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Sartorelli DS, Diez-Garcia RW, Franco LJ. Reply to "Undisclosed outcome switching, undisclosed analysis switching, inappropriate rounding, and selective reporting render paper 'Effectiveness of a minimally processed food based nutritional counselling intervention on weight gain in overweight pregnant women: a randomized controlled trial' unreliable". Eur J Nutr 2023; 62:2337-2339. [PMID: 37140646 PMCID: PMC10157620 DOI: 10.1007/s00394-023-03147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/20/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Daniela Saes Sartorelli
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Rosa Wanda Diez-Garcia
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Laércio Joel Franco
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Sartorelli DS, Crivellenti LC, Baroni NF, de Andrade Miranda DEG, da Silva Santos I, Carvalho MR, de Lima MC, Carreira NP, Chaves AVL, Manochio-Pina MG, Franco LJ, Diez-Garcia RW. Correction to: Effectiveness of a minimally processed food-based nutritional counselling intervention on weight gain in overweight pregnant women: a randomized controlled trial. Eur J Nutr 2023:10.1007/s00394-023-03148-2. [PMID: 37133533 PMCID: PMC10155155 DOI: 10.1007/s00394-023-03148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Daniela Saes Sartorelli
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Lívia Castro Crivellenti
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Naiara Franco Baroni
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Izabela da Silva Santos
- Programa de Pós-Graduação em Nutrição e Metabolismo, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Mariana Rinaldi Carvalho
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Maria Carolina de Lima
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Natália Posses Carreira
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Ana Vitória Lanzoni Chaves
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Laércio Joel Franco
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Rosa Wanda Diez-Garcia
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Sartorelli DS, Crivellenti LC, Baroni NF, de Andrade Miranda DEG, da Silva Santos I, Carvalho MR, de Lima MC, Carreira NP, Chaves AVL, Manochio-Pina MG, Franco LJ, Diez-Garcia RW. Effectiveness of a minimally processed food-based nutritional counselling intervention on weight gain in overweight pregnant women: a randomized controlled trial. Eur J Nutr 2023; 62:443-454. [PMID: 36087136 PMCID: PMC9463499 DOI: 10.1007/s00394-022-02995-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed at evaluating the effectiveness of a nutritional counselling intervention based on encouraging the consumption of unprocessed and minimally processed foods, rather than ultra-processed products, and the practice of physical activities to prevent excessive gestational weight gain in overweight pregnant women. METHODS This was a two-armed, parallel, randomized controlled trial conducted in primary health units of a Brazilian municipality from 2018 to 2021. Overweight, adult pregnant women (n = 350) were randomly assigned to control (CG) or intervention groups (IG). The intervention consisted of three individualized nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods rather than ultra-processed products, following the NOVA food classification system, and the practice of physical activities. The primary outcome was the proportion of women whose weekly gestational weight gain (GWG) exceeded the Institute of Medicine guidelines. Adjusted logistic regression models were employed. RESULTS Complete data on weight gain were available for 121 women of the IG and 139 of the CG. In modified intention-to-treat analysis, there was a lower chance of the IG women having excessive GWG [OR 0.56 (95% CI 0.32, 0.98), p = .04], when compared to the CG. No between-group differences were observed for the other maternal outcomes investigated. CONCLUSION The present study was unprecedented in demonstrating that nutritional counselling based on the NOVA food classification system, together with encouraging the practice of physical activity, is effective in preventing excessive weight gain in overweight pregnant women. TRIAL REGISTRATION Registered on July 30th 2018 at Brazilian Registry of Clinical Trials (RBR-2w9bhc).
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Affiliation(s)
- Daniela Saes Sartorelli
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Lívia Castro Crivellenti
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Naiara Franco Baroni
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Izabela da Silva Santos
- Programa de Pós-Graduação em Nutrição e Metabolismo, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Mariana Rinaldi Carvalho
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Maria Carolina de Lima
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Natália Posses Carreira
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Ana Vitória Lanzoni Chaves
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Laércio Joel Franco
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Rosa Wanda Diez-Garcia
- Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Santos IDS, Crivellenti LC, Franco LJ, Sartorelli DS. Relationship between the quality of the pregnant woman's diet and birth weight: a prospective cohort study. Eur J Clin Nutr 2021; 75:1819-1828. [PMID: 33742155 DOI: 10.1038/s41430-021-00894-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/01/2021] [Accepted: 02/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Birth weight is a relevant predictor of childhood health outcomes. Studies investigating the association between modifiable risk factors, as the maternal diet quality, and birth weight are needed. We aimed to investigate the association between the Diet Quality Index Adapted for Pregnant Women (IQDAG) score and birth weight. METHODS This is a prospective cohort that includes 547 Brazilian mother-child pairs. Dietary recalls and a food frequency questionnaire were obtained during pregnancy. Information on birth weight, sex, and gestation duration were obtained from the Live Birth Information System (SINASC). RESULTS On total, 3.8% of the newborns were classified as low birth weight (LBW), 6.0% with macrosomia, 10.2% small for gestational age (SGA), and 11.2% large for gestational age (LGA). The mean (SD) IQDAG score was 70.1 (11.8). Adjusted logistic regression models showed that women in the third tertile of the IQDAG score presented a lower risk of having LGA babies [OR 0.44 (95% CI 0.22, 0.90), p-trend = 0.02] compared to the first tertile. Women in the third tertile of omega-3 intake presented a lower risk of giving birth to LGA infants [OR 0.33 (95% CI 0.15, 0.69), p-trend = 0.00] and LBW infants [OR 0.18 (95% CI 0.04, 0.83), p-trend = 0.02] when compared to the first tertile. There was also a lower SGA trend among the children of women in the third tertile of omega-3 intake [OR 0.43 (95% CI 0.17, 1.07), p-trend = 0.03] compared to the first tertile. CONCLUSION A better diet quality and higher omega-3 intake are protective factors for LGA babies, and increased maternal omega-3 intake reduce the risk of LBW and LGA, and may be a protective factor against the birth of SGA infants.
