RESUMO

PURPOSE: To compare the effect of early vs delayed metformin treatment for glycaemic management among patients with incident diabetes. METHODS: Cohort study using electronic health records of regular patients (1+ visits per year in 3 consecutive years) aged 40+ years with 'incident' diabetes attending Australian general practices (MedicineInsight, 2011-2018). Patients with incident diabetes were defined as those who had a) 12+ months of medical data before the first recording of a diabetes diagnosis AND b) a diagnosis of 'diabetes' recorded at least twice in their electronic medical records or a diagnosis of 'diabetes' recorded only once combined with at least 1 abnormal glycaemic result (i.e., HbA1c ≥6.5%, fasting blood glucose [FBG] ≥7.0 mmol/L, or oral glucose tolerance test ≥11.1mmol/L) in the preceding 3 months. The effect of early (<3 months), timely (3-6 months), or delayed (6-12 months) initiation of metformin treatment vs no metformin treatment within 12 months of diagnosis on HbA1c and FBG levels 3 to 24 months after diagnosis was compared using linear regression and augmented inverse probability weighted models. Patients initially managed with other antidiabetic medications (alone or combined with metformin) were excluded. FINDINGS: Of 18,856 patients with incident diabetes, 38.8% were prescribed metformin within 3 months, 3.9% between 3 and 6 months, and 6.2% between 6 and 12 months after diagnosis. The untreated group had the lowest baseline parameters (mean HbA1c 6.4%; FBG 6.9mmol/L) and maintained steady levels throughout follow-up. Baseline glycaemic parameters for those on early treatment with metformin (<3 months since diagnosis) were the highest among all groups (mean HbA1c 7.6%; FBG 8.8mmol/L), reaching controlled levels at 3 to 6 months (mean HbA1c 6.5%; FBG 6.9mmol/L) with sustained improvement until the end of follow-up (mean HbA1c 6.4%; FBG 6.9mmol/L at 18-24 months). Patients with timely and delayed treatment also improved their glycaemic parameters after initiating treatment (timely treatment: mean HbA1c 7.3% and FBG 8.3mmol/L at 3-6 months; 6.6% and 6.9mmol/L at 6-12 months; delayed treatment: mean HbA1c 7.2% and FBG 8.4mmol/L at 6-12 months; 6.7% and 7.1mmol/L at 12-18 months). Compared to those not managed with metformin, the corresponding average treatment effect for HbA1c at 18-24 months was +0.04% (95%CI -0.05;0.10) for early, +0.24% (95%CI 0.11;0.37) for timely, and +0.29% (95%CI 0.20;0.39) for delayed treatment. IMPLICATIONS: Early metformin therapy (<3 months) for patients recently diagnosed with diabetes consistently improved HbA1c and FBG levels in the first 24 months of diagnosis.

RESUMO

AIMS: To estimate the effectiveness of metformin on glycaemic parameters among participants with incident prediabetes attending Australian general practices. METHODS: This retrospective cohort study used electronic health records of regular participants (3+ visits in two consecutive years) attending 383 Australian general practices (MedicineInsight). Participants with 'incident' prediabetes (newly recorded diagnosis between 2012 and 2017) and their glycaemic parameters (haemoglobin A1c [HbA1c] or fasting blood glucose [FBG]) at 6-, 12-, and 18-24 months post diagnosis (unexposed) or post-management with metformin (treatment) were identified from the database. We estimated the average treatment effect (ATE) of metformin management on glycaemic parameters using both linear regression and augmented inverse probability weighting. RESULTS: Of the 4770 investigated participants with 'incident' prediabetes, 10.2% were managed with metformin. Participants on metformin had higher HbA1c levels at the baseline than those unexposed (mean 45 mmol/mol [6.2%] and 41 mmol/mol [5.9%], respectively), but no differences were observed at 6-12 months (mmol/mol ATE 0.0, 95% CI -0.4; 0.7) or 12-18 months (ATE -0.3, 95% CI -1.2; 0.3). However, participants on metformin had lower mean HbA1c mmol/mol at 18-24 months (ATE -1.1, 95% CI -2.0; 0.1) than those unexposed. Consistent results were observed for FBG (ATE at 6-12 months -0.14 [95% CI -0.25; -0.04], 12-18 months 0.02 [95% CI -0.08; 0.13] and 18-24 months -0.07 [95% CI -0.25; 0.12]). CONCLUSION: The higher HbA1c and FBG baseline levels among participants with 'incident' prediabetes managed with metformin improved after 6-12 months of starting pharmacological management, and the effect persisted for up to 24 months. Management with metformin could prevent further deterioration of glycaemic levels.

Assuntos

Diabetes Mellitus Tipo 2, Metformina, Estado Pré-Diabético, Humanos, Metformina/uso terapêutico, Estado Pré-Diabético/tratamento farmacológico, Estado Pré-Diabético/epidemiologia, Diabetes Mellitus Tipo 2/tratamento farmacológico, Diabetes Mellitus Tipo 2/epidemiologia, Hemoglobinas Glicadas, Controle Glicêmico, Estudos Retrospectivos, Glicemia, Austrália/epidemiologia, Prontuários Médicos, Atenção Primária à Saúde, Hipoglicemiantes/uso terapêutico, Resultado do Tratamento

RESUMO

Aims: To investigate the epidemiology of diabetes diagnosis and screening in Australian general practice. Methods: Cross-sectional study using electronic health records of 1,522,622 patients aged 18+ years attending 544 Australian general practices (MedicineInsight database). The prevalence of diagnosed diabetes and diabetes screening was explored using all recorded diagnoses, laboratory results, and prescriptions between 2016 and 2018. Their relationship with patient sociodemographic and clinical characteristics was also investigated. Results: Overall, 7.5% (95% CI 7.3, 7.8) of adults had diabetes diagnosis, 0.7% (95% CI 0.6, 0.7) prediabetes, and 0.3% (95% CI 0.3, 0.3) unrecorded diabetes/prediabetes (elevated glucose levels without a recorded diagnosis). Patients with unrecorded diabetes/prediabetes had clinical characteristics similar to those with recorded diabetes, except for a lower prevalence of overweight/obesity (55.5% and 69.9%, respectively). Dyslipidaemia was 1.8 times higher (36.2% vs. 19.7%), and hypertension was 15% more likely (38.6% vs. 33.8%) among patients with prediabetes than with diabetes. Diabetes screening (last three years) among people at high risk of diabetes was 55.2% (95% CI 52.7, 57.7), with lower rates among young or elderly males. Conclusions: Unrecorded diabetes/prediabetes is infrequent in Australian general practice, but prediabetes diagnosis was also lower than expected. Diabetes screening among high-risk individuals can be improved, especially in men, to enhance earlier diabetes diagnosis and management.

