The relationship between body mass index and lifestyle in a Brazilian adult population: a cross-sectional survey

Lifestyle choices of Brazilian college students

Background

Lifestyle choices reflect the beliefs that individuals attribute to aspects of life. This construct can be assessed with the Individual Lifestyle Profile (PEVI) questionnaire, which measures elements of Nutrition, Physical Activity, Preventive Behaviors, Social Relationships and Stress Management.

Objective

The objective of this study was to estimate the psychometric properties of the PEVI applied to a sample of Brazilian university students, identifying the prevalence of each lifestyle component according to participants’ age, sex, weight status, course area/field and economic stratum and to estimate the contribution of these characteristics on physical and psychological lifestyle.

Methods

The PEVI data was analyzed by confirmatory factor analysis, using the indexes chi-square per degrees of freedom ratio (χ²/df), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI) and Root Mean Square Error of Approximation (RMSEA). First-order and second-order models (physical and psychological lifestyle) were tested. Prevalences of lifestyle components were calculated and compared by participants’ age, sex, weight status, course area/field and economic stratum. A hypothetical causal structural model was elaborated to investigate the impact of sample characteristics on physical and psychological lifestyles. This model was evaluated considering the global fit to the data (χ²/df, CFI, TLI and RMSEA) and the hypothetical causal trajectories (β) (α = 5%).

Results

A sample of 1,303 students was used. The mean age was 20.9 (standard deviation = 2.8) years, 66.8% of participants were females, 63.4% had weights in the normal range and 73.7% were students of the social and exact sciences. The PEVI data showed an adequate fit for both the first- (χ²/df = 2.03, CFI = 0.98; TLI = 0.97; RMSEA = 0.04) and second-order (χ²/df = 2.25; CFI = 0.97; TLI = 0.97; RMSEA = 0.04) models. There was a higher prevalence of unfavorable physical and psychological lifestyle choices among females, among underweight and obese individuals, in older students and in those with lower economic strata. Moreover, negative behaviors in physical lifestyle were more prevalent in students from human/social/exact sciences and worse psychological lifestyle was observed among health sciences students. These results were confirmed by a structural model.

Conclusion

The PEVI data presented validity and reliability. Negative lifestyle choices had high prevalence among students. Moreover, individual characteristics had different impact on physical and psychological lifestyle choices.

Eating frequency and weight and body composition: a systematic review of observational studies

Objective

The present review aimed to examine the association of eating frequency with body weight or body composition in adults of both sexes.

Design

PubMed, EMBASE and Scopus databases were searched. PRISMA and MOOSE protocols were followed. Observational studies published up to August 2016 were included. The methodological quality of the studies was assessed with the Downs and Black checklist.

Setting

A systematic review of the literature.

Subjects

Adults (n 136 052); the majority of studies were developed in the USA and Europe.

Results

Thirty-one articles were included in the review: two prospective and twenty-nine cross-sectional studies. Thirteen per cent of the studies received quality scores above 80 %. The assessment of eating frequency and body composition or body weight varied widely across the studies. Potential confounders were included in 73 % of the studies. Fourteen studies reported an inverse association between eating frequency and body weight or body composition, and seven studies found a positive association. The majority of studies applied multiple analyses adjusted for potential confounders, such as sex, age, education, income, smoking, physical activity and alcohol intake. Six studies took into account under-reporting of eating frequency and/or energy intake in the analysis, and one investigated the mediation effect of energy intake.

Conclusions

There is not sufficient evidence confirming the association between eating frequency and body weight or body composition when misreporting bias is taken into account. However, in men, a potential protective effect of high eating frequency was observed on BMI and visceral obesity.

Associations between behavioural risk factors and overweight and obesity among adults in population-based samples from 31 countries

OBJECTIVE

Concern about overweight and obesity is growing worldwide, and more research to examine behaviours associated with the risk for increased weight in adult populations is needed. The aim of this study was to estimate associations between behavioural risk factors and overweight and obesity among adults in nationally representative population samples from 20 countries in Europe, 8 countries in Asia, Australia, Chile and USA.

