Depressive symptoms and self-rated health among Brazilian older adults: baseline data from the ELSI-Brazil study

OBJECTIVE

To investigate whether having a higher number of depressive symptoms is associated with negative self-rated health (SRH) even in the absence of illness.

METHODS

This is a secondary analysis of baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, using a national sample of 9,412 people aged 50 or over. SRH was dichotomized into poor or very poor and very good or excellent, good, or average. Depressive symptoms were assessed through the eight-item Center for Epidemiologic Studies Depression Scale (CES-D8). Sociodemographic variables, information about unhealthy behaviors, and the number of chronic conditions were also analyzed.

RESULTS

Having depressive symptoms was strongly associated with poor or very poor SRH both in the unadjusted and adjusted analyses. The magnitude of the association was reduced when the number of chronic illnesses was included in the multivariate analysis, along with the other sociodemographic variables and unhealthy behaviors (OR 1.35, 95%CI 1.31-1.39).

CONCLUSION

Having depressive symptoms may contribute towards having a poorer perception of health, even in the absence of health conditions. SRH is a multidimensional construct that can accurately reflect a person's state of general mental health.

X-Chromosome Association Study in Latin American Cohorts Identifies New Loci in Parkinson's Disease

BACKGROUND

Sex differences in Parkinson's disease (PD) risk are well-known. However, the role of sex chromosomes in the development and progression of PD is still unclear.

OBJECTIVE

The objective of this study was to perform the first X-chromosome-wide association study for PD risk in a Latin American cohort.

METHODS

We used data from three admixed cohorts: (1) Latin American Research consortium on the Genetics of Parkinson's Disease (n = 1504) as discover cohort, and (2) Latino cohort from International Parkinson Disease Genomics Consortium (n = 155) and (3) Bambui Aging cohort (n = 1442) as replication cohorts. We also developed an X-chromosome framework specifically designed for admixed populations.

RESULTS

We identified eight linkage disequilibrium regions associated with PD. We replicated one of these regions (top variant rs525496; discovery odds ratio [95% confidence interval]: 0.60 [0.478-0.77], P = 3.13 × 10-5 replication odds ratio: 0.60 [0.37-0.98], P = 0.04). rs5525496 is associated with multiple expression quantitative trait loci in brain and non-brain tissues, including RAB9B, H2BFM, TSMB15B, and GLRA4, but colocalization analysis suggests that rs5525496 may not mediate risk by expression of these genes. We also replicated a previous X-chromosome-wide association study finding (rs28602900), showing that this variant is associated with PD in non-European populations.

CONCLUSIONS

Our results reinforce the importance of including X-chromosome and diverse populations in genetic studies. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

The relationship between loneliness and healthy aging indicators in Brazil (ELSI-Brazil) and England (ELSA): sex differences

OBJECTIVES

This study aimed to estimate five harmonized healthy aging indicators covering functional ability and intrinsic capacity among older women and men from Brazil and England and evaluate their association with loneliness.

STUDY DESIGN

This was a cross-sectional study.

METHODS

We used two nationally representative samples of men and women aged ≥60 years from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) wave 2 (2019-2021; n = 6929) and the English Longitudinal Study of Aging wave 9 (2018-2019; n = 5902). Healthy aging included five separate indicators (getting dressed, taking medication, managing money, cognitive function, and handgrip strength). Loneliness was measured by the 3-item University of California Loneliness Scale. Logistic regression models stratified by sex and country were performed.

RESULTS

Overall, age-adjusted healthy aging indicators were worse in Brazil compared with England for both men and women. Considering functional ability, loneliness was negatively associated with all indicators (ranging from odds ratio [OR] = 0.26, [95% confidence interval (CI) 0.13-0.52] in English men regarding the ability to take medication to OR = 0.49 [95% CI 0.27-0.89] in Brazilian women regarding the ability to manage money). Considering intrinsic capacity, loneliness was negatively associated with a higher cognitive function (OR = 0.72; 95% CI 0.55-0.95 in English women) and a higher handgrip strength (OR = 0.61; 95% CI 0.45-0.83 in Brazilian women). Lonely women demonstrated lower odds of a higher number of healthy aging indicators than men in both countries.

CONCLUSIONS

Country-specific social environments should be targeted by public policies to decrease loneliness and promote healthy aging later in life.

