Paulo A Lotufo

Verified

Paulo verified their affiliation via an institutional email.

Learn more

Verified

Paulo verified their affiliation via an institutional email.

Learn more

• MD, DrPH
• Professor (Full) at University of São Paulo

Background : Due to enhancements in health care, the number of individuals who survive an acute coronary syndrome (ACS) event is rising. In this population, the impact of physical activity on long-term survival is still a matter of debate. We aimed to analyze the association between the level of physical activity during the first 4 years of follow-...

Background While midlife obesity is linked to cognitive decline, this association is inconsistent in older adults, possibly due to the limitations of body mass index (BMI) in accurately assessing adiposity at older ages. Most studies focused on White or Asian populations, did not include other adiposity measures besides BMI, adjusted the analyses f...

Background Type 2 diabetes mellitus (T2DM) is a major driver of coronary atherosclerosis progression, yet its impact is highly heterogeneous. Insulin resistance contributes to a complex interplay of metabolic disturbances that accelerate atherogenesis to varying degrees. Identifying biomarkers that refine cardiovascular risk prediction in this popu...

Purpose Previous research indicates a higher prevalence of glaucoma in Black individuals of African descent. However, the association between race and glaucoma in Brazil’s multiracial population remains underexplored. This study examines this association and seeks to identify preventable factors potentially influencing prevalence differences among...

Low-density lipoproteins (LDL) comprise a pool of particles with different densities that may have variable impact on atherogenesis. Studies suggest that obese individuals with elevated body mass index (BMI) and waist circumference (WC) have increased small and dense LDL subfractions (sdLDL-c). It is unclear if diabetes (T2D) and insulin resistance...

Background Heart failure (HF) has a major impact on public health. HF staging helps capture preclinical disease and its progression to advanced stages. There are scarce data on HF staging from longitudinal studies in Latin America. This study aimed to determine the prevalence and mortality of HF stages in a Brazilian adult cohort of participants 60...

Background Hand grip strength (HGS) may represent an epidemiologically relevant alternative as an initial screening tool for sarcopenia and sarcopenic obesity. However, no study evaluated the performance capacity of HGS compared to other biomarkers in discriminating these conditions in adults. Objective The study aimed to evaluate the performance...

Study Objectives Insufficient/irregular sleep patterns are common conditions, but their cardiovascular consequences and strategies to minimize these risks are poorly explored. We aimed to determine whether weekend sleep extension (catch-up sleep) and social jetlag may impact the incidence of subclinical atherosclerosis. Methods We performed a 7-da...

Background Hearing loss (HL) of moderate or higher grades is common in older adults with increasing prevalence as people age, rising from 12% at the age of 60 years to over 58% at 90 years. HL in midlife is one of the main potentially modifiable risk factors for dementia. It is estimated that 7% of dementia cases globally could be avoided if this r...

Rationale: Previous studies evaluating the effect of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) on blood pressure (BP) showed variable results. Moreover, several studies recruited patients with normal or controlled BP, and compliance to antihypertensive drugs was not monitored. In addition, very few s...

Objective: Major depressive disorder (MDD) is heterogeneous. While transcranial direct current stimulation (tDCS) is an effective treatment, its impact on symptoms remains underexplored. This ancillary study investigated home-use tDCS effects on depression symptom clusters. Methods: Data were from the Psylect study, where 210 depressed patients...

Background Using multiple drugs with anticholinergic properties is common and might lead to cumulative anticholinergic toxicity and increased risk of cognitive decline. The cumulative adverse effects of anticholinergic medications that a person takes are called the “anticholinergic burden”. We hypothesized that a high anticholinergic burden may be...

Background The association of serum cholesterol with cognitive performance is controversial. Besides, little is known about the association of triglycerides to HDL cholesterol ratio (TG/HDL‐c) with cognitive performance. We aimed to verify the association of baseline cholesterol, triglyceride, and TG/HDL‐c levels with cognitive decline in the Brazi...

