar a associação do nível socioeconômico e características obstétricas com registro vacinal de gestantes. Métodos: estudo transversal, realizado com 480 puérperas. Foi considerada, como variável dependente, a vacinação de gestantes; e como variáveis independentes: idade, cor de pele, escolaridade, união estável, trabalho remunerado e número de consultas no pré-natal. Associação entre as variáveis foi verificada por meio de modelo de regressão de Poisson. Resultados: das 480 cadernetas de gestantes, 10,63% possuíam informações da vacinação contra hepatite B; 31,46% para o tétano; e, para influenza, observou-se ausência de registro em 90% das cadernetas. Houve associação de trabalho remunerado e número de consultas realizadas no prénatal com vacinação contra hepatite B. Conclusões: menores proporções de ausência de vacinação ocorreram em mulheres que estavam no mercado de trabalho e que realizaram maior número de consultas de pré-natal. Isso sugere que desigualdades socioeconômicas podem interferir na vacinação de gestantes nos serviços de saúde.

Anormalidades lipídicas e inflamação sistêmica subclínica estão associadas ao processo de aterosclerose, sendo utilizadas como marcadores de risco cardiovascular. Estudos sugerem um possível efeito benéfico dos produtos lácteos na saúde cardiovascular, mas os resultados em marcadores lipídicos e inflamatórios ainda são controversos. O objetivo deste trabalho foi avaliar a associação entre o consumo de produtos lácteos e seus diferentes subgrupos e proteína C-reativa (PCR), LDL-colesterol (LDL-C) e razão triglicerídeo/HDL-colesterol (TG/HDL-C) nos participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) (n = 9.372). O consumo de lácteos foi avaliado por meio de questionário de frequência alimentar validado e apresentado em porções/dia. O consumo total de lácteos foi descrito em quatro categorias (≤ 1 porção/dia a > 4 porções/dia). As associações foram estimadas por meio do odds ratios (OR), utilizando-se o grupo de menor consumo (≤ 1 porção/dia) como referência. Os menores valores de OR para TG/HDL-C no modelo multivariado (0,70; IC95%: 0,55-0,90 em homens; e 0,55; IC95%: 0,43-0,70 em mulheres) foram encontrados no grupo com consumo > 4 porções/dia de lácteos totais. Esses resultados foram apoiados pelas associações inversas encontradas entre diferentes subgrupos de lácteos e a razão TG/HDL-C. Não foi encontrada associação entre consumo de produtos lácteos e seus subgrupos e valores de LDL-C e de PCR. Os resultados sugerem um possível efeito benéfico dos lácteos no perfil lipídico, porém são necessárias evidências de estudos longitudinais e de intervenção que elucidem os mecanismos de efeito dos diferentes tipos de lácteos.

The aim of the study was to investigate the role of the proteolytic fraction from Vasconcellea cundinamarcensis, designated as P1G10, on the healing of chronic foot ulcers in neuropathic patients with diabetes 2. Fifty patients were enrolled in a prospective, randomized, double-blind trial, to verify the efficacy and safety of a topical dressing formulated with 0.1% P1G10, intended for wound healing, versus a hydrogel (control) protocol. Upon completion of the intervention, the outcome evaluated the number of patients attaining full epithelization (100%), or at least 80% healing. Statistical analysis compared the data on each group for the significance of the differences. Collection of data was finished in week 16, and the results were analyzed by intention to treat. The results showed that, in the control group, 5 patients attained 100% ulcer healing, 3 patients ≥ 80% healing and 11 experienced ulcer changes ≤ 80%, and the remainder showed no changes or their wounds became worse. Meanwhile, in the P1G10 group, 11 patients experienced full healing, 4 had healing ≥ 80% and 5 had ulcer changes ≤ lower than 80%, and the remainder showed no changes or their wounds became worse. The healing incidence for the first endpoint (100% healing) showed that the P1G10 group was 2.95-fold more efficacious than the control group (CI 95%) and 2.52-fold (CI, 95%) higher than its control for the second endpoint (80% healing). These data support the hypothesis that topical application of the proteolytic fraction identified as P1G10 significantly enhances foot ulcer healing compared to hydrogel treatment.

Objective To evaluate the interrelations between adiposity, sociodemographic characteristics, and lifestyle of a Brazilian adult population. Methods We conducted a cross-sectional study with 808 individuals over 18 years. The structural equation model evaluated the interrelations between sociodemographic conditions, practice of physical activities and food intake in relation to adiposity. Results Age presented a positive and significant effect on adiposity (β = 0.41; p = 0.001) and food intake (β = 0.36; p Conclusion The present study found a significant association between the model's variables, with age advancement and female sex associated with high adiposity.

RESUMO: Objetivo: Analisar a carga global de doença, quanto aos anos de vida ajustados por incapacidade (disability adjusted life years - DALYs) atribuídos a fatores de risco (FRs) selecionados, para Brasil e 27 Unidades Federadas (UFs). Métodos: Foram utilizadas bases de dados do estudo Carga Global de Doença (Global Burden of Disease - GBD) para Brasil e UFs estimando a síntese de exposição de risco (summary exposure value - SEV) para FRs selecionados, incluindo os ambientais, comportamentais, metabólicos e suas combinações. Os DALYs foram usados como métrica principal do estudo. Construiu-se o ranking dos principais FRs entre 1990 e 2015, com comparações por sexo e UF. Resultados: Os FRs analisados explicariam 38,8% da perda de DALYs no país. A dieta inadequada foi a principal causa de DALYs em 2015. Em homens, a dieta inadequada contribuiu com 12,2% dos DALYs, e, em mulheres, com 11,1% deles. Outros FRs importantes foram: pressão arterial sistólica elevada, índice de massa corporal (IMC) elevado, tabagismo, glicose sérica elevada; entre homens, destaca-se o uso de álcool e drogas. Os principais FRs foram metabólicos e comportamentais. Na maioria das UFs, predominou a dieta inadequada, seguida da pressão arterial elevada. Conclusão: A dieta inadequada lidera o ranking de FRs para Brasil e UF. Os homens estão mais expostos aos FRs comportamentais, e as mulheres, aos metabólicos. ABSTRACT: Objective: To analyze the global burden of disease related to disability adjusted life years (DALYs) attributed to selected risk factors in Brazil and its 27 Federated Units. Methods: Databases from the Global Burden of Disease study in Brazil and its Federated Units were used, estimating the summary exposure value (SEV) for selected environmental, behavioral, and metabolic risk factors (RFs), and their combinations. The DALYs were used as the main metric. The ranking of major RFs between 1990 and 2015 was compiled, comparing data by sex and states. Results: The analyzed RFs account for 38.8% of the loss of DALYs in the country. Dietary risks was the main cause of DALYs in 2015. In men, dietary risks contributed to 12.2% of DALYs and in women, to 11.1%. Other RFs were high systolic blood pressure, high body mass index, smoking, high fasting plasma glucose and, among men, alcohol and drug use. The main RFs were metabolic and behavioral. In most states, dietary risks was the main RF, followed by high blood pressure. Conclusion: Dietary risks leads the RF ranking for Brazil and its Federated Units. Men are more exposed to behavioral risk factors, and women are more exposed to metabolic ones.

