RESUMO
BACKGROUND: Investigation of alterations to retinal microvasculature may contribute towards understanding the role of such changes in the pathophysiology of several chronic non-communicable diseases. The objective here was to evaluate the validity and reproducibility of retinal arteriole and venule diameter measurements made by Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) graders. DESIGN AND SETTING: Cross-sectional study at six teaching and research institutions. METHODS: To evaluate validity, each of 25 retinal images from the University of Wisconsin (gold standard) was measured by five ELSA-Brasil graders. To evaluate reproducibility, 105 images across the spectrum of vessel diameters were selected from 12,257 retinal images that had been obtained between 2010 and 2012, and each image was reexamined by the same grader and by an independent grader. All measurements were made using the Interactive Vessel Analysis (IVAN) software. Bland-Altman plots, paired t tests and intraclass correlation coefficients (ICCs) were analyzed. RESULTS: Mean differences between ELSA-Brasil and gold-standard readings were 0.16 µm (95% CI -0.17-0.50; P = 0.31) for central retinal artery equivalent (CRAE), -0.21 µm (95% CI -0.56-0.14; P = 0.22) for central retinal vein equivalent (CRVE) and 0.0005 (95% CI -0.008-0.009; P = 0.55) for arteriole/venule ratio (AVR). Intragrader ICCs were 0.77 (95% CI 0.67-0.86) for CRAE, 0.90 (95% CI 0.780.96) for CRVE and 0.70 (0.55-0.83) for AVR. Intergrader ICCs were 0.75 (95% CI 0.64-0.85) for CRAE, 0.90 (95% CI 0.79-0.96) for CRVE and 0.68 (95% CI 0.55-0.82) for AVR. CONCLUSIONS: Retinal microvascular diameter measurements are valid and present moderate to high intra and intergrader reproducibility in ELSA-Brasil.
Assuntos
Arteríolas/anatomia & histologia , Interpretação de Imagem Assistida por Computador , Vasos Retinianos/anatomia & histologia , Vênulas/anatomia & histologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores SocioeconômicosRESUMO
ABSTRACT BACKGROUND: Investigation of alterations to retinal microvasculature may contribute towards understanding the role of such changes in the pathophysiology of several chronic non-communicable diseases. The objective here was to evaluate the validity and reproducibility of retinal arteriole and venule diameter measurements made by Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) graders. DESIGN AND SETTING: Cross-sectional study at six teaching and research institutions. METHODS: To evaluate validity, each of 25 retinal images from the University of Wisconsin (gold standard) was measured by five ELSA-Brasil graders. To evaluate reproducibility, 105 images across the spectrum of vessel diameters were selected from 12,257 retinal images that had been obtained between 2010 and 2012, and each image was reexamined by the same grader and by an independent grader. All measurements were made using the Interactive Vessel Analysis (IVAN) software. Bland-Altman plots, paired t tests and intraclass correlation coefficients (ICCs) were analyzed. RESULTS: Mean differences between ELSA-Brasil and gold-standard readings were 0.16 µm (95% CI -0.17-0.50; P = 0.31) for central retinal artery equivalent (CRAE), -0.21 µm (95% CI -0.56-0.14; P = 0.22) for central retinal vein equivalent (CRVE) and 0.0005 (95% CI -0.008-0.009; P = 0.55) for arteriole/venule ratio (AVR). Intragrader ICCs were 0.77 (95% CI 0.67-0.86) for CRAE, 0.90 (95% CI 0.780.96) for CRVE and 0.70 (0.55-0.83) for AVR. Intergrader ICCs were 0.75 (95% CI 0.64-0.85) for CRAE, 0.90 (95% CI 0.79-0.96) for CRVE and 0.68 (95% CI 0.55-0.82) for AVR. CONCLUSIONS: Retinal microvascular diameter measurements are valid and present moderate to high intra and intergrader reproducibility in ELSA-Brasil.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Arteríolas/anatomia & histologia , Vasos Retinianos/anatomia & histologia , Vênulas/anatomia & histologia , Interpretação de Imagem Assistida por Computador , Fatores Socioeconômicos , Estudos Transversais , Reprodutibilidade dos Testes , Estudos LongitudinaisRESUMO
The prevalence of the metabolic syndrome is rising worldwide. Its association with alcohol intake, a major lifestyle factor, is unclear, particularly with respect to the influence of drinking with as opposed to outside of meals. We investigated the associations of different aspects of alcohol consumption with the metabolic syndrome and its components. In cross-sectional analyses of 14,375 active or retired civil servants (aged 35-74 years) participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), we fitted logistic regression models to investigate interactions between the quantity of alcohol, the timing of its consumption with respect to meals, and the predominant beverage type in the association of alcohol consumption with the metabolic syndrome. In analyses adjusted for age, sex, educational level, income, socioeconomic status, ethnicity, smoking, body mass index, and physical activity, light consumption of alcoholic beverages with meals was inversely associated with the metabolic syndrome (≤4 drinks/week: OR = 0.85, 95%CI 0.74-0.97; 4 to 7 drinks/week: OR = 0.75, 95%CI 0.61-0.92), compared to abstention/occasional drinking. On the other hand, greater consumption of alcohol