This study aimed to investigate the atherogenicity (quality) of LDL particles in patients with acute and recovered from COVID-19 infection. The participants were adults, aged 18 years or older of both sexes. Those with positive RT-PCR results at baseline were included in the Acute COVID-19 group (n = 33), and those with negative RT-PCR six months a...

Hearing loss is common in older adults and its prevalence increases with age, being present in 40% of adults aged 50 years or older and increasing to 70% in adults aged 70 years or older. Hearing loss in middle age is one of the main risk factors for dementia, and it is estimated that 7% of dementia cases in Brazil are due to hearing loss. Therefor...

Background/Objectives: Lowering low-density lipoprotein cholesterol (LDL-C) to <70 mg/dL is recommended for most patients with diabetes. However, clinical trials investigating subjects with diabetes who are not at high cardiovascular risk are inconclusive regarding the all-cause mortality benefit of the current target, and real-world studies sugges...

Background: Coronary calcium scoring (CCS) evaluates atherosclerotic burden and cardiovascular risk, correlating with coronary artery disease (CAD) severity. Advances in Nuclear Magnetic Resonance ( ¹ H-NMR) spectroscopy for lipoprotein fraction analysis highlight precise atherogenic lipid parameter estimation. Enhanced lipid testing, including sub...

Introduction: Obesity increases coronary artery disease (CAD) risk and is highly associated with diabetes. Although body mass index (BMI) is more frequently used as an objective assessment of obesity, abdominal circumference (AC) is often overlooked as a risk factor, especially in nonobese individuals. We examined the association between AC and cor...

Introduction: Current guidelines recommend 500-1000 metabolic equivalent minutes per week (METs-min/wk) of physical activity (PA) to reduce cardiovascular (CVD) risk. Interestingly, studies (DeFina 2019, Aengevaeren 2017) have found an association between high PA and subclinical coronary artery atherosclerosis (CAD) cross-sectionally by coronary ar...

The Cardiovascular Health Diet Index (CHDI) is a diet quality score based on the dietary guidelines of the American Heart Association for cardiovascular health, but with some adaptations, such as red meat, dairy, beans, and ultra-processed foods in its components. The CHDI has shown good relative validity parameters, however, its association with h...

Background While headache disorders are linked to low physical activity levels, the impact of depression on this relationship is unclear. Objective To assess how single and comorbid diagnoses of migraine and tension‐type headache (TTH) interact with depression and leisure‐time physical activity (LTPA) levels in The Brazilian Longitudinal Study of...

Aims Heart failure (HF) has a major impact on public health, affecting up to 2% of adult population. HF staging is helpful in capturing pre-clinical disease and its progression to advanced stages. We aimed to determine the prevalence and mortality of HF stages in the participants of a Brazilian adult cohort. Methods The ELSA-Brasil cohort comprise...

Background Experimental studies have shown that urinary dipeptidyl peptidase 4 (uDPP4), unlike serum DPP4 (sDPP4) activity, correlates with proteinuria, serum creatinine, and left ventricular (LV) hypertrophy in 5/6 nephrectomized rats, suggesting a potential role for uDPP4 in chronic kidney disease (CKD) progression. This study investigated the re...

Objective Gender differences may interfere with the association between Negative Life Events (NLEs) and prevalent/incident depression. This study evaluated the effect of gender in this association using data from the ELSA-Brazil cohort. Methods The authors analyzed 15,088 participants (mean age, 52.1 (9.1), 54.4 % women). NLEs (robbery, hospitaliz...

Understanding the relationship between antithyroperoxidase antibodies (TPOAb) and carotid intima-media thickness (cIMT) could provide insights into the mechanisms linking thyroid autoimmunity and cardiovascular disease. We aimed to explore the association of multiple categories of TPOAb with the increased cIMT at baseline and at follow-up in partic...