Objective: To estimate the association between maternal socioeconomic factors and the occurrence of nutritional outcomes in children under five years of age in a representative sample of the Brazilian population. Methods: This was a cross-sectional study that evaluated data from the latest National Survey of Children and Women's Demographics and Health, carried out in Brazil in 2006–2007. Maternal employment and maternal level of schooling were the main exposures. The following nutritional outcomes in children were considered: height/age 2SD for overweight. Generalized estimating equations (GEE) were utilized as the regression method. Results: After adjustments, it was observed that children whose mothers had low level of schooling had a higher chance of having short stature (OR = 3.97, 95% CI, 1.23–12.80) and children whose mothers worked outside the home were more likely to have excess weight (OR = 1.57, 95% CI, 1.02–2.42). Maternal employment was not associated with short stature in children (OR = 1.09, 95% CI, 0.67–1.77). Conclusion: Maternal level of schooling was associated with short stature in children and maternal employment with overweight, indicating the need to take into account the socioeconomic factors when proposing programs and strategies aimed at health and nutrition improvement of children, considering inter-sectoral interventions. Resumo: Objetivo: Estimar a associação entre fatores socioeconômicos maternos e a ocorrência de desfechos nutricionais nas crianças menores de cinco anos em uma amostra representativa da população brasileira. Métodos: Trata-se de um estudo transversal que avaliou dados da última Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher, realizada no Brasil em 2006-2007. Trabalho materno e escolaridade materna foram as exposições principais. Considerou os seguintes desfechos nutricionais nas crianças: estatura/idade 2DP para excesso de peso. Utilizou-se o método regressão de equações de estimação generalizadas (GEE). Resultados: Após ajustes, observou-se que crianças cujas mães possuíam baixa escolaridade tiveram maiores chances de baixa estatura (OR = 3,97; IC 95% 1,23-12,80) e crianças cujas mães trabalhavam fora de casa apresentaram maior chance de excesso de peso (OR = 1,57; IC 95% 1,02-2,42). O trabalho materno não se associou a baixa estatura em crianças (OR = 1,09; IC 95% 0,67-1,77). Conclusão: Escolaridade materna associou-se à baixa estatura nas crianças e trabalho materno ao excesso de peso, indicando a necessidade de se levar em conta os fatores socioeconômicos na proposta de programas e estratégias de melhorias da saúde e nutrição das crianças, tendo em vista intervenções intersetoriais. Keywords: Stature, Overweight, Socioeconomic factors, Child, Epidemiological surveys, Brazil, Palavras-chave: Estatura, Sobrepeso, Fatores socioeconômicos, Criança, Inquéritos epidemiológicos, Brasil

RESUMO: Objetivo: Analisar as prevalências dos níveis de colesterol total e frações alterados na população brasileira, segundo dados bioquímicos da Pesquisa Nacional de Saúde. Métodos: Estudo descritivo, utilizando dados laboratoriais da Pesquisa Nacional de Saúde coletados entre os anos de 2014 e 2015. Foram analisados exames de colesterol total e frações e calculadas prevalências populacionais de valores alterados segundo variáveis sociodemográficas. Consideraram-se os seguintes pontos de corte: colesterol total ≥ 200mg/dL; lipoproteínas de baixa densidade (LDL) ≥ 130mg/dL e lipoproteínas de alta densidade (HDL) < 40mg/dL. Resultados: Aprevalência de colesterol total ≥ 200mg/dL na população foi de 32,7%, mais elevada em mulheres (35,1%). A prevalência de HDL alterado foi de 31,8%, sendo de 42,8% no sexo masculino e 22,0% no feminino. LDL≥ 130mg/dL foi observado em 18,6%, com prevalência mais elevada em mulheres (19,9%). População com idade de 45 anos ou mais e com baixa escolaridade apresentou maiores prevalências de colesterol com alterações. Conclusão: Valores de colesterol total e frações alterados foram frequentes na população brasileira, especialmente entre mulheres, idosos e pessoas de baixa escolaridade. Esses resultados poderão orientar as ações de controle e prevenção, como alimentação saudável, atividade física e tratamento, visando à prevenção de doenças coronarianas. ABSTRACT: Objective: To analyze the prevalence of altered total cholesterol and fractions levels in the Brazilian population, according to biochemical data from the National Health Survey. Methods: A descriptive study, using data from the National Health Survey, collected between 2014 and 2015. Total cholesterol and fractions were analyzed and population prevalences of altered values according to socio-demographic variables were calculated. The cutoff points considered were: total cholesterol ≥ 200mg/dl; low-density lipoprotein LDL ≥ 130mg/dL and high-density lipoprotein HDL < 40mg/dL. Results: The prevalence of total cholesterol ≥200mg/dL in the population was 32.7%, and higher in women (35.1%). The prevalence of altered HDL was 31.8%, 22.0% in females and 42.8% in males. LDL ≥ 130mg/dL was found in 18.6% and was higher in women (19.9%). The population aged 45 years old and older and those with low levels of education presented a higher prevalence of altered cholesterol. Conclusion: Altered values of total cholesterol and fractions were frequent in the Brazilian population, especially among women, the elderly and people with low levels of education. These results may guide control and preventative actions such as healthy eating, physical activity and treatment, all of which aim to prevent coronary diseases.

To investigate the association between the alcohol outlet density in residential areas and the current and lifetime alcohol consumption, adjusted for individual and family factors.Information from a three-stage household stratified probabilistic cluster sampling survey (census tract, household, adult and adolescent), conducted in Belo Horizonte, Brazil ("Health in BH", 2008-2009) and data of the establishments were obtained from official sources and subsequently georeferenced. The outcome was the adolescents' report of current and lifetime alcohol consumption. The exposure variable was the alcohol outlet density, defined as the number of establishments within a 200-meter range from the adolescents' residence. The association was estimated by Poisson regression adjusted by individual and family variables.In total, 601 adolescents aged 14 to 17 years were included in this study. Of these, 53.3% were males and 71.0% lived in a family with income up to five minimum wages. The prevalence of lifetime alcohol consumption was 57.0% (95%CI 51.5 - 62.6) and the current was 11.9% (95%CI 8.7 - 15.0). The multivariate analysis showed a significant association between current alcohol consumption and density of snack bars (PR = 1.13; 95%CI 1.03 - 1.24), bars (PR = 1.21; 95CI% 1.05 - 1.38), and restaurants (PR = 1.11; 95%CI 1.02 - 1.21). Significant interactions between density of establishments with sex and age were found.Current alcohol consumption may be enhanced by the availability of some types of establishments located within a range of 200 meters from the adolescents' residence.