Assuntos

Diabetes Mellitus Tipo 2, Medicina Geral, Estado Pré-Diabético, Adolescente, Adulto, Idoso, Austrália/epidemiologia, Estudos Transversais, Diabetes Mellitus Tipo 2/epidemiologia, Humanos, Masculino, Estado Pré-Diabético/diagnóstico, Estado Pré-Diabético/epidemiologia

RESUMO

OBJECTIVE: To examine trends in prescribing psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018. METHOD: A retrospective cohort study examined prescriptions written by general practitioners using MedicineInsight, a large Australian primary care database, covering approximately 9% of all general practitioner practices. Numbers of patients receiving prescriptions for five main classes of psychotropics (antipsychotics, antidepressants, attention deficit hyperactivity disorder medications, anxiolytics, and hypnotics/sedatives [including benzodiazepines and Z-drugs, but excluding melatonin]) were examined annually by age-group (0-4, 5-9, 10-14, 15-18 years). Melatonin was analysed separately. RESULTS: The number of patients prescribed any psychotropic increased from 25.6 to 36.2 per 1000 individuals from 2011 to 2018 (average annual increase +4.5%, 95% confidence interval [4.1%, 4.9%]; overall +41.4%). Among the five main classes, the largest annual increase was for attention deficit hyperactivity disorder medications (+9.6%, 95% confidence interval [8.8%, 10.5%]; overall +95.8%), followed by antipsychotics (+6.2%, 95% confidence interval [5.0%, 7.3%]; overall +62.8%) and antidepressants (+4.5%, 95% confidence interval [4.0%, 5.0%]; overall +42.8%). Hypnotic/sedative prescribing decreased on average 6.5% per year (95% confidence interval [-8.0%, -5.0%]; overall -40.2%). Anxiolytic prescribing remained steady. Melatonin prescriptions showed the highest increase of all (+24.7%, 95% confidence interval [23.7%, 25.8%]; overall +606.7%). The largest annual increase in antipsychotic, antidepressant or attention deficit hyperactivity disorder medication prescribing occurred in 10- to 14-year-olds (+7.5%, +6.5% and +10.4%, respectively). The largest point prevalence occurred in 2018 among 15- to 18-year-olds, with 98.5 per 1000 prescribed antidepressants. Antidepressants were more frequently prescribed to females; antipsychotics, attention deficit hyperactivity disorder medications and melatonin more often to males. The most prescribed antipsychotics were risperidone (<15 years) and quetiapine (15- to 18-year-olds). Fluoxetine was the most prescribed antidepressant in those aged 5+ years and amitriptyline in 0- to 4-year-olds. CONCLUSION: General practitioner prescribing of melatonin, antipsychotics, antidepressants and attention deficit hyperactivity disorder medications to under-19-year-olds increased markedly from 2011 to 2018. Although benzodiazepine and Z-drug prescriptions declined, this was offset by a substantial increase in melatonin prescribing.

Assuntos

Ansiolíticos, Antipsicóticos, Melatonina, Criança, Masculino, Feminino, Adolescente, Humanos, Pré-Escolar, Antipsicóticos/uso terapêutico, Ansiolíticos/uso terapêutico, Estudos Retrospectivos, Fumarato de Quetiapina, Risperidona, Fluoxetina, Amitriptilina, Melatonina/uso terapêutico, Austrália/epidemiologia, Psicotrópicos/uso terapêutico, Prescrições de Medicamentos, Antidepressivos/uso terapêutico, Benzodiazepinas/uso terapêutico, Hipnóticos e Sedativos/uso terapêutico, Atenção Primária à Saúde

RESUMO

Surveillance systems are fundamental to detect infectious disease outbreaks and guide public health responses. We compared influenza-like illness (ILI) rates for 2015-2017 using data from the Australian Sentinel Practice Research Network (ASPREN) and electronic medical records from 550 general practices across Australia (MedicineInsight). There was a high correlation between both sources (r = .84-.95) and a consistent higher ILI rate in 2017. Both sources also showed higher ILI rates among women and patients aged 20-49 years. The use of routinely collected electronic medical records like those in MedicineInsight could be used to complement active influenza surveillance systems in Australia.

Assuntos

Registros Eletrônicos de Saúde/estatística & dados numéricos, Medicina Geral/estatística & dados numéricos, Influenza Humana/epidemiologia, Adolescente, Adulto, Idoso, Austrália/epidemiologia, Criança, Pré-Escolar, Feminino, Humanos, Masculino, Pessoa de Meia-Idade, Vigilância de Evento Sentinela, Adulto Jovem