X-Chromosome Association Study in Latin American Cohorts Identifies New Loci in Parkinson Disease

Sex differences in Parkinson Disease (PD) risk are well-known. However, it is still unclear the role of sex chromosomes in the development and progression of PD. We performed the first X-chromosome Wide Association Study (XWAS) for PD risk in Latin American individuals. We used data from three admixed cohorts: (i) Latin American Research consortium on the GEnetics of Parkinson's Disease (n=1,504) as discover cohort and (ii) Latino cohort from International Parkinson Disease Genomics Consortium (n = 155) and (iii) Bambui Aging cohort (n= 1,442) as replication cohorts. After developing a X-chromosome framework specifically designed for admixed populations, we identified eight linkage disequilibrium regions associated with PD. We fully replicated one of these regions (top variant rs525496; discovery OR [95%CI]: 0.60 [0.478 - 0.77], p = 3.13 × 10 ^-5 ; replication OR: 0.60 [0.37-0.98], p = 0.04). rs525496 is an expression quantitative trait loci for several genes expressed in brain tissues, including RAB9B, H2BFM, TSMB15B and GLRA4 . We also replicated a previous XWAS finding (rs28602900), showing that this variant is associated with PD in non-European populations. Our results reinforce the importance of including X-chromosome and diverse populations in genetic studies.

Origins, Admixture Dynamics, and Homogenization of the African Gene Pool in the Americas

The Transatlantic Slave Trade transported more than 9 million Africans to the Americas between the early 16th and the mid-19th centuries. We performed a genome-wide analysis using 6,267 individuals from 25 populations to infer how different African groups contributed to North-, South-American, and Caribbean populations, in the context of geographic and geopolitical factors, and compared genetic data with demographic history records of the Transatlantic Slave Trade. We observed that West-Central Africa and Western Africa-associated ancestry clusters are more prevalent in northern latitudes of the Americas, whereas the South/East Africa-associated ancestry cluster is more prevalent in southern latitudes of the Americas. This pattern results from geographic and geopolitical factors leading to population differentiation. However, there is a substantial decrease in the between-population differentiation of the African gene pool within the Americas, when compared with the regions of origin from Africa, underscoring the importance of historical factors favoring admixture between individuals with different African origins in the New World. This between-population homogenization in the Americas is consistent with the excess of West-Central Africa ancestry (the most prevalent in the Americas) in the United States and Southeast-Brazil, with respect to historical-demography expectations. We also inferred that in most of the Americas, intercontinental admixture intensification occurred between 1750 and 1850, which correlates strongly with the peak of arrivals from Africa. This study contributes with a population genetics perspective to the ongoing social, cultural, and political debate regarding ancestry, admixture, and the mestizaje process in the Americas.

Does undiagnosed diabetes mitigate the association between diabetes and cognitive impairment? Findings from the ELSI-Brazil study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is associated with cognitive impairment. However, most of the evidence has been based on self-reported T2DM, and undiagnosed diabetes has not been considered as a separate category. We aimed to examine the extent to which undiagnosed diabetes modifies the association between diabetes and cognitive impairment in a representative sample of Brazilian adults aged 50 years and older.

METHODS

We analyzed baseline data from 1944 participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) conducted from 2015 to 2016. Diabetes was evaluated based on self-reported doctor diagnosis and glycosylated hemoglobin levels. Participants were classified as diabetics (D), undiagnosed diabetics (UDD), or nondiabetics (ND). Cognitive function was assessed by word list learning and verbal fluency tests. Three multiple logistic regression models were used to evaluate the changes in the strength of the associations.

RESULTS

Participants with diabetes had 49% greater odds of exhibiting impaired memory than nondiabetics (odds ratio [OR] = 1.49; 95% CI: 1.01-2.20). By combining UDD and ND, the association between diabetes and impaired memory was attenuated by 2.0%, losing its statistical significance (OR = 1.46; 95% CI: 0.98-2.17). By combining UDD and D, the association was attenuated by 7.4% (OR = 1.38; 95% CI: 1.01-1.90). No significant association was found between T2DM and impaired verbal fluency.

CONCLUSION

This study found an association between T2DM and impaired memory but not with impaired verbal fluency. When UDD individuals are considered diabetics, this association is attenuated; when UDD individuals are considered as ND, this association is attenuated to the extent that it loses its statistical significance, affecting thus the clinical interpretation.