Background: Type 2 diabetes mellitus (DM) is an important disease with an impact on public health globally. Early assessment is necessary with accessible markers, such as the TG/HDL ratio, in predicting DM. Methods: A total of 11,653 subjects from the ELSA-Brazil were included in this analysis and were reevaluated after 3.9 ± 0.6 years of follow-up...

We investigated whether neighborhood greenspaces were associated with physical activity in adulthood over 3 cohort visits after considering perceived safety and neighborhood contextual factors. We also evaluated whether the association with greenspace varied by neighborhood socioeconomic status. Participants (N = 4,800) from the Brazilian Longitudi...

The association of thyroid function with essential and non-essential amino acids is understudied, despite their common metabolic roles. Thus, our aim was to evaluate the association of thyroid function with the levels of branched-chain amino acids (BCAAs—leucine, isoleucine, and valine) and of alanine in the general population. We utilized data fro...

Introduction Food intake biomarkers are used to estimate dietary exposure; however, selecting a single biomarker to evaluate a specific dietary component is difficult due to the overlap of diverse compounds from different foods. Therefore, combining two or more biomarkers can increase the sensitivity and specificity of food intake estimates. Objec...

Introduction Pollution harms the health of people with asthma. The effect of the anti-inflammatory cholinergic pathway in chronic allergic inflammation associated to pollution is poorly understood. Methods One hundred eight animals were divided into 18 groups (6 animals). Groups included: wild type mice (WT), genetically modified with reduced VACh...

Background Thyroid dysfunction has been associated with cognitive decline and dementia. However, the role of subtle thyroid hormone alterations in cognitive function is still debatable. Methods Participants without overt thyroid dysfunction aged 35–74 years at baseline were evaluated in 3 study waves (2008–2010, 2012–2014, and 2017–2019). We asses...

The EAT–Lancet Commission proposed a planetary health diet to improve human health within planetary boundaries; however, little is known about the association between adherence to this diet and cognitive decline. We used data from three waves of the Brazilian Longitudinal Study of Adult Health to evaluate the association between the planetary healt...

Objectives We aimed at defining the direct and the mediated pathways for the association between leisure-time physical activity (LTPA) and carotid-to-femoral pulse wave velocity (cf-PWV), and also to identify whether these effects are influenced by sex and age. Methods Cross-sectional data from 13 718 adults (35–74 years) were obtained at the base...

Objective: Polygraphy (PG) is an attractive alternative for diagnosing obstructive sleep apnea (OSA) in patients with high pre-test probability. However, several patients may not present typical symptoms. In this scenario, it is unclear the performance of PG for diagnosing OSA in non-referred populations to sleep laboratories. Methods: Data from...

To investigate the time-dependent effects of traditional risk factors on functional disability in all-cause mortality post-stroke, we evaluated data from a long-term stroke cohort. Baseline cerebrovascular risk factors (CVRF) and functionality at 1 and 6 months were evaluated in survivors from a prospective stroke cohort using the modified Rankin s...

This study aimed to investigate the atherogenicity (quality) of LDL particles in patients with acute and recovered from COVID-19 infection. The participants were adults, aged 18 years or older of both sexes. Those with positive RT-PCR results at baseline were included in the Acute COVID-19 group (n=33), and those with negative RT-PCR six months aft...

Current data shows that the autonomic and vascular systems can influence each other. However, only a few studies have addressed this association in the general population. We aimed to investigate whether heart rate variability (HRV) was associated with coronary artery calcium (CAC) in a cross-sectional analysis of the Brazilian Longitudinal Study o...

The longitudinal association between psoriasis and carotid intima-media thickness (CIMT) has not yet been established. This study aimed do compare CIMT and its change (∆CIMT) after an 8-year follow-up according to psoriasis diagnosis and the association with risk factors in the ELSA-Brasil study. Data from 7564 participants were analyzed (median ag...

The systematic assessment of cognitive performance of older people without cognitive complaints is controversial and unfeasible. Identifying individuals at higher risk of cognitive impairment could optimize resource allocation. We aimed to develop and test machine learning models to predict cognitive impairment using variables obtainable in primary...