RESUMO

OBJECTIVES: To investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing. DESIGN: Open cohort study. SETTING: A representative sample of 550 Australian general practices contributing data to the MedicineInsight programme. PARTICIPANTS: 4 228 149 patients of all age groups who had at least one consultation between 2015 and 2017. Median age was 37 years (Interquartile range: 21-57), 54.4% women, 16.4% aged ≥65 years, 2.2% Aboriginal or Torres Strait Islander, 17.6% had a chronic disease and 18.1% a mental health condition. PRIMARY AND SECONDARY OUTCOME MEASURES: ILI consultation rates (per 1000 consultations) were calculated using all ILI diagnoses for all clinical encounters with a general practitioner between 2015 and 2017. Antiviral and antibiotic prescribing for ILI cases were investigated and logistic regression models adjusted for practice and patient characteristics used to analyse associations. RESULTS: ILI consultation rates in 2017 were higher than in previous years. Antiviral prescribing increased from 20.6% in 2015, to 23.7 in 2016 and 29.7% in 2017, while antibiotic prescribing decreased from 30.3% to 28.0% and 26.7%, respectively (p<0.05 in both cases). Practices located in high socioeconomic areas had higher ILI consultation rates (4.3 vs 2.5 per 1000 consultations, p<0.05), antibiotic (30.7% vs 23.4%, p<0.05) and antiviral (34.2% vs 13.5%, p<0.05) prescribing than those in lower socioeconomic areas. The coexistence of chronic or mental health conditions was associated with lower ILI consultation rates, higher antibiotic use, but not with antiviral prescribing. However, those with chronic respiratory conditions had a higher frequency of antibiotic and antiviral prescribing in 2017 than individuals with other comorbidities. CONCLUSIONS: Although the apparent decline in antibiotic prescribing for ILI is welcome, the increase in antiviral use may not be targeting those at high risk of complications from infection.

Assuntos

Antibacterianos/farmacologia, Prescrições de Medicamentos/estatística & dados numéricos, Medicina Geral/estatística & dados numéricos, Influenza Humana/tratamento farmacológico, Padrões de Prática Médica, Adolescente, Adulto, Idoso, Austrália/epidemiologia, Criança, Pré-Escolar, Bases de Dados Factuais, Feminino, Humanos, Incidência, Influenza Humana/epidemiologia, Masculino, Pessoa de Meia-Idade, Estudos Retrospectivos, Adulto Jovem

RESUMO

OBJECTIVE: To describe the sample plan, operational aspects, and strategies used in the 2009/2010 and 2013/2014 EpiFloripa Aging Study. METHODS: The EpiFloripa Aging is a population-based longitudinal study with 1,705 older adults (60 years or more) living in the municipality of Florianópolis, State of Santa Catarina, Brazil, in 2009/2010 (baseline). The research was conducted with a face-to-face interviews, organized into blocks of identification, socioeconomic, mental health, health and life habits, global functionality, falls, physical activity, morbidities, use of health services, use of medications, food, oral health, and violence, evaluated in the first (2009/2010) and in the second wave (2013/2014). Additionally, in the second wave, we investigated the issue of discrimination and quality of life. RESULTS: The response rate of the first wave was 89.2% (n = 1,705). The baseline sample, with predominance of women (63.9%), was similar to the 2010 Census regarding age for women and slightly different for younger men. In the second wave, 1,197 participants were interviewed (response rate of 70.3%). Follow-up losses were only observed for the variable age group (p = 0.003), and predominantly for those aged 80 years or more. Mortality data linkage and active search for participants were used as a follow-up strategies. CONCLUSIONS: This study used strategies that were able to help locate the participants and maintain adherence, which ensured a good response rate during investigations.

Assuntos

Avaliação Geriátrica/métodos, Inquéritos Epidemiológicos/métodos, Envelhecimento Saudável/psicologia, Idoso, Idoso de 80 Anos ou mais, Brasil, Estudos de Coortes, Feminino, Seguimentos, Humanos, Expectativa de Vida, Masculino, Pessoa de Meia-Idade, Qualidade de Vida, Fatores Socioeconômicos

RESUMO

Introdução: Úlceras pépticas ainda são um problema de saúde pública, portanto há interesse em obter dados atuais com a finalidade de melhorias nas estratégias de saúde. Objetivos: Conhecer o perfil epidemiológico dos pacientes diagnosticados com úlcera gástrica e/ou duodenal. Metodologia: Foi realizado um estudo observacional, transversal, prospectivo, de abordagem quantitativa, com uma população composta por crianças, adultos e idosos, submetidos ao exame de endoscopia digestiva alta em um serviço de referência público e outro privado do extremo sul catarinense entre agosto de 2012 e agosto de 2013. Resultados: A idade média foi 56,3 (±16,9) anos naqueles diagnosticados com úlceras pépticas, 60,2 (±15,3) anos naqueles com úlcera gástrica e entre os casos de úlcera duodenal, a média foi de 49,4 (±17,9) anos. A presença de H. Pylori, foi confirmada em 57,6% do total de pacientes com úlcera péptica, todavia a presença de H. Pylori variou conforme o tipo de úlcera presente. Entre aqueles com úlcera gástrica, a maioria, 66,7% (IC95% 44,7;88,7), teve resultado negativo para a bactéria, enquanto 33,3% (IC95% 11,3;55,3) apresentaram H. Pylori. Em contrapartida, nos pacientes com úlceras duodenais, a bactéria estava presente em 100% (IC95% 100,0;100,0) dos casos (p=0,001). Conclusão: Foi observada maior frequência de úlceras gástricas em homens, brancos, não tabagistas e não usuários de AINEs. Constatou-se maior presença de H. Pylori naqueles com úlceras duodenais e, dentre as úlceras gástricas, a maioria dos pacientes não apresentou neoplastias ao exame anatomopatológico.

