Social representations of low-income diabetic women according to the health-disease process

The purpose of this article is to identify the social representations of low-income diabetic women according to the health-disease process. This is a descriptive, exploratory study. Eight participants, all of them patients at a basic health unit in Ribeirão Preto, were interviewed in 2003. The data were organized according to thematic content analysis and analyzed according to theory of social representations. Diabetes is related to negative feelings, such as shock, anger and sadness; the diet plan is linked to the loss of pleasure, and also to health risks. The diabetic women showed an ambivalent relation to medication, perceived it as both tiring and as a resource that promotes well-being and improvements in quality of life. The negative representation of health services seems to interfere with the behavior of adherence to pharmacological treatment. Understanding the representations of women with diabetes contributes to integral healthcare for diabetic patients.

Prevalência de sobrepeso e obesidade em nipo-brasileiros: comparação entre sexos e geração

OBJETIVO: Descrever a prevalência de sobrepeso, obesidade e obesidade abdominal em nipo-brasileiros residentes na cidade de Bauru (SP), Brasil. MÉTODOS: Os dados foram obtidos a partir de um estudo transversal com 1 330 nipo-brasileiros de 1ª e 2ª geração, de ambos os sexos, com idade >30 anos. Os critérios para sobrepeso e obesidade foram índice de massa corporal entre 25-29,9kg/m² e >30kg/m², respectivamente. A obesidade abdominal foi classificada com valores de circunferência da cintura >90cm, para homens, e >80cm para mulheres. Foram calculadas as prevalências de sobrepeso, obesidade e obesidade abdominal por ponto e por intervalo, com 95% de confiança. RESULTADOS: Verificou-se que a prevalência de sobrepeso em nipo-brasileiros foi de 26,1% e 27,9% na primeira geração e de 44,8% e 32,5% na segunda geração, respectivamente, para homens e mulheres. Em relação à obesidade, a prevalência entre homens foi de 3,7% e 12%, e nas mulheres de 6,6% e 9,9% respectivamente na primeira e na segunda geração. Observou-se aumento na prevalência de sobrepeso e obesidade nos homens entre as gerações, apesar de as diferenças não serem estatisticamente significantes. A obesidade abdominal nos homens de primeira e segunda geração foi de 32,1% e 45,3%, e nas mulheres estes valores foram de 49,2% e 48,5%, respectivamente. No período de estudo não foram observados aumentos nas prevalências de sobrepeso e obesidade estatisticamente significantes (p<0,05). CONCLUSÃO: O aumento percentual na prevalência de sobrepeso e obesidade abdominal em nipo-brasileiros pode ser, em parte, explicado pelo processo da ocidentalização, reforçando a necessidade de medidas preventivas, visando a minimizar as conseqüências metabólicas da obesidade nos nipo-brasileiros.

Beneficial effects of short-term nutritional counselling at the primary health-care level among Brazilian adults

Objective

To evaluate the impact of a low-cost nutritional intervention in changing the lifestyle of adults.

Design

Randomised clinical trial.

Setting

Primary health-care centre in São José do Rio Preto, São Paulo State, Brazil.

Subjects

We randomly assigned 104 adults (83 women and 21 men aged 30–65 years, body mass index 24–35 kg m−2, non-diabetic) into two groups: nutrition counselling and control. Each subject in the intervention group received three individualised nutritional counselling sessions during the first 6 months aimed at increasing intakes of fruits, vegetables and olive oil, reducing saturated fat and improving physical activity. Body composition, biochemical indicators and lifestyle were assessed at baseline and at 6 months and 1 year in both groups.

Results

After 6 months of follow-up, body weight, waist circumference, diastolic blood pressure, fasting blood glucose, total and low-density lipoprotein cholesterol, total and saturated fat, and dietary energy and cholesterol levels showed a more significant decrease among subjects in the intervention group than in the control group (P<05). Moreover, the intervention group showed significantly greater improvement in each intervention goal, such as reduced intake of saturated fat and increased intakes of fruits, vegetables, fibre and olive oil (P<0.05). After 12 months of follow-up, most of the outcomes were maintained.

Conclusions

The low-cost nutritional intervention programme improved serum lipids profile and weight control, and appeared to be feasible for use at a primary health-care centre in a developing country.