METHODS

This secondary analysis is based on the International Social Survey Program (ISSP), 2011-2013, Health and Health Care Module. In a cross-sectional population-based survey (N=48,741) (mean age 46.6 years, SD=17.4, age range 15-102 years) simple or multi-stage stratified random sampling was used, yielding representative samples of the adult population of respective countries. Body Mass Index was assessed by self-reported height and weight. Correlates were risk behaviours for chronic disease (smoking status, alcohol intake, consumption of fruits and vegetable (=FV), and physical activity).

RESULTS

Overall, for all 31 countries the prevalence of overweight or obesity was 44.1%, 31.7% overweight and 12.4% obese. In adjusted logistic regression models, among men and among women ex-smoking was positively associated with both overweight and obesity, while light or moderate smoking overall and among men were inversely related with obesity. Moderate alcohol use was positively associated with both overweight and obesity, while heavy alcohol use was negatively associated with overweight. The daily consumption of FV was found to be protective from both overweight and obesity, overall and for men but not for women. Physical activity was positively associated with overweight but not obesity.

CONCLUSIONS

Some risk behaviours for chronic disease appear to be associated with overweight and obesity among adults. Interventions targeting these risk behaviours may have the potential to reduce weight.

Prevalence and clinical features of celiac disease in patients with autoimmune thyroiditis: cross-sectional study

CONTEXT AND OBJECTIVE

Celiac disease is an autoimmune disorder with an average prevalence of 1% in Europe and the United States. Because of strong European ancestry in southern Brazil, this study aimed to evaluate the seroprevalence of celiac disease among autoimmune thyroiditis patients.

DESIGN AND SETTING

Cross-sectional study in a public university hospital.

METHODS

This cross-sectional prevalence study included autoimmune thyroiditis patients who were tested for anti-endomysial and anti-transglutaminase antibodies between August 2010 and July 2011.

RESULTS

Fifty-three patients with autoimmune thyroiditis were included; 92.5% were women, with mean age of 49.0 ± 13.5 years. Five patients (9.3%) were serologically positive for celiac disease: three of them (5.6%) were reactive for anti-endomysial antibodies and two (3.7%) for anti-transglutaminase. None of them exhibited anemia and one presented diarrhea. Endoscopy was performed on two patients: one with normal histology and the other with lymphocytic infiltrate and villous atrophy.

CONCLUSION

The prevalence of celiac disease among patients with autoimmune thyroid disease was 9.3%; one patient complained of diarrhea and none presented anemia. Among at-risk populations, like autoimmune thyroiditis patients, the presence of diarrhea or anemia should not be used as a criterion for indicating celiac disease investigation. This must be done for all autoimmune thyroiditis patients because of its high prevalence.

Padrão alimentar de risco para as doenças crônicas não transmissíveis e sua associação com a gordura corporal - uma revisão sistemática

O objetivo do presente artigo é revisar estudos sobre padrão alimentar de risco para as doenças crônicas não transmissíveis (DCNT) e sua associação com a gordura corporal em adultos, publicados entre os anos de 2005 e 2012. Os artigos foram revisados sistematicamente de forma independente por 2 pesquisadores, utilizando os descritores: food consumption, chronics diseases, anthropometry, body fat e adults, nas bases de dados eletrônicas Medline, Lilacs e Scielo. Foram identificados 8 estudos que atenderam aos critérios de inclusão, todos realizados na população brasileira. A prevalência do excesso de peso e de gordura abdominal oscilou de 38,6% a 51,3% e 23,4% a 43,1%, respectivamente. Na maioria dos estudos, o consumo de frutas, legumes e verduras esteve abaixo do recomendado. Foi encontrada associação significativa entre padrões alimentares e perfil antropométrico em 5 estudos. As variações nas prevalências e nos resultados dos estudos indicam a necessidade de padronização dos instrumentos de coleta e métodos utilizados e a realização de estudos com delineamentos mais apropriados. As altas prevalências de excesso de peso e de baixo consumo de alimentos marcadores de padrões alimentares saudáveis indicam a necessidade de medidas de intervenção.