The study aims to describe the consumption of alcoholic and non-alcoholic beverages according to sociodemographic, health and location variables. Cross-sectional study with ELSA-Brasil data (2008-2010). A questionnaire was used to collect sociodemographic, food, health data and anthropometry. Descriptive analysis and association with variables of interest were carried out. In the sample, 8% of the total caloric value comes from non-alcoholic beverages (5.6%: sugary drinks), and 4% from alcoholic beverages (2.7%: beer). Consumers of unsweetened and artificially sweetened beverages reported moderate/strong physical activity, former smokers and higher education. The opposite was true for sugary drinks. Eutrophic people reported higher consumption of sugary drinks and those obese, artificially sweetened and beer. Alcohol consumption varied with age (young: beer; elderly: wine/spirits) and education (low education: beer/spirits; higher education: wine). Coffee, natural juice and soda were the most consumed non-alcoholic beverages and beer was the most prevalent alcoholic beverage. Consumption variation was observed according to geographic location. The consumption of sugary and alcoholic beverages is high in Brazil and public health strategies are required.Objetiva-se descrever o consumo de bebidas alcoólicas e não alcoólicas segundo variáveis sociodemográficas, de saúde e localização. Estudo transversal com dados do ELSA-Brasil (2008-2010). Aplicou-se questionário para coleta de dados sociodemográficos, de alimentação, saúde, além de antropometria. Realizou-se análise descritiva e associação com variáveis de interesse. Na amostra, 8% do valor calórico total é proveniente de bebidas não alcoólicas (5,6%: bebidas açucaradas), e 4% de bebidas alcoólicas (2,7%: cerveja). Os consumidores de bebidas não adoçadas e adoçadas artificialmente realizam atividade física moderada/forte, são ex-fumantes e apresentam escolaridade alta. O oposto foi verificado para as bebidas açucaradas. Indivíduos eutróficos relataram maior consumo de bebidas açucaradas e os obesos, as adoçadas artificialmente e cerveja. O consumo de bebidas alcoólicas variou com a idade (jovens: cerveja; idosos: vinho/destiladas) e escolaridade (baixa: cerveja/destiladas; alta: vinho). Café, suco natural e refrigerante foram as bebidas não alcoólicas mais consumidas e a cerveja a alcoólica mais prevalente. Observou-se variação de consumo segundo a localização geográfica. O consumo de bebidas açucaradas e alcoólicas é alto no Brasil e estratégias de saúde pública são necessárias.

Objective We aimed to estimate trends in population-level adult body weight indicators in the 26 state capitals and the Federal District of Brazil. Methods Self-reported weight and height data of 572,437 adults were used to estimate the mean body mass index (BMI), and the prevalence of BMI categories ranging from underweight to morbid obesity, in Brazil’s state capitals and Federal District, from 2006 to 2016, by sex. All estimates were standardized by age. Results From 2006 to 2016, the main findings showed that: (i) the overall mean BMI increased from 25.4 kg/m2 to 26.3 kg/m2 in men, and from 24.5 kg/m2 to 25.8 kg/m2 in women; (ii) the overall prevalence of overweight increased from 48.1% to 57.5% in men, and from 37.8% to 48.2% in women; (iii) the overall prevalence of obesity increased from 11.7% to 18.1% in men, and from 12.1% to 18.8% in women; (iv) in general, the largest increases in overweight and obesity prevalence were found in state capitals located in the north, northeast, and central-west regions of Brazil; (v) the prevalence of severe obesity surpassed the prevalence of underweight in 22 and 9 state capitals among men and women, respectively; and (vi) the mean BMI trend was stable only in Vitoria state capital in men. Conclusions The policies for preventing and treating obesity in Brazil over the past years were not able to halt the increase in obesity prevalence either in the state capitals or the Federal District. Thus, a revision of policies is warranted. Furthermore, although policies are necessary in all state capitals, our results suggest that policies are especially necessary in the north, northeast, and central-west regions’ state capitals, where, in general, the largest increases in overweight and obesity prevalence were experienced.

Resumo OBJETIVO Avaliar a sobrevida de feridas em membros inferiores de pacientes diabéticos e não diabéticos. MÉTODO Estudo de coorte retrospectivo de pacientes com úlceras de membros inferiores tratados em centro especializado entre 2011 e 2013. Desfecho: cicatrização de lesões de membros inferiores em dias. Realizou-se análise da função de sobrevida das feridas de membros inferiores e das diferenças entre diabéticos e não diabéticos. Aplicou-se o teste Log-rank para comparação das curvas de sobrevida entre os grupos de estudo. RESULTADOS Em até 600 dias, 23% dos diabéticos apresentaram cicatrização das feridas, enquanto 63% dos não diabéticos tiveram suas feridas cicatrizadas, com diferença estatística das curvas de sobrevida na comparação entre os grupos. Os Hazard Ratios (HR) de cicatrização foram menores para pacientes diabéticos (HR = 0,13, IC95% = 0,02-0,97). CONCLUSÃO Os resultados mostram que há retardo na cicatrização de feridas em pacientes diabéticos. Resumen OBJETIVO Evaluar la supervivencia de las heridas en miembros inferiores de pacientes diabéticos y no diabéticos. MÉTODO Estudio de cohorte retrospectivo de pacientes con úlceras de miembros inferiores tratados en centro especializado entre 2011 y 2013. CONCLUSIÓN cicatrización de lesiones de miembros inferiores, en días. Se realizó un análisis de la función de supervivencia de las heridas de miembros inferiores y de las diferencias entre diabéticos y no diabéticos. Se aplicó el test Log-rank para la comparación de las curvas de supervivencia entre los grupos de estudio. RESULTADOS En un total de 600 días, el 23% de los diabéticos presentaron cicatrización de las heridas, mientras que el 63% de los no diabéticos tuvieron sus heridas cicatrizadas, con diferencia estadística de las curvas de sobrevida en la comparación entre los grupos. Los Hazard Ratios (HR) de cicatrización fueron menores para pacientes diabéticos (HR = 0,13, IC95% = 0,02-0,97). CONCLUSIÓN Los resultados muestran que hay retraso en la cicatrización de heridas en pacientes diabéticos. Abstract OBJECTIVE To evaluate the survival of wounds in lower limbs of diabetic and non-diabetic patients. METHOD Retrospective cohort study of patients with lower limb ulcers treated at a specialized center between 2011 and 2013. Outcome: healing of lower limb injuries in days. The survival function of lower limb wounds and the differences between diabetic and non-diabetic were analyzed. The Log-rank test was used to compare the survival curves between the study groups. RESULTS In up to 600 days, 23% of the diabetic patients presented wound healing, while 63% of the non-diabetic patients had their wounds healed, with a statistically significant difference in survival curves in comparison between the groups. The Hazard Ratios (RH) of healing were lower for diabetic patients (HR = 0.13, 95% CI = 0.02-0.97). CONCLUSION The results show that there is a delay in wound healing in diabetic patients.

Para a avaliação da tendência temporal da prevalência de obesidade mórbida na população adulta das capitais brasileiras entre os anos 2006 e 2017, foi realizado estudo transversal com dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel), analisados por regressão linear simples. Resultados evidenciaram tendência de aumento da prevalência de obesidade mórbida no Brasil. As mulheres apresentaram maiores prevalências (1,3%, em 2006, e 1,9%, em 2017) ao serem comparadas com os homens (0,9% e 1,4%). Na faixa etária entre 25 a 44 anos, a tendência foi de crescimento de 0,9% para 2,1% (p < 0,001). Em todos os níveis de escolaridade e regiões do Brasil, houve aumento da obesidade mórbida. As capitais que apresentaram tendência de aumento no sexo masculino foram: Campo Grande, Curitiba, Fortaleza, Macapá, Manaus, Palmas, Porto Velho, Rio Branco e Teresina. Em relação ao sexo feminino: Belo Horizonte, Campo Grande, Rio de Janeiro e Teresina. O crescimento da obesidade mórbida no país constitui um alerta para a urgente necessidade de adotar medidas para detê-la, como a regulação de alimentos ultraprocessados e ações de educação para a saúde para toda a população.