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Affiliation(s)
- Izabela da Silva Santos
- Graduate Program in Nutrition and Metabolism, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lívia Castro Crivellenti
- Graduate Program in Public Health, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Laércio Joel Franco
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniela Saes Sartorelli
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Sartorelli DS, Carvalho MR, da Silva Santos I, Crivellenti LC, Souza JP, Franco LJ. Dietary total antioxidant capacity during pregnancy and birth outcomes. Eur J Nutr 2020; 60:357-367. [PMID: 32347332 DOI: 10.1007/s00394-020-02251-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 04/14/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE To investigate the effect of maternal dietary total antioxidant capacity (DTAC) and main food sources on the risk of preterm birth (PB) and offspring birth size. METHODS Cohort study that included 733 Brazilian mother-child pairs. Two 24 h dietary recalls were obtained during pregnancy and the usual intake was estimated through the Multiple Source Method. Data of the offspring were extracted from the national live births information system. Adjusted multivariable logistic regression models were used to investigate the relationship that energy-adjusted DTAC and food sources have with the outcomes. RESULTS In total, 9.7% of the children were PBs, 6.0% were born with low birth weight (LBW), 6.7% with macrosomia, 9.3% were small for gestational age (SGA) and 16.4% large for gestational age (LGA). The mean energy-adjusted DTAC ± SD was 4.7 ± 2.1 mmol. The adjusted OR (95%CI) of PB for each increasing tertile of maternal DTAC were 0.71 (0.41, 1.30) and 0.54 (0.29, 0.98), when compared with the lowest intake. For LBW, these were 0.25 (0.09, 0.65) and 0.63 (0.28, 1.41). A likelihood of lower odds for PB was found for a higher intake of fruits [0.66 (0.39, 1.09)]. Women with a higher consumption of milk were less likely to have a child with LBW [0.48 (0.23, 1.01)], and children whose mothers reported a higher intake of beans had lower odds of being born LGA [0.61 (0.39, 0.93)]. CONCLUSION The data suggest that a higher intake of foods with antioxidant activity during pregnancy might reduce the chance of adverse birth outcomes.
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Affiliation(s)
- Daniela Saes Sartorelli
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil.
| | - Mariana Rinaldi Carvalho
- Graduate Program of Public Health, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Izabela da Silva Santos
- Graduate Program of Nutrition and Metabolism, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Lívia Castro Crivellenti
- Graduate Program of Public Health, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Laércio Joel Franco
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
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Sartorelli DS, Crivellenti LC, Zuccolotto DCC, Franco LJ. Relationship between minimally and ultra-processed food intake during pregnancy with obesity and gestational diabetes mellitus. CAD SAUDE PUBLICA 2020; 35:e00049318. [PMID: 31066773 DOI: 10.1590/0102-311x00049318] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/22/2018] [Indexed: 01/11/2023] Open
Abstract
This study aimed to investigate the relationship between food intake (considering the nature, extent, and purpose of food processing) during pregnancy and overweight, obesity, and gestational diabetes mellitus conditions. This is a cross-sectional study conducted among 785 adult women in singleton pregnancies (between 24th and 39th weeks of gestation) in Brazil. Usual food intake was estimated by the Multiple Source Method, using two 24-hour dietary recalls. The food groups of interest in this study were the unprocessed or minimally processed foods and ultra-processed foods. The World Health Organization criteria for the diagnosis of gestational diabetes mellitus and the Atalah criteria for excess weight were used. Adjusted multinomial logistic regression models were used to assess the relationship between energy contribution (%E) from foods with overweight and obesity conditions and, adjusted logistic regression models for gestational diabetes mellitus. In total, 32.1% participants were overweight, 24.6% were obese, and 17.7% of women were diagnosed with gestational diabetes mellitus . After adjustments, an inverse association between the highest tertile of %E from the intake of unprocessed or minimally processed foods and obesity was found [0.49 (0.30-0.79)]. Moreover, a positive association between the highest tertile of %E from ultra-processed food intake [3.06 (1.27-3.37)] and obesity was observed. No association between food intake (considering the nature, extent, and purpose of food processing) during pregnancy and overweight or gestational diabetes mellitus was found. The findings suggest a role of food processing in obesity but not in gestational diabetes mellitus. Further research is warranted to provide robust evidence on the relationship between the role of processed foods in obesity and gestational diabetes mellitus.
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Affiliation(s)
| | | | | | - Laércio Joel Franco
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
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Sartorelli DS, Crivellenti LC, Manochio-Pina MG, Baroni NF, Carvalho MR, Diez-Garcia RW, Franco LJ. Study Protocol effectiveness of a nutritional intervention based on encouraging the consumption of unprocessed and minimally processed foods and the practice of physical activities for appropriate weight gain in overweight, adult, pregnant women: a randomized controlled trial. BMC Pregnancy Childbirth 2020; 20:24. [PMID: 31910819 PMCID: PMC6947817 DOI: 10.1186/s12884-019-2672-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Evidence from observational studies suggests that a greater intake of ultra-processed foods during pregnancy is associated with a higher chance of obesity, increased gestational weight gain, and neonatal adiposity. The aim of the present study is to evaluate the effectiveness of a nutritional intervention based on encouraging the consumption of unprocessed and minimally processed foods and the practice of physical activities for appropriate weight gain in overweight, adult, pregnant women. Additionally, the effect of the intervention on pregnancy outcomes, neonatal adiposity, and the child's weight and height will be investigated. METHODS This is a two-armed parallel randomized controlled trial that will be conducted at primary health units in Ribeirão Preto, SP, Brazil. Adult pregnant women who are overweight and receiving prenatal care in the public health system will be included. The women will be randomly allocated into control (standard care) or intervention groups. Those enrolled in the intervention group will participate in three individualized nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods and the practice of physical activities. The recruitment of the participants will be carried out at seven health facilities over 12 months, with a sample of 300 women expected. Maternal anthropometric, sociodemographic, blood pressure, biochemical, and lifestyle data will be obtained at baseline (up to the 16th week of gestation), and during a second assessment (34th to 36th gestational week). The neonate body composition will be estimated after birth, and data on pregnancy outcomes, weight and height of children at 6, 12 and 24 months of age will be further obtained from medical records. DISCUSSION This will be the first randomized controlled trial to test the effectiveness of a nutritional intervention based on encouraging the consumption of unprocessed and minimally processed foods and the practice of physical activities for appropriate weight gain in adult, overweight, pregnant women. Furthermore, the effect of the intervention on pregnancy outcomes, neonatal adiposity and the child's weight and height will be evaluated. TRIAL REGISTRATION Registro Brasileiro de Ensaios Clínicos (Rebec) RBR-2w9bhc July 30th 2018 (http://www.ensaiosclinicos.gov.br/rg/?q=RBR-2w9bhc+), and RBR-7yx36h June 4th 2019 (http://www.ensaiosclinicos.gov.br/rg/?q=RBR-7yx36h+0.
