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Metabolic health in Brazil: trends and challenges
... Tackling the burden of poor cardiovascular health and resisting this trend require the collaboration of healthcare and civil society organizations as well as vigorous government efforts. In order to assist Bangladeshis to have a healthy lifestyle and reduce the burden and fatal effects of this poor health, there is an urgent need to incorporate educational programs and improve dedicated public facilities 13 . Timely preventive measures against poor cardiovascular health can save Bangladeshi people from the fatal outcomes of future epidemics. ...
... The prevalence of diabetes has increased globally (over 463 million adults) [8] but at a faster rate in low-and middle-income countries (LMICs) [9]. In Brazil, the prevalence of T2D has increased by 24% between 2006 and 2019 [10] and an estimate of 65,581 deaths have been shown to be caused by diabetes among adults aged 35-80 years [11]. It has been reported that the prevalence of prediabetes and T2D among Brazilian adolescents were 22.0% and 3.3%, respectively [12]. ...
Purpose
The development of metabolic diseases such as type 2 diabetes (T2D) is closely linked to a complex interplay between genetic and dietary factors. The prevalence of abdominal obesity, hyperinsulinemia, dyslipidaemia, and high blood pressure among Brazilian adolescents is increasing and hence, early lifestyle interventions targeting these factors might be an effective strategy to prevent or slow the progression of T2D.
Methods
We aimed to assess the interaction between dietary and genetic factors on metabolic disease-related traits in 200 healthy Brazilian young adults. Dietary intake was assessed using 3-day food records. Ten metabolic disease-related single nucleotide polymorphisms (SNPs) were used to construct a metabolic-genetic risk score (metabolic-GRS).
Results
We found significant interactions between the metabolic-GRS and total fat intake on fasting insulin level (P interaction = 0.017), insulin-glucose ratio (P interaction = 0.010) and HOMA-B (P interaction = 0.002), respectively, in addition to a borderline GRS-fat intake interaction on HOMA-IR (P interaction = 0.051). Within the high-fat intake category [37.98 ± 3.39% of total energy intake (TEI)], individuals with ≥ 5 risk alleles had increased fasting insulin level (P = 0.021), insulin-glucose ratio (P = 0.010), HOMA-B (P = 0.001) and HOMA-IR (P = 0.053) than those with < 5 risk alleles.
Conclusion
Our study has demonstrated a novel GRS-fat intake interaction in young Brazilian adults, where individuals with higher genetic risk and fat intake had increased glucose and insulin-related traits than those with lower genetic risk. Large intervention and follow-up studies with an objective assessment of dietary factors are needed to confirm our findings.
... Results from the National Health and Nutrition Examination Survey (NHANES) showed an increase of over 35% in the prevalence of MetS among adults in the United States between the reports from 1988 to 2012 [1]. In Brazil, data from the National Health Survey in 2013 found a MetS prevalence of 8.9%, which is significantly higher among women compared to men, [2,3]. MetS can be described as a set of metabolic and cardiovascular alterations, including, obesity, diabetes, hypertension, and dyslipidemia, whereby all those disorders are connected through similar metabolic pathways [4]. ...
Purpose
The study objected to investigate potential changes in metabolic, dietary, and nutritional status in women with stages I-III breast cancer exposed to chemotherapy.
Methods
Women who were starting chemotherapy with no previous treatment were recruited. Anthropometrics, bioelectrical impedance analysis, handgrip strength, blood pressure and blood sample were collected. Visceral adiposity index and lipid accumulation product were calculated. Dietary intake was evaluated, and the multiple source methods program was applied. Metabolic syndrome (MetS) was assessed following the NCEP-ATP III criteria (defined as 3 of 5 components of MS). All data were collected at 2-time points: diagnosis (T0) and after 1 month of completion of therapy (T1). Mean, standard deviation, percentage, and ANOVA in SAS Studio® were used to explore the results.
Results
61 women were included. We did not find any changes in anthropometrics and body composition. However, phase angle, extracellular water (EX) and EX/TBW had expressive changes (p<0.001). The results showed changes in lipid profile (p<0.001), and greater unfavorable outcomes on adiposities index (P<0.001). At the end of the study, 68,8% (N=42) of the women developed MetS post-chemotherapy.
Conclusion
We have found supporting evidence for chemotherapy treatment resulting in worsening of nutritional markers, lipid profile and adiposity markers. After chemotherapy part of the sample developed MS, even without changes in body weight, fat mass, and food intake. Breast cancer patients may benefit from targeted interventions before starting chemotherapy to prevent MetS post-treatment, and therefore reduce the risk of cardiovascular disease. Further investigation into this theme is needed.