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Background: Peptic ulcers currently remain a public health care issue, hence there is interest in obtain current data for improve the health care strategies. Objectives: To acknowledge the epidemiological profile of patients diagnosed with gastric and/or duodenal ulcer via upper endoscopy. Method: An observational, cross-sectional, prospective and quantitative approach was conducted. The population was composed by children, adults and seniors, examined by upper endoscopy in a renown public and a renown private institutions in the far-south of Santa Catarina between August 1st of 2012 and August 1st of 2013. Results: The mean age was 56,3 (±16,9) years old in those diagnosed with peptic ulcers, 60,2 (±15,3) in those diagnosed with gastric ulcer and 49,4 (±17,9) in those diagnosed with duodenal ulcer. The presence of H. Pylori was confirmed in 57,6% of the patients with peptic ulcers, however, the percentage varied according to the type of the ulcer: among those with gastric ulcer, the majority - 66,7% (IC95% 44,7;88,7) ­ shown negative results for H. Pylori while 33,3% (IC95% 11,3;55,3) shown positive test results, indicating the presence of the bacteria. In the other hand, patients with duodenal ulcer had the bacteria in 100% of the cases (p=0,001). Conclusion: It was observed higher frequency of gastric ulcers among men, whites, non-AINEs-users, and non-smokers. Higher prevalence of the H. Pylori was observed in patients with duodenal ulcers. The majority of the patients with gastric ulcers did not show gastric neoplasia in the anatomopathological exam.

RESUMO

Abstract Objective: to evaluate if the prevalence of healthy food consumption indicators among elderly persons with the self-reported diagnosis of diabetes mellitus and/or systemic arterial hypertension (DM and/or SAH) improved after diagnosis of these diseases, and to compare if the prevalence of such indicators was more frequent among elderly persons with DM and/or SAH than in elderly persons without these diseases. Method: a longitudinal study of 1,197 elderly persons aged 60-104 years, living in Florianopolis, Santa Catarina, Brazil, was performed, considering as an outcome the self-reported diagnosis of diabetes and/or hypertension. Healthy consumption indicators (exposures) were considered the maintenance and/or acquisition of the intake of fruit and vegetables ≥3 and ≥2 times/day, respectively, the consumption of fatty meat <2 times/week, and fried foods <2 times/week. Data was analyzed in terms of absolute and relative frequencies, and Poisson Regression was used to obtain the crude and adjusted prevalence of food consumption indicators. Values of p≤0.05 were considered statistically significant. Results: when comparing the prevalences of the indicators of healthy food consumption among elderly persons with DM and/or SAH with those without these diseases, it was observed that only the consumption of fried foods changed positively between the periods 2009-2010 and 2013-2014. This result was statistically significant only for women, with maintaining/acquiring the infrequent consumption of fried foods (<2 times/week) 8.2% higher among elderly women with DM and/or SAH, p=0.043. Conclusion: The prevalence of healthy food consumption indicators was low and there was almost no difference between older adults with and without DM and/or SAH. AU

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Resumo Objetivo: Avaliar se a prevalência de indicadores de consumo alimentar saudável entre idosos com diagnóstico autorreferido de diabetes mellitus e/ou hipertensão arterial sistêmica (DM e/ou HAS) melhorou após diagnóstico dessas doenças, e comparar se a prevalência de tais indicadores foi mais frequente entre idosos com DM e/ou HAS do que em idosos sem essas doenças. Método: estudo longitudinal, com 1.197 idosos de 60-104 anos, residentes em Florianópolis, Santa Catarina, Brasil, considerando como desfecho o diagnóstico autorreferido de DM e/ou HAS. Foram considerados como indicadores de consumo alimentar saudável (exposições) a manutenção e/ou aquisição de um consumo alimentar: de frutas e vegetais ≥3 e ≥2 vezes/dia, respectivamente, de gordura das carnes <2 vezes/semana, e de frituras <2 vezes/semana. Os dados foram analisados em frequências absolutas e relativas e, para a obtenção das prevalências brutas e ajustadas dos indicadores de consumo alimentar, foi empregada a Regressão de Poisson. Valores de p≤0,05 foram considerados como estatisticamente significantes. Resultados: Ao se comparar as prevalências dos indicadores de consumo alimentar saudável entre idosos com DM e/ou HAS com aqueles sem tais doenças, foi possível observar que apenas o consumo de frituras se modificou positivamente entre as ondas de 2009-2010 e 2013-2014, contudo, esse resultado só foi estatisticamente significante para as mulheres (a manutenção/aquisição de consumo infrequente de frituras (<2 vezes/semana), foi 8,2% maior entre idosas com DM e/ou HAS; p=0,043). Conclusão: as prevalências de indicadores de consumo alimentar saudável foram baixas e praticamente não diferiram entre idosos com e sem DM e/ou HAS. AU

Assuntos

Humanos, Masculino, Feminino, Idoso, Idoso de 80 Anos ou mais, Diabetes Mellitus, Ingestão de Alimentos, Saúde do Idoso, Hipertensão, Estudos Longitudinais

RESUMO

ABSTRACT OBJECTIVE To describe the sample plan, operational aspects, and strategies used in the 2009/2010 and 2013/2014 EpiFloripa Aging Study. METHODS The EpiFloripa Aging is a population-based longitudinal study with 1,705 older adults (60 years or more) living in the municipality of Florianópolis, State of Santa Catarina, Brazil, in 2009/2010 (baseline). The research was conducted with a face-to-face interviews, organized into blocks of identification, socioeconomic, mental health, health and life habits, global functionality, falls, physical activity, morbidities, use of health services, use of medications, food, oral health, and violence, evaluated in the first (2009/2010) and in the second wave (2013/2014). Additionally, in the second wave, we investigated the issue of discrimination and quality of life. RESULTS The response rate of the first wave was 89.2% (n = 1,705). The baseline sample, with predominance of women (63.9%), was similar to the 2010 Census regarding age for women and slightly different for younger men. In the second wave, 1,197 participants were interviewed (response rate of 70.3%). Follow-up losses were only observed for the variable age group (p = 0.003), and predominantly for those aged 80 years or more. Mortality data linkage and active search for participants were used as a follow-up strategies. CONCLUSIONS This study used strategies that were able to help locate the participants and maintain adherence, which ensured a good response rate during investigations.