Periodontal disease in patients with ischemic coronary atherosclerosis at a University Hospital

OBJECTIVE

To verify the prevalence of periodontal disease (PD) in patients with ischemic heart disease. PD is a serious public dental health care problem with a differentiated distribution in regards to severity, age group, type of infection, co-morbidities and risk factors.

METHODS

Four hundred and eighty patients were examined at the Ischemic Cardiopathy Outpatient Clinic of the Hospital das Clínicas of the Ribeirão Preto Medical School, São Paulo University, as well as 154 patients without heart disease from the same institution. Fifty-eight patients with heart disease and 62 patients without heart disease between the ages of 30 and 79 met the criteria to be included in the investigation. In accordance with recommendations of WHO (1999) the Community Periodontal Index (CPI) and the Periodontal Attachment Loss Index (PALI) were used.

RESULTS

Patients with heart disease had a prevalence of sextants with moderate to advanced PD (76.3% versus 20.2%; p < 0.00001). In these patients, 1.1% of the sextants were found to be healthy versus 32.0% of those without heart disease (p < 0.00001). In regards to the progression of PD, 6.0% of the sextants of the patients with heart disease did not exhibit attachment loss versus 68.0% of those without heart disease (p < 0.00001). Dental biofilm was observed in 100.0% of the patients with heart disease and in 82.3% of those without heart disease (p < 0.001). Treatment of periodontal pockets > 6 mm was required in 79.3% of the patients with heart disease versus 9.7% of those without heart disease (p < 0.0001).

CONCLUSION

PD was very prevalent in the groups studied with a higher degree of severity in those with ischemic heart diseases. The elevated prevalence of risk factors found, indicates that intervention strategies are required.

Perda dentária e a imagem do cirurgião-dentista entre um grupo de idosos

O presente estudo busca analisar as percepções, memórias e crenças de um grupo de idosos de origem japonesa quanto às perdas dentárias. Para o presente estudo, foram definidos em processo de amostragem aleatória simples quarenta indivíduos com critérios de inclusão a partir da geração (Issei e Nisei) e condição bucal (edêntulos e dentados), formando quatro grupos com dez indivíduos cada. Foram realizadas entrevistas domiciliares, com os indivíduos que preencheram os critérios de inclusão-exclusão para cada grupo. Utilizando como estratégia metodológica a construção do Discurso do Sujeito Coletivo, foram definidas as categorias de análise: motivo das perdas dentárias, momento das perdas e o papel do cirurgião-dentista. Dificuldades de acesso à assistência odontológica e a naturalização da perda dentária constituem fatores sociais e culturais fortemente imbricados que resultam em edentulismo precoce. Dor e medo são sentimentos estritamente ligados à imagem do cirurgião-dentista, ainda que se reconheça uma evolução na odontologia, tanto com relação aos equipamentos, materiais e técnicas utilizadas quanto à formação e conduta do profissional.

Which body mass index is best associated with risk of diabetes mellitus and hypertension in a Japanese-Brazilian population?

The objective of this study was to evaluate the impact of different body mass index (BMI) ranges associated with the risk of diabetes and hypertension in Japanese-Brazilians. This cross-sectional study was based on data from 1,330 Japanese-Brazilians > 30 years of age who participated in a population-based survey on the prevalence of diabetes mellitus and associated diseases. Glucose tolerance status was classified according to WHO criteria and blood pressure levels according to the VI-JNC. Odds ratios for diabetes and hypertension were calculated for different BMI ranges; for different BMIs, sensitivity and specificity for percentiles 25, 50, 75, 90 and 95 were obtained. Increased odds ratios for diabetes mellitus and hypertension were observed with BMI values > 25kg/m². The 50th percentile corresponded to the highest sensitivity and specificity for the identification of risk for both diseases. Our results suggest that BMI values proposed by WHO should also be useful for this group of Japanese descendants in the assessment of risk for DM and hypertension.