The Genomic Impact of European Colonization of the Americas

The human genetic diversity of the Americas has been affected by several events of gene flow that have continued since the colonial era and the Atlantic slave trade. Moreover, multiple waves of migration followed by local admixture occurred in the last two centuries, the impact of which has been largely unexplored. Here, we compiled a genome-wide dataset of ∼12,000 individuals from twelve American countries and ∼6,000 individuals from worldwide populations and applied haplotype-based methods to investigate how historical movements from outside the New World affected (1) the genetic structure, (2) the admixture profile, (3) the demographic history, and (4) sex-biased gene-flow dynamics of the Americas. We revealed a high degree of complexity underlying the genetic contribution of European and African populations in North and South America, from both geographic and temporal perspectives, identifying previously unreported sources related to Italy, the Middle East, and to specific regions of Africa.

Effects of Calcium, Magnesium, and Potassium Concentrations on Ventricular Repolarization in Unselected Individuals

BACKGROUND

Subclinical changes on the electrocardiogram are risk factors for cardiovascular mortality. Recognition and knowledge of electrolyte associations in cardiac electrophysiology are based on only in vitro models and observations in patients with severe medical conditions.

OBJECTIVES

This study sought to investigate associations between serum electrolyte concentrations and changes in cardiac electrophysiology in the general population.

METHODS

Summary results collected from 153,014 individuals (54.4% women; mean age 55.1 ± 12.1 years) from 33 studies (of 5 ancestries) were meta-analyzed. Linear regression analyses examining associations between electrolyte concentrations (mmol/l of calcium, potassium, sodium, and magnesium), and electrocardiographic intervals (RR, QT, QRS, JT, and PR intervals) were performed. The study adjusted for potential confounders and also stratified by ancestry, sex, and use of antihypertensive drugs.

RESULTS

Lower calcium was associated with longer QT intervals (-11.5 ms; 99.75% confidence interval [CI]: -13.7 to -9.3) and JT duration, with sex-specific effects. In contrast, higher magnesium was associated with longer QT intervals (7.2 ms; 99.75% CI: 1.3 to 13.1) and JT. Lower potassium was associated with longer QT intervals (-2.8 ms; 99.75% CI: -3.5 to -2.0), JT, QRS, and PR durations, but all potassium associations were driven by use of antihypertensive drugs. No physiologically relevant associations were observed for sodium or RR intervals.

CONCLUSIONS

The study identified physiologically relevant associations between electrolytes and electrocardiographic intervals in a large-scale analysis combining cohorts from different settings. The results provide insights for further cardiac electrophysiology research and could potentially influence clinical practice, especially the association between calcium and QT duration, by which calcium levels at the bottom 2% of the population distribution led to clinically relevant QT prolongation by >5 ms.

The Effects of Weight and Waist Change on the Risk of Long-Term Mortality in Older Adults- The Bambuí (Brazil) Cohort Study of Aging

OBJECTIVE

We aimed to investigate the risk of long-term mortality associated with weight and waist circumference (WC) change among older adults, particularly the overweight and obese ones.

DESIGN

Cohort Study.

SETTING

The Bambuí (Brazil) Cohort Study of Aging.

PARTICIPANTS

Community-dwelling elderly (n=1138).

MEASUREMENTS

Weight and WC were reassessed three years after baseline. Mortality risk associated with a 5% weight/WC loss and gain was compared to that of weight/WC stability by Cox models adjusted for clinical, behavioral and social known risk factors for death (age, gender, BMI, smoking, diabetes, total cholesterol, hypertension, Chagas disease, major electrocardiographic changes, physical activity, B-type natriuretic peptide, C-reactive protein, creatinine, education and household income).

RESULTS

Female sex was predominant (718; 63.1%). Mean age was 68 (6.7) years. Weight stability (696; 61.1%) was more common than weight loss (251; 22.1%) or gain (191; 16.8%). WC remained stable in 422 (37.3%), decreased in 418 (37.0%) and increased in 291 (25.7%) participants. There were 334 (29.3%) deaths over a median follow-up time of 8.0 (6.4-8.0) years from weight/WC reassessment. Weight loss (HR 1.69; 95% CI 1.30-2.21) and gain (HR 1.37; 95% CI 1.01-1.85) were associated with increased mortality, except in those who were physically active in which weight gain was associated with decreased mortality. Results were similar for participants who were overweight/obese or with abdominal obesity at baseline (HR 1.41; 95%CI 1.02-1.97 and HR 2.01; 95%CI 1.29-3.12, for weight loss and gain, respectively). WC change was not significantly associated with mortality.

CONCLUSION

Although weight loss has been recommended for adults with excessive weight regardless of age, weight change might be detrimental in older adults. Rather than weight loss, clinical interventions should target healthy lifestyle behaviors that contribute to weight stability, particularly physical activity in overweight and obese older adults.