Body mass index in individuals with HIV infection and factors associated with thinness and overweight/obesity

A cross-sectional study was conducted using body mass index (BMI) to estimate the prevalence of thinness and overweight/obesity and associated factors in 2,018 individuals with HIV/AIDS attending health services referral centers. The dependent variable was classified as thinness, overweight/obesity and eutrophy. Multinomial logistic regression analyses were performed considering eutrophy as the reference level. The prevalence of thinness was 8.8% and of overweight/obesity, 32.1%. The variables associated with thinness were anemia and CD4 cell count < 200mm³. The variables associated with risk of overweight/obesity were age > 40 years and diabetes, and the variables identified as decreasing likelihood of overweight/obesity were having no long-term partner, smoking, presence of an opportunistic disease, anemia, and albumin levels < 3.5mg/dL. The main nutritional problem observed in this population was overweight and obesity, which were much more prevalent than thinness. Older individuals with diabetes should be targeted for nutritional interventions and lifestyle changes.

Selected eating behaviours and excess body weight: a systematic review

The relationship between obesity and the intake of macronutrients and specific foods is uncertain. Thus, there is growing interest in some eating behaviours because they may reflect the joint effect of several foods and nutrients and, thus, increase the likelihood of finding a link to obesity. This study examined the association between selected eating behaviours and excess weight in the general population throughout a systematic review of publications written in English, Spanish or Portuguese identified in a PubMed search up to 31 December 2010. We included 153 articles, 73 of which have been published since 2008. Only 30 studies had a prospective design; of these, 15 adjusted for sociodemographic variables, physical activity and energy or food intake. Moreover, definitions of eating behaviours varied substantially across studies. We found only small or inconsistent evidence of a relationship between excess weight and skipping breakfast, daily eating frequency, snacking, irregular meals, eating away from home, consumption of fast food, takeaway food intake, consumption of large food portions, eating until full and eating quickly. In conclusion, this review highlights the difficulty in measuring human behaviour, and suggests that a more systematic approach is needed for capturing the effects of eating behaviours on body weight.

Estado nutricional e fatores sociodemográficos em adultos residentes em Ribeirão Preto, SP, 2006: projeto OBEDIARP

OBJETIVO: Estimar as prevalências de sobrepeso e obesidade e identificar fatores sociodemográficos associados a estes desfechos, em residentes de Ribeirão Preto - SP, Brasil, em 2006. MÉTODOS: Estudo epidemiológico transversal, de base populacional, conduzido em adultos de ambos os sexos com 30 anos e mais. O processo de amostragem foi desenvolvido em três estágios, sorteando-se inicialmente 81 setores censitários e, subsequentemente, 1.671 domicílios e 1.205 elegíveis. A variabilidade introduzida na terceira fração de amostragem (sorteio de elegíveis) foi corrigida pela atribuição de pesos, originando amostra ponderada de 2.197 participantes. O estado nutricional foi classificado em três categorias (eutróficos, sobrepeso e obesos), utilizando-se os pontos de corte para o Índice de Massa Corporal (IMC), recomendados pela Organização Mundial da Saúde-2000. Para a investigação de fatores associados ao sobrepeso e à obesidade, utilizou-se a regressão de Poisson, obtendo-se razões de prevalência que foram estimadas por pontos e por intervalos com 95% de confiança. RESULTADOS: A prevalência de sobrepeso foi mais elevada entre os homens (49,7%) que entre as mulheres (33,7%), ocorrendo o inverso em relação à obesidade, nas mulheres, cuja prevalência (27,5%) ultrapassou a dos homens (19,1%). Nos modelos finais, ao se considerar o "sobrepeso", permaneceram como fatores positivamente associados: as faixas etárias de "50 a 59 anos" e "60 anos e mais"; o "1º terço" de renda e "viver com companheiro(a)". Em relação ao sexo, ser do sexo feminino constituiu-se em fator de proteção para este desfecho. Para a "obesidade", todas as categorias de idade e o estado marital permaneceram positivamente associados a este desfecho. CONCLUSÃO: Além da elevada prevalência de sobrepeso e obesidade no município, a detecção de diferentes conjuntos de variáveis sociodemográficas associadas aos componentes do excesso de peso indica a necessidade de estratégias específicas de intervenção sobre estes grupos, tendo em vista a promoção da saúde e a prevenção de doenças crônico-degenerativas, na população.

