Relationship between Health Costs and Inflammatory Profile in Public Health

INTRODUCTION

The association between obesity and physical activity level is well established in the literature, as well as its consequences that lead to chronic noncommunicable diseases. In addition, it is also possible to obtain the immunometabolic mechanism that explains the pathway of associations between obesity, chronic noncommunicable diseases and the level of physical activity. It also seems clear that treating illnesses has a financial impact on healthcare systems around the world, so it seems important to assess the financial impact on the healthcare system of individuals with immunometabolic dysfunction.

AIM

This study aimed to assess whether there is a correlation between metabolic and inflammatory markers and healthcare costs according to body adiposity and habitual physical activity (HPA).

METHODS

This is a cross-sectional study, where the sample includes men and women aged over 50. Participants underwent evaluations that included the following variables: i) immunometabolic markers, ii) healthcare costs, iii) obesity, iv) habitual physical activity, and v) history of personal illness. Statistical significance was set at values lower than 5% and the software used was BioEstat.

RESULTS

The correlation between metabolic and inflammatory markers and healthcare costs demonstrated a positive and significant relationship, adjusted for obesity and HPA, between glucose concentrations and exam costs (r = 0.343, p-value = 0.007) and total cost (r = 261; p-value = 0.043); HOMA index and cost of exams (r = 0.267; pvalue = 0.038); and IL-10 and cost of medical consultation (r = 0.297; p-value = 0.020).

CONCLUSION

Metabolic and inflammatory markers may be related to the costs of consultations and examinations, independent of obesity and HPA.

Impact of sports participation on incidence of bone traumatic fractures and health-care costs among adolescents: ABCD - Growth Study

Objective: To analyze the risk of bone traumatic fractures according to the engagement in sports, as well as to identify the potential impact of sports participation and traumatic fractures on health-care costs among adolescents. Methods: This is a longitudinal 12-month study of 285 adolescents of both sexes in Brazil. We assessed the occurrence of traumatic fractures and health-care services (hospitalizations, medicine use, medical consultations, and exams) by phone contact every month for 12 months. Adolescents were divided into four groups according to sport characteristics: non-sport (n = 104), non-impact sport (swimming [n = 34]), martial arts (n = 49 [judo, karate, kung-Fu]) and impact sports (n = 98 [track-and-field, basketball, gymnastics, tennis, and baseball]). Results: The incidence of new fractures was 2.1%. The overall costs accounted during the 12-month follow-up were U$ 3,259.66. Swimmers (US$ 13.86) had higher health-care costs than non-sport (US$ 1.82), martial arts (US$ 2.23), and impact sports (US$ 2.32). Conclusion: swimming seems to be related to higher health-care costs among adolescents.

Twelve year trajectories of physical activity and health costs in mid-age Australian women

Background

Few studies have examined relationships between physical activity (PA) during mid-age and health costs in women. The aim of this study was to investigate associations between PA levels and trajectories over 12 years with medical and pharmaceutical costs in mid-age Australian women.

Methods

Data from 6953 participants in the Australian Longitudinal Study on Women’s Health (born in 1946–1951) were analysed in 2019. PA was self-reported in 2001 (50-55y), 2007 (56-61y) and 2013 (62-67y). PA data were linked with 2013–2015 data from the Medicare (MBS) and Pharmaceutical (PBS) Benefits Schemes. Quantile regression was used to examine associations between PA patterns [always active, increasers, decreasers, fluctuaters or always inactive (reference)] with these medical and pharmaceutical costs.

Results

Among women who were consistently inactive (< 500 MET.minutes/week) in 2001, 2007 and 2013, median MBS and PBS costs (2013 to 2015) were AUD4261 and AUD1850, respectively. Those costs were AUD1728 (95%CI: 443–3013) and AUD578 (95%CI: 426–729) lower among women who were consistently active in 2001, 2007 and 2013 than among those who were always inactive. PBS costs were also lower in women who were active at only one survey (AUD205; 95%CI: 49–360), and in those whose PA increased between 2001 and 2013 (AUD388; 95%CI: 232–545).