Interactive effects of ApoE polymorphism, alcohol and smoking on age-related trends of blood pressure levels in elderly men: the Bambuì Cohort Study of Ageing (1997-2008)

Data from a population-based prospective study were used to examine longitudinal changes in blood pressure (BP) and seek interactions between apolipoprotein E (ApoE) genotypes, smoking and alcohol in a cohort of 557 elderly Brazilian men. Repeated BP measurements were obtained in four waves, and multi-level random-effects pattern-mixture models were used to evaluate age-related BP trajectories while accounting for non-ignorable dropouts/deaths and handling heterogeneities as random parameter variations. Alcohol was associated with high systolic BP in ε2 carriers and those with the ε3/3 genotype, but not in ε4 carriers. This was dependent on age and smoking habits: at the age of 60, expected systolic BP in alcohol drinking ε2 carriers was 16.5 mm Hg higher than in the reference group of non-smokers/non-drinkers if they were not smokers (P=0.049), and 28.6 mm Hg higher if they were also smokers (P=0.004). The youngest smoking/non-drinking ε2 carriers had lower systolic BP, but it increased rapidly and led to higher expected levels among older carriers. Alcohol consumption, alone or together with smoking, interacts with the effects of ApoE genotype on systolic BP, probably nullifying the more favourable lipid profile of ε2 carriers. The interactions of gene-modifiable risk factors have major public health implications.

Factors associated with the calibration of a food frequency questionnaire for the Bambuí Project, Brazil

BACKGROUND

The present study aimed to calibrate a food frequency questionnaire (FFQ) using one 24-h recall (R24) associated with foodstuff replicas.

METHODS

Calibration was performed by linear regression. Of a probability sample of 150 individuals (>18 years) of the town of Bambui, 98 completed the study.

RESULTS

The mean age of the participants was 43.8 years and 63.3% were women. The calibration of the FFQ included sex for the estimation of iron, protein and zinc; and an interaction between sex and R24 was significant for vitamin A and cholesterol models. Age contributed to the vitamin C, polyunsaturated fatty acids, proteins and zinc models, and an interaction between age and R24 was significant for protein and zinc.

CONCLUSIONS

Calibration coefficients and many interactions in linear regression models revealed important differences between dietary methods, indicating the complexity encountered when combining two methodologies for estimating food intake.

The influence of primary care and hospital supply on ambulatory care-sensitive hospitalizations among adults in Brazil, 1999-2007

OBJECTIVES

We assessed the influence of changes in primary care and hospital supply on rates of ambulatory care-sensitive (ACS) hospitalizations among adults in Brazil.

METHODS

We aggregated data on nearly 60 million public sector hospitalizations between 1999 and 2007 to Brazil's 558 microregions. We modeled adult ACS hospitalization rates as a function of area-level socioeconomic factors, health services supply, Family Health Program (FHP) availability, and health needs by using dynamic panel estimation techniques to control for endogenous explanatory variables.

RESULTS

The ACS hospitalization rates declined by more than 5% annually. When we controlled for other factors, FHP availability was associated with lower ACS hospitalization rates, whereas private or nonprofit hospital beds were associated with higher rates. Areas with highest predicted ACS hospitalization rates were those with the highest private or nonprofit hospital bed supply and with low (< 25%) FHP coverage. The lowest predicted rates were seen for areas with high (> 75%) FHP coverage and very few private or nonprofit hospital beds.

CONCLUSIONS

These results highlight the contribution of the FHP to improved health system performance and reflect the complexity of the health reform processes under way in Brazil.

Alcohol consumption in late-life--the first Brazilian National Alcohol Survey (BNAS)

To investigate the alcohol consumption in later life in Brazil and its association with socio-demographic characteristics. This study was a cross-sectional analysis of nationally representative survey data. A multistage cluster sampling procedure was used to select 3007 individuals of 14 years of age and older from the Brazilian household population. In this study we analyzed data from all 400 participants who were over 60 years old. Alcohol Abuse and Dependence Syndrome was established according to DSM-IV and Risky Drinking was defined in two ways: heavy drinkers (>7 drinks/week) and as binge drinkers (>3 drinks/one occasion). Twelve percent of participants reported heavy drinking behavior while 10.4% and 2.9% were binge drinkers and alcohol dependent respectively. In the adjusted logistic regression only gender was associated with heavy drinking behavior. Males, the youngest and the wealthiest were more likely to report binge drinking behaviors. In conclusion, alcohol related-problems are common but under recognized among older adults. Health professionals should be aware that common definitions of alcohol abuse and dependence may not apply as readily to older people, who have had biological changes for alcohol tolerance and its effects on the Central Nervous System.