Influência da aculturação na autopercepção dos idosos quanto à saúde bucal em uma população de origem japonesa

O presente estudo busca avaliar a influência da aculturação da população idosa na autopercepção de sua saúde bucal, utilizando metodologia qualitativa. A população-alvo foi composta por quarenta indivíduos divididos em dois grupos principais, o dos pertencentes à primeira geração de imigrantes japoneses e o da segunda geração. Mediante entrevista gravada, foi avaliado o nível de aculturação de cada grupo e sua influência sobre os cuidados tomados com a saúde bucal, a auto-avaliação da condição bucal e o tempo decorrido desde a última visita ao cirurgião-dentista. O processo de aculturação atinge ambos os grupos, porém com maior intensidade o grupo da segunda geração; isso, no entanto, não interfere na autopercepção da saúde bucal desta população. Os principais cuidados tomados com a saúde bucal foram: escovação, uso do fio dental e imersão da prótese em soluções anti-sépticas. Na auto-avaliação da condição bucal, as principais queixas se deram em relação ao uso de próteses; o tempo decorrido desde a última visita ao cirurgião-dentista foi, em média, de 1,4 ano para os não edêntulos e 6,3 anos para os edêntulos.

Comportamento alimentar em mulheres portadoras de diabetes tipo 2

OBJETIVO: Conhecer os pensamentos, sentimentos e comportamentos em relação à dieta de mulheres portadoras de diabetes tipo 2. MÉTODOS: Trata-se de um estudo descritivo exploratório, de natureza qualitativa. Foram entrevistadas oito mulheres portadoras de diabetes tipo 2 em uma Unidade Básica de Saúde do município de Ribeirão Preto, SP, em janeiro de 2003. Foi utilizada entrevista semi-estruturada para a coleta dos dados. O referencial teórico adotado foi a teoria das representações sociais. Os registros audiogravados e transcritos foram submetidos à análise temática de conteúdo. RESULTADOS: Os resultados evidenciaram dificuldade no seguimento da dieta prescrita, em função dos diversos significados associados, tais como a perda do prazer de comer e beber, da autonomia e da liberdade para se alimentar. Assim, seguir a dieta adquire caráter extremamente aversivo e cerceador, tendo representação de que realizá-la traz prejuízos à saúde. A freqüente ausência de sintomas foi citada como um dos aspectos que dificultam o seguimento da dieta. Outra dificuldade foi tocar, olhar e manipular os alimentos durante o seu preparo e não poder ingeri-los. Os alimentos doces despontaram como algo extremamente desejado. Transgressão e desejo alimentar estão igualmente presentes na vida das pessoas entrevistadas. Seguir o padrão dietético recomendado elicia tristeza, e o ato de comer, muitas vezes, vem acompanhado de medo, culpa e revolta. CONCLUSÕES: O comportamento alimentar da mulher portadora de diabetes tipo 2 é bastante complexo e precisa ser compreendido à luz dos aspectos psicológicos, biológicos, sociais, culturais, psicológicos e econômicos para maior eficácia das intervenções educativas.

[Introduction of sucrose in the diet plan of persons with type 1 diabetes: its influence in the glycemic control]

To evaluate the influence of sucrose intake in the glycemic control, ten adolescents with type 1 diabetes were followed during eight months. Initially, they received personalized orientation on diet, self monitoring blood glucose and insulin dose adjustment; after four months, all patients introduced sucrose in their afternoon meals, through the method of carbohydrate counting. Total cholesterol and triglycerides levels were measured in the beginning and in the final of the study. Hemoglobin A1C levels were measured in the beginning, after four months without and after four months with intake of foods with sucrose. All patients showed adequate pubertal development and growth; two had overweight and the others were eutrophic. After four months of follow up, the frequency of self monitoring blood glucose was reduced (p< 0.001). Total cholesterol and triglycerides values were in the normal range and A1C values decreased during the observed period (p= 0.027).

CONCLUSION

The consumption of foods with sucrose, using the technique of carbohydrate counting, did not affect the metabolic control of adolescents with type 1 diabetes.

Intervenção nutricional e prevenção primária do diabetes mellitus tipo 2: uma revisão sistemática

O diabetes mellitus tipo 2 pode ser considerado um dos principais problemas de saúde pública no mundo atual. A prevalência crescente em diversos países e o difícil controle metabólico dos indivíduos com a doença em evolução justificam o estudo de estratégias para prevenção primária do diabetes mellitus tipo 2. Ensaios clínicos aleatorizados controlados recentes sugerem um impacto importante da intervenção nutricional na redução do risco de desenvolvimento de diabetes mellitus tipo 2 entre indivíduos portadores de fatores de risco. O presente artigo de revisão descreve o impacto de programas de intervenção no estilo de vida em ensaios clínicos aleatorizados controlados para a prevenção primária do diabetes mellitus tipo 2.