Objective: To estimate the prevalence of concurrency of risk factors for Noncommunicable Diseases and non-random aggregation of these in Brazilian school adolescents. Method: Descriptive study, with data from the National School Health Survey (Pesquisa Nacional de Saúde do Escolar), 2015. The prevalence of concurrent risk factors was estimated: smoking, alcohol use, physical inactivity and low consumption of fruits and vegetables. Aggregation was verified when the observed-expected prevalence ratio was greater than 1. The analyses were performed in Stata 15.0 software. Results: The proportion of concurrent risk factors was higher for those who had two risk factors (56.1%; 95%CI: 55.5-56.6). The most prevalent risk factors combination was “Low consumption of fruits and vegetables + Physical inactivity” (66%; 95% CI: 65.8-66.9). There was an aggregation of risk factors, and the highest ratio between observed and expected prevalence was: “Smoking + Alcohol” (79.0%; 95%CI: 73.8-84.2). Conclusion and implications for practice: The findings show a high prevalence of concurrent risk factors, with aggregation of these in adolescents. Identifying these risk groups may favor early interventions by minimizing exposure and targeting primary prevention strategies in early exposure to risk factors.

To analyze the prevalence of altered total cholesterol and fractions levels in the Brazilian population, according to biochemical data from the National Health Survey.A descriptive study, using data from the National Health Survey, collected between 2014 and 2015. Total cholesterol and fractions were analyzed and population prevalences of altered values according to socio-demographic variables were calculated. The cutoff points considered were: total cholesterol ≥ 200mg/dl; low-density lipoprotein LDL ≥ 130mg/dL and high-density lipoprotein HDL40mg/dL.The prevalence of total cholesterol ≥200mg/dL in the population was 32.7%, and higher in women (35.1%). The prevalence of altered HDL was 31.8%, 22.0% in females and 42.8% in males. LDL ≥ 130mg/dL was found in 18.6% and was higher in women (19.9%). The population aged 45 years old and older and those with low levels of education presented a higher prevalence of altered cholesterol.Altered values of total cholesterol and fractions were frequent in the Brazilian population, especially among women, the elderly and people with low levels of education. These results may guide control and preventative actions such as healthy eating, physical activity and treatment, all of which aim to prevent coronary diseases.Analisar as prevalências dos níveis de colesterol total e frações alterados na população brasileira, segundo dados bioquímicos da Pesquisa Nacional de Saúde.Estudo descritivo, utilizando dados laboratoriais da Pesquisa Nacional de Saúde coletados entre os anos de 2014 e 2015. Foram analisados exames de colesterol total e frações e calculadas prevalências populacionais de valores alterados segundo variáveis sociodemográficas. Consideraram-se os seguintes pontos de corte: colesterol total ≥ 200mg/dL; lipoproteínas de baixa densidade (LDL) ≥ 130mg/dL e lipoproteínas de alta densidade (HDL)40mg/dL.Aprevalência de colesterol total ≥ 200mg/dL na população foi de 32,7%, mais elevada em mulheres (35,1%). A prevalência de HDL alterado foi de 31,8%, sendo de 42,8% no sexo masculino e 22,0% no feminino. LDL≥ 130mg/dL foi observado em 18,6%, com prevalência mais elevada em mulheres (19,9%). População com idade de 45 anos ou mais e com baixa escolaridade apresentou maiores prevalências de colesterol com alterações.Valores de colesterol total e frações alterados foram frequentes na população brasileira, especialmente entre mulheres, idosos e pessoas de baixa escolaridade. Esses resultados poderão orientar as ações de controle e prevenção, como alimentação saudável, atividade física e tratamento, visando à prevenção de doenças coronarianas.

RESUMO: Objetivo: Estimar a associação entre consumo de refrigerantes e o índice de massa corporal (IMC) em adolescentes eutróficos e com excesso de peso. Métodos: Foram utilizados dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2009. Considerou-se como variável de desfecho os tercis do escore de IMC (zIMC) e como variável de exposição principal, o consumo de refrigerantes adoçados com açúcar. Idade, tipo de escola, escore de bens e serviços do domicílio e escolaridade materna foram incluídos nos modelos como variáveis de ajuste. Modelos de regressão multinomial, estratificados por sexo e pelos subgrupos de eutrofia e de excesso de peso foram utilizados para estimar a associação entre exposição e desfecho. Resultados: Dos adolescentes avaliados, 23,8% apresentaram excesso de peso e 21,7% relataram o consumo de refrigerantes diariamente. Nos meninos eutróficos, o consumo de refrigerantes esteve associado à maior chance de estar nos tercis mais altos de zIMC comparados aos não consumidores. Já nos adolescentes com excesso de peso, tanto do sexo masculino quanto feminino, o consumo de refrigerantes esteve associado à menor chance de estar no tercil mais alto de escore zIMC. Conclusão: Os resultados evidenciam a possibilidade de causalidade reversa entre o consumo de refrigerantes adoçados e zIMC no grupo de adolescentes com excesso de peso. Nos adolescentes eutróficos do sexo masculino, o consumo de refrigerantes pode, potencialmente, aumentar as chances de ter zIMC mais alto, o que reforça a necessidade de medidas visando à ampla redução do consumo dessa bebida. ABSTRACT: Objective: To estimate the association between soft drink consumption and body mass index (BMI) in eutrophic and overweight adolescents. Methods: We used data from the National Adolescent Student Health Survey (Pesquisa Nacional de Saúde do Escolar - PeNSE) of 2009. The dependent variable (outcome) was the tertiles of BMI score (zBMI), and the main independent variable (exposure) was the consumption of sugar-sweetened soft drinks. The models included age, school type, home goods and services score, and maternal schooling as adjustment variables. We estimated the association between exposure and outcome by using multinomial regression models, stratified by gender, and eutrophic and overweight subgroups. Results: 23.8% of the adolescents evaluated were overweight, and 21.7% reported consuming soft drinks daily. For eutrophic boys, those who consumed soft drinks had a greater chance of being in higher zBMI tertiles than non-consumers. For overweight adolescents, both male and female, soft drink consumption was associated with a lower chance of being in the highest tertile of zBMI score. Conclusion: The results show the possibility of reverse causality between consumption of sweetened soft drinks and zBMI in the overweight adolescents group. For eutrophic male adolescents, soft drink consumption can potentially increase the chances of having higher zBMI, which reinforces the need for measures to significantly reduce the consumption of this beverage.