Association of ApoE polymorphisms with prevalent hypertension in 1406 older adults: the Bambuí Health Aging Study (BHAS)

Apolipoprotein E (ApoE) polymorphism influences lipid metabolism, but its association with arterial hypertension is controversial. The objective of this study was to examine the association between ApoE polymorphism and prevalent hypertension in a large unselected population of older adults. Participants from the baseline of the Bambuí Health Aging Study whose ApoE genes had been genotyped were selected for this study (N = 1406, aged 60-95 years). These subjects represented 80.7% of the total elderly residents in Bambuí city, MG, Brazil. Hypertension was defined as a systolic blood pressure > or =140 mmHg and/or a diastolic blood pressure > or =90 mmHg, or the use of anti-hypertensive medication. The exposure variable was the ApoE genotype as follows: epsilon3 carriers, epsilon3epsilon3; epsilon2 carriers, epsilon2epsilon2 or epsilon2epsilon3, and epsilon4 carriers, epsilon3epsilon4 or epsilon4epsilon4. Potential confounding variables were age, gender, traditional cardiovascular risk factors, uric acid, and creatinine levels. The prevalence of hypertension was 61.3%. Compared with the epsilon3 homozygotes, neither the epsilon2 nor the epsilon4 carrier status was associated with hypertension (adjusted prevalence ratios = 0.94, 95%CI = 0.83-1.07 and 0.98, 0.89-1.07, respectively). On the other hand, the epsilon2 allele carriers had lower LDL cholesterol levels (P < 0.001) and the epsilon4 carriers had higher LDL cholesterol levels (P = 0.036). This study provides epidemiologic evidence that the ApoE genotype is not associated with prevalent hypertension in old age.

The influence of socio-economic conditions on the prevalence of depressive symptoms and its covariates in an elderly population with slight income differences: the Bambuí Health and Aging Study (BHAS)

BACKGROUND

The influence of socio-economic conditions on covariates of depression has received little attention.

AIMS

Examine whether prevalence and covariates of depressive symptoms are affected by socio-economic circumstances.

METHODS

Participants were 1,499 (86%) residents in Bambuí city, Brazil, aged ->- 60 years. Depressive symptoms were assessed by the GHQ-12 questionnaire and exploratory variables included demographic characteristics, life events, social support, health conditions and health service use. The analysis was stratified by family income (<US$240.00 [lowest tertile] vs. ->- US$240.00).

RESULTS

The prevalence of depressive symptoms was higher in those with lower income (43.9%) in comparison with the better off (27.7%). Dissatisfaction with relationships, worse self-rated health and insomnia were independently associated with depressive symptoms in both income groups (OR from 2.00 to 4.74; p<0.05). Depressive symptoms were associated with number of chronic diseases, functional disability and hospitalizations among the poorer (OR from 1.73 to 2.37; p<0.05), while old age (OR 2.08) and female gender (OR 2.03) were associated with depressive symptoms among the better off.

CONCLUSION

This study provides evidence that the prevalence of depressive symptoms and their covariates are influenced by socio-economic conditions in a population with slight income differences.

Apolipoprotein E polymorphism distribution in an elderly Brazilian population: the Bambuí Health and Aging Study

Apolipoprotein E (ApoE) is one of the most extensively studied genes in the context of aging, but there are few population-based studies on ApoE polymorphism in the elderly in developing countries. The objective of the present study was to assess ApoE allele and genotype distribution in a large elderly community-based sample and its association with age, sex and skin color. Participants included 1408 subjects (80.8% of all residents aged (3)60 years) residing in Bambuí city, MG, Brazil. The DNA samples were subjected to the polymerase chain reaction amplification, followed by the restriction fragment length polymorphism technique, with digestion by HhaI. Analysis was carried out taking into consideration the six ApoE genotypes (e3/e3, e3/e4, e2/e3, e4/e4, e2/e4, and e2/e2), the three ApoE alleles, and the number of ApoE4 alleles for each individual. The e3 allele predominated (80.0%), followed by e4 (13.5%) and e2 (6.5%). All six possible genotypes were observed, the e3/e3 genotype being the most frequent (63.4%). This distribution was similar to that described in other western populations. Sex was not associated with number of ApoE4 alleles. Black skin color was significantly and independently associated with the presence of two ApoE4 alleles (age-sex adjusted OR = 7.38; 95%CI = 1.93-28.25), showing that the African-Brazilian elderly have a high prevalence of the e4 allele, as observed in blacks from Africa. No association between number of ApoE4 alleles and age was found, suggesting the absence of association of ApoE genotype with mortality in this population.