... Worth noting is that some of the causes of death which predate the pandemic also feature as comorbidities of the COVID-19 virus infection. Across the three countries, populations of specific ethnicities are prone to the burden of communicable and noncommunicable diseases [16][17][18][24][25][26]. On the infectious disease front, HIV and TB constitute a considerable fraction especially in South Africa. ...
The SARS-CoV-2 infection, which causes the coronavirus disease (COVID-19), has affected lives, with very adverse outcomes in specific populations in the United States of America (USA), a high-income country, and two middle-income countries, Brazil and South Africa. This paper aims to discuss the relationship of race/ethnicity with COVID-19-associated factors in the three countries. The information is based on data collected from infectious disease/epidemiological centers in the USA, Brazil, and South Africa. Adverse COVID-19 outcomes have been associated with the burden of exposure and disease, linked to socioeconomic determinants, among specific ethnicities in all three countries. The prevalence of comorbidities before and the likelihood of work-related exposure in the context of COVID-19 infection puts ethnic minorities in the USA and some ethnic majorities and minorities in Brazil and South Africa at greater risk. We envisage that this work will contribute to ongoing discussions related to addressing socioeconomic determinants of health, and the need for stakeholders in various sectors to work on addressing observed health disparities for overall improvement in health and healthcare given the current pandemic.
Aim:
To estimate the association between consumption of sugar-sweetened soft drinks and unsweetened fruit juice with metabolic syndrome (MetS) and its components in participants of the Brazilian Longitudinal Adult Health Study (ELSA-Brasil) after 4 years of follow-up.
Methods:
We used data from ELSA-Brasil cohort (N = 15,105). The sample consisted of 6,124 civil servants free of the MetS at baseline (35 to 74 years, both sexes). The consumption of sugar-sweetened soft drinks and unsweetened fruit juice was estimated by a food frequency questionnaire previously validated. The outcome was MetS and its components (Joint Interim Statement criteria). To test the association between beverage consumption at baseline (2008-2010) and MetS and its components at follow-up (2012-2014), we used Poisson regression models with robust variance adjusting for potential confounders.
Results:
After 4-year follow-up, the higher consumption of sugar-sweetened soft drinks (≥ 1 serving/day = 250 mL/day) increased the relative risk of MetS (RR = 1.22; 95% CI 1.04-1.45), high fasting glucose (RR = 1.23; 95% CI 1.01-1.48), and high blood pressure (RR = 1.23; 95% CI 1.00-1.54). Moderate consumption of this beverage (0.4 to < 1 serving/day) increased the relative risk of high waist circumference (WC) (RR = 1.21; 95% CI 1.02-1.42). After adjustment for confounding variables, the consumption of unsweetened fruit juice was not associated with the MetS and its components.
Conclusion:
Higher sugar-sweetened soft drinks consumption was associated with a higher risk relative of MetS, high fasting glucose, and high blood pressure, while moderate consumption of this beverage increased the relative risk of high WC in Brazilian adults.
Introduction: Physical activity is essential for preventing and treating many diseases. Although physicians are the most influential health professionals in advising their patients on the benefits of physical activity, most medical degree programs in Brazil do not seem to include physical activity topics in their curricula. Objective: This study aimed to investigate physical activity topics on active medical curricula in Brazil. Method: The research was conducted separately in April 2015 and February 2019 using a governmental resource, the e-MEC system, and search in internet databases. Data were split into categories according to the type of enrollment (mandatory or optional) of the courses that have subjects or thematic modules with topics on physical activity, type of activities (theoretical, practical, or theoretical-practical), and emphasis on the content (health, performance, or health and performance). Results: Of the 223 medical curricula compiled in 2015 and 286 in 2019, respectively, only 24 (10.8%) and 19 (6.7%) had at least one subject or thematic module concerning physical activity with emphasis on health. Conclusion: In Brazil, the number of undergraduate medical curricula covering physical activity topics is still small and suffered a reduction between 2015 and 2019, which should warn medical education institutions about the need to include physical activity longitudinally distributed contents, with theoretical and - if possible - practical approaches, and emphasis on health promotion and treatment of diseases, in mandatory curricular units.