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Affiliation(s)
- Daniela Saes Sartorelli
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Brazil, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil.
| | - Lívia Castro Crivellenti
- Graduate Program of Public Health, Ribeirão Preto Medical School, University of São Paulo, Brazil, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Marina Garcia Manochio-Pina
- Program in Health Promotion, University of Franca, Avenida Dr. Armando Salles Oliveira, 201, Franca, SP, 14404-600, Brazil
| | - Naiara Franco Baroni
- Graduate Program of Public Health, Ribeirão Preto Medical School, University of São Paulo, Brazil, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Mariana Rinaldi Carvalho
- Graduate Program of Public Health, Ribeirão Preto Medical School, University of São Paulo, Brazil, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Rosa Wanda Diez-Garcia
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Brazil, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Laércio Joel Franco
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Brazil, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
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Zuccolotto DCC, Crivellenti LC, Franco LJ, Sartorelli DS. Dietary patterns of pregnant women, maternal excessive body weight and gestational diabetes. Rev Saude Publica 2019; 53:52. [PMID: 31269091 PMCID: PMC6629290 DOI: 10.11606/s1518-8787.2019053000909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/27/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the relationship between the dietary patterns of pregnant women with maternal excessive body weight and gestational diabetes mellitus. METHODS A cross-sectional study conducted with a convenience sample of 785 adult pregnant women attended by the Unified Health System of Ribeirão Preto, state of São Paulo, between 2011 and 2012. Two 24-hour dietary recalls, corrected by the multiple source method, were employed . For the classification of the body mass index and the diagnosis of gestational diabetes mellitus, the criteria by Atalah and the World Health Organization were used, respectively. Dietary patterns were obtained by principal component analysis using the Varimax rotation method. The relationship between adherence to patterns, overweight and obesity was analyzed by multinomial logistic regression models and the relationship with gestational diabetes mellitus by adjusted unconditional logistic regression models. RESULTS We identified four dietary patterns: “traditional Brazilian”; “snacks”; “coffee” and “healthy”. Women with a higher adherence to the “Healthy” (OR = 0.52; 95%CI 0.33–0.83) and “Brazilian Traditional” patterns (OR = 0.61; 95%CI 0.38–0.96) presented a lower chance of obesity, when compared to women with lower adherence, regardless of confounding factors. After adjustment for maternal excessive body weight, there was no association between dietary patterns and gestational diabetes mellitus. CONCLUSIONS Among the pregnant women, greater adherence to “traditional Brazilian” and “healthy” patterns was inversely associated with obesity, but no relationship was identified with gestational diabetes mellitus after adjusting for excessive body weight. Prospective studies are recommended to investigate the relationship between dietary patterns, overweight and gestational diabetes mellitus, reducing the chance of reverse causality.
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Affiliation(s)
| | - Lívia Castro Crivellenti
- Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Programa de Pós-Graduação em Saúde Pública. Ribeirão Preto, SP, Brasil
| | - Laércio Joel Franco
- Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Departamento de Medicina Social. Ribeirão Preto, SP, Brasil
| | - Daniela Saes Sartorelli
- Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Departamento de Medicina Social. Ribeirão Preto, SP, Brasil
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Balbi MDA, Crivellenti LC, Zuccolotto DCC, Franco LJ, Sartorelli DS. The relationship of flavonoid intake during pregnancy with excess body weight and gestational diabetes mellitus. Arch Endocrinol Metab 2019; 63:241-249. [PMID: 31166364 PMCID: PMC10522197 DOI: 10.20945/2359-3997000000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 04/08/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the relationship of flavonoid intake during pregnancy with maternal excessive body weight and gestational diabetes mellitus (GDM). SUBJECTS AND METHODS A cross-sectional study was conducted among 785 adult women in singleton pregnancies, and data were collected at the time of the oral glucose tolerance test. For the body mass index (BMI) classification according to the gestational age, the criteria of Atalah was used, and the diagnosis of GDM was based on the World Health Organization of 2014. Two 24-hour dietary recalls were obtained, and the usual intake was determined by the Multiple Source Method. Adjusted multinomial logistic regression was used to investigate the relationship of the flavonoids with overweight and obesity, and adjusted non-conditional logistic regression for the relationship of the flavonoids with GDM. RESULTS The mean (SD) age of the women was 28 (5) years, 32.1% were overweight, 24.6% were obese and 17.7% were diagnosed with GDM. The median (P25, P75) of total flavonoid intake was 50 (31,75) mg/day. Considering the eutrophic women as the reference, the pregnant women with a higher total flavonoid intake [OR 0.62 (95% CI 0.38; 0.96)] and anthocyanidin intake [OR 0.62 (95% CI 0.40; 0.99)] were less likely to be obese when compared to the women with lower intakes. No association of the flavonoids intake with overweight or GDM was found. CONCLUSION A very low intake of flavonoids was observed. The data suggest that the intake of foods naturally rich in total flavonoids and anthocyanidin has a beneficial role regarding obesity among pregnant women.
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Affiliation(s)
- Mariana de Andrade Balbi
- Universidade de São PauloUniversidade de São PauloFaculdade de Medicina de Ribeirão Preto (FMRP)Programa de Pós-Graduação em Saúde PúblicaRibeirão PretoSPBrasilPrograma de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil
| | - Lívia Castro Crivellenti
- Universidade de São PauloUniversidade de São PauloFaculdade de Medicina de Ribeirão Preto (FMRP)Programa de Pós-Graduação em Saúde PúblicaRibeirão PretoSPBrasilPrograma de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil
| | - Daniela Cristina Candelas Zuccolotto
- Universidade de São PauloUniversidade de São PauloFaculdade de Medicina de Ribeirão Preto (FMRP)Programa de Pós-Graduação em Saúde PúblicaRibeirão PretoSPBrasilPrograma de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil
| | - Laércio Joel Franco
- Universidade de São PauloUniversidade de São PauloFaculdade de Medicina de Ribeirão Preto (FMRP)Departamento de Medicina SocialRibeirão PretoSPBrasilDepartamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil
| | - Daniela Saes Sartorelli
- Universidade de São PauloUniversidade de São PauloFaculdade de Medicina de Ribeirão Preto (FMRP)Departamento de Medicina SocialRibeirão PretoSPBrasilDepartamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil
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Sartorelli DS, Zuccolotto DCC, Crivellenti LC, Franco LJ. Dietary patterns during pregnancy derived by reduced-rank regression and their association with gestational diabetes mellitus. Nutrition 2019; 60:191-196. [DOI: 10.1016/j.nut.2018.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/27/2018] [Accepted: 10/07/2018] [Indexed: 01/11/2023]
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Soares LP, Fabbro ALD, Silva AS, Sartorelli DS, Franco LF, Kuhn PC, Moises RS, Vieira-Filho JPB, Franco LJ. Cardiovascular Risk in Xavante Indigenous Population. Arq Bras Cardiol 2019; 110:542-550. [PMID: 30226913 PMCID: PMC6023632 DOI: 10.5935/abc.20180090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/19/2017] [Indexed: 11/20/2022] Open
Abstract
Background The prevalence of cardiovascular risk factors is little known in Brazilian
indigenous populations. In the last two decades, important changes have
occurred in the lifestyle and epidemiological profile of the Xavante
people. Objective to assess the prevalence of cardiovascular risk factors in Xavante adults in
São Marcos and Sangradouro/Volta Grande reserves, in the state of
Mato Grosso, Brazil. Methods Cross-sectional study carried out with 925 Xavante people aged ≥ 20
years between 2008 and 2012. The following indicators were assessed:
triglycerides (TG), total, LDL and HDL-cholesterol, Castelli index I and II,
TG/HDL-cholesterol ratio, apo B / Apo A1 ratio, Framingham risk score,
C-reactive protein, body mass index (BMI), waist circumference (WC),
hypertriglyceridemic waist (HW), glycemia and blood pressure.