Features of metabolic syndrome in non-diabetic Italians and Brazilians: a discriminant analysis

This aim of this study was to compare the characteristics of metabolic syndrome (MetS) in a Brazilian and an Italian population. The subjects were non-diabetic men and women aged 40-74 years from population-based surveys: 1242 from Brazil and 1198 from Italy. Logistic regression models were used to compare adjusted prevalence rates and make a discrimination analysis to distinguish the subjects with a diagnosis of MetS in the two groups. Dyslipidemia [low high-density lipoprotein (HDL)-cholesterol] and impaired fasting glucose were more prevalent among the Brazilians, and increased blood pressure and abdominal obesity (in men) among the Italians. Generally, the Italians showed higher prevalence of overall obesity and high pulse-pressure, and the Brazilians had higher prevalence of metabolic markers of insulin resistance. Among the subjects with the syndrome, HDL-cholesterol was the most discriminant factor, followed by plasma uric acid levels (which were higher in the Brazilians). The Italian men had a larger waist circumference and the Italian women higher body mass index values than the Brazilians. Italians had higher systolic and lower diastolic pressure values. The patterns of the metabolic alterations seemed to be more linked to insulin resistance among Brazilian subjects, whereas obesity seemed to play a more important role among the Italians. Although they are not sufficient to support the hypothesis of differences in the underlying pathophysiological processes between these groups, our results illustrate the difficulty of using a single unifying definition of MetS, and suggest that different benefits may be obtained from treatments targeting obesity, blood pressure or insulin resistance.

The burden of social phobia in a Brazilian community and its relationship with socioeconomic circumstances, health status and use of health services: the Bambuí study

AIMS

Social phobia in the environment of poverty and major social inequalities, as observed in most developing countries, has received little attention. This population-based study was carried out in a poor community in Brazil (15,000 inhabitants), aiming at determining the prevalence of social phobia and its associated factors.

METHOD

The Composite International Diagnostic Interview was applied in a random sample of 1037 residents aged > or = 18 years.

RESULTS

The 1-month, 1-year and lifetime prevalence of social phobia were 7.9, 9.1 and 11.8%, respectively. One-month social phobia was independently associated with age (45-64 years), marital status (divorced/separated), worse socioeconomic indicators (family income and education), number of months worked, worse health status and use of health services and medications.

CONCLUSION

There was an important burden of social phobia in the study community, due to its high prevalence (similar or superior to those observed in most developed countries), and due to its association with worse health status and use of health services and medications. The strong association between social phobia and socioeconomic circumstance, even in a small and poor community, is certainly a reflex of the major social inequalities in Brazil.

The Bambui health and aging study: is calibration of dietary intake necessary among older adults?

Accurate measurements of food intake in surveys are difficult to be obtained especially in the older adults. Calibration, using two instruments, has been adopted in order to improve the information. This study was carried out in a random sample of older adults (> or =60) living in a Brazilian town. Food intake was obtained by the semi-quantitative food frequency questionnaire associated with photos (SFFQ-P) and the 24 hours recall (R24) with or without food models. Statistical analysis included tests to compare averages, Pearson's correlation coefficient and multiple linear regression. For all nutrients, the average intake obtained through SFFQ-P was significantly higher compared to the obtained by the R24 (p < or =0.05). SFFQ-P correlated better with R24 with food models, which was chosen as the reference method. In the multiple linear regression, vitamin C, fatty acid, protein and zinc intakes were influenced by age, especially when such nutrients were more concentrated in food not frequently reported. For protein and zinc, the significantly interaction between age with the 24 hours recall may have happened because of a differential selection of food sources as a function of age. This fact is probable related to chewing difficulties, reduction in the income and, a diet simplification associated with less complicated preparations, such as meat. This study reinforces the need for calibration of SFFQ in nutritional surveys among older adults, especially in etiological studies where the exposure assessment has to be accurate. In this case, R24 with food models should be used as a reference method to best estimate the true intake.

Hypertension and clustering of cardiovascular risk factors in a community in Southeast Brazil--The Bambuí Health and Ageing Study

OBJECTIVE

A population-based prospective study was analysed to: a) determine the prevalence of hypertension; b) investigate the clustering of other cardiovascular risk factors and c) verify whether older differed from younger adults in the pattern of clustering.