Incubation of human blood in saline solution of 0–36% (v/v) ethanol for 30 min produces lysis or stabilization of erythrocytes depending on the ethanol concentration. Under less elevated concentrations of ethanol, erythrocytes are present in expanded shapes (R state) that present lower stability and suffer lysis with increase in the ethanol concentration. Under more elevated concentrations of ethanol, erythrocytes are present in contracted shapes (T state) that have higher stability and suffer lysis at even more elevated ethanol concentrations. This work evaluated the effects of glycerol (0 to 2.0 M) and temperature (7 to 47°C) on the stability of the R erythrocytes, characterized by the ethanol concentration at the mid-transition point (D
50R
) of the hemolysis curve (D
50R
). D
50R
declined sigmoidally with increase in the glycerol concentration or temperature, due to transition of the R to the T state erythrocytes. In 1.5 M glycerol, the erythrocytes stability decreased below 32 but increased above 37°C. The combination of temperature, glycerol and ethanol actions generates a critical value of osmotic pressure below which the R state predominates and above which the T state predominates. At 7°C 1.5 M glycerol decreased the erythrocytes stability against ethanol but increased the erythrocytes stability against hypotonic shock. Those conditions favor the R state, which has a lower stability against ethanol; however, in the absence of ethanol, glycerol determines less water entrance in the erythrocytes, making more difficult its lysis by hypotonicity.
Background
Brazil ranks second worldwide in total number of COVID-19 cases and deaths. Understanding the possible socioeconomic and ethnic health inequities is particularly important given the diverse population and fragile political and economic situation. We aimed to characterise the COVID-19 pandemic in Brazil and assess variations in mortality according to region, ethnicity, comorbidities, and symptoms.
Methods
We conducted a cross-sectional observational study of COVID-19 hospital mortality using data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) dataset to characterise the COVID-19 pandemic in Brazil. In the study, we included hospitalised patients who had a positive RT-PCR test for severe acute respiratory syndrome coronavirus 2 and who had ethnicity information in the dataset. Ethnicity of participants was classified according to the five categories used by the Brazilian Institute of Geography and Statistics: Branco (White), Preto (Black), Amarelo (East Asian), Indígeno (Indigenous), or Pardo (mixed ethnicity). We assessed regional variations in patients with COVID-19 admitted to hospital by state and by two socioeconomically grouped regions (north and central-south). We used mixed-effects Cox regression survival analysis to estimate the effects of ethnicity and comorbidity at an individual level in the context of regional variation.
Findings
Of 99 557 patients in the SIVEP-Gripe dataset, we included 11 321 patients in our study. 9278 (82·0%) of these patients were from the central-south region, and 2043 (18·0%) were from the north region. Compared with White Brazilians, Pardo and Black Brazilians with COVID-19 who were admitted to hospital had significantly higher risk of mortality (hazard ratio [HR] 1·45, 95% CI 1·33–1·58 for Pardo Brazilians; 1·32, 1·15–1·52 for Black Brazilians). Pardo ethnicity was the second most important risk factor (after age) for death. Comorbidities were more common in Brazilians admitted to hospital in the north region than in the central-south, with similar proportions between the various ethnic groups. States in the north had higher HRs compared with those of the central-south, except for Rio de Janeiro, which had a much higher HR than that of the other central-south states.
Interpretation
We found evidence of two distinct but associated effects: increased mortality in the north region (regional effect) and in the Pardo and Black populations (ethnicity effect). We speculate that the regional effect is driven by increasing comorbidity burden in regions with lower levels of socioeconomic development. The ethnicity effect might be related to differences in susceptibility to COVID-19 and access to health care (including intensive care) across ethnicities. Our analysis supports an urgent effort on the part of Brazilian authorities to consider how the national response to COVID-19 can better protect Pardo and Black Brazilians, as well as the population of poorer states, from their higher risk of dying of COVID-19.
Funding
None.
OBJECTIVE
To determine the distribution of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides in Brazilian adolescents, as well as the prevalence of altered levels of such parameters.
METHODS
Data from the Study of Cardiovascular Risks in Adolescents (ERICA) were used. This is a country-wide, school-based cross-sectional study that evaluated 12 to 17-year old adolescents living in cities with over 100,000 inhabitants. The average and distribution of plasma levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were evaluated. Dyslipidemia was determined by levels of total cholesterol ≥ 170 mg/dl, LDL cholesterol ≥ 130 mg/dl, HDL cholesterol < 45 mg/dL, or triglycerides ≥ 130 mg/dl. The data were analyzed by gender, age, and regions in Brazil.