consumed outside of meals was significantly associated with the metabolic syndrome (7 to 14 drinks/week: OR = 1.32, 95%CI 1.11-1.57; ≥14 drinks/week: OR = 1.60, 95%CI 1.29-1.98). Drinking predominantly wine, which occurred mostly with meals, was significantly related to a lower syndrome prevalence; drinking predominantly beer, most notably when outside of meals and in larger quantity, was frequently associated with a greater prevalence. In conclusion, the alcohol-metabolic syndrome association differs markedly depending on the relationship of intake to meals. Beverage preference-wine or beer-appears to underlie at least part of this difference. Notably, most alcohol was consumed in metabolically unfavorable type and timing. If further investigations extend these findings to clinically relevant endpoints, public policies should recommend that alcohol, when taken, should be preferably consumed with meals.
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Consumo de Bebidas Alcoólicas , Síndrome Metabólica/epidemiologia , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Recent animal studies suggest that artificially sweetened beverage (ASB) consumption increases diabetes risk. OBJECTIVE: We examined the relation of ASB intake with newly diagnosed diabetes and measures of glucose homeostasis in a large Brazilian cohort of adults. METHODS: We used cross-sectional data from 12,884 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). ASB use was assessed by questionnaire and newly diagnosed diabetes by a 2-h 75-g oral glucose tolerance test and/or glycated hemoglobin. Logistic and linear regression analyses were performed to examine the association of ASB consumption with diabetes and continuous measures of glucose homeostasis, respectively. RESULTS: Although ASB consumption was not associated with diabetes in logistic regression analyses after adjustment for body mass index (BMI; in kg/m(2)) overall, the association varied across BMI categories (P-interaction = 0.04). Among those with a BMI <25, we found a 15% increase in the adjusted odds of diabetes for each increase in the frequency of ASB consumption per day (P = 0.001); compared with nonusers, ASB users presented monotonic increases in the adjusted ORs (95% CIs) of diabetes with increased frequency of consumption: 1.03 (0.60, 1.77), 1.43 (0.93, 2.20), 1.62 (1.08, 2.44), and 2.51 (1.40, 4.50) for infrequent, 1-2, 3-4, and >4 times/d, respectively. In linear regression analyses, among normal-weight individuals, greater ASB consumption was also associated with increased fasting glucose concentrations (P = 0.01) and poorer ß-cell function (P = 0.009). No such associations were seen for those with BMI ≥25. In fact, in overweight or obese participants, greater ASB consumption was significantly associated with improved indexes of insulin resistance and 2-h postload glucose. CONCLUSIONS: Normal-weight, but not excess-weight, individuals with greater ASB consumption presented diabetes more frequently and had higher fasting glucose and poorer ß-cell function.
Assuntos
Bebidas/efeitos adversos , Glicemia/metabolismo , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/etiologia , Comportamento Alimentar , Obesidade/complicações , Edulcorantes/efeitos adversos , Adulto , Idoso , Brasil , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Dieta , Feminino , Teste de Tolerância a Glucose , Hemoglobinas Glicadas/metabolismo , Humanos , Resistência à Insulina , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Sobrepeso , Valores de Referência , Aumento de PesoRESUMO
Background: Echocardiography, though non-invasive and having relatively low-cost, presents issues of variability which can limit its use in epidemiological studies. Objective: To evaluate left ventricular mass reproducibility when assessed at acquisition (online) compared to when assessed at a reading center after electronic transmission (offline) and also when assessed by different readers at the reading center. Methods: Echocardiographers from the 6 ELSA-Brasil study investigation centers measured the left ventricular mass online during the acquisition from 124 studies before transmitting to the reading center, where studies were read according to the study protocol. Half of these studies were blindly read by a second reader in the reading center. Results: From the 124 echocardiograms, 5 (4%) were considered not measurable. Among the remaining 119, 72 (61%) were women, mean age was 50.2 ± 7.0 years and 2 had structural myocardial abnormalities. Images were considered to be optimal/ good by the reading center for 110 (92.4%) cases. No significant difference existed between online and offline measurements (1,29 g, CI 95% −3.60-6.19), and the intraclass correlation coefficient between them was 0.79 (CI 95% 0.71-0.85). For images read by two readers, the intraclass correlation coefficient was 0.86 (CI 95% 0.78-0.91). Conclusion: There were no significant drifts between online and offline left ventricular mass measurements, and reproducibility was similar to that described in previous studies. Central quantitative assessment of echocardiographic studies in reading centers, as performed in the ELSA-Brasil study, is feasible and useful in clinical and epidemiological studies performed in our setting. .