The growing amount of evidence suggests the existence of a bidirectional relation between coronavirus disease 2019 (COVID-19) and type 2 diabetes mellitus (T2DM), as these two conditions exacerbate each other, causing a significant healthcare and socioeconomic burden. The alterations in innate and adaptive cellular immunity, adipose tissue, alveola...

Background: São Paulo is the biggest city in Latin America with more than 7 million vehicles. Principal sources of air pollution are vehicles and industries. High pollutant indices directly affect respiratory diseases. However, in the last years several interventions tend to reduce these levels. Aims: To evaluate whether asthma and COPD are associ...

This study aimed to predict dietary recommendations and compare the performance of algorithms based on collaborative filtering for making predictions of personalized dietary recommendations. We analyzed the baseline cross-sectional data (2008–2010) of 12,667 participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The partici...

Background and aims High serum uric acid (sUA) has been associated to coronary artery calcium (CAC) and increased carotid intima-media thickness (cIMT) in people at high cardiovascular risk. However, association is unclear in apparently healthy individuals. Our study aims to evaluate association between sUA and subclinical atherosclerosis measures:...

Purpose The EAT-Lancet Commission released a reference sustainable diet to improve human health and respect the planetary boundaries. The Planetary Health Diet Index (PHDI) was developed with the purpose of evaluate the adherence to this reference diet. The aim of the present study was to evaluate the association between adherence to the EAT-Lancet...

Coronavirus disease 2019 (COVID-19) is a highly heterogeneous disease regarding severity, vulnerability to infection due to comorbidities, and treatment approaches. The hypothalamic–pituitary–adrenal (HPA) axis has been identified as one of the most critical endocrine targets of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that migh...

The American Heart Association (AHA) has developed the concept of “ideal cardiovascular health” (ICH), a seven-component score, which includes health dietary metrics. Higher ultra-processed foods intake is related with several cardiometabolic and cardiovascular diseases. We propose to develop and validate the Cardiovascular Health Diet Index (CHDI)...

Sarcopenia and sleep problems share common physiopathology. We aimed to investigate the association of sleep disturbances with sarcopenia and its defining components in Brazilian middle-aged and older adults. In this cross-sectional analysis of the second wave of the ELSA-Brasil study, we included data from 7948 participants aged 50 years and older...

The EAT-Lancet Commission has proposed a model diet to improve the health of human beings and that of the planet. Recently, we proposed the Planetary Health Diet Index (PHDI) to assess adherence of the population to this model diet. In this study, we aimed to evaluate adherence to the PHDI and obesity outcomes using baseline data from 14,515 partic...

The EAT-Lancet Commission has proposed a planetary health diet. We propose the development of the Planetary Health Diet Index (PHDI) based on this proposed reference diet. We used baseline dietary data obtained through a 114-item FFQ from 14,779 participants of the Longitudinal Study on Adult Health, a multicenter cohort study conducted in Brazil....

The objective of this study was to cross-sectionally analyze the diet quality of active workers and retirees to identify possible differences by gender and subgroups of working and nonworking retirees using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study of employees of six higher education centers...

This study examined the association between coffee consumption and all-cause mortality in patients with a prior acute myocardial infarction or unstable angina. Data were from the prospective study ERICO, totalising 928 patients with Acute Coronary Syndrome (ACS). During 4 years’ follow-up, a total of 111 deaths occurred. Moderate coffee consumption...

Importance Predicting risk of Type 2 Diabetes Mellitus (T2DM) accurately allows allocation of resources to prevent its development. Fasting blood triglycerides are highly predictive for T2DM. Triglyceride remnant lipoproteins (TRL) more accurately reflect pathophysiological changes that underlie progression to T2DM, such as pancreatic steatosis and...

Recent evidence suggests that glaucoma and Alzheimer's disease are neurodegenerative diseases sharing common pathophysiological and etiological features, although findings are inconclusive. We sought to investigate whether self-reported glaucoma patients without dementia present poorer cognitive performance, an issue that has been less investigated...