Kolmogorov-Smirnov, Student's t test and Chi-square test
(χ2) were used for statistical analysis, and
significance level was set at 5%. Results High prevalence of elevated cardiovascular risk was observed in men and women
according to HDL-cholesterol (66.2% and 86.2%, respectively), TG (53.2% and
51.5%), TG/HDL-cholesterol ratio (60.0% and 49.1%), C-reactive protein
(44.1% and 48.1%), BMI (81.3% and 81.7%), WC (59.1% and 96.2%), HW (38.0%
and 50,6%) and glycemia (46.8% and 70.2%). Individuals aged 40 to 59 years
had the highest cardiovascular risk. Conclusions The Xavante have a high cardiovascular risk according to several indicators
evaluated. The present analysis of cardiovascular risk factors provides
support for the development of preventive measures and early treatment, in
attempt to minimize the impact of cardiovascular diseases on this
population.
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Affiliation(s)
- Luana Padua Soares
- Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP - Brazil.,Universidade Federal de Uberlândia, Uberlândia, MG - Brazil
| | | | - Anderson Soares Silva
- Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP - Brazil
| | | | | | | | | | | | - Laércio Joel Franco
- Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP - Brazil
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Soares LP, Fabbro ALD, Silva AS, Sartorelli DS, Franco LF, Kuhn PC, Moises RS, Vieira-Filho JPB, Franco LJ. Prevalence of metabolic syndrome in the Brazilian Xavante indigenous population. Diabetol Metab Syndr 2015; 7:105. [PMID: 26594249 PMCID: PMC4654846 DOI: 10.1186/s13098-015-0100-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/05/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The raising prevalence of weight excess and of non-communicable diseases in indigenous populations, as well as changes in food consumption and reduction in the frequency and intensity of physical activity, suggest that the prevalence of metabolic syndrome (MS) is also elevated. The objective of this study was to evaluate the prevalence of MS and the frequency of its components in the Xavante adult population living in the Indian reservations of São Marcos and Sangradouro/Volta Grande, in the state of Mato Grosso, Brazil. A cross-sectional study was carried out among 932 Xavante Indians aged 20 years or more, in the 2008-2012 period. The variables analysed were gender, age, weight, height, waist circumference, blood pressure, initial and 2-h capillary glycemia in a 75 g OGTT, levels of triglycerides and HDL-cholesterol. The diagnostic criteria for MS proposed by the IDF and AHA/NHLBI were used. RESULTS The prevalence of MS was 66.1 % (95 % CI 63.0-69.2), being 76.2 % (95 % CI 72.4-80.0) in women and 55.6 % (95 % CI 51.0-60.2) in men. Women had higher prevalence of MS in all age groups. Elevated waist circumference and lower levels of HDL-cholesterol were the more frequent components in those with MS, and elevated blood pressure was the less frequent. CONCLUSIONS The high prevalence of MS in the Xavante Indians is mainly due to the increased prevalence of weight excess that resulted from an intense change in their life-style, in a short period of time in a population with a genetic predisposition. These findings highlight the magnitude of this health problem and make an alert about the necessity to implement specific preventive interventions.
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Affiliation(s)
- Luana Padua Soares
- />Medical School, Federal University of Uberlândia, Av. Pará 1720, Bloco 2U, Uberlândia, MG CEP 38405-320 Brazil
- />Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP CEP 14049-900 Brazil
| | - Amaury Lelis Dal Fabbro
- />Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP CEP 14049-900 Brazil
| | - Anderson Soares Silva
- />Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP CEP 14049-900 Brazil
| | - Daniela Saes Sartorelli
- />Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP CEP 14049-900 Brazil
| | - Luciana Ferreira Franco
- />Division of Endocrinology, Escola Paulista de Medicina, Federal University of São Paulo, Rua Pedro de Toledo, 781/12º andar, São Paulo, SP CEP 04039-001 Brazil
| | - Patrícia Chamadoira Kuhn
- />Division of Endocrinology, Escola Paulista de Medicina, Federal University of São Paulo, Rua Pedro de Toledo, 781/12º andar, São Paulo, SP CEP 04039-001 Brazil
| | - Regina Santiago Moises
- />Division of Endocrinology, Escola Paulista de Medicina, Federal University of São Paulo, Rua Pedro de Toledo, 781/12º andar, São Paulo, SP CEP 04039-001 Brazil
| | - João Paulo Botelho Vieira-Filho
- />Division of Endocrinology, Escola Paulista de Medicina, Federal University of São Paulo, Rua Pedro de Toledo, 781/12º andar, São Paulo, SP CEP 04039-001 Brazil
| | - Laércio Joel Franco
- />Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP CEP 14049-900 Brazil
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Franco LJ, Dal Fabbro AL, Martinez EZ, Sartorelli DS, Silva AS, Soares LP, Franco LF, Kuhn PC, Vieira-Filho JPB, Moisés RS. Performance of glycated haemoglobin (HbA1c) as a screening test for diabetes and impaired glucose tolerance (IGT) in a high risk population--the Brazilian Xavante Indians. Diabetes Res Clin Pract 2014; 106:337-42. [PMID: 25271115 DOI: 10.1016/j.diabres.2014.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 08/06/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
Abstract
AIMS To examine the properties of HbA1c to detect diabetes and IGT in adult Brazilian Xavante Indians, a high risk population for diabetes. METHODS The survey was carried out between October 2010 and January 2012 and based on a 75 g oral glucose tolerance test (OGTT). Basal and 2h capillary glycaemia were measured by HemoCue Glucose 201+; HbA1c using an automated high-performance liquid chromatography analyzer (Tosoh G7). RESULTS 630 individuals aged ≥ 20 years were examined and 80 had a previous diagnosis of diabetes. Sensitivity, specificity and accuracy for HbA1c ≥ 6.5% (≥ 48 mmol/mol) were 71.3%, 90.5% and 87.2%. The areas under the ROC curve (AUC) was 0.88 (95%CI: 0.83-0.93). To identify IGT, HbA1c values between 5.7% and 6.4% (39-47 mmol/mol) presented sensitivity, specificity and accuracy of 87.2%, 24.7% and 51.4%, with an AUC of 0.62 (95%CI: 0.57-0.67). CONCLUSIONS The ADA/WHO proposed cut-off of 6.5% (48 mmol/mol) for HbA1c was adequate to detect diabetes among the Xavante. However, the performance of the ADA proposed cut-off points for pre-diabetes, when used to detect IGT was inadequate and should not be recommended.