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RESUMO OBJETIVO Descrever o plano amostral, aspectos operacionais e estratégias utilizadas no Estudo EpiFloripa Idoso 2009/2010 e 2013/2014. MÉTODOS O EpiFloripa Idoso é um estudo de base populacional com 1.705 idosos (60 anos ou mais) residentes no município de Florianópolis, SC, em 2009/2010 (linha de base). A investigação foi realizada por meio de entrevista face a face, organizada nos blocos de identificação, geral (características socioeconômicas), saúde mental, saúde e hábitos de vida, funcionalidade global, quedas, atividade física, morbidades, uso de serviços de saúde, uso de medicamentos, alimentação, saúde bucal e violência, avaliados na primeira (2009/2010) e na segunda onda (2013/2014). Adicionalmente, na segunda onda, investigou-se a temática de discriminação e qualidade de vida. RESULTADOS A taxa de resposta na primeira onda foi de 89,2% (n = 1.705). A amostra da linha de base, com predomínio de mulheres (63,9%), foi semelhante ao Censo 2010 em relação à idade nas mulheres e ligeiramente diferente nos homens mais jovens. Na segunda onda, 1.197 participantes foram entrevistados (taxa de resposta de 70,3%). Houve perda de seguimento somente para a variável faixa etária (p=0,003), principalmente naqueles com 80 anos ou mais. Utilizou-se como estratégias de seguimento o relacionamento de dados e a busca ativa. CONCLUSÕES O presente estudo utilizou estratégias que conseguiram auxiliar na localização dos participantes e manutenção da aderência, o que garantiu boa taxa de resposta durante as investigações.

Assuntos

Humanos, Masculino, Feminino, Idoso, Idoso de 80 Anos ou mais, Avaliação Geriátrica, Inquéritos Epidemiológicos/métodos, Envelhecimento Saudável/psicologia, Qualidade de Vida, Fatores Socioeconômicos, Brasil, Estudos de Coortes, Seguimentos, Expectativa de Vida, Pessoa de Meia-Idade

RESUMO

OBJECTIVE To analyze if differences according to gender exists in the association between tooth loss and obesity among older adults. METHODS We analyzed data on 1,704 older adults (60 years and over) from the baseline of a prospective cohort study conducted in Florianopolis, SC, Southern Brazil. Multivariable logistic regression models were used to assess the association between tooth loss and general and central obesity after adjustment for confounders (age, gender, skin color, educational attainment, income, smoking, physical activity, use of dentures, hypertension, and diabetes). Linear regressions were also assessed with body mass index and waist circumference as continuous outcomes. Interaction between gender and tooth loss was further assessed. RESULTS Overall mean body mass index was 28.0 kg/m2. Mean waist circumference was 96.8 cm for males and 92.6 cm for females. Increasing tooth loss was positively associated with increased body mass index and waist circumference after adjustment for confounders. Edentates had 1.4 (95%CI 1.1;1.9) times higher odds of being centrally obese than individuals with a higher number of teeth; however, the association lost significance after adjustment for confounders. In comparison with edentate males, edentate females presented a twofold higher adjusted prevalence of general and central obesity. In the joint effects model, edentate females had a 3.8 (95%CI 2.2;6.6) times higher odds to be centrally obese in comparison with males with more than 10 teeth present in both the arches. Similarly, females with less than 10 teeth in at least one arch had a 2.7 (95%CI 1.6;4.4) times higher odds ratio of having central obesity in comparison with males with more than 10 teeth present in both the arches. CONCLUSIONS Central obesity was more prevalent than general obesity among the older adults. We did not observe any association between general obesity and tooth loss. The association between central obesity and tooth loss depends on gender - females with tooth loss had greater probability of being obese.

Assuntos

Obesidade/complicações, Fatores Sexuais, Perda de Dente/complicações, Idoso, Idoso de 80 Anos ou mais, Índice de Massa Corporal, Brasil/epidemiologia, Estudos Transversais, Feminino, Humanos, Masculino, Pessoa de Meia-Idade, Obesidade/epidemiologia, Obesidade Abdominal/complicações, Obesidade Abdominal/epidemiologia, Prevalência, Estudos Prospectivos, Fatores Socioeconômicos, Perda de Dente/epidemiologia, Circunferência da Cintura

RESUMO

OBJECTIVE To analyze if differences according to gender exists in the association between tooth loss and obesity among older adults. METHODS We analyzed data on 1,704 older adults (60 years and over) from the baseline of a prospective cohort study conducted in Florianopolis, SC, Southern Brazil. Multivariable logistic regression models were used to assess the association between tooth loss and general and central obesity after adjustment for confounders (age, gender, skin color, educational attainment, income, smoking, physical activity, use of dentures, hypertension, and diabetes). Linear regressions were also assessed with body mass index and waist circumference as continuous outcomes. Interaction between gender and tooth loss was further assessed. RESULTS Overall mean body mass index was 28.0 kg/m2. Mean waist circumference was 96.8 cm for males and 92.6 cm for females. Increasing tooth loss was positively associated with increased body mass index and waist circumference after adjustment for confounders. Edentates had 1.4 (95%CI 1.1;1.9) times higher odds of being centrally obese than individuals with a higher number of teeth; however, the association lost significance after adjustment for confounders. In comparison with edentate males, edentate females presented a twofold higher adjusted prevalence of general and central obesity. In the joint effects model, edentate females had a 3.8 (95%CI 2.2;6.6) times higher odds to be centrally obese in comparison with males with more than 10 teeth present in both the arches. Similarly, females with less than 10 teeth in at least one arch had a 2.7 (95%CI 1.6;4.4) times higher odds ratio of having central obesity in comparison with males with more than 10 teeth present in both the arches. CONCLUSIONS Central obesity was more prevalent than general obesity among the older adults. We did not observe any association between general obesity and tooth loss. The association between central obesity and tooth loss depends on gender ­ females with tooth loss had greater probability of being obese.(AU)