Prevalência e fatores associados ao excesso de peso em adultos: inquérito populacional em Rio Branco, Acre, Brasil, 2007-2008

Estudos populacionais no Brasil apontam aumento da prevalência de excesso de peso e obesidade na população adulta, em todas as regiões. O objetivo deste estudo foi estimar a prevalência e identificar os principais fatores associados ao excesso de peso em adultos, em Rio Branco, Acre, Brasil, por meio de um estudo transversal de base populacional com amostra composta de 1.469 adultos. A análise multivariada foi realizada através de regressão de Poisson, adotando-se, como variável dependente, excesso de peso (IMC > 25kg/m²). A prevalência de excesso de peso foi observada em 46,9% da amostra, sendo mais elevada entre as mulheres. Observou-se tendência de aumento do excesso de peso com o aumento da idade em ambos os gêneros. Observaram-se associações entre o excesso de peso e variáveis socioeconômicas, demográficas e morbidades como hipertensão arterial e dislipidemias. A alta prevalência de excesso de peso em adultos de ambos os sexos sugere um problema de saúde pública. Tornam-se necessárias medidas de controle e prevenção dos riscos à saúde associados ao excesso de peso.

Tabagismo associado a outros fatores comportamentais de risco de doenças e agravos crônicos não transmissíveis

Foram entrevistados via ligação telefônica 1.410 indivíduos, amostra aleatória e representativa da população acima de 18 anos residente em domicílios conectados à rede de telefonia fixa. A prevalência de tabagismo foi de 21,8%, maior em homens (25%) e em indivíduos na faixa entre 18 e 29 anos. Tabagismo e sedentarismo juntos ocorrem em 13,9% dos homens e 14,2% das mulheres; tabagismo e baixo consumo de frutas em 12,9% dos homens e 12,3% das mulheres; e tabagismo e baixo consumo de legumes em 5,8% dos homens e 5,1% das mulheres. A associação de tabagismo e consumo excessivo de álcool foi observada apenas nos homens (em 3,5% deles) e, da mesma forma que verificada para tabagismo isoladamente, sua ocorrência concomitante a outros fatores comportamentais de risco de doenças e agravos crônicos não transmissíveis (DANT) associou-se inversamente à escolaridade. Os dados apontam indícios de efeito de aglomeração entre tabagismo e sedentarismo, tabagismo e álcool em excesso, tabagismo e dieta inadequada, justificando intervenções focadas na prevenção e redução concomitante dos principais fatores comportamentais de risco de DANT.

Prevalence of obesity and associated sociodemographic and lifestyle factors in Morocco

OBJECTIVE

In Morocco, the association between obesity/overweight and socio-demographic and lifestyle factors is poorly understood. The present study aimed to investigate this association in a representative sample of the Moroccan population aged 18 years and above.

DESIGN

This is a cross-sectional study using a questionnaire including demographic, socio-economic and physical activity items. Height and weight were measured and BMI was computed. The association between obesity (BMI ≥ 30.0 kg/m2) or overweight (25.0 ≤ BMI < 29.9 kg/m2) and the other variables was analysed using multiple binomial logistic regression, separately in men and women.

SETTING

The whole Moroccan territory.

SUBJECTS

A total of 2891 subjects took part in the survey (1430 men and 1461 women).

RESULTS

The prevalence of obesity was 20.9 % in women and 6.0 % in men (P < 0.0001). The prevalence of overweight was 32.9 % in women v. 26.8 % in men (P < 0.0001). In women, the risk of obesity and overweight increased with age, with the highest risk being in individuals aged 45-54 years (OR = 3.02, 95 % CI 2.06, 4.44) compared to individuals <35 years old. Married women were more prone to obesity and overweight (OR = 2.42, 95 % CI 1.50, 3.91) than single women. In men, the risk of obesity and overweight increased with average family income (OR = 2.62, 95 % CI 1.40, 4.87 for family income ≥5000 MAD/month compared to <2000 MAD/month) and in married persons (OR = 3.75, 95 % CI 1.78, 7.81) compared to single individuals.

CONCLUSIONS

These results contribute to target groups in whom prevention programmes could be implemented.