Conclusion

Maintaining ‘active’ PA status was associated with 40% lower MBS and 30% lower PBS costs over three years in Australian women. Helping women to remain active in mid-life could result in considerable savings for both women and the Australian government.

Sports Participation and Health Care Costs in Older Adults Aged 50 Years or Older

The objective of the study was to analyze the relationship between sports participation and health care costs in older adults. The sample was composed of 556 participants (145 men and 411 women) who were followed from 2010 to 2014. The engagement in sports considered three different components (intensity, volume, and previous time). Health care costs were assessed annually through medical records. Structural equation modeling (longitudinal relationship between sport and costs) and analysis of variance for repeated measures (comparisons over time) were used. Health care costs increased significantly from 2010 to 2014 (analysis of variance; p value = .001). Higher baseline scores for intensity were related to lower health care costs (r = -.223, 95% confidence interval [-.404, -.042]). Similar results were found to volume (r = -.216, 95% confidence interval [-.396, -.036]) and time of engagement (r = -.218, 95% confidence interval [-.402, -.034]). In conclusion, higher sports participation is related to lower health care costs in older adults.

Body size dissatisfaction associated with dietary pattern, overweight, and physical activity in adolescents - a cross-sectional study

This study analyzed the association of body size dissatisfaction with body mass index, dietary pattern, and physical activity in adolescents. A sample of 1,074 participants between 10-17years was recruited. Body size dissatisfaction was assessed by silhouettes scale. Dietary pattern, physical activity, and socioeconomic status were assessed by questionnaires. Body mass index was objectively measured. Body size dissatisfaction prevalence was 77.0%, where 29.8% desired to increase body size and 47.2% desired to decrease body size. Adolescents who desired to increase body size were more likely to consume vegetables and sweets, and less likely to be in highest quartile of physical activity than satisfied adolescents. Those adolescents who desired to reduce body size were more likely to have low fruit consumption and low vegetables consumption than satisfied adolescents. Health actions aiming to reduce body dissatisfaction in adolescents should address the improvement of dietary pattern and physical activity engagement, considering the desire to increase or to decrease body size, once were differently associated in this study. This article is protected by copyright. All rights reserved.

Health indicators and costs among outpatients according to physical activity level and obesity

OBJECTIVE

How biochemical variables influence the costs of the Brazilian National Healthcare System, according to body composition and physical activity.

METHODS

Participated in this study 168 patients. Biochemical variables were glucose, triglycerides, total cholesterol, high, low, very low density lipoprotein and C-reactive protein (CRP). For the cost analysis the medical records was analyzed. Physical activity was assessed through questionnaire. Body adiposity was assessed by body mass index. Four groups were defined according body adiposity and physical activity.

RESULTS

The active obese group had higher values of very low density lipoprotein and triglycerides when compared to the inactive obese. The non-obese inactive group had lower values of non-high density lipoprotein compared to the inactive obese. The non-obese active group presented lower insulin value when compared to the inactive obese. The inactive obese group presented higher values in the CRP when compared to the non-obese active and inactive groups when compared to non-obese and active obese group. There was a positive correlation between insulin, glucose, CRP and drug and total costs.

CONCLUSIONS

Biochemical variables were different according to body composition and physical activity. Insulin, glucose and CRP were related to cost in drugs and total costs.

Screen time by different devices in adolescents: association with physical inactivity domains and eating habits

BACKGROUND

Sedentary behaviors in adolescents are associated with using screen devices, analyzed as the total daily time in television viewing, using the computer and video game. However, an independent and clustered analysis of devices allows greater understanding of associations with physical inactivity domains and eating habits in adolescents.

METHODS

Sample of adolescents aged 10-17 years (N.=1011) from public and private schools, randomly selected. The use of screen devices was measured by hours per week spent in each device: TV, computer, videogames and mobile phone/tablet. Physical inactivity domains (school, leisure and sports), eating habits (weekly food consumption frequency) and socioeconomic status were assessed by questionnaire.