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OBJETIVO Analisar se há diferenças entre gêneros na associação entre obesidade e perda dentária em idosos. MÉTODOS Foram avaliados dados de 1.704 idosos (60 anos ou mais) da linha de base de um estudo de coorte prospectivo realizado em Florianópolis, SC. Modelos de regressão logística multivariáveis foram realizados para aferição da associação entre perda dentária e obesidade geral e central, ajustados por variáveis de confusão (idade, gênero, cor da pele, educação, renda, tabagismo, atividade física, uso de prótese dentária, hipertensão e diabetes). Na regressão linear, índice de massa corporal e circunferência da cintura foram tratados como variáveis contínuas. Foi avaliada também a interação entre gênero e perda dentária. RESULTADOS A média geral do índice de massa corporal foi 28,0. A média de circunferência da cintura foi de 96,8 cm para homens e 92,6 cm para mulheres. O aumento da perda dentária associou-se positivamente com o aumento do índice de massa corporal e da circunferência da cintura, após ajuste por variáveis de confusão. Edêntulos apresentaram chance 1,4 (IC95% 1,1;1,9) vez maior de apresentarem obesidade central quando comparados com aqueles com maior número de dentes presentes; entretanto, a associação perdeu significância estatística após o ajuste pelas variáveis de confusão. Comparadas com homens edêntulos, mulheres edêntulas apresentaram prevalência ajustada de obesidade geral e central duas vezes maior. No modelo de efeitos conjuntos, mulheres edêntulas tiveram uma razão de chances 3,8 (IC95% 2,2;6,6) vezes maior de apresentarem obesidade central, quando comparadas com homens com mais de 10 dentes presentes em ambas as arcadas. De maneira similar, mulheres com menos de 10 dentes presentes em pelo menos uma arcada tiveram uma razão de chances 2,7 (IC95% 1,6;4,4) vezes maior de terem obesidade central quando comparadas com homens com mais de 10 dentes presentes em ambas arcadas. CONCLUSÕES Obesidade central foi mais prevalente que obesidade geral em idosos. Não foram encontradas associações entre obesidade geral e perda dentária. Associação entre obesidade central e perda dentária depende do gênero ­ mulheres com perdas dentárias apresentaram maior probabilidade de serem obesas.(AU)

Assuntos

Humanos, Masculino, Feminino, Pessoa de Meia-Idade, Idoso, Idoso de 80 Anos ou mais, Obesidade/complicações, Fatores Sexuais, Perda de Dente/complicações, Índice de Massa Corporal, Brasil/epidemiologia, Estudos Transversais, Obesidade Abdominal/complicações, Obesidade Abdominal/epidemiologia, Obesidade/epidemiologia, Prevalência, Estudos Prospectivos, Fatores Socioeconômicos, Perda de Dente/epidemiologia, Circunferência da Cintura

RESUMO

OBJECTIVE: To examine the association between tooth loss and general and central obesity among adults. METHODS: Population-based cross-sectional study with 1,720 adults aged 20 to 59 years from Florianópolis, Southern Brazil. Home interviews were performed and anthropometric measures were taken. Information on sociodemographic data, self-reported diabetes, self-reported number of teeth, central obesity (waist circumference [WC] > 88 cm in women and > 102 cm in men) and general obesity (body mass index [BMI] ≥ 30 kg/m²) was collected. We used multivariable Poisson regression models to assess the association between general and central obesity and tooth loss after controlling for confounders. We also performed simple and multiple linear regressions by using BMI and WC as continuous variables. Interaction between age and tooth loss was also assessed. RESULTS: The mean BMI was 25.9 kg/m² (95%CI 25.6;26.2) in men and 25.4 kg/m2 (95%CI 25.0;25.7) in women. The mean WC was 79.3 cm (95%CI 78.4;80.1) in men and 88.4 cm (95%CI 87.6;89.2) in women. A positive association was found between the presence of less than 10 teeth in at least one arch and increased mean BMI and WC after adjusting for education level, self-reported diabetes, gender and monthly per capita income. However, this association was lost when the variable age was included in the model. The prevalence of general obesity was 50% higher in those with less than 10 teeth in at least one arch when compared with those with 10 or more teeth in both arches after adjusting for education level, self-reported diabetes and monthly per capita family income. However, the statistical significance was lost after controlling for age. CONCLUSIONS: Obesity was associated with number of teeth, though it depended on the participants' age groups.

Assuntos

Obesidade/etiologia, Perda de Dente/complicações, Adulto, Fatores Etários, Índice de Massa Corporal, Brasil/epidemiologia, Estudos Transversais, Feminino, Humanos, Masculino, Pessoa de Meia-Idade, Obesidade/epidemiologia, Obesidade Abdominal/epidemiologia, Obesidade Abdominal/etiologia, Fatores Sexuais, Fatores Socioeconômicos, Inquéritos e Questionários, População Urbana, Adulto Jovem

RESUMO

OBJECTIVE: To examine the association between tooth loss and general and central obesity among adults. METHODS: Population-based cross-sectional study with 1,720 adults aged 20 to 59 years from Florianópolis, Southern Brazil. Home interviews were performed and anthropometric measures were taken. Information on sociodemographic data, self-reported diabetes, self-reported number of teeth, central obesity (waist circumference [WC] > 88 cm in women and > 102 cm in men) and general obesity (body mass index [BMI] ≥ 30 kg/m²) was collected. We used multivariable Poisson regression models to assess the association between general and central obesity and tooth loss after controlling for confounders. We also performed simple and multiple linear regressions by using BMI and WC as continuous variables. Interaction between age and tooth loss was also assessed. RESULTS: The mean BMI was 25.9 kg/m² (95%CI 25.6;26.2) in men and 25.4 kg/m2 (95%CI 25.0;25.7) in women. The mean WC was 79.3 cm (95%CI 78.4;80.1) in men and 88.4 cm (95%CI 87.6;89.2) in women. A positive association was found between the presence of less than 10 teeth in at least one arch and increased mean BMI and WC after adjusting for education level, self-reported diabetes, gender and monthly per capita income. However, this association was lost when the variable age was included in the model. The prevalence of general obesity was 50% higher in those with less than 10 teeth in at least one arch when compared with those with 10 or more teeth in both arches after adjusting for education level, self-reported diabetes and monthly per capita family income. However, the statistical significance was lost after controlling for age. CONCLUSIONS: Obesity was associated with number of teeth, though it depended on the participants' age groups.