RESULTS
We evaluated 38,069 adolescents – 59.9% of females, and 54.2% between 15 and 17 years. The average values found were: total cholesterol = 148.1 mg/dl (95%CI 147.1-149.1), HDL cholesterol = 47.3 mg/dl (95%CI 46.7-47.9), LDL cholesterol = 85.3 mg/dl (95%CI 84.5-86.1), and triglycerides = 77.8 mg/dl (95%CI 76.5-79.2). The female adolescents had higher average levels of total cholesterol, LDL cholesterol, and HDL cholesterol, without differences in the levels of triglycerides. We did not observe any significant differences between the average values among 12 to 14 and 15- to 17-year old adolescents. The most prevalent lipid alterations were low HDL cholesterol (46.8% [95%CI 44.8-48.9]), hypercholesterolemia (20.1% [95%CI 19.0-21.3]), and hypertriglyceridemia (7.8% [95%CI 7.1-8.6]). High LDL cholesterol was found in 3.5% (95%CI 3.2-4.0) of the adolescents. Prevalence of low HDL cholesterol was higher in Brazil’s North and Northeast regions.
CONCLUSIONS
A significant proportion of Brazilian adolescents has alterations in their plasma lipids. The high prevalence of low HDL cholesterol and hypertriglyceridemia, especially in Brazil’s North and Northeast regions, must be analyzed in future studies, to support the creation of strategies for efficient interventions.
The global burden of diabetes mellitus and other chronic diseases is high, and 80% of those with diabetes now live in low and middle income countries. Yet, little information is available regarding prevalence of diabetes and intermediate hyperglycemia in these countries, especially when a full range of diagnostic tests is employed. The purpose of this study is to provide a full accounting of these prevalences in a large, free-living Brazilian population.
We report baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study of 15,105 civil servants aged 35-74 years. Diabetes mellitus was ascertained by self-report of diagnosis, medication use, fasting glucose, an oral glucose tolerance test, and/or glycated hemoglobin. Cut-offs for diabetes and intermediate hyperglycemia followed the recommendations of the World Health Organization and the American Diabetes Association. Adjusted prevalences were estimated through logistic regression.
With this full accounting, 19.7% (19.0%-20.3%) had diabetes mellitus, 50.4% being previously undiagnosed. Frequencies of intermediate hyperglycemia according to various criteria ranged from 16.1% to 52.6%. Diabetes or intermediate hyperglycemia was present in 79.1% of participants when using the most comprehensive definitions. The burden was greatest in the elderly, the obese, non-whites, and those with less formal education (p < 0.001).
That four of every five free-living individuals aged 35-74 years working in selected public institutions in six Brazilian state capitals presented either diabetes or intermediate hyperglycemia highlights the advanced stage of the obesity - diabetes epidemic in urban Brazil and indicates the need for urgent action.
The prevalence of metabolic syndrome (MetS) has increased in developing countries in recent decades. This syndrome, a clustering of metabolic abnormalities, has been correlated to various socioeconomic and behavioral variables. We investigated the prevalence and prevalence ratios (PR) of MetS and related factors in an adult population of the Federal District (FD) of Brazil, which is located in the central region of the country.
A cross-sectional, population-based study conducted in 2007, with 2130 adults (aged 18 years or older) in the FD of Brazil. Metabolic syndrome was defined according to the recently harmonized criteria. The prevalence of MetS and PR were estimated for each sex according to the diagnostic components and the overall contribution of the selected correlates.
The overall prevalence of MetS was 32.0% (95%CI: 28.9-35.2), with no gender difference. The single component with the greatest contribution to the diagnosis of MetS was hypertension in men (PR 5.10, 95%CI: 3.17-8.22) and high waist circumference in women (PR 5.02, 95%CI: 3.77-6.69). The prevalence of MetS increased significantly and progressively with age and excess weight. In women, higher education was protective against MetS (PR 0.66, 95%CI: 0.49-0.89) compared to 8 or less years of education. There was no association between the prevalence of MetS and behavioral variables studied.
This study provides comprehensive and alarming data about the prevalence of MetS among the adult population of Brazil's FD. The results suggest that reducing education inequalities may be an important public policy goal to improve health outcomes, especially among women.
Background:
Data on mortality burden and excess deaths attributable to diabetes are sparse and frequently unreliable, particularly in low and middle-income countries. Estimates in Brazil to date have relied on death certificate data, which do not consider the multicausal nature of deaths. Our aim was to combine cohort data with national prevalence and mortality statistics to estimate the absolute number of deaths that could have been prevented if the mortality rates of people with diabetes were the same as for those without. In addition, we aimed to estimate the increase in burden when considering undiagnosed diabetes.