METHODS

The data comprised a representative sample of the population of Bambuí, Brazil. Multiple logistic regression was used to investigate the independent association between hypertension and selected factors.

RESULTS

A total of 820 younger adults (82.5%) and 1494 older adults (85.9%) participated in this study. The overall prevalence of hypertension was 24.8% (SE=1.4 %), being higher in women (26.9+/-1.5%) than in men (22.0+/- 1.7%) (p=0.033). Hypertension was positively and significantly associated with physical inactivity, overweight, hypercholesterolemia hyperglycemia and hypertriglyceridemia. The coexistence of hypertension with 4 or more of these risk factors occurred 6 times more than expected by chance, after adjusting for age and sex (OR=6.3; 95%CI: 3.4-11.9). The pattern of risk factor clustering in hypertensive individuals differed with age.

CONCLUSION

Our results reinforce the need to increase detection and treatment of hypertension and to approach patients' global risk profiles.

The Bambuí health and aging study (BHAS). Prevalence of intermittent claudication in the aged population of the community of Bambuí and its associated factors

OBJECTIVE

To assess the prevalence of intermittent claudication in the aged population of Bambuí, Brazil, and to identify the factors associated with this disease.

METHODS

Population-based cross-sectional study of the aged population (>/= 60 years of age) of Bambuí. Participants were interviewed and examined, after written consent. Intermittent claudication was defined based on a standardized questionnaire. Analysis was performed using multiple logistic regression.

RESULTS

Of the 1,742 elderly living in Bambuí, 1,485 (85.2%) were enrolled in the study. Thirty-seven individuals (2.5%) with intermittent claudication were identified: 28 (1.9%) males and 9 (0.6%) females. Their age brackets were: 16 (1.08%) individuals between 60 and 69 years of age, 17 (1.15%) between 70 and 79 years, and 4 (0.27%) >/= 80 years. A significant association between intermittent claudication and the following characteristics was found: male sex (OR=5.1; CI 2.4-11.0), smokers (OR=3.1; CI 1.2-8.5), ex-smokers (OR=3.4; CI 1.3-8.7), and more than 2 hospital admissions in the last 12 months (OR=2.8; CI 1.1-7.2).

CONCLUSION

Disease prevalence was similar to that of other countries. The association between intermittent claudication and smoking strengthens the significance of tobacco in peripheral artery disease pathogenesis. The association of intermittent claudication and a higher number of hospital admissions suggests greater morbidity in the elderly affected.

The Bambuí Health and Aging Study (BHAS): factors associated with hospitalization of the elderly

This study aimed to identify factors associated with hospital admissions of the elderly. All residents of Bambuí, Minas Gerais State >/= 60 years (n = 1,742) were selected. Some 1,606 of these (92.2%) participated in the study. The dependent variable was the number of hospital admissions (none, one, and two or more) during the previous 12 months. Independent variables were grouped as enabling, predisposing, and need-related factors. The strongest associations with multiple hospital admissions were: living alone; financial constraints to purchase of medication; and various indicators of need (worse self-perceived health, more visits to physician, greater use of prescription medications, and history of coronary heart disease). Such variables could help identify older adults at greatest risk and thus prevent hospitalization.

Unexpected high prevalence of 1-month depression in a small Brazilian community: the Bambuí Study

OBJECTIVE

To determine the prevalence of depression in a community with 15 000 inhabitants in Brazil (Bambuí).

METHOD

The Composite International Diagnostic Interview was applied in a random sample of 1041 residents aged 18+ years.

RESULTS

The ICD-10 1-month, 1-year and lifetime prevalences of depression were 8.2% (95% CI:6.5-9.8), 10.0% (95% CI:8.2-11.8) and 15.6% (95% CI:13.4-17.8), respectively. Kappa coefficients comparing ICD-10 and DSM-III-R diagnoses were high (0.73-0.79). Female sex (OR=2.4; 95% CI:1.3-4.2), age 45-59 years (OR=3.5; 95% CI:1.7-7.2) and > or =60 years (OR=4.0; 95% CI:1.9-8.5) and being out of work (OR=2.1; 95% CI:1.2-3.6) were independently and positively associated with 1-month depression.

CONCLUSION

The 1-month prevalence of depression was higher than that observed in similar studies in developed and developing countries. Depression may be a major unidentified disease of people living in small communities of Brazil and other developing countries, especially among older women.