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Affiliation(s)
- L J Franco
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, CEP: 14049-900 Ribeirão Preto, SP, Brazil.
| | - A L Dal Fabbro
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - E Z Martinez
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - D S Sartorelli
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - A S Silva
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - L P Soares
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - L F Franco
- Division of Endocrinology, Escola Paulista de Medicina, Federal University of São Paulo. Rua Pedro de Toledo, 781-12 floor, CEP: 04039-001 São Paulo, SP, Brazil
| | - P C Kuhn
- Division of Endocrinology, Escola Paulista de Medicina, Federal University of São Paulo. Rua Pedro de Toledo, 781-12 floor, CEP: 04039-001 São Paulo, SP, Brazil
| | - J P B Vieira-Filho
- Division of Endocrinology, Escola Paulista de Medicina, Federal University of São Paulo. Rua Pedro de Toledo, 781-12 floor, CEP: 04039-001 São Paulo, SP, Brazil
| | - R S Moisés
- Division of Endocrinology, Escola Paulista de Medicina, Federal University of São Paulo. Rua Pedro de Toledo, 781-12 floor, CEP: 04039-001 São Paulo, SP, Brazil
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Hirooka LB, Mestriner- Junior W, Mestriner SF, Nunes SAC, Lemos PN, Franco LJ. Dental caries in mother-child pairs from Xingu. Braz J Oral Sci 2014. [DOI: 10.1590/1677-3225v13n1a09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Teixeira CRDS, Franco LJ, Monteiro RA, Granado F. [Diabetes in hospital deliveries in public and private health system hospitals]. Rev Saude Publica 2013; 47:460-9. [PMID: 24346558 DOI: 10.1590/s0034-8910.2013047003687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 11/12/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze trends of diagnoses of diabetes mellitus in hospital deliveries. METHODS Transversal study analyzing data on hospital deliveries for pregnant women living in Ribeirão Preto, SP, from 1998 to 2007. The data on diabetes mellitus in pregnancy were obtained from the Faculdade de Medicina de Ribeirão Preto of the Universidade de São Paulo Hospital Data Processing Center. The data analyzed were: age group, type of delivery (vaginal or cesarean), length of hospitalization and type of care: public (SUS) or private (private and supplemented health care). RESULTS There was a 3.9 fold increase in the proportion of deliveries with a record of diabetes in relation to the total number of births (p = 0.01). This increase was of 4.5 times in deliveries in the public health care system (p = 0.01) and 3 times in private care. An increase in the presence of diabetes was observed in all age groups, proportionally larger in lower age groups. The frequency of cesarean delivery in pregnancies which recorded diabetes fell from 64.5% in 1998/1999 to 39.8% in 2006/2007 in the public system; in the private system the frequency remained over 90%. CONCLUSIONS The presence of diabetes mellitus in hospital deliveries increased throughout the two year periods, despite a fall in the overall number of deliveries and an increase in the number of women of childbearing age living in Ribeirão Preto. This trend means that not only diagnosis and treatment, but also pre-pregnancy interventions which may reverse it are called for.
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Gomes PM, Andrade RCGD, Figueiredo RCD, Pace AE, Dal Fabbro AL, Franco LJ, Foss MC, Foss-Freitas MC. Cardiovascular risk in Japanese-Brazilian subjects. ACTA ACUST UNITED AC 2012; 56:608-13. [DOI: 10.1590/s0004-27302012000900002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 08/23/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To evaluate the prevalence of risk factors for cardiovascular disease in Japanese-Brazilian subjects. SUBJECTS AND METHODS: One hundred thirty-one residents of the Mombuca community were studied. Statistical analysis was based on the X² test, Fisher's Exact test, Student's t test, and ANOVA, at a 5% significance level. RESULTS: The average age was 56.7 years-old; 76.3% had dyslipidemia, 24.4% pre-diabetes (PDM), 10.7% type 2 diabetes mellitus (T2DM), 46.6% hypertension, 52.7% abdominal obesity, and 35.8% metabolic syndrome (MS). There were significant correlations between HOMA-IR and MS diagnosis and obesity, while HOMA-β levels were decreased in T2DM and PDM. The ankle-brachial index was positive for peripheral artery disease in 22.3% of the individuals. Electrocardiograms did not show increased evidence of myocardial ischemia. CONCLUSION: Subjects of this community are exposed to major cardiovascular risk factors, namely high prevalence of MS diagnoses and increased HOMA-IR. Arq Bras Endocrinol Metab. 2012;56(9):608-13
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Andrade RCGD, Figueiredo RCD, Foss-Freitas MC, Pace AE, Dal Fabbro AL, Franco LJ, Foss MC. Prevalence of diabetes mellitus in the Japanese-Brazilian community of Mombuca, Guatapará, SP. ACTA ACUST UNITED AC 2011; 55:127-33. [DOI: 10.1590/s0004-27302011000200005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 01/26/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To estimate the prevalence of type 2 diabetes mellitus (DM2) and impaired glucose tolerance (IGT) in the Japanese-Brazilian community of Mombuca in relation to risk factors (FR) for diabetes and cardiovascular disease. SUBJECTS AND METHODS: Cross-sectional study with 131 individuals of Japanese ancestry (69% first generation), aged 20 years or more, submitted to socio-cultural, anthropometric, and biochemistry evaluation. RESULTS: Of the individuals studied (n = 131, age = 55.1 ± 15.9 years), 58.8% were women. The prevalence of DM2 and IGT were 13.7% and 14.5%, respectively. Regarding RF, 76.3% presented dyslipidemia, 52.7% abdominal obesity, 48.1% arterial hypertension, and 42.3% whole body obesity. CONCLUSIONS: The prevalence of DM2, IGT, and RF in this Japanese-Brazilian community was higher than in the adult population of the city of Ribeirão Preto-SP, Brazil, suggesting an increase in risk conditions for these morbidities.