Methods:
We estimated self-reported diabetes prevalence from the National Health Survey (PNS) and overall mortality from the national mortality information system (SIM). We estimated the diabetes mortality rate ratio (rates of those with vs without diabetes) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), an ongoing cohort study. Joining estimates from these three sources, we calculated for the population the absolute number and the fraction of deaths attributable to diabetes. We repeated our analyses considering both self-reported and unknown diabetes, the latter estimated based on single point-in-time glycemic determinations in ELSA-Brasil. Finally, we compared results with diabetes-related mortality information from death certificates.
Results:
In 2013, 65 581 deaths, 9.1% of all deaths between the ages of 35-80, were attributable to known diabetes. If cases of unknown diabetes were considered, this figure would rise to 14.3%. In contrast, based on death certificates only, 5.3% of all death had diabetes as the underlying cause and 10.4% as any mentioned cause.
Conclusions:
In this first report of diabetes mortality burden in Brazil using cohort data to estimate diabetes mortality rate ratios and the prevalence of unknown diabetes, we showed marked underestimation of the current burden, especially when unknown cases of diabetes are also considered.
Background and aims:
Familial hypercholesterolemia (FH) is a genetic disorder associated with high cardiovascular burden of disease. FH prevalence may vary widely across populations and data in race/ethnically diverse and admixed populations is scarce. ELSA-Brasil epidemiology may be widely generalizable in this regard, and we calculated the ELSA-Brasil FH prevalence and its variation according to age, sex and race/ethnicity.
Methods:
In 14,460 individuals aged from 35 to 75 years from the ELSA-Brasil cohort baseline, we classified FH according to the Dutch Lipid Clinic Network criteria score ≥6 (probable and definite FH). LDL-C levels were adjusted for statin use. We calculated the overall ELSA-Brasil FH prevalence and the weighted prevalence for age, sex and race/ethnic categories. We extrapolated those frequencies to the Brazilian population weighting for age-sex-race/ethnicity according to the 2015 Statistics and Geography Brazilian Institute survey.
Results:
The overall FH prevalence per 1000 individuals in ELSA-Brasil was 3.8 (2.9, 4.9) or 1 in 263. The age/sex/race-ethnicity-weighted FH prevalences were: male, 3.0 (1.7, 4.4) or 1 in 333; female, 4.1 (3.0, 5.2) or 1 in 244 (p<0.001). White race prevalence was 2.4 (1.9, 3.0) or 1 in 417; Brown, 4.9 (4.0, 5.9) or 1 in 204; and Black 6.4 (41.1, 8.7) or 1 in 156 (p<0.001). The weighted extrapolation for the Brazilian population derived similar magnitude frequencies.
Conclusions:
FH affects 1 in 263 in ELSA-Brasil and affects disproportionally more Brown (1 in 204), and Black (1 in 156), than White (1 in 417). Weighted extrapolation for the Brazilian population derived similar magnitude frequencies.
Background: Little is known about the magnitude of excess mortality due to diabetes in low and middle income countries. Brazilian data to that end have been limited by reliance on death certificates and their subjective assignment of diabetes as a cause of death. We provide estimates of excess mortality due to diabetes by combining mortality risks from the ELSA-Brasil cohort with nationally representative surveys and databases.
Methods: We calculated the standardized mortality rate ratio for those with (vs. without) self-reported diabetes in ELSA-Brasil by Poisson regression adjusting for age, sex, race and education. We obtained similarly adjusted, self-reported diabetes prevalence from the 2013 National Health Survey. Mortality and population projections were from national statistics. We combined these data to model the excess deaths due to diabetes.
Results: In 2013, among adults with diabetes aged 35 to 74 (table), 73,092 deaths (13% of total) could have been avoided if the mortality rate in people with diabetes were the same as in those without diabetes. The percent ranged from 5.9% in persons aged 35-49 to more than 16% in those 60 or older. In the national mortality system, only 31,117 deaths had diabetes as a main cause.