This study was an assessment of time trends in morbid obesity prevalence in the adult population in Brazil's state capitals from 2006 to 2017. A cross-sectional study was performed with data from the Risk and Protective Factors Surveillance System for Chronic Noncommunicable Diseases Through Telephone Interview (Vigitel), analyzed by simple linear regression. The results showed an upward trend in morbid obesity prevalence in Brazil. Women showed higher prevalence rates (1.3% in 2006 and 1.9% in 2017) when compared to men (0.9% and 1.4%). The 25-44-year age bracket showed an upward trend from 0.9% to 2.1% (p0.001). There was an increase in morbid obesity in all levels of schooling and all regions of Brazil. The state capitals with upward trends in males were Campo Grande, Curitiba, Fortaleza, Macapá, Manaus, Palmas, Porto Velho, Rio Branco, and Teresina. In females, they were Belo Horizonte, Campo Grande, Rio de Janeiro, and Teresina. The growth in morbid obesity in Brazil sounds a warning on the urgent need to adopt measures to detain it, such as regulation of ultra-processed foods and health education measures for the entire population.Para a avaliação da tendência temporal da prevalência de obesidade mórbida na população adulta das capitais brasileiras entre os anos 2006 e 2017, foi realizado estudo transversal com dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel), analisados por regressão linear simples. Resultados evidenciaram tendência de aumento da prevalência de obesidade mórbida no Brasil. As mulheres apresentaram maiores prevalências (1,3%, em 2006, e 1,9%, em 2017) ao serem comparadas com os homens (0,9% e 1,4%). Na faixa etária entre 25 a 44 anos, a tendência foi de crescimento de 0,9% para 2,1% (p0,001). Em todos os níveis de escolaridade e regiões do Brasil, houve aumento da obesidade mórbida. As capitais que apresentaram tendência de aumento no sexo masculino foram: Campo Grande, Curitiba, Fortaleza, Macapá, Manaus, Palmas, Porto Velho, Rio Branco e Teresina. Em relação ao sexo feminino: Belo Horizonte, Campo Grande, Rio de Janeiro e Teresina. O crescimento da obesidade mórbida no país constitui um alerta para a urgente necessidade de adotar medidas para detê-la, como a regulação de alimentos ultraprocessados e ações de educação para a saúde para toda a população.Evaluación de la tendencia temporal de la prevalencia de obesidad mórbida en la población adulta de capitales brasileñas entre los años 2006 y 2017. Se realizó un estudio transversal con datos procedentes de la Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas No Transmisibles por Entrevista Telefónica (Vigitel), analizados por regresión lineal simple. Los resultados evidenciaron una tendencia de aumento de la obesidad mórbida en Brasil. Las mujeres presentaron mayores prevalencias (1,3% en 2006 y 1,9% en 2017) al compararlas con los hombres (0,9% y 1,4%). En la franja de edad entre 25 a 44 años la tendencia fue de crecimiento de 0,9% a 2,1% (p0,001). En todos los niveles de escolaridad y regiones de Brasil hubo un aumento de obesidad mórbida. Las capitales que presentaron una tendencia de aumento en el sexo masculino fueron: Campo Grande, Curitiba, Fortaleza, Macapá, Manaus, Palmas, Porto Velho, Río Branco y Teresina. En relación con el sexo femenino: Belo Horizonte, Campo Grande, Río de Janeiro y Teresina. El crecimiento de la obesidad mórbida en el país constituye una alerta para la necesidad urgente de adoptar medidas con el fin de detenerla como pueden ser la regulación de alimentos ultraprocesados, así como acciones educativas para la salud de toda la población.

Objective: To estimate the association between regular consumption of sweetened soft drinks, natural fruit juice, and coconut water with metabolic syndrome (MetS).Methods: This was a cross-sectional study including men and women aged 35–74 years from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Study, excluding patients with type 2 diabetes. The main explanatory variables were beverage consumption and the outcome variable was metabolic syndrome (Adult Treatment Panel III).Results: After adjustments, a daily intake of 250 ml of soft drink increased the chance of metabolic syndrome (odds ratio [OR] = 1.95; 95% confidence interval [CI], 1.60–2.38). There was no association between coconut water and MetS. Moderate consumption of fruit juices has low odds of MetS compared to no consumption.Conclusion: Our results add evidence to potential negative effects of sweetened soft drinks on cluster metabolic abnormalities in middle-income countries.

ObjectiveTo estimate factors associated with double burden of nutritional outcomes in the mother–child dyad at the household level (child stunting and/or maternal overweight).DesignCross-sectional study using the Brazilian Demographic and Health Survey. Nutritional outcomes were: mother with normal weight and child with normal height; overweight mother and child with normal height; mother with normal weight and short-stature child; and overweight mother and child with short stature (double burden). The child was classified as short when height-for-ageZ-score was 2. Socio-economic status, environment, social vulnerability, maternal characteristics and the child’s food intake were the exposure factors. The hierarchical approach for multinomial logistic regression modelling was used to assess the associations.SettingNational Demographic and Health Survey of Children and Women conducted in Brazil, 2006–2007.SubjectsMother–child dyads (n3676).ResultsAfter adjustments, lower maternal educational level (OR=3·53; 95 % CI 1·33, 9·33) and inadequate household (non-masonry house; OR=2·54; 95 % CI 1·39, 4·66) were associated with the double burden of malnutrition. Mother’s short stature (OR=3·41; 95 % CI 1·76, 6·61), child’s vegetable intake on less than or equal to 4 d/week (OR=2·21; 95 % CI 1·03, 4·75) and inadequate household (non-masonry house; OR=2·29; 95 % CI 1·36, 3·87) were associated with child’s short stature. The lack of breast-feeding (OR=2·00; 95 % CI 1·07, 3·72) was associated with maternal overweight.ConclusionsThe present findings contribute to establishing strategies promoting health and healthy diets, by considering the growth deficit and overweight/obesity concomitantly.

Objectives: The purpose of this study was to estimate the heritability of genetic and environmental correlations between cardiometabolic risk factors in extended pedigrees. Methods: The Jequitinhonha Community Family Study Cohort (JCFSC) consists of individuals aged ≥18 years living in rural villages. Family pedigrees were constructed of the cohort. The following data were collected: demographic and socioeconomic status, lifestyle variables, anthropometrics, and lipid traits. Results: The JCFSC consists of 931 individuals distributed into 69 pedigrees with 4,907 members in total. The heritabilities were 0.47 for total cholesterol (TC), 0.44 for triglycerides (TG) and 0.42 for high-density lipoprotein cholesterol (HDLc), 0.49 for metabolic syndrome, approximately 0.60 for anthropometric traits and 0.30 for blood pressure/hypertension. Significant genetic correlations (ρg) were found mainly between TG and TC (ρg = 0.58) and hypertension and TG (ρg = 0.52). Systolic blood pressure (SBP) was correlated with TG (ρg = 0.39) and HDLc (ρg = −0.30). Diastolic blood pressures correlated with TG (ρg=0.56) and TC (ρg=0.30). Genetic correlations were also found between anthropometric traits, including: body mass index (BMI) and TG (ρg=0.34), waist circumference (WC) and TG (ρg=0.42), and WC and HDLc (ρg=-0.33). Household effects were found for HDLc (c2= 0.19), SBP (c2 = 0.14) and Hypertension (c2= 0.14). Conclusions: To some phenotypes, including lipids, hypertension, blood pressure, and anthropometric traits, genetic contribution is important in the determination of cardiometabolic risk factors. This study provides a foundation for future studies. These will mainly focus on rare variants that could describe the genetic mechanisms influencing cardiometabolic risk

Summary Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian metaregression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5−89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks. Funding Bill & Melinda Gates Foundation. Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the fi rst of a series of annual updates of the GBD. Risk factor quantifi cation, particularly of modifi able risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the fi rst level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular fi ltration rate. For most risks, data for exposure were synthesised with a Bayesian metaregression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5−89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks. Funding Bill & Melinda Gates Foundation.