Analysis of criteria for metabolic syndrome in a population-based study of Japanese-Brazilians

OBJECTIVE

Criteria for metabolic syndrome (MS) differ particularly regarding the definition of central obesity and consequently, there could be differences in the assessment of cardiovascular risk. We estimated the prevalence of metabolic syndrome, compared the agreement of the World Health Organization (WHO) criteria with the standard and a modified National Cholesterol Education Program (NCEP) criterion and investigated whether additional factors were associated with the diagnosis of the syndrome in a Japanese descendant population.

METHODS

In this cross-sectional, population-based survey, 1166 Japanese-Brazilians (533 men, 633 women) aged 57.4 +/- 12.4 years with mean body mass index (BMI) and waist of 25.2 +/- 4.0 kg/m(2) and 84.5 +/- 10.6 cm, respectively, were included. McNemar and kappa statistics were used to assess the concordance between WHO criteria with the standard and a modified NCEP criteria (waist of 90 and 80 cm, for men and women, respectively). In logistic regression analysis, a number of metabolic variables and albumin-to-creatinine ratio were included to test independent associations with metabolic syndrome defined by the modified NCEP criteria.

RESULTS

According to WHO, 55.4% (95% CI 52.5-58.2%) of the subjects had MS and to NCEP 47.4% (95% CI 44.6-50.0%). WHO criterion detected 48.3% of central obese subjects while NCEP only 14.0%. Kappa statistics showed a good strength of agreement (k = 0.67, p < 0.01) between WHO and NCEP standard definitions of MS. Using the modified NCEP criterion for Asians, more subjects with metabolic syndrome were identified (58%) and agreement with WHO was improved (k = 0.72, p < 0.001). However, similar Framingham risk scores were attributed to the subsets of subjects classified by any of the three criteria. Areas under the receiver operating characteristic curves, obtained for the modified waist values to diagnose metabolic syndrome according to WHO, were > 0.80 and corresponded, respectively, to sensitivity and specificity of 63 and 83% for men and 77 and 72% for women. In final logistic regression model, age, male sex, BMI and homeostasis model assessment-insulin resistance but not with albumin-to-creatinine ratio (ACR) were independently associated with the syndrome.

CONCLUSIONS

High prevalence of MS, independent of the criterion considered, was found in this Japanese-Brazilian population. The replacement of waist cutoff by those proposed by WHO for Asians lead to this diagnosis in a higher number of subjects with elevated cardiovascular risk. Our data did not support that ACR should be included in the classical definition of MS in Japanese descendants as previously suggested by WHO.

Independent impact of glycemia and blood pressure in albuminuria on high-risk subjects for metabolic syndrome

BACKGROUND

Microalbuminuria may reflect diffuse endothelial damage. Considering that diabetes and hypertension cause vasculopathy, we investigated associations of albumin-to-creatinine ratio (ACR) with plasma glucose and blood pressure levels in high-risk subjects for metabolic syndrome.

METHODS

A sample of 519 (246 men) Japanese-Brazilians (aged 60 +/- 11 years), who participated in a population-based study, had their ACR determined in a morning urine specimen. Backward models of multiple linear regression were created for each gender including log-transformed values of ACR as dependent variable; an interaction term between diabetes and hypertension was included.