RESULTS

The prevalence of high use of mobile phone/tablet was 70% among adolescents, 63% showed high use of TV or computer and 24% reported high use of videogames. High use of videogames was greater among boys and high use of mobile phone/tablet was higher among girls. Significant associations of high use of TV (OR=1.43, 95% CI: 1.04-1.99), computer (OR=1.44, 95% CI: 1.03-2.02), videogames (OR=1.65, 95% CI: 1.13-2.69) and consumption of snacks were observed. High use of computer was associated with fried foods consumption (OR=1.32, 95% CI: 1.01-1.75) and physical inactivity (OR=1.41, 95% CI: 1.03-1.95). Mobile phone was associated with consumption of sweets (OR=1.33, 95% CI: 1.00-1.80). Cluster using screen devices showed associations with high consumption of snacks, fried foods and sweets, even after controlling for confounding variables.

CONCLUSIONS

The high use of screen devices was associated with high consumption of snacks, fried foods, sweets and physical inactivity in adolescents.

Functional training reduces body fat and improves functional fitness and cholesterol levels in postmenopausal women: a randomized clinical trial

BACKGROUND

This randomized clinical trial with concealed allocations, and blinding of the assessors and the data analyst, was aimed at determining the effects of 16 weeks of functional training on the body composition, functional fitness and lipid profiles in postmenopausal women.

METHODS

The study began with 64 subjects (N.=32 functional training and N.=32 control group) and ended with 50 subjects (N.=28 functional training and N.=22 control group). The exercise was conducted in circuit training format with 8 stations related to the development of muscular strength (using elastic bands for resistance) plus 3 stations focused on balance, coordination, and agility. The training session also incorporated an 18 to 30 minute walk. The control group did not participate in the exercise programs during the period of study. The participants were evaluated before and after the training period as regards their body composition (fat and lean mass), functional fitness, abdominal strength and blood chemistry variables.

RESULTS

Significant reductions were observed in all body composition variables related to fat (FM= -3.4 and Android FM= -7.7%) (P<0.05). The functional fitness components had significant improvements in coordination (-33.3%), strength (66.5%), agility (-19.5%) and aerobic capacity (-7%), and significant improvement in abdominal strength (188.2%). We observed significant improvements in total cholesterol (-4.4%) and HDL (-9.9%).

CONCLUSIONS

The observed data lead us to conclude that functional training utilizing with elastic bands and unstable bases causes significantly improved in body composition, functional fitness and lipid profiles.

The burden of abdominal obesity with physical inactivity on health expenditure in Brazil

The purpose of this study was to analyze the association between the clustering of physical inactivity with abdominal obesity and public health care expenditure in Brazilian adults. The sample was composed of 963 patients of both genders, randomly selected in the Brazilian Public Health care System during 2010. Entire health care expenditures during the last year were computed and stratified into: medical consultations, medication dispensing, laboratory tests and overall expenditure. Waist circumference was used to diagnose abdominal obesity and physical activity was assessed by previously validated questionnaire. Sedentary and abdominally obese patients (OR= 3.01 [OR95%CI= 1.81-4.99]) had higher likelihood be inserted in the group of higher expenditures than only abdominally obese patients (OR= 1.66 [OR95%CI= 1.07-2.59]). There is a synergic effect between abdominal obesity and physical inactivity on overall health care expenditures.

Early and current physical activity: relationship with intima-media thickness and metabolic variables in adulthood

BACKGROUND

It is unclear whether early physical activity has a greater influence on intima-media thickness and metabolic variables than current physical activity.

OBJECTIVE

To analyze the relationship between current and early physical activity, metabolic variables, and intima-media thickness measures in adults.

METHOD

The sample was composed of 55 healthy subjects of both sexes (33 men and 22 women). Total body fat and trunk fat were estimated by dual-energy X-ray absorptiometry. Carotid and femoral intima-media thickness were measured using a Doppler ultrasound device. A 12-hour fasting blood sample collection was taken (fasting glucose and lipid profile). Early physical activity was assessed through face-to-face interview, and the current physical activity was assessed by pedometer (Digi-Walker Yamax, SW200), which was used for a period of seven days.