RESUMO: A prevenção primordial é definida como a prevenção inicial de fatores de risco, por meio da adoção de comportamentos mais saudáveis. Dentro desse conceito, a American Heart Association (AHA) definiu sete métricas, baseadas em evidências, para se alcançar uma saúde cardiovascular (SCV) ideal. O objetivo deste trabalho foi avaliar a prevalência de SCV na população brasileira, segundo sexo, faixa etária e região de moradia, utilizando os dados da última Pesquisa Nacional de Saúde (PNS), de 2013. Foram avaliados, como preconizado pela AHA, de forma conjunta (número de fatores) e isolada, quatro fatores comportamentais (tabagismo, atividade física, índice de massa corporal e dieta) e três biológicos (pressão arterial, glicemia e níveis de colesterol). A população brasileira atingiu prevalências menores de 1%, de sete fatores em nível ideal. Isoladamente, 3,2% da população apresentaram a dieta em nível ideal, seguido da atividade física (23,6%) e índice de massa corporal (43,7%). A população entre 18 e 35 anos apresentou a maior prevalência de número de métricas conjuntas em nível ideal (0,5%), valor também atingido pela população geral da Região Norte. Os resultados indicam que devem ser realizados ainda maiores esforços por meio de políticas públicas de prevenção primordial para atingir metas adequadas de SCV na população brasileira. ABSTRACT: Primordial prevention is defined as the initial prevention of risk factors, through the adoption of healthier behaviors. Within this concept, the American Heart Association (AHA) has defined seven metrics, based on evidence, to achieve ideal cardiovascular health. The aim of this study was to evaluate the prevalence of cardiovascular health in the Brazilian population, according to sex, age, and region of residence, using data from the latest National Health Survey (2013). We assessed the risk factors, as recommended by the AHA, combined (number of factors) and individually: four behavioral (smoking, physical activity, body mass index and diet) and three biological factors (blood pressure, blood glucose and cholesterol levels). The Brazilian population has reached very low prevalence (1%), for the sum of 7 factors in ideal level. Individually, 3.2% of the population consumed ideal diet, followed by physical activity (23.6%) and body mass index (43.7%). The subjects aged between 18 and 35 years showed higher prevalence of metrics combined at the optimal levels (0.5%), which was also reached by the population of the Northern region. These results indicate that greater efforts are urgent by public policies at the level of primordial prevention in order to achieve appropriate targets of cardiovascular health in the Brazilian population.

The objective of this article is to analyze the spatial distribution of Hepatitis B vaccine (HBVAC) of pregnant women. This is a cross-sectional study carried with 266 puerperae. The HBVAC record was obtained through the prenatal care booklet. The spatial scanning technique was used to detect a cluster of risk for the presence or absence of an HBVAC record. After this cluster identification, the individual and environmental variables were compared between the Coverage Areas of Basic Health Units (CAs-BHUs). The mean prevalence of non-HBVAC was 88.34%. Scan spatial scan analysis observed a cluster of a high prevalence of puerperae with a HBVAC record. Comparative analyses have shown that paid work and the number of prenatal visits are positively associated with an HBVAC record. Given the above, this work brings a reflection on possible disparities with other CAs-BHUs, besides the influence of the environmental perspective. It should be emphasized that the vaccination situation is influenced not only by factors intrinsic to the individuals. However, in this study, the results indicate that individual variables are predominantly mandatory in the decision of HBVAC uptake among pregnant women.O objetivo deste artigo é analisar a distribuição espacial da vacina contra Hepatite B (VCHB) de gestantes. Estudo transversal, realizado com 266 puérperas. O registro da VCHB foi obtido por meio da caderneta de pré-natal. Para a detecção do cluster de risco para presença de registro ou ausência de VCHB foi utilizada a técnica de varredura espacial. Posteriormente a esta identificação do cluster, procedeu-se à comparação das variáveis individuais e ambientais entre as Áreas de Abrangência da Unidade Básica de Saúde (AA-UBS). A prevalência média de não VCHB foi de 88,34%. A análise de varredura espacial Scan observou-se um cluster de alta prevalência de puérperas que apresentava o registro da VCHB em suas cadernetas. Análises comparativas demonstraram que trabalho remunerado e o número de consultas realizadas no pré-natal estão associados positivamente a VCHB. Este trabalho suscita uma reflexão de possíveis disparidades com as demais AA-UBS, além da perspectiva a nível ambiental. Ressalta-se que a situação vacinal sofre influência não somente de fatores intrínsecos aos indivíduos, entretanto, nesse estudo, os resultados apontam que as variáveis individuais são majoritariamente mandatórias na decisão das gestantes em vacinarem.

Resumo A prática regular da caminhada contribui para melhor qualidade de vida, reduzindo riscos para doenças cardiovasculares. O objetivo deste artigo é verificar a associação entre fatores sociodemográficos e de saúde relacionados à prática de caminhada de adultos no contexto rural brasileiro. Estudo transversal com 567 adultos. A variável desfecho foi a prática regular de caminhada (≥ 150 minutos/semana) e as de exposição foram as sociodemográficas, antropométricas, clinico laboratoriais e autopercepção de saúde. As análises foram realizadas pelo teste do qui-quadrado e regressão de Poisson, considerando p ≤ 0,05. Apenas 34,7% da população pratica a caminhada de forma regular. O sexo feminino (RP 0,84; IC95% 0,78–0,89), a idade entre 31-45 anos (RP 1,11; IC95% 1,02–1,22 para comparação entre pessoas de 18-30 anos) e a autopercepção de saúde ruim/regular (RP 0,90; IC95% 0,84–0,97 para a comparação entre pessoas com autopercepção excelente/boa) permaneceram independentemente associadas à prática regular de caminhada. A idade entre 31-45 anos e o sexo masculino foram positivamente associados à caminhada e a percepção de saúde regular/ruim apresentou associação negativa. Esses achados podem sugerir que as políticas públicas de incentivo a atividade física nas áreas urbanas podem ser aplicadas também nas rurais. Abstract The regular practice of walking can contribute to a better quality of life, reducing the risk of cardiovascular disease. Objective: To assess the association between sociodemographic and health factors related to adult practice of walking in the Brazilian rural context. Methods: Cross-sectional study of 567 adults. The outcome variable was the regular practice of walking (≥150 minutes per week) and the explanatory variables were sociodemographic factors, anthropometric measures, laboratory tests and self-perceived health. The chi-square test and Poisson regression were used in analysis, considering p ≤ 0.05. Results: Only 34.7% of the population practices walking regularly. Women (PR 0.84, 95% CI 0.78-0.89), age of 31-45 years (OR 1.11, 95% CI 1.02-1.22, comparing to 18-30 years), and self-perception of poor/fair health (OR 0.90, 95% CI 0.84-0.97 comparing to people with great/good health) remained independently associated with regular practice of walking. Conclusion Age between 31 and 45 years and males were positively associated with walking and the perception of poor/fair health had negative association. These findings may suggest that public policies to encourage physical activity in urban areas should also be applied to rural areas.