[The Bambuí Project: a population-based study of factors associated with regular utilization of dental services in adults]

A cross-sectional study was conducted in Bambuí, Minas Gerais, to identify factors associated with regular use of dental services. Participants were interviewed with a structured questionnaire and previously validated questions. 999/1,221 (81.8%) randomly selected individuals aged > 18 years participated in the Bambuí dental survey. Of these, 654 out of 656 individuals who had at least one natural tooth and had visited a dentist during their lifetime participated in the study. Results adjusted by multiple logistic regression showed that regular use of dental services was significantly related to having > 8 and 4-7 years of schooling (OR = 9.90; 95% CI = 2.90-33.77 and OR = 3.87; 95% CI = 1.11-13.51, respectively), having a preference for restorative treatment rather than extraction (OR = 4.91; 95% CI = 2.23-10.79), having no present need of dental treatment (OR = 4.87; 95% CI = 3.17-7.49), and belief that visiting the dentist prevents tooth decay and gum disease (OR = 1.73; 95% CI = 1.13-2.65). The results show that regular use of dental services was related to factors distributed in the Andersen and Newman model (1973) explaining use of dentistry services.

The Bambuí Health and Aging Study (BHAS): prevalence of risk factors and use of preventive health care services

OBJECTIVE

To describe, for the first time in Brazil, the prevalence of risk factors and the use of preventive health care services among adults 60 years and older.

METHODS

This population-based study was conducted during 1996-1997 in the state of Minas Gerais, in the town of Bambuí, which is located in the municipality of the same name. In 1996 the town had 14,950 inhabitants. For the study, all the town's residents aged > or = 60 years were selected, along with a comparison sample of persons aged 18-59 years. Data were gathered using interviews and physical examinations.

RESULTS

Of the 1,742 inhabitants of the town of Bambuí aged > or = 60 years, 1,606 (92.2%) participated in the interview and 1,495 (85.8%) were examined (blood pressure, anthropometric measurements, and blood tests). Among the 1,020 younger adults selected for the survey, 909 of them (89.1%) participated in the interview, and 820 of them (80.4%) underwent the physical examination. The prevalence of the following risk factors was higher among older adults than among younger adults: physical inactivity (47.7% vs. 28.0%); blood pressure 140-159 mmHg (systolic) or 90-99 mmHg (diastolic) (25.8% vs. 8.7%); blood pressure > or = 160 mmHg (systolic) or > or = 100 mmHg (diastolic) (19.1% vs. 4.1%); total cholesterol > or = 240 mg/dL (40.6% vs. 9.8%); and blood glucose > or = 126 mg/dL (12.4% vs. 2.2%). The daily consumption of fruits and vegetables was similar among the older adults and the younger ones (51.9% and 51.7%), as was also body mass index > or = 25 kg/m2 (51.6% and 56.2%). Smoking was lower among the older adults (18.7%) than among the younger ones (31.1%). The proportion of participants whose blood pressure had been checked in the preceding year was high (86.8% among the older adults and 61.2% among the younger ones), suggesting that the high prevalence of uncontrolled hypertension was not due to limited access to health care.

CONCLUSIONS

For a long time it was believed that the kinds of risk factors that we found in the urban section of the municipality of Bambuí were public health problems only in large Brazilian cities. Around 72% of the municipalities in Brazil have < or = 20,000 inhabitants, and these smaller municipalities contain some 19% of the country's entire population. The high prevalence of various risk factors among the older and younger adults in Bambuí indicates a great need for health promotion and disease prevention actions. More research is needed to find out whether our results in Bambuí reflect the reality of other small towns in Brazil.

[Cutaneous leishmaniasis in the Metropolitan Region of Belo Horizonte: clinical, laboratorial, therapeutic and prognosis features (1989-1995)]

This study investigated clinical, laboratorial, therapeutic and prognostic aspects of American cutaneous leishmaniasis in Belo Horizonte in 358 patients with cutaneous leishmaniasis (CL) and 25 with mucocutaneous leishmaniasis (MCL). Compared to CL patients, the MCL patients reported longer duration of disease and higher frequency of other diseases, suggesting that debilitation caused by leishmaniasis or other conditions might contribute to activation and/or mucous dissemination of the parasite. The sensitivity of skin test, indirect immunofluorescence reactions and direct detection of parasites was 78.4, 79.3 and 68.3%, respectively. The treatment with meglumine antimoniate presented 100% efficacy, but 59% patients had side-effects. During two years of follow-up, there were 32/318 relapses after successful treatment. Most relapses (31/32) were of CL patients treated with 15 mg Sb5+/kg/day. The negative response to skin test was the only factor associated with a significant threefold increased risk of relapse. Higher dose or longer duration of treatment might improve the prognosis in these patients.