Associação entre excesso de peso e hábito de fumar, Santarém, PA, 2007

OBJETIVO: Estudar associação entre excesso de peso e hábito de fumar. METODOLOGIA: Estudo transversal desenvolvido por telefone numa amostra probabilística de adultos (Santarém /PA), em 2007. Variável desfecho foi excesso de peso, explanatória hábito de fumar e de confusão idade, escolaridade, união conjugal, estado nutricional prévio, abuso de bebidas alcoólicas, atividade física no lazer e padrão alimentar. Associação entre excesso de peso e demais variáveis foi investigada pelo teste do qui-quadrado e regressão de Poisson para o cálculo das razões de prevalência de excesso de peso conforme hábito de fumar, considerando-se três níveis de hierarquia: características sociodemográficas, estado nutricional prévio e padrão comportamental. RESULTADOS: Verificou-se 40,6% de excesso de peso e 16,4% de fumantes. As variáveis associadas ao excesso de peso foram: maior idade, menor escolaridade, união conjugal estável, excesso de peso aos 20 anos e hábito de não consumo de refrigerante para ambos os sexos; não ativo no lazer para homens e hábito de fumar (atual e passado) para mulheres. As razões de prevalência de excesso de peso não apresentaram associação com hábito de fumar para homens, porém para mulheres houve tendência de maior prevalência de excesso de peso para fumantes atuais, chegando a 2,56 vezes mais do que para nunca fumantes e ex-fumantes. CONCLUSÃO: Este estudo constatou que a prevalência de excesso de peso foi maior para mulheres fumantes, comparativamente às ex-fumantes e nunca fumantes. Para os homens não se observou nenhuma associação entre excesso de peso e tabagismo.

Effects of dietary coconut oil on the biochemical and anthropometric profiles of women presenting abdominal obesity

The effects of dietary supplementation with coconut oil on the biochemical and anthropometric profiles of women presenting waist circumferences (WC) >88 cm (abdominal obesity) were investigated. The randomised, double-blind, clinical trial involved 40 women aged 20-40 years. Groups received daily dietary supplements comprising 30 mL of either soy bean oil (group S; n = 20) or coconut oil (group C; n = 20) over a 12-week period, during which all subjects were instructed to follow a balanced hypocaloric diet and to walk for 50 min per day. Data were collected 1 week before (T1) and 1 week after (T2) dietary intervention. Energy intake and amount of carbohydrate ingested by both groups diminished over the trial, whereas the consumption of protein and fibre increased and lipid ingestion remained unchanged. At T1 there were no differences in biochemical or anthropometric characteristics between the groups, whereas at T2 group C presented a higher level of HDL (48.7 +/- 2.4 vs. 45.00 +/- 5.6; P = 0.01) and a lower LDL:HDL ratio (2.41 +/- 0.8 vs. 3.1 +/- 0.8; P = 0.04). Reductions in BMI were observed in both groups at T2 (P < 0.05), but only group C exhibited a reduction in WC (P = 0.005). Group S presented an increase (P < 0.05) in total cholesterol, LDL and LDL:HDL ratio, whilst HDL diminished (P = 0.03). Such alterations were not observed in group C. It appears that dietetic supplementation with coconut oil does not cause dyslipidemia and seems to promote a reduction in abdominal obesity.

Fatores associados a excesso de peso e concentração de gordura abdominal em adultos na cidade de Salvador, Bahia, Brasil

O objetivo foi identificar os fatores associados ao excesso de peso e concentração de gordura abdominal em adultos de ambos os sexos. Um estudo transversal envolvendo amostra representativa de 570 adultos de Salvador, Bahia, Brasil. A regressão de Poisson foi utilizada na análise, adotando-se o índice de massa corporal (IMC) e a circunferência da cintura como variáveis dependentes. Para as mulheres, a inadequação do IMC e da circunferência da cintura ocorreu com o aumento da idade e entre as que faziam dieta no momento do estudo, a história familiar de obesidade associou-se apenas com o IMC elevado. Para os homens, o IMC elevou-se na faixa etária de 30 a 39 e 50 a 59 anos. A circunferência da cintura elevou-se com a realização de três ou menos refeições-dia, com a hipertensão arterial, uso de bebida alcoólica e diminuiu entre mulatos e negros. Tanto IMC quanto circunferência da cintura elevaram-se com a historia familiar de infarto. Portanto são distintos os fatores que se associam ao excesso de peso e da gordura abdominal em homens e mulheres. Mas muitos deles podem ser modificados com a adoção do estilo de vida saudável.