ObjectiveIn the present study we investigated gender-specific associations of low birth weight (LBW) and shorter relative leg length with metabolic syndrome (MetS) after adjusting for sociodemographic characteristics and health-related behaviours. We also investigated whether these associations are independent of age at menarche and BMI at 20 years old.DesignCross-sectional analysis.SubjectsBaseline data from 12 602 participants (35–74 years) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), 2008–2010.SettingMetS was defined according to the revised National Cholesterol Education Program Adult Treatment Panel III guidelines. LBW (ResultsMetS prevalence was 34·2 %; it was more prevalent in men (36·8 %) than in women (32·2 %). In multivariate analysis, LBW was associated (prevalence ratio; 95 % CI) with MetS only in women (1·28; 1·24, 1·45). Shorter leg length was associated with MetS in both men (1·21; 1·09, 1·35 and 1·46; 1·29, 1·65 for low and medium lengths, respectively) and women (1·12; 1·00, 1·25 and 1·40; 1·22, 1·59 for low and medium lengths, respectively). Additional adjustments for age at menarche and BMI at 20 years old did not change the associations.ConclusionsPoor nutritional status as estimated by LBW and lower leg length in childhood was associated with a higher prevalence of MetS, although LBW was a significant factor only among women.

To determine if breastfeeding for at least the first six months of life is associated with overweight and obesity in children 2 to 5 years old.Cross sectional analysis of data from national demographic and health surveys conducted in Bolivia, Colombia and Peru. Overweight and obesity were defined using World Health Organization standard definitions. Odds ratios (OR) were calculated using multinomial logistic regression.The prevalence of obesity in children 2 to 5 years old was 10.4% (95% confidence interval [95%CI]: 8.2-12.6) in Bolivia, 4.9% in Colombia (95%CI: 4.0-5.8), and 6.4% (95%CI: 5.2-8.0) in Peru. Prevalence of exclusive breastfeeding for at least the first 6 months in the study population was 89.9% (95%CI: 87.8-91.9) in Bolivia, 73.9% (95%CI: 72.2-75.6) in Colombia, and 92.8% (95%CI: 91.2-92.4) in Peru. Exclusive breastfeeding was associated with a decreased risk of obesity in children as compared to no breastfeeding or breastfeeding for less than 6 months in Bolivia (OR = .30; 95%CI: .16-.57) and a marginal association in Colombia (OR = .71; 95%CI: .47-1.06) and Peru (OR = .49; 95%CI: 0.23-1.04). No association between breastfeeding and overweight was found.Exclusive breastfeeding for at least the first six months of life decreases the risk of obesity in children 2 to 5 years old in Bolivia. A similar but weaker pattern was observed for children in Colombia and Peru.

RESUMO: Objetivo: Avaliar a relação de indicadores de supervisão dos pais e fatores sociodemográficos com o uso de álcool pelos adolescentes brasileiros. Métodos: Trata-se de estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2015. A amostra foi composta de 16.608 adolescentes de 13 a 17 anos estudantes de escolas públicas e privadas brasileiras. Foram analisadas variáveis relacionadas ao uso de álcool, aos fatores sociodemográficos e aos indicadores de supervisão dos estudantes pelos pais. Foram calculadas razões de prevalência (RPs) para análise das relações existentes entre as variáveis sociodemográficas, de supervisão dos pais e o uso de álcool por adolescentes. As análises foram estratificadas por sexo. Resultados: Encontrou-se que 61,4% dos adolescentes já haviam experimentado bebida alcoólica, 27,2% já tiveram episódio de embriaguez alguma vez na vida, 9,3% já tiveram problemas devido ao uso de álcool e 29,3% relataram uso nos últimos 30 dias. Menores escores de supervisão dos pais se associaram à maior prevalência de uso de álcool, que também foi elevada entre as meninas, os que tinham idade superior a 16 anos, moravam na Região Sul, trabalhavam e não moravam com os pais. Conclusão: Os resultados obtidos evidenciaram, em adolescentes, a experimentação precoce de bebidas alcoólicas e a ocorrência de problemas devido ao uso da substância. Além disso, a falta de supervisão e acompanhamento mais próximo dos filhos pelos pais e responsáveis aumentou o uso de álcool nessa idade. ABSTRACT: Objective: To evaluate the relation between parental supervision and sociodemographic factors and alcohol use by Brazilian adolescents. Methods: This is a cross-sectional study with data from National School-based Health Survey (PeNSE) 2015, which included 16,608 adolescents aged 13 to 17 years, students from Brazilian public and private schools. Variables related to alcohol use, sociodemographic factors and parental supervision were evaluated. In order to analyze the relation between sociodemographic variables, parental supervision and use of alcohol among adolescents, prevalence ratios stratified by sex were used. Results: It was observed that 61.4% of the adolescents had tried alcohol, 27.2% had a drunken episode in their lifetime, 9.3% have had problems with alcohol and 29.3% reported alcohol use in last 30 days. The lack of parental supervision was associated with increased use of alcohol. The proportion of alcohol use was higher for girls, and also among those who were older than 16 years, worked, did not live with one or both parents, and lived in the South, regardless of sex. Conclusion: The results showed early alcohol experimentation and occurrence of problems due to its use among Brazilian adolescents. In addition, the lack of monitoring by parents and guardians shows a risk of alcohol use in this age.

Background Political, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses. Methods We analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries. Findings Nationally, LE increased from 68·4 years (95% uncertainty interval [UI] 68·0–68·9) in 1990 to 75·2 years (74·7–75·7) in 2016, and HALE increased from 59·8 years (57·1–62·1) to 65·5 years (62·5–68·0). All-cause age standardised mortality rates decreased by 34·0% (33·4–34·5), while all-cause age-standardised DALY rates decreased by 30·2% (27·7–32·8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index. Interpretation Health improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities Antecedentes As mudanças políticas, econômicas e epidemiológicas no Brasil têm afetado a saúde e o sistema de saúde. Nós usou os resultados do Global Burden of Disease Study 2016 (GBD 2016) para entender a mudança nos padrões de saúde e informar respostas políticas. Métodos Analisamos as estimativas do GBD 2016 para expectativa de vida ao nascer (LE), expectativa de vida saudável (HALE), todas as causas e mortalidade por causa específica, anos de vida perdidos (YLLs), anos vividos com incapacidade (YLDs), anos de vida ajustados por incapacidade (DALYs) e fatores de risco para o Brasil, seus 26 estados e o Distrito Federal de 1990 a 2016, e comparou-os com estimativas nacionais para dez países comparadores. Achados Nacionalmente, LE aumentou de 68,4 anos (intervalo de incerteza de 95% [UI] 68,0–68,9) em 1990 para 75,2 anos (74·7–75·7) em 2016, e a HALE aumentou de 59·8 anos (57·1–62·1) para 65·5 anos (62·5–68·0). As taxas de mortalidade padronizadas por idade por todas as causas diminuíram em 34,0% (33,4–34,5), enquanto as taxas de DALY padronizadas por idade por todas as causas diminuíram em 30,2% (27,7–32,8); a magnitude dos declínios variou entre os estados. Em 2016, a cardiopatia isquêmica foi o principal causa de YLLs padronizados por idade, seguido por violência interpessoal. Lombalgia e dor no pescoço, órgão dos sentidos doenças e doenças de pele foram as principais causas de YLDs em 1990 e 2016. Principais fatores de risco que contribuem para Os DALYs em 2016 foram uso de álcool e drogas, pressão alta e alto índice de massa corporal. Interpretação A saúde melhorou de 1990 a 2016, mas as melhorias e a carga de doenças variaram entre os estados. A transição epidemiológica para doenças não transmissíveis e riscos relacionados ocorreu nacionalmente, mas mais tarde em alguns estados, enquanto a violência interpessoal cresceu como um problema de saúde. Os formuladores de políticas podem usar esses resultados para abordar disparidades de saúde