RESULTS

Macroalbuminuria was found in 18 subjects. ACR mean values for subjects with normal glucose tolerance, impaired fasting glycemia, impaired glucose tolerance and diabetes were 9.9 +/- 6.0, 19.0 +/- 35.4, 20.7 +/- 35.4, and 33.9 +/- 55.0 mg/g, respectively. Diabetic subjects showed higher ACR than the others (p < 0.05). An increase in the proportion of albuminuric subjects was observed as glucose metabolism deteriorated (4.9, 17.0, 23.0 and 36.0%). Stratifying into 4 groups according to postchallenge glycemia (< 7.8 mmol/l, n = 91; > or = 7.8 mmol/l, n = 410) and hypertension, hypertensive and glucose-intolerant subgroups showed higher ACR values. ACR was associated with gender, waist circumference, blood pressure, plasma glucose and triglyceride (p < 0.05); albuminuric subjects had significantly higher levels of such variables than the normoalbuminuric ones. In the final models of linear regression, systolic blood pressure and 2-hour glycemia were shown to be independent predictors of ACR for both genders (p < 0.05). In men, also waist was independently associated with ACR. No interaction was detected between "diabetes and hypertension".

CONCLUSIONS

These findings suggest that both glucose intolerance and hypertension could have independent but not synergistic effects on endothelial function--reflected by albumin loss in urine. Such hypothesis needs to be confirmed in prospective studies.

[Trends in diabetes mellitus in Brazil: the role of the nutritional transition]

Prevalence of type 2 diabetes mellitus has increased rapidly and is expected to increase even further. In Latin America countries there is an upward trend among the younger age groups, with a major negative impact on the quality of life and burden of the disease for the health care system. Increasing rates of overweight and obesity associated with lifestyle changes and aging of the population are the main contributing factors to the increasing prevalence of type 2 diabetes. Dietary shifts in the Brazilian population (low frequency of fiber-rich foods and heavy consumption of saturated fatty acids and sugars) and sedentary lifestyle are the main risk factors for obesity, type 2 diabetes, and other chronic diseases. Diabetes prevention programs are being promoted in several countries with results showing improvement in quality of life.

Prevalência de diabetes mellitus: diferenças de gênero e igualdade entre os sexos

O presente estudo tem como propósito caracterizar a prevalência de Diabetes Mellitus (DM) em São Paulo, segundo diferenciais sociais e de gênero, constituindo um desdobramento do inquérito domiciliar realizado em nove capitais brasileiras (Estudo Multicêntrico de Prevalência de Diabetes Mellitus no Brasil). Este levantamento envolveu duas etapas de investigação: numa primeira fase, foi rastreada a glicemia capilar de jejum (GCJ) em 2.007 indivíduos, na faixa etária de 30 a 69 anos; numa segunda fase, foi realizada a determinação da glicemia capilar após 2 horas de sobrecarga com 75g de glicose em todos os indivíduos com GCJ maior ou igual a 100mg/dl e em 1/6 dos indivíduos com GCJ menor que 100mg/dl. Realizada a expansão dos resultados obtidos na segunda fase da investigação para a amostra original, foram estudadas as prevalências de DM pré e recém diagnosticados, relacionando-as com idade, sexo, ocupação, escolaridade, naturalidade, bem como com a distribuição por área. Ancorada na oposição e complementaridade das relações de gênero, a presente proposta se organiza norteada pela hipótese de que o DM recém-diagnosticado aumentaria na população masculina e nos segmentos mais pobres da população, diante da busca ativa, como contraponto dos resultados referenciados ao DM pré- diagnosticado ou auto-referido. Os resultados encontrados confirmaram as referidas hipóteses, ressaltando o desaparecimento das diferenças entre os sexos. A elevada proporção da doença decorrente da busca ativa, duplicando a prevalência observada entre os pré-diagnosticados, chamou a atenção para a relevância da consideração socialmente diferenciada na detecção dos novos casos. A identificação de diversificadas injunções sociais junto às populações masculina e feminina, associadas à ocorrência do diabetes, reforçaram a necessidade da realização de estudos específicos sobre a obesidade, com vistas à melhor compreensão das situações de risco e prevenção da doença.