RESULTS

Current physical activity was negatively related to total cholesterol (rho=-0.31), while early physical activity was negatively related to triglycerides (rho=-0.42), total cholesterol (rho=-0.28), very low density lipoprotein (rho=-0.44), and carotid intima-media thickness (rho=-0.50). In the multivariate model, subjects engaged in sports activities during early life had lower values of very low density lipoprotein (b=-8.74 [b95%CI=-16.1; -1.47]) and carotid intima-media thickness (b=-0.17 [95%CI: -0.28; -0.05]).

CONCLUSION

Early 95%CI physical activity has a significant influence on carotid intima-media thickness, regardless of the current physical activity.

The association between skipping breakfast and biochemical variables in sedentary obese children and adolescents

OBJECTIVE

To investigate the relationship between skipping meals and biochemical variables in obese children and adolescents.

STUDY DESIGN

The sample was composed of 174 obese children and adolescents, aged between 6 and 16 years (80 male and 94 female). Body composition was assessed by dual-energy x-ray absorptiometry, fasting blood glucose, and lipid profile were measured after 12 hours fasting. The frequency of skipping breakfast, lunch, or dinner was assessed through a face-to-face interview carried out with the parents.

RESULTS

The prevalence of eating breakfast daily was low in boys (47.5%) and girls (44.7%). A higher frequency of eating breakfast was negatively correlated with glucose (r = -0.16; P = .026), triglycerides (r = -0.19; P = .011), and very low density lipoprotein cholesterol (r = -0.21; P = .005). In the multivariate model, the weekly frequency of eating breakfast remained negatively associated with glucose (β = -0.975; P = .017), triglycerides (β = -7.792; P = .017), and very low density lipoprotein cholesterol (β = -1.870; P = .009) independent of age, sex, trunk fatness, and parents' education.

CONCLUSION

Skipping meals, mainly breakfast, is associated with glucose and lipid levels in obese children and adolescents.

Resting heart rate as a predictor of metabolic dysfunctions in obese children and adolescents

BACKGROUND

Recent studies have identified that a higher resting heart rate (RHR) is associated with elevated blood pressure, independent of body fatness, age and ethnicity. However, it is still unclear whether RHR can also be applied as a screening for other risk factors, such as hyperglycemia and dyslipidemia. Thus, the purpose of the presented study was to analyze the association between RHR, lipid profile and fasting glucose in obese children and adolescents.

METHODS

The sample was composed of 180 obese children and adolescents, aged between 7-16 years. Whole-body and segmental body composition were estimated by Dual-energy X-ray absorptiometry. Resting heart rate (RHR) was measured by heart rate monitors. The fasting blood samples were analyzed for serum triglycerides, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and glucose, using the colorimetric method.

RESULTS

Fasting glucose, TC, triglycerides, HDL-C, LDL-C and RHR were similar in both genders. The group of obese subjects with a higher RHR presented, at a lower age, higher triglycerides and TC. There was a significant relationship between RHR, triglycerides and TC. In the multivariate model, triglycerides and TC maintained a significant relationship with RHR independent of age, gender, general and trunk adiposity. The ROC curve indicated that RHR has a high potential for screening elevated total cholesterol and triglycerides as well as dyslipidemia.

CONCLUSION

Elevated RHR has the potential to identify subjects at an increased risk of atherosclerosis development.

Modifiable risk factors for overweight and obesity in children and adolescents from São Paulo, Brazil

Background

Brazil is currently experiencing a nutrition transition: the displacement of traditional diets with foods high in saturated fat, sodium, and cholesterol and an increase in sedentary lifestyles. Despite these trends, our understanding of child obesity in Brazil is limited. Thus, the aims of this study were (1) to investigate the current prevalence of overweight and obesity in a large sample of children and adolescents living in São Paulo, Brazil, and (2) to identify the lifestyle behaviors associated with an increased risk of obesity in young Brazilians.