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Gimeno SGA, Andreoni S, Ferreira SRG, Franco LJ, Cardoso MA. Assessing food dietary intakes in Japanese-Brazilians using factor analysis. CAD SAUDE PUBLICA 2010; 26:2157-67. [PMID: 21180989 DOI: 10.1590/s0102-311x2010001100017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 02/11/2010] [Indexed: 11/22/2022] Open
Abstract
We describe the use of factor analysis for assessing food habits in Japanese-Brazilians. Dietary data from 1,283 participants of a cross-sectional study were used. Besides statistical criteria, we also used the conceptual meaning of identified profiles to obtain scores for dietary patterns (Japanese or Western profile). Paired Student t test, linear regression and Poisson models were used to verify the existence of relationship between these scores and generation, body mass index (BMI), waist circumference and presence of metabolic syndrome, respectively. First generation subjects had higher mean Japanese profile scores and lower Western profile scores than those of second generation. The Western dietary pattern was associated with BMI (p = 0.001), waist circumference (p = 0.023) and metabolic syndrome (p < 0.05). We concluded that these scores were able to discriminate subjects who maintained their traditional Japanese lifestyle or otherwise, and that the incorporation of a Western lifestyle is associated to high values of BMI, waist circumference and presence of metabolic syndrome.
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Camargo MAGD, Franco LJ, Gimeno SGA, Ferreira SRG, Sartorelli DS. Fatores preditores do alcance das metas de um programa de intervenção em nipo-brasileiros. CAD SAUDE PUBLICA 2010; 26:1141-52. [DOI: 10.1590/s0102-311x2010000600008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 04/16/2010] [Indexed: 11/22/2022] Open
Abstract
Identificar fatores da linha de base preditores do alcance das metas do programa de intervenção no estilo de vida após 12 meses em população de nipo-brasileiros, empregando-se modelos de regressão logística ajustados. Em 2005, 321 participantes eram portadores de excesso de peso e houve maior chance [OR (IC95%)] de alcance da meta de perda de peso após 12 meses entre mulheres [2,45 (1,33; 4,13)], indivíduos de maior idade [1,03 (1,00; 1,06)] e menor chance entre portadores de morbidades no início do estudo [0,33 (0,14; 0,77)]. Dos 261 indivíduos sedentários, o alcance da meta de atividades físicas foi inversamente relacionado ao exercício de atividades profissionais [0,40 (0,17; 0,95)]. Não se verificou fatores da linha de base associados ao alcance das metas do consumo de legumes, verduras e frutas e gorduras saturadas da dieta após 12 meses. Indivíduos de maior idade, mulheres, não portadores de morbidades e sem exercício de atividades profissionais na linha de base apresentaram maior chance de alcance das metas após 12 meses de intervenção no estilo de vida.
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Oliveira PBD, Franco LJ. Consumo de adoçantes e produtos dietéticos por indivíduos com diabetes melito tipo 2, atendidos pelo Sistema Único de Saúde em Ribeirão Preto, SP. ACTA ACUST UNITED AC 2010; 54:455-62. [DOI: 10.1590/s0004-27302010000500005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 04/08/2010] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Analisar o consumo de adoçantes e produtos dietéticos por indivíduos com diabetes melito tipo 2, atendidos pelo Sistema Único de Saúde (SUS) em Ribeirão Preto, SP. SUJEITOS E MÉTODOS: Por meio de questionário, foram entrevistados 120 pacientes, estratificados por sexo, faixa etária e nível de atendimento. RESULTADOS: Os resultados mostram que o uso de adoçantes é frequente na população em estudo, com predomínio do tipo líquido, e o uso de produtos dietéticos é menor, com predomínio dos refrigerantes. O diagnóstico do DM foi determinante para o uso dos produtos e o critério de seleção mais utilizado foi o sabor. É pequena a porcentagem da amostra que sabe a diferença entre diet e light, que tem o hábito de ler o rótulo dos alimentos e que se preocupa com a quantidade utilizada de adoçante. CONCLUSÃO: É uma necessidade a inclusão de informações sobre o uso adequado desses produtos nas atividades assistenciais aos pacientes com DM nos diversos níveis do SUS.
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Sartorelli DS, Franco LJ, Damião R, Gimeno S, Cardoso MA, Ferreira SRG. Dietary glycemic load, glycemic index, and refined grains intake are associated with reduced β-cell function in prediabetic Japanese migrants. ACTA ACUST UNITED AC 2009; 53:429-34. [DOI: 10.1590/s0004-27302009000400007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 03/03/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To investigate the association between carbohydrate intakes and β-cell function (HOMA-β) in Japanese-Brazilians with impaired glucose tolerance (IGT). METHODS: Dietary intakes were assessed by a validated food frequency questionnaire in a cross-sectional survey carried out in 2000. The associations between diet and HOMA-β were verified in 270 newly diagnosed IGT in multiple linear regression models. RESULTS: The mean (SD) age was 58 (11) years and the mean HOMA-β was 65 (47). The glycemic load was inversely associated with HOMA-β, β1 -0.140 (95%CI = -1.044; -0.078), p = 0.023. The inverse association was also observed for refined grains intakes: -0.186 (95%CI = -0.4862; -0.058), p = 0.012. After adjustments for body mass index, the glycemic index was inversely associated with HOMA-β: -0.1246 (95%CI = -2.2482, -0.0257), p < 0.001. CONCLUSIONS: These data suggested that dietary glycemic load, glycemic index, and refined grains intakes are associated with reduced β-cell function, and the quality of dietary carbohydrates may be relevant for maintaining β-cell function among individuals with IGT.