Condições de saúde bucal e diabetes mellitus na população nipo-brasileira de Bauru-SP

Este estudo transversal foi delineado para estimar a prevalência de diabetes mellitus, intolerância à glicose e condições de saúde bucal na população de origem japonesa, na faixa de 40 a 79 anos de idade, residente no município de Bauru-Brasil. Todos os indivíduos da primeira geração (isseis) e uma amostra casualizada de um terço da segunda geração (niseis) foram submetidos a entrevista domiciliar, totalizando 530 indivíduos. O exame clínico e teste oral de tolerância à glicose, e exame das condições de saúde bucal, foram realizados no Hospital de Reabilitação de Anomalias Crânio-Faciais - USP. Os dados foram processados através do programa Epi-Info, sendo que 22,9% apresentaram ocorrência de diabetes mellitus (grupo I), 15,1% tolerância à glicose diminuída (grupo II) e 61,9% foram considerados normoglicêmicos (grupo III). O percentual de indivíduos desdentados totais foi de 45,9% para a amostra e valores de 58,4%, 46,7% e 41,2% foram verificados para os grupos I, II e III, respectivamente. Entre os indivíduos edêntulos, nenhum apresentava necessidade de confecção de prótese total, em contraposição aos dados encontrados para a população brasileira em levantamento realizado pelo Ministério da Saúde (1986), cuja necessidade era da ordem de 8,3% na faixa etária de 35 a 59 anos. Pôde-se concluir que o edentulismo apresenta associação significante com a ocorrência de diabetes mellitus, porém não com a intolerância à glicose.

Prevalence and 7-year incidence of Type II diabetes mellitus in a Japanese-Brazilian population: an alarming public health problem

AIMS/HYPOTHESIS

In 1993, the prevalence of glucose intolerance was studied in a sample of 647 first-generation and second-generation Japanese-Brazilians. Their cohort was followed until 2000, when a second survey was conducted, this included the first and second generations, aged 30 or more years. The aims were to estimate the prevalence of glucose intolerance and 7-yr incidence of Type II (non-insulin-dependent) diabetes mellitus in this population.

METHODS

Prevalence rates were obtained for 1330 subjects examined in 2000. The incidence of diabetes mellitus was calculated for those classified as normal glucose tolerant in 1993 (n=253). A Student's t test and the Cox proportional hazard model were used in data analysis.

RESULTS

In the year 2000, higher proportions of subjects were observed in all categories of glucose intolerance than those found in 1993. The overall incidence of diabetes was 30.9 per 1000 per year. A worse profile was observed among incident cases of diabetes, characterized by higher baseline values of anthropometric and metabolic variables as compared to those who had not developed diabetes. Analysis considering the simultaneous effects of demographic, nutritional and metabolic variables and physical activity levels for the development of diabetes showed that age, sex, waist circumference, fasting and 2-h plasma glucose concentrations were independent predictors.

CONCLUSION/INTERPRETATION

Our data point towards a worsening of glucose tolerance status among Japanese-Brazilians, who show one of the highest prevalence rates of diabetes mellitus worldwide. This could reflect their strong genetic susceptibility associated with unfavourable environmental conditions.

Capture-recapture method to estimate lower extremity amputation rates in Rio de Janeiro, Brazil

OBJECTIVE

To estimate rates of lower extremity amputations (LEAs) in persons with peripheral vascular disease, diabetes mellitus, trauma, neoplasm, osteomyelitis, or emphysematous gangrene.

METHODS

Regional amputee registries were used to estimate the rate of lower extremity amputations with the capture-recapture (CR) technique. Data were extracted from three amputee registries in Rio de Janeiro: source 1, with 1,191 cases from 23 hospitals; source 2, with 157 cases from a limb-fitting center; and source 3, with 34 cases from a rehabilitation center. Amputee death certificates from source 1 identified 257 deaths from 1992 to 1994. Three CR models were evaluated using sources 2 and 3. In order to avoid an overestimation of the rate of LEAs, two models were applied for the data analysis: in one case, deceased patients listed in source 1 were excluded from the model, and in the other case, deceased patients were included as well.

RESULTS

Excluding the 257 deaths, the estimated number of amputations in the municipality of Rio de Janeiro from 1992 to 1994 was 3,954, for a mean annual incidence rate of 13.9 per 100,000 inhabitants. Among persons with diabetes, the annual incidence rate of lower extremity amputations was substantially higher (180.6 per 100,000 persons per year), representing 13 times the risk of individuals without diabetes. The yearly rate of LEAs according to the routine surveillance system was estimated at 5.4 and 96.9 per 100,000 in the general population and in diabetics, respectively. If data from the three registries are added, 1,382 patients with LEAs were identified, with the reasons for the amputations distributed as follows: peripheral vascular disease = 804 (58.1%); diabetes mellitus = 379 (27.4%); trauma = 103 (7.4%); osteomyelitis = 44 (3.1%); gangrene = 36 (2.6%), and neoplasm = 16 (1.1%).