The main objectives were to analyse the validity and accuracy of Body Mass Index (BMI) and Waist Circumference (WC) to evaluate obesity by excess of body fat in older adults and to identify more adequate cut-off points for this age group. The recommended cut-off points for BMI (25, 27 or 30 kg/m2) and WC (≥ 102 cm for men and ≥ 88 cm for women or ≥ 90cm for men and ≥ 80 cm for women) were compared to the total body densitometry. BF was defined by a value higher than the 90th percentile. Out of the 132 participants, 61% were women and aged between 60 and 91 years. The recommended cut-off points of BMI ≥ 25kg/m2 and BMI ≥ 27 kg/m2 showed similar performances. BMI ≥ 30 kg/m2 showed high specificity but low sensitivity to identify BF in men and better performance in women. Conventional WC cut-off points showed low sensitivity and specificity. Based on our analyses, new cut-off points for BMI (25 kg/m2 for men and 26.6 kg/m2 for women) and WC (98.8 cm for men and 77.8cm for women) were proposed. The new cut-off points showed sensitivity and specificity values74% and accuracy76%. The areas under the curve (ROC) were0.86. The new BMI and WC cut-off points proposed in the present study for the diagnosis of obesity in older adults showed the best levels of sensitivity and specificity for this age group.O objetivo deste estudo foi analisar a validade e a acurácia do Índice de Massa Corporal (IMC) e da Circunferência da Cintura (CC) na avaliação de obesidade avaliada pelo excesso de gordura corporal (GC) e propor pontos de corte mais adequados para idosos. Os pontos propostos da literatura IMC (25,27 ou 30 kg/m2) e CC (≥ 102 cm-homens e ≥ 88 cm-mulheres ou ≥ 90 cm-homens e ≥ 80 cm-mulheres) foram avaliados conforme densitometria corporal total. A elevada GC foi definida por percentil90. Dos 132 idosos, 60,6% eram mulheres de 60-91 anos. Os pontos de corte recomendados de IMC ≥ 25 e ≥ 27kg/m2 apresentaram desempenhos similares, sendo que o IMC ≥ 30kg/m2 apresentou alta especificidade e baixa sensibilidade no sexo masculino e melhor desempenho para GC nas mulheres. Os pontos de corte convencionais de CC não apresentaram boa sensibilidade/especificidade. Foram propostos novos pontos de corte para IMC (masculino-25 kg/m2; feminino-26,6 kg/m2) e CC (masculino-98,8 cm; feminino-77,8 cm). Estes valores demonstraram sensibilidade e especificidade74% e acurácia76%. As áreas sob a curva foram0,86. O presente estudo propõe a utilização de pontos de corte mais acurados para diagnóstico de obesidade/GC em idosos, sendo para homens IMC 25kg/m2 e CC de 98,8cm e para mulheres IMC de 26,6kg/m2 e CC de 77,8cm, com melhores níveis de sensibilidade e especificidade.

Objective. This study identified environmental variables associated with obesity in the adult population of a city in Brazil. Methods. It was conducted using the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey from 2008 to 2010. The body mass index (BMI) was calculated from the participants' self-reported weight and height. Obesity was defined as a BMI ≥ 30 kg/m2. The food establishments, georeferenced areas conducive to physical activity, total income of the neighbourhood, homicide rate and population density were used to characterise the environment. In addition, individual variables were considered. A multilevel logistic regression was performed. Results. A total of 5273 individuals were evaluated. The odds of obesity was found to be significantly decreased with increases in the number of establishments that sell healthy food, number of restaurants, number of places for physical activity and total income — in different models. In addition, these associations remained significant after adjustment for age, gender, education and consumption of meat with visible fat. Conclusions. This study contributes to a better understanding of the complex interaction between environmental and individual determinants of obesity and may aid in the development of effective interventions, such as the expansion of obesity control programmes., Highlights • We estimated the association of environmental and individual factors with obesity. • The likelihood of obesity decreased with increases of environmental factors. • There is a complex interaction between environmental determinants of obesity. • Our findings provide justification for the development of effective strategies.

To evaluate the relation between parental supervision and sociodemographic factors and alcohol use by Brazilian adolescents.This is a cross-sectional study with data from National School-based Health Survey (PeNSE) 2015, which included 16,608 adolescents aged 13 to 17 years, students from Brazilian public and private schools. Variables related to alcohol use, sociodemographic factors and parental supervision were evaluated. In order to analyze the relation between sociodemographic variables, parental supervision and use of alcohol among adolescents, prevalence ratios stratified by sex were used.It was observed that 61.4% of the adolescents had tried alcohol, 27.2% had a drunken episode in their lifetime, 9.3% have had problems with alcohol and 29.3% reported alcohol use in last 30 days. The lack of parental supervision was associated with increased use of alcohol. The proportion of alcohol use was higher for girls, and also among those who were older than 16 years, worked, did not live with one or both parents, and lived in the South, regardless of sex.The results showed early alcohol experimentation and occurrence of problems due to its use among Brazilian adolescents. In addition, the lack of monitoring by parents and guardians shows a risk of alcohol use in this age.Avaliar a relação de indicadores de supervisão dos pais e fatores sociodemográficos com o uso de álcool pelos adolescentes brasileiros.Trata-se de estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2015. A amostra foi composta de 16.608 adolescentes de 13 a 17 anos estudantes de escolas públicas e privadas brasileiras. Foram analisadas variáveis relacionadas ao uso de álcool, aos fatores sociodemográficos e aos indicadores de supervisão dos estudantes pelos pais. Foram calculadas razões de prevalência (RPs) para análise das relações existentes entre as variáveis sociodemográficas, de supervisão dos pais e o uso de álcool por adolescentes. As análises foram estratificadas por sexo.Encontrou-se que 61,4% dos adolescentes já haviam experimentado bebida alcoólica, 27,2% já tiveram episódio de embriaguez alguma vez na vida, 9,3% já tiveram problemas devido ao uso de álcool e 29,3% relataram uso nos últimos 30 dias. Menores escores de supervisão dos pais se associaram à maior prevalência de uso de álcool, que também foi elevada entre as meninas, os que tinham idade superior a 16 anos, moravam na Região Sul, trabalhavam e não moravam com os pais.Os resultados obtidos evidenciaram, em adolescentes, a experimentação precoce de bebidas alcoólicas e a ocorrência de problemas devido ao uso da substância. Além disso, a falta de supervisão e acompanhamento mais próximo dos filhos pelos pais e responsáveis aumentou o uso de álcool nessa idade.