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Affiliation(s)
| | | | - Renata Damião
- Universidade Federal do Triângulo Mineiro, Brazil; Japanese-Brazilian Diabetes Study Group
| | - Suely Gimeno
- Universidade Federal de São Paulo, Brazil; Japanese-Brazilian Diabetes Study Group
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Sartorelli DS, Franco LJ, Cardoso MA. High intake of fruits and vegetables predicts weight loss in Brazilian overweight adults. Nutr Res 2009; 28:233-8. [PMID: 19083413 DOI: 10.1016/j.nutres.2008.02.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 01/04/2008] [Accepted: 02/04/2008] [Indexed: 10/22/2022]
Abstract
To determine whether changes in dietary intakes predict weight loss, we studied 80 overweight adults who attended a nutritional counseling program during 6 months of follow-up at a primary health care center in Brazil. Habitual diet was assessed using a validated food frequency questionnaire at baseline and after 6 months. The mean age (+/-SD) of the participants was 46.5 +/- 9.5 years, and their mean body mass index was 29 +/- 3 kg/m(2) at baseline. After 6 months, the differences in body weight and fruit/vegetable intake were -1.4 +/- 3 kg and +/-109 +/- 320 g daily, respectively. Using multiple linear regression models adjusted for age, sex, changes in walking time, and total energy intake, the increased intake of dietary fiber from fruits/vegetables was associated with a greater weight loss (beta1 [95% confidence interval (CI)] = -0.180 [-0.269, -0.091]) after 6 months of follow-up. Similar results were observed for increased intake of vegetables (beta1 [95% CI] = -0.00497 [-0.008, -0.002]) and fruits (beta1 [95% CI] = -0.00290 [-0.005, -0.001]) as predictors of weight loss. The increase of 100 g/d of vegetables and fruits represented a body weight loss of 500 and 300 g after 6 months, respectively (P < .05). Our findings support the relevance of increased intakes of fruits and vegetables that may help avoid weight gain in overweight adults.
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Affiliation(s)
- Daniela Saes Sartorelli
- Department of Social Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, SP 14049-900, Brazil.
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Sartorelli DS, Franco LJ, Gimeno SGA, Ferreira SRG, Cardoso MA. Dietary fructose, fruits, fruit juices and glucose tolerance status in Japanese-Brazilians. Nutr Metab Cardiovasc Dis 2009; 19:77-83. [PMID: 18676134 DOI: 10.1016/j.numecd.2008.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 04/14/2008] [Accepted: 04/15/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Evidence suggests that fructose and sweetened beverages may be a risk factor for obesity and type 2 diabetes, but the role of sweetened fruit juices in glucose disturbances has been minimally explored. The aim of this study was to examine the association of total fructose, fresh fruit and sweetened fruit juice intake with glucose tolerance homeostasis in Japanese-Brazilians. METHODS AND RESULTS A total of 475 men and 579 women aged >or=30 years were evaluated in a cross-sectional population-based survey with a standardized protocol including a 2-h oral glucose tolerance test (WHO criteria). Habitual food consumption was obtained using a validated food frequency questionnaire for Japanese-Brazilians. After adjustments for potential confounding variables, the odds ratio (OR; 95%CI) for impaired glucose tolerance was 2.1 (1.0-4.5; P for trend=0.05) for the highest as compared to the lowest tertile intake of total fructose and 2.3 (1.1-5.1; P for trend=0.05) for the highest as compared to the lowest tertile intake of sweetened fruit juices. CONCLUSION Our results showed that high intakes of dietary fructose and sweetened fruit juices, but not whole fresh fruits, were associated with impaired glucose tolerance among genetically susceptible individuals.
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Affiliation(s)
- D S Sartorelli
- Department of Social Medicine, School of Medicine of Ribeirão Preto, University of São Paulo (USP), São Paulo, SP, Brazil.
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Figueiredo RCD, Franco LJ, Andrade RCGD, Foss-Freitas MC, Pace AE, Dal Fabbro AL, Foss MC. Obesidade e sua relação com fatores de risco para doenças cardiovasculares em uma população nipo-brasileira. ACTA ACUST UNITED AC 2008; 52:1474-81. [DOI: 10.1590/s0004-27302008000900011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 10/20/2008] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Descrever associações entre excesso de peso e obesidade abdominal com fatores de risco cardiovascular na população nipo-brasileira de Mombuca, Guatapará, SP. MÉTODOS: Participaram do estudo 131 indivíduos com descendência japonesa (69,2% da primeira e 30,8% da segunda geração), com idade > 20 anos, correspondendo a 66,8% da população residente dessa faixa etária. Os dados foram coletados por meio de questionários padronizados e foram realizados exames clínicos e laboratoriais. RESULTADOS: A prevalência de sobrepeso foi de 29,6% entre os homens e de 25,6% entre as mulheres e a de obesidade foi de 46,3% entre os homens e de 39,0% entre as mulheres. Entre os homens a prevalência de obesidade abdominal foi de 55,6% e entre as mulheres de 20,8%. O índice de massa corpórea foi associado independentemente com triglicérides, circunferência abdominal e idade; a pressão arterial sistólica com a circunferência abdominal. CONCLUSÃO: O presente estudo enfatiza a necessidade de medidas de intervenção para a prevenção da obesidade na população nipo-brasileira de Mombuca.
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Péres DS, Franco LJ, dos Santos MA. Feelings of women after the diagnosis of type 2 diabetes. Rev Lat Am Enfermagem 2008; 16:101-8. [PMID: 18392538 DOI: 10.1590/s0104-11692008000100016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 08/20/2007] [Indexed: 11/22/2022] Open
Abstract
Descriptive and exploratory study with the objective of knowing feelings and emotional reactions of women after the diagnosis of diabetes. Data were collected at a primary health care unit in Ribeirão Preto-SP, Brazil, through a semi-structured interview. Thematic content analysis was used for interpreting the data. The results showed that women's behavior after the diagnosis of diabetes was associated with feelings and emotional reactions that interfere with treatment adherence and which the health team needs to understand. In an educational process, it is not enough to offer information. Human behavior is extremely complex, going beyond the cognitive aspects, and is rooted in affective-emotional dispositions.
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Péres DS, Franco LJ, Santos MAD, Zanetti ML. Social representations of low-income diabetic women according to the health-disease process. Rev Lat Am Enfermagem 2008; 16:389-95. [DOI: 10.1590/s0104-11692008000300009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 11/26/2007] [Indexed: 11/22/2022] Open
Abstract
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.
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Abstract
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.
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Affiliation(s)
- Rosana Farah Simony
- Centro Universitário São Camilo, Brasil; Universidade Presbiteriana MacKenzie, Brasil
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Sartorelli DS, Sciarra EC, Franco LJ, Cardoso MA. Beneficial effects of short-term nutritional counselling at the primary health-care level among Brazilian adults. Public Health Nutr 2007; 8:820-5. [PMID: 16277797 DOI: 10.1079/phn2005737] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectiveTo evaluate the impact of a low-cost nutritional intervention in changing the lifestyle of adults.DesignRandomised clinical trial.SettingPrimary health-care centre in São José do Rio Preto, São Paulo State, Brazil.SubjectsWe 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.ResultsAfter 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.ConclusionsThe 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.