Objectives We investigated the role of peripheral biomarkers associated with neuroplasticity and immune-inflammatory processes on the effects of transcranial direct current stimulation (tDCS), a safe, affordable, and portable non-invasive neuromodulatory treatment, in bipolar depression. Methods This is an exploratory analysis using a dataset from...

Body fat distribution predicts cardiovascular events better than body-mass index (BMI). Waist circumference (WC) and neck circumference (NC) are inexpensive anthropometric measurements. We aimed to present the conditional distribution of WC and NC values according to BMI, stratified by age and sex, from the Brazilian Longitudinal Study of Adult Hea...

Aim Depression is more prevalent in people with diabetes, and is associated with worse diabetes outcomes. Depression in diabetes is more treatment resistant, and as underlying mechanisms are unknown, development of more effective treatment strategies is complicated. A biopsychosocial model may improve our understanding of the pathophysiology, and t...

Objective: to investigate the effect of general alcohol consumption and of the type of alcoholic beverage consumed, in different lipid measurements. Method: the effect of alcohol consumption as well as that of the type of alcoholic beverage consumed were investigated, in different lipid measurements, for the participants in the Longitudinal Study o...

Background: The mechanisms that underlie the link between migraine and cardiovascular diseases are not clear and arterial stiffness could play a role in that association. We analyzed the association between migraine and vascular stiffness measured by carotid-to-femoral pulse wave velocity (PWV-cf). Methods: In a cross-sectional analysis of a wel...

The degree to which weight reduction leads to the remission of hypertension in population studies is not clear. We investigated whether the changes in adiposity measures predicted the remission of hypertension in a racially admixed population over a mean 4-year follow-up. All 4847 hypertensive individuals at baseline (2008–2010) from the multicente...

Objectives: Neuropsychological tests are often used in aging studies to compare distinct groups regarding diagnosis and prognosis. Because sociodemographic characteristics can influence cognitive scores, measurement of invariance is useful to assess the tests' ability to estimate the underlying constructs equally across groups and thus prevent bia...

Objective: The association between cognitive performance and hemoglobin concentration has long been a topic of debate, but few data for middle-aged persons have been explored. The authors examined the association between anemia and cognitive performance at baseline assessment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a mul...

Objective: The association between cognitive performance and hemoglobin concentration has long been a topic of debate, but few data for middle-aged persons have been explored. The authors examined the association between anemia and cognitive performance at baseline assessment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a mult...

Background: Living in a neighborhood with a low socioeconomic context may increase the risk of coronary heart disease. However, few studies have explored the impact of neighborhood characteristics on subclinical atherosclerosis, and their role as a risk factor for cardiovascular disease has not yet been studied in poor countries. Objectives: Thi...

Background Depression is a main source of disability worldwide. Identifying risk factors associated with incident and persistent episodes could inform clinical practice and hence mitigate their burden. However, previous research has focused on populations from developed countries. Thus, we evaluated sociodemographic risk factors and psychiatric com...

Background: Cognitive deficits in major depressive disorder (MDD) are associated with low quality of life and higher suicide risk. Antidepressant drugs have modest to null effects in improving such deficits. Therefore, we investigated the cognitive effects of transcranial direct current stimulation (tDCS), which is a promising antidepressant non-p...

Background: Both increased carotid intima-media thickness (cIMT) and low heart rate variability (HRV) have been associated with cardiovascular mortality and morbidity. Thus, the aim of this study was to investigate whether cardio autonomic alterations are accompanied or not by subclinical atherosclerosis in participants of the Brazilian Longitudin...

Assessing risk factors exposure, such as stress in the workplace during adulthood, may contribute to detecting early signs of cognitive impairment in order to implement effective actions to improve brain health and consequently to decrease cognitive disorders later in life. In this cross‐sectional study, we aimed to investigate whether work‐related...