Methods

A total of 3,397 children and adolescents (1,596 male) aged 7-18 years were randomly selected from 22 schools in São Paulo, Brazil. Participants were classified as normal weight, overweight, or obese based on international age- and sex-specific body mass index thresholds. Selected sociodemographic, physical activity, and nutrition behaviors were assessed via questionnaire.

Results

Overall, 19.4% of boys and 16.1% of girls were overweight while 8.9% and 4.3% were obese. Two-way analysis of variance revealed that the prevalence of overweight and obesity was significantly higher in boys and in younger children when compared to girls and older children, respectively (P < 0.05 for both). Logistic regression analysis revealed that overweight was associated with more computer usage, parental encouragement to be active, and light soft drink consumption after controlling for differences in sex, age, and parental education (P < 0.05 for all). Conversely, overweight was associated with less active transport to school, eating before sleep, and consumption of breakfast, full-sugar soft drinks, fried food and confectionery (P < 0.05 for all).

Conclusions

Our results show that obesity in São Paulo children and adolescents has reached a level equivalent to that seen in many developed countries. We have also identified three key modifiable factors related to obesity that may be appropriate targets for future intervention in Brazilian youth: transport mode to school, computer usage, and breakfast consumption.

The burden of physical activity on type 2 diabetes public healthcare expenditures among adults: a retrospective study

BACKGROUND

Determinants of public healthcare expenditures in type 2 diabetics are not well investigated in developing nations and, therefore, it is not clear if higher physical activity decreases healthcare costs. The purpose of this study was to analyze the relationship between physical activity and the expenditures in public healthcare on type 2 diabetes mellitus treatment.

METHODS

Cross-sectional study carried out in Brazil. A total of 121 type 2 diabetics attended to in two Basic Healthcare Units were evaluated. Public healthcare expenditures in the last year were estimated using a specific standard table. Also evaluated were: socio-demographic variables; chronological age; exogenous insulin use; smoking habits; fasting glucose test; diabetic neuropathy and anthropometric measures. Habitual physical activity was assessed by questionnaire.

RESULTS

Age (r = 0.20; p = 0.023), body mass index (r = 0.33; p = 0.001) and waist-to-hip ratio (r = 0.20; p = 0.025) were positively related to expenditures on medication for the treatment of diseases other than diabetes. Insulin use was associated with increased expenditures. Higher physical activity was associated with lower expenditure, provided medication for treatment of diseases other than diabetes (OR = 0.19; p = 0.007) and medical consultations (OR = 0.26; p = 0.029).

CONCLUSIONS

Type 2 diabetics with higher enrollment in physical activity presented consistently lower healthcare expenditures for the public healthcare system.

Fatores associados ao excesso de peso entre adolescentes de diferentes redes de ensino do município de Presidente Prudente, São Paulo

OBJETIVO: analisar associações entre excesso de peso e fatores de risco familiares em diferentes âmbitos escolares. MÉTODOS: estudo descritivo/analítico de delineamento transversal com 1779 adolescentes (11 a 17 anos) de ambos os sexos, da rede pública (n=1309) e privada de ensino (n=470). Foram avaliados os fatores familiares: sexo, condição econômica, número de irmãos/televisores e escolaridade dos pais. A razão de prevalência (RP) em modelo univariado e multivariado indicou a magnitude das associações analisadas. RESULTADOS: nas escolas particulares, o excesso de peso associou-se com a escolaridade paterna (RP= 0,68 [0,5-0,9]) e sexo masculino (RP= 1,38 [1,0-1,8]). Nas escolas públicas, com a escolaridade materna (RP= 1,42 [1,1-1,8]), menor número de irmãos (RP= 1,23 [0,9-1,5]) e sexo masculino (RP= 1,32 [1,6-1,6]). CONCLUSÕES: o excesso de peso associou-se com diferentes fatores familiares, dependendo da rede de ensino em que foi analisado.