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Affiliation(s)
- Daniela Saes Sartorelli
- Department of Nutrition, School of Public Health, University of São Paulo (USP), Av. Dr Arnaldo 715, São Paulo, SP 01246-904, Brazil
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Barilli ALA, Passos ADC, Marin-Neto JA, Franco LJ. Periodontal disease in patients with ischemic coronary atherosclerosis at a University Hospital. Arq Bras Cardiol 2007; 87:695-700. [PMID: 17262105 DOI: 10.1590/s0066-782x2006001900003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 07/01/2005] [Indexed: 02/08/2023] Open
Abstract
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.
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Hiramatsu DA, Tomita NE, Franco LJ. Perda dentária e a imagem do cirurgião-dentista entre um grupo de idosos. Ciênc saúde coletiva 2007; 12:1051-6. [PMID: 17680163 DOI: 10.1590/s1413-81232007000400026] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Accepted: 11/24/2006] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Daniel Afonso Hiramatsu
- Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru.
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Simony RF, Gimeno SGA, Ferreira SRG, Franco LJ. Which body mass index is best associated with risk of diabetes mellitus and hypertension in a Japanese-Brazilian population? CAD SAUDE PUBLICA 2007; 23:297-304. [PMID: 17221078 DOI: 10.1590/s0102-311x2007000200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 10/21/2005] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Rosana Farah Simony
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil.
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Hiramatsu DA, Franco LJ, Tomita NE. Influência da aculturação na autopercepção dos idosos quanto à saúde bucal em uma população de origem japonesa. CAD SAUDE PUBLICA 2006; 22:2441-8. [PMID: 17091181 DOI: 10.1590/s0102-311x2006001100018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Accepted: 12/19/2005] [Indexed: 11/21/2022] Open
Abstract
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.
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Abstract
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.
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Affiliation(s)
- Denise Siqueira Péres
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP, Brasil.
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Abstract
UNLABELLED 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.
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Abstract
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.
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Abstract
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.
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Affiliation(s)
- P Rosenbaum
- Endocrinology Division, Internal Medicine Department, Federal University of São Paulo, São Paulo, SP, Brazil.
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Franco LJ, Campos GP, Machado CA. Entrevista: O enfoque das políticas do SUS para promoção da saúde e prevenção das DCNT: do passado ao futuro. Ciênc saúde coletiva 2004. [DOI: 10.1590/s1413-81232004000400015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rosenbaum P, Gimeno SGA, Sanudo A, Franco LJ, Ferreira SRG. Independent impact of glycemia and blood pressure in albuminuria on high-risk subjects for metabolic syndrome. Clin Nephrol 2004; 61:369-76. [PMID: 15224799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
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.
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Affiliation(s)
- P Rosenbaum
- Endocrinology Division, Internal Medicine Department, Federal University of Sao Paulo, Brazil.
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Abstract
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.
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Affiliation(s)
- Daniela Saes Sartorelli
- Departamento de Medicina Social, Faculdade de Medicina de Ribeir o Preto, Universidade de São Paulo, Ribeir o Preto, SP, 14049-900, Brasil.
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Abstract
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.
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Tomita NE, Chinellato LEM, Franco LJ, Iunes M, Freitas JADS, Lopes ES. Condições de saúde bucal e diabetes mellitus na população nipo-brasileira de Bauru-SP. J Appl Oral Sci 2003; 11:15-20. [DOI: 10.1590/s1678-77572003000100004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Gimeno SGA, Ferreira SRG, Franco LJ, Hirai AT, Matsumura L, Moisés RS. Prevalence and 7-year incidence of Type II diabetes mellitus in a Japanese-Brazilian population: an alarming public health problem. Diabetologia 2002; 45:1635-8. [PMID: 12488952 DOI: 10.1007/s00125-002-0963-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2002] [Revised: 07/25/2002] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- S G A Gimeno
- Preventive Medicine Department, Federal University of São Paulo (UNIFESP-EPM), Brazil.
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Spichler ER, Spichler D, Lessa I, Costa e Forti A, Franco LJ, LaPorte RE. Capture-recapture method to estimate lower extremity amputation rates in Rio de Janeiro, Brazil. Rev Panam Salud Publica 2001; 10:334-40. [PMID: 11774806 DOI: 10.1590/s1020-49892001001100007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- E R Spichler
- Ministério da Saúde, Núcleo Estadual do Rio de Janeiro, Rio de Janeiro, Brazil.
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França AP, Bezerra DL, Franco LJ, Dib SA. GAD65 autoantibodies, beta-cell function, and insulin resistance in Japanese-Brazilian adults. Centro de Estudos da Comunidade Nipo Brasileira de Bauru. Diabetes Care 2000; 23:1437-9. [PMID: 10977052 DOI: 10.2337/diacare.23.9.1437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
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.
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Affiliation(s)
- N E Tomita
- Departamento de Odontopediatria, Ortodontia e Saúde Coletiva da Faculdade de Odontologia de Bauru da Universidade de São Paulo. Bauru,SP, Brasil
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Costa MB, Ferreira SR, Franco LJ, Gimeno SG, Iunes M. Dietary patterns in a high-risk population for glucose intolerance. Japanese-Brazilian Diabetes Study Group. J Epidemiol 2000; 10:111-7. [PMID: 10778035 DOI: 10.2188/jea.10.111] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- M B Costa
- Department of Medicine, Federal University of Juiz de Fora, Brazil
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Gimeno SG, Ferreira SR, Cardoso MA, Franco LJ, Iunes M. Weight gain in adulthood and risk of developing glucose tolerance disturbance: a study of a Japanese-Brazilian population. Japanese-Brazilian Diabetes Study Group. J Epidemiol 2000; 10:103-10. [PMID: 10778034 DOI: 10.2188/jea.10.103] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- S G Gimeno
- Department of Preventive Medicine, Federal University of São Paulo, Brazil
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Gimeno SG, Ferreira SR, Franco LJ, Iunes M. 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. Diabetes Care 1998; 21:1889-92. [PMID: 9802738 DOI: 10.2337/diacare.21.11.1889] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- S G Gimeno
- Department of Preventive Medicine, Federal University of São Paulo, Brazil.
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Reichelt AJ, Spichler ER, Branchtein L, Nucci LB, Franco LJ, Schmidt MI. Fasting plasma glucose is a useful test for the detection of gestational diabetes. Brazilian Study of Gestational Diabetes (EBDG) Working Group. Diabetes Care 1998; 21:1246-9. [PMID: 9702428 DOI: 10.2337/diacare.21.8.1246] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- A J Reichelt
- Hospital de Clínicas de Porto Alegre, São Paulo, Brazil.
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