CONCLUSIONS

These findings show a high incidence of LEAs in Brazil, when compared to countries such as Spain, that is attributable mainly to peripheral vascular disease and diabetes mellitus.

[The relationship between oral habits and malocclusion in preschool children]

OBJECTIVE

To evaluate the way oral habits and speech problems affect dental occlusion in preschool children.

METHODS

A random sample of 2,139 boys and girls aged 3-5 years old was evaluated. The children were enrolled in private and state institutions in the city of Bauru, São Paulo State, Brazil. The cross-sectional study was developed in two steps: occlusion assessment, and a questionnaire about their social and economic status. The occlusal anatomical-functional characteristics assessment was done according to Angle classification. Additionally, overjet, overbite, crowding, anterior open bite, posterior crossbite, and anterior crossbite were evaluated. A sub-sample of 618 children filled out the questionnaire. The prevalence of malocclusion and some variables of exposure were tested by bivariate analysis.

RESULTS

The prevalence of malocclusion was 51.3% for boys and 56.9% for girls. There was no difference related to gender. In regard to age, there was a higher prevalence of malocclusion in the 3 year-old group, which decreased significantly with age (p<0.05).

CONCLUSIONS

Among the environmental factors evaluated, the habit of sucking a pacifier was the most important in the association with malocclusion (OR=5.46) followed by the habit of sucking fingers (OR=1.54). Speech problems did not show any influence in malocclusion occurrence.

Dietary patterns in a high-risk population for glucose intolerance. Japanese-Brazilian Diabetes Study Group

We evaluated dietary habits as risk factor for glucose intolerance in a high risk population of Japanese-Brazilians enrolled in a study on the prevalence of diabetes (DM). Based on oral glucose tolerance test and WHO criteria, 331 had normal tolerance (NGT), 88 impaired tolerance (IGT) and 83 had type 2 DM (51 self-reported, 32 newly diagnosed diabetics). Clinical, laboratory and dietary data, assessed by food frequency questionnaire (FFQ), were compared between the NGT group and another composed of IGT and newly diagnosed DM (disturbed glucose tolerance or DGT group). Associations of total energy intake and nutrient intakes with glucose intolerance were analyzed by logistic regression. Also, subjects with NGT and DGT entered into separate models of multiple linear regression including BMI as the dependent variable, and total energy intake or each nutrient as independent variables. DGT group showed higher waist-to-hip ratio, blood pressure, plasma glucose and insulin levels and worse lipid profile. Total energy intake, macronutrients, fibers, alcohol and saturated fat intakes did not differ between groups; DGT was not associated with any nutrient intake in multivariate analyses. BMI of the subjects with DGT but not with NGT was associated with protein and cholesterol intakes in linear regression analysis. Our findings did not support an association between nutritional factors and glucose intolerance even in subjects who are unaware of their DGT, using FFQ to reflect current habits. However, we suggest that protein and cholesterol intakes may be markers of increased BMI. Despite assuming that obesity and insulin resistance precedes DM, FFQ may not be useful in the assessment of unfavorable dietary patterns among subjects at risk for glucose intolerance, such as Japanese-Brazilians with elevated BMI.

Weight gain in adulthood and risk of developing glucose tolerance disturbance: a study of a Japanese-Brazilian population. Japanese-Brazilian Diabetes Study Group

We examined the data from 530 subjects enrolled in a survey on the prevalence of diabetes in a Japanese-Brazilian population aged 40-79 years. Past self-reported and current weight values were analysed. Student t test was used to compare anthropometric measures between subjects with and without disturbance of glucose tolerance (DGT), hypertension and dyslipidemia. Point and interval estimates of the weight at 20 years-, age- and sex-adjusted odds ratios (OR) were obtained by logistic regression analysis to evaluate the relationship between these diseases and the percent weight gain. Subjects with DGT, hypertension or dyslipidemia tended to have higher BMI during adulthood and to gain more weight in a shorter interval of time. Also, they presented higher waist-to-hip ratio and plasma glucose and worse lipid profile. OR were consistent with associations between chronic diseases and percent weight gain. Trend test of OR indicated that the risk of developing DGT alone or combined with hypertension and abdominal obesity increased 2% and 15% by percent unit of gained weight, respectively, as compared with those subjects with stable weight. Weight gain and the rate by which this occurs during lifetime may confer increased risk of chronic diseases. We suggested that preventive measures against obesity, i.e. the maintenance of healthy body weight lifelong, are necessary to minimize the occurrence of these diseases, also among migrant populations such as the Japanese-Brazilians.