Age GroupStandardized Mortality Rate Ratio Population NTotal Deaths NDeaths among People with Diabetes NExcess Deaths Associated with Self-Reported Diabetes With diabetesWithout diabetes Assuming diabetes mortality rateAssuming non-diabetes mortality rateExcess deaths among people with diabetes N% of total deaths35-492.40 (1.13 - 5.08)746,790 (3.7 %)19,538,124 (96.3%)120,20011,7224,6777,0455.950-591.94 (1.24 - 3.04)992,878 (10.2%)8,781,526 (79.8%)140,57730,86012,91417,94612.860-691.93 (1.35 - 2.74)941,815 (16.3%)4,853,378 (83.7%)182,45055,78725,15930,62816.870-741.58 (0.94 - 2.66)338,769 (20.3%)1,333,776 (79.7%)106,63735,53518,06217,47316.4Total1.91 (1.51 - 2.41)3,020,252 (8.1%)34,506,804 (92.9%)549,864133,90460,81273,09213.3
Conclusion: This calculation of excess deaths related to known diabetes in Brazil suggests a major diabetes mortality burden, which is considerably underestimated by calculations based only on death certificates.
Disclosure
P. Bracco: None. E.W. Gregg: None. D.B. Rolka: None. M.I. Schmidt: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company. S. Barreto: None. P.A. Lotufo: Consultant; Self; AbbVie Inc.. E.C. Melo: None. B.B. Duncan: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company.
Background:
There is little information regarding lipid profiles of racially mixed populations. Differently from other Latin American countries, the proportion of African ancestry is much higher in Brazil.
Objective:
Verify whether there are differences in the lipid profile between black and white subjects and if people with mixed ancestry have a pattern more closely resembling whites or blacks.
Methods:
A total of 15,105 civil servants aged 35-74 years from the ELSA-Brasil study had their fasting lipid profile determined. Race/skin color was self-reported as white, mixed, black, Asian, or indigenous. Dyslipidemia subtypes were classified as high triglycerides (TG) (≥150 mg/dL), low HDL-C (<40 [men] and <50 [women] mg/dL), and high LDL-C (≥130 mg/dL or ever taking lipid-lowering agents). The adjusted odds ratios (95% confidence interval) for dyslipidemia were calculated for each racial group using white participants as the reference group by logistic regression.
Results:
Elevated concentrations in LDL-C and TG and low-HDL-C had a lower prevalence in the black group compared with whites after multivariate adjustment including adiposity and socioeconomic status. For women and men, respectively, the odds ratios (95% confidence interval) for high LDL-C are 0.94 (0.89-0.99) and 0.93 (0.87-0.99); for high TG, 0.63 (0.54-0.74) and 0.92 (0.84-1.00); and for low HDL-C, 0.77 (0.66-0.91) and 0.78 (0.64-0.94). The mixed race group presented a pattern of dyslipidemia closer to white than to black subjects.
Conclusions:
Blacks in comparison with whites had lipid concentrations that are associated with a lower risk of atherosclerotic cardiovascular disease. The mixed racial group had lipid concentrations closer to the white grouping.
Non-communicable diseases (NCDs) have become a major health priority in Brazil--72% of all deaths were attributable to NCDs in 2007. They are also the main source of disease burden, with neuropsychiatric disorders being the single largest contributor. Morbidity and mortality due to NCDs are greatest in the poor population. Although the crude NCD mortality increased 5% between 1996 and 2007, age-standardised mortality declined by 20%. Declines were primarily for cardiovascular and chronic respiratory diseases, in association with the successful implementation of health policies that lead to decreases in smoking and the expansion of access to primary health care. Of note, however, the prevalence of diabetes and hypertension is rising in parallel with that of excess weight; these increases are associated with unfavourable changes of diet and physical activity. Brazil has implemented major policies for the prevention of NCDs, and its age-adjusted NCD mortality is falling by 1·8% per year. However, the unfavourable trends for most major risk factors pose an enormous challenge and call for additional and timely action and policies, especially those of a legislative and regulatory nature and those providing cost-effective chronic care for individuals affected by NCDs.
Level of leisure-time physical activity and its association with the prevalence of metabolic syndrome in adults: a population-based study.
- Santos FAAD
- Back IC
- Giehl MWC
- Fassula AS
- Boing AF
- González-Chica DA
Santos FAAD, Back IC, Giehl MWC, Fassula AS,
Boing AF, González-Chica DA. Level of leisuretime physical activity and its association with
the prevalence of metabolic syndrome in
adults: a population-based study.
Rev Bras Epidemiol 2020; 23: e200070.
ERICA: prevalence of dyslipidemia in Brazilian adolescents.
- Faria Neto JR
- Bento VFR
- Baena CP
Faria Neto JR, Bento VFR, Baena CP, et al.
ERICA: prevalence of dyslipidemia in Brazilian
adolescents. Rev Saude Publica 2016;
50 (suppl 1): 10s (in Portuguese).
Level of leisure-time physical activity and its association with the prevalence of metabolic syndrome in adults: a population-based study
- Santos