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OBJETIVO: Analisar a associação entre perda dentária e obesidade geral e central em adultos. MÉTODOS: Estudo transversal de base populacional com 1.720 adultos (20 a 59 anos) de Florianópolis, SC, em 2009. Entrevistas e medidas antropométricas foram realizadas nos domicílios. Foram incluídos dados sociodemográficos, diabetes e número de dentes autorreferidos, obesidade central (circunferência da cintura > 88 cm em mulheres e > 102 cm em homens) e geral (índice de massa corporal ≥ 30 kg/m²). Utilizou-se um modelo múltiplo por meio da regressão de Poisson para associações entre obesidade geral e central e perda dentária após controle pelas variáveis de confusão. Também foram realizadas análises de regressão linear simples e múltipla utilizando índice de massa corporal e circunferência da cintura como variáveis contínuas. A interação entre idade e perda dentária também foi investigada. RESULTADOS: A média de índice de massa corporal foi 25,9 kg/m² (IC95% 25,6;26,2) em homens e 25,4 kg/m2 (IC95% 25,0;25,7) em mulheres. A média de circunferência da cintura foi 79,3 cm (IC95% 78,4;80,1) nos homens e 88,4 cm (IC95% 87,6;89,2) nas mulheres. Observou-se associação positiva entre a presença de menos de dez dentes em pelo menos uma arcada e o aumento do índice de massa corporal e da circunferência da cintura após ajuste para escolaridade, diabetes autorreferida, sexo e renda mensal per capita. Entretanto, essa associação foi perdida quando a idade foi incluída no modelo. A prevalência de obesidade geral foi 50% maior em adultos que apresentavam menos de dez dentes em pelo menos uma arcada quando comparados àqueles com dez ou mais dentes em ambas as arcadas após ajuste para escolaridade, diabetes autorreferida e renda mensal per capita. Porém, a significância estatística foi perdida após controle pela idade. CONCLUSÕES: Obesidade foi associada ao número de dentes, entretanto dependeu do grupo etário dos participantes.

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OBJETIVO: Analizar la asociación entre pérdida dentaria y obesidad general y central en adultos. MÉTODOS: Estudio transversal de base poblacional con 1.720 adultos (20 a 59 años) de Florianópolis, Sur de Brasil, en 2009. Se realizaron entrevistas y medidas antropométricas en los domicilios. Se incluyeron datos sociodemográficos, diabetes y número de dientes auto-referidos, obesidad central (circunferencia de la cintura > 88 cm en mujeres y > 102 cm en hombres) y general (índice de masa corporal ≥ 30 kg/m2). Se utilizó un modelo múltiple por medio de la regresión de Poisson para asociaciones entre obesidad general y central y pérdida dentaria posterior al control por las variables de confusión. También se realizaron análisis de regresión linear simple y múltiple utilizando índice de masa corporal y circunferencia de la cintura como variables continuas. La interacción entre edad y pérdida dentaria también fue investigada. RESULTADOS: El promedio de índice de masa corporal fue 25,9 kg/m2 (IC95% 25,6;26,2) en hombres y 25,4 kg/m2 (IC95% 25,0;25,7) en mujeres. El promedio de circunferencia de la cintura fue 79,3 cm (IC95% 78,4;80,1) en los hombres y 88,4 cm (IC95% 87,6;89,2) en las mujeres. Se observó asociación positiva entre la presencia de menos de diez dientes en al menos una arcada y el aumento del índice de masa corporal y de la circunferencia de la cintura luego del ajuste para escolaridad, diabetes auto-referida, sexo y renta mensual per cápita. Sin embargo, esta asociación se perdió al incluir la edad en el modelo. La prevalencia de obesidad general fue 50% mayor en adultos que presentaron menos de diez dientes en al menos una arcada, en comparación con aquellos con diez dientes o más en ambas arcadas luego del ajuste por escolaridad, diabetes auto-referida y renta mensual per cápita. No obstante, la significancia estadística se perdió posterior al control por edad. CONCLUSIONES: La obesidad estuvo asociada al número de dientes, aun así, dependió del grupo etario de los participantes.

Assuntos

Adulto, Feminino, Humanos, Masculino, Pessoa de Meia-Idade, Adulto Jovem, Obesidade/etiologia, Perda de Dente/complicações, Fatores Etários, Índice de Massa Corporal, Brasil/epidemiologia, Estudos Transversais, Obesidade Abdominal/epidemiologia, Obesidade Abdominal/etiologia, Obesidade/epidemiologia, Inquéritos e Questionários, Fatores Sexuais, Fatores Socioeconômicos, População Urbana

RESUMO

To assess the association of parents' nutritional status, and dietary and sociodemographic factors with overweight/obesity in schoolchildren in Florianópolis Island, Santa Catarina State, Brazil, this cross-sectional epidemiological study examined 2,826 schoolchildren 7 to 14 years old, classified according to body mass index curves for age and sex recommended by the International Obesity Task Force. Data were analyzed using Poisson regression. The final model showed overweight/obesity in boys associated directly with father's educational level, mother's age, and parents' nutritional status, and inversely with mother's educational level, and number of daily meals. Among girls, it associated directly with parents' nutritional status and the schoolchildren's age, and inversely with consumption of risk foods. The variables that associated with overweight/obesity differed between the sexes, except parents' nutritional status. Boys and girls with both parents overweight or obese were, respectively, 80% and 150% more likely to exhibit the same diagnosis, indicating the need for interventions that include the family environment.