Comparison of glucose tolerance categories according to World Health Organization and American Diabetes Association diagnostic criteria in a population-based study in Brazil. The Japanese-Brazilian Diabetes Study Group

OBJECTIVE

To compare the prevalence of different categories of glucose tolerance in a Japanese-Brazihan population using World Health Organization (WHO) and American Diabetes Association (ADA) diagnostic criteria. RESEARCH DIVISION AND METHODS: The analyses were based on the data obtained from a study conducted in a representative sample of the Japanese-Brazilian population composed of 647 subjects (40-79 years) who were submitted to a 2-h oral glucose tolerance test. Prevalence of glucose tolerance categories and the level of agreement (K statistics) were obtained using WHO and ADA criteria. Cardiovascular risk profile of the subjects with different diagnostic categories were compared.

RESULTS

Similar prevalences of diabetes were found considering both criteria (WHO, 20.3%; ADA, 19.2%). The prevalence of impaired glucose tolerance (IGT) by WHO criteria was 14.7%, contrasting with 7.4% of impaired fasting glucose (IFG) by ADA criteria. Subjects with discordant diagnostic categories by the criteria, considered at risk for diabetes (IGT/IFG), showed a worse metabolic profile than the concordant normal subjects. However, subjects with discordant diagnoses who had IGT or diabetes by WHO criteria but who were normal by ADA criteria exhibited a higher number of cardiovascular risk factors (higher blood pressure and triglyceride and low HDL cholesterol) than those who were discordant (IFG/diabetes) by ADA criteria but normal by WHO criteria.

CONCLUSIONS

Although the number of diabetic subjects was similar between the criteria, those identified as being at risk for diabetes were quite distinct. Fewer subjects were classified as having IFG by ADA criteria than as having IGT by WHO criteria. Abnormal glucose tolerance based on WHO criteria seems to identify a worse cardiovascular profile than abnormal tolerance based on ADA criteria. Follow-up studies are necessary to know the prognostic significance of IFG to predict subsequent diabetes.

Fasting plasma glucose is a useful test for the detection of gestational diabetes. Brazilian Study of Gestational Diabetes (EBDG) Working Group

OBJECTIVE

To evaluate fasting plasma glucose as a screening test for states of gestational diabetes.

RESEARCH DESIGN AND METHODS

Baseline data of a cohort conducted in general prenatal care units in Brazil, enrolling 5,579 women aged > or = 20 years with gestational ages of 24-28 weeks at the time of testing and no previous diagnosis of diabetes. A standardized 2-h 75-g oral glucose tolerance test was performed in 5,010 women. Gestational diabetes and its subcategories--diabetes and impaired glucose tolerance--were defined according to the 1994 World Health Organization panel recommendations. We evaluated screening properties of calculated sensitivity and specificity for fasting plasma glucose with receiver operator characteristic curves.

RESULTS

For detection of the subcategory diabetes, a fasting plasma glucose of 89 mg/dl jointly maximizes sensitivity (88%) and specificity (78%), identifying 22% of the women as test-positive. For detection of impaired glucose tolerance, a value of 85 mg/dl jointly maximizes sensitivity and specificity (68%), identifying as test-positive 35% of the women. Lowering the cut point to 81 mg/dl increases sensitivity to 81%, but decreases specificity to 54%, labeling as test-positive 49% of the women.

CONCLUSIONS

Fasting plasma glucose is a useful test for the screening of both subcategories of gestational diabetes, a threshold of 85 mg/dl being an acceptable option. Effective screening for the subcategory diabetes can be achieved using a cut point of 89 mg/dl. If greater emphasis is placed on the detection of impaired glucose tolerance, a lower value, 81 mg/dl, may be needed.