Assuntos

Dieta/efeitos adversos, Estado Nutricional/fisiologia, Obesidade/epidemiologia, Pais, Adolescente, Fatores Etários, Antropometria, Brasil/epidemiologia, Criança, Estudos Transversais, Escolaridade, Feminino, Humanos, Masculino, Sobrepeso/epidemiologia, Distribuição de Poisson, Prevalência, Fatores de Risco, Fatores Sexuais, Fatores Socioeconômicos, Inquéritos e Questionários

RESUMO

To assess the association of parents' nutritional status, and dietary and sociodemographic factors with overweight/obesity in schoolchildren in Florianópolis Island, Santa Catarina State, Brazil, this cross-sectional epidemiological study examined 2,826 schoolchildren 7 to 14 years old, classified according to body mass index curves for age and sex recommended by the International Obesity Task Force. Data were analyzed using Poisson regression. The final model showed overweight/obesity in boys associated directly with father's educational level, mother's age, and parents' nutritional status, and inversely with mother's educational level, and number of daily meals. Among girls, it associated directly with parents' nutritional status and the schoolchildren's age, and inversely with consumption of risk foods. The variables that associated with overweight/obesity differed between the sexes, except parents' nutritional status. Boys and girls with both parents overweight or obese were, respectively, 80 percent and 150 percent more likely to exhibit the same diagnosis, indicating the need for interventions that include the family environment.

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O objetivo deste estudo foi analisar a associação entre estado nutricional dos pais, variáveis sociodemográficas, dietéticas e o sobrepeso/obesidade em escolares de 7-14 anos de Florianópolis, Santa Catarina, Brasil. Estudo transversal com 2.826 escolares, classificados com base nas curvas de índice de massa corporal para idade e sexo segundo a International Obesity Task Force. Para as análises utilizou-se a Regressão de Poisson. No modelo final, mostraram associação direta ao sobrepeso/obesidade em meninos: escolaridade do pai, idade da mãe e estado nutricional dos pais; e inversa: escolaridade da mãe e número de refeições diárias. Entre as meninas houve associação direta com estado nutricional dos pais, e inversa com idade do escolar e consumo de alimentos de risco. As variáveis associadas ao sobrepeso/obesidade diferiram entre os sexos, com exceção do estado nutricional dos pais. Filhos e filhas de ambos os pais com sobrepeso/obesidade têm risco cerca de, respectivamente, 80 por cento e 150 por cento maior de apresentar o mesmo diagnóstico, indicando a necessidade de intervenções também no ambiente familiar.

Assuntos

Adolescente, Criança, Feminino, Humanos, Masculino, Dieta/efeitos adversos, Estado Nutricional/fisiologia, Obesidade/epidemiologia, Pais, Fatores Etários, Antropometria, Brasil/epidemiologia, Estudos Transversais, Escolaridade, Sobrepeso/epidemiologia, Distribuição de Poisson, Prevalência, Fatores de Risco, Fatores Sexuais, Fatores Socioeconômicos, Inquéritos e Questionários

RESUMO

OBJETIVOS: verificar a associação entre o Índice de Massa Corporal (IMC) de escolares de 7 a 14 anos e dos respectivos pais. MÉTODOS: estudo transversal com 886 escolares de quatro escolas de Florianópolis, SC. Diagnóstico antropométrico dos escolares e dos pais definido, respectivamente, a partir do IMC para idade de acordo com Centers for Disease Control and Prevention e dos pontos de corte da Organização Mundial da Saúde. A associação entre o IMC dos pais e dos escolares foi estimada por meio da razão de prevalência (RP) com intervalo de confiança (IC) de 95 por cento e teste qui-quadrado com valor de significância de p< 0,05. RESULTADOS: identificou-se prevalência de sobrepeso/obesidade mais elevada em meninos (29,9 por cento) quando comparada a de meninas (17,7 por cento) (p<0,001). Observou-se relação estatisticamente significante entre o IMC de escolares do sexo feminino com o IMC das mães (RP=1,63; IC95 por cento=1,1-3,0; p=0,02) e dos pais (RP=1,78; IC95 por cento= 1,1-3,5; p=0,01). Nos escolares do sexo masculino a associação observada não foi estatisticamente significante. CONCLUSÕES: identificou-se que a prevalência do sobrepeso ou obesidade é 1,63 vezes maior, entre as meninas, quando a mãe também apresenta esse distúrbio e 1,78 vezes maior quando o pai o apresenta, em comparação a mães e pais eutróficos ou de baixo peso.

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OBJECTIVES: to assess the association between parents 'Body Mass Index and schoolchildren from the age of 7 to 14 years old. METHODS: cross sectional epidemiological study with 886 schoolchildren from two public and two private schools in Florianópolis Island, Santa Catarina state. Schoolchildren and theirs parents anthropometric diagnostic was defined from the respectively BMIfor age according to the Centers for Disease Control and Prevention and WHO cutoff points. The association between parents BMI and schoolchildren was estimated through the prevalence ratio (PR) with confidence interval (CI) 95 percent and Pearson 's chi-square test with the significant value of p<0.05. RESULTS: higher overweight and obesity prevalence was verified in male students, 29.9 percent, compare to 17.7 percent to female students (p<0.001). Significant statistical relation between female students BMI and theirs mothers BMI was found, according to PR=1.63; CI95 percent=1.1-3.0;p=0.02 and theirs fathers BMI, PR=1.78; CI95 percent= 1.1-3.5; p=0.01. The association between male students IMC and theirs mothers and fathers did not show significant statistical relation. CONCLUSIONS: the female students prevalence of show overweight or obesity is 1.63 times higher when theirs mothers also showed the same nutritional status and 1.78 times higher when the father shows overweight/obesity in comparison to mothers and fathers with normal weight or underweight.

Assuntos

Humanos, Masculino, Criança, Índice de Massa Corporal, Obesidade, Pais, Estudantes