Fundamento: A ecocardiografia, apesar de não invasiva e de relativo baixo custo, tem na variabilidade de medidas repetidas um dos principais limitantes a sua utilização em estudos epidemiológicos. Objetivo: Avaliar a reprodutibilidade da massa ventricular esquerda obtida em centros de investigação (on-line) com aquela obtida em centro de leitura (off-line) e entre medidas realizadas por diferentes avaliadores no centro de leitura. Métodos: Ecocardiografistas dos seis centros de investigação do ELSA-Brasil mediram on-line a massa ventricular esquerda e outras medidas ecocardiográficas de 124 exames antes de enviá-los ao centro de leitura, onde foram lidos off-line de acordo com o protocolo do estudo. Metade desses exames foi medida de forma cega por um segundo leitor. Resultados: Dos 124 exames, cinco (4%) foram considerados não mensuráveis. Dos 119 restantes, 72 (61%) eram de mulheres, com idade média de 50,2 ± 7,0 anos, sendo apenas dois exames com alteração estrutural cardíaca. Em 110 (92,4%) dos exames, as imagens foram consideradas ótimas/boas pelo centro de leitura. Não foram observadas diferenças significativas entre as médias da massa ventricular esquerda obtidas on-line e off-line (1,29 g, IC 95% −3,60-6,19), sendo o coeficiente de correlação intraclasse de 0,79 (IC 95% 0,72-0,85). Para as medidas realizadas no centro de leitura, % 0,78-0,91). Conclusão: Não houve diferenças sistemáticas relevantes na medida da massa ventricular esquerda on-line versus off-line e a reprodutibilidade das medidas foi similar à de estudos anteriores. A realização das medidas em centros de leitura, como utilizado no ELSA-Brasil, é factível e útil em estudos clínico-epidemiológicos realizados em nosso meio. .
Assuntos
Idoso , Feminino , Humanos , Masculino , Cognição/fisiologia , Nível de Saúde , Saúde Mental , Apoio Social , Estudos de Coortes , Saúde Mental/tendências , Escócia/epidemiologiaRESUMO
BACKGROUND: Echocardiography, though non-invasive and having relatively low-cost, presents issues of variability which can limit its use in epidemiological studies. OBJECTIVE: To evaluate left ventricular mass reproducibility when assessed at acquisition (online) compared to when assessed at a reading center after electronic transmission (offline) and also when assessed by different readers at the reading center. METHODS: Echocardiographers from the 6 ELSA-Brasil study investigation centers measured the left ventricular mass online during the acquisition from 124 studies before transmitting to the reading center, where studies were read according to the study protocol. Half of these studies were blindly read by a second reader in the reading center. RESULTS: From the 124 echocardiograms, 5 (4%) were considered not measurable. Among the remaining 119, 72 (61%) were women, mean age was 50.2 ± 7.0 years and 2 had structural myocardial abnormalities. Images were considered to be optimal/ good by the reading center for 110 (92.4%) cases. No significant difference existed between online and offline measurements (1,29 g, CI 95% -3.60-6.19), and the intraclass correlation coefficient between them was 0.79 (CI 95% 0.71-0.85). For images read by two readers, the intraclass correlation coefficient was 0.86 (CI 95% 0.78-0.91). CONCLUSION: There were no significant drifts between online and offline left ventricular mass measurements, and reproducibility was similar to that described in previous studies. Central quantitative assessment of echocardiographic studies in reading centers, as performed in the ELSA-Brasil study, is feasible and useful in clinical and epidemiological studies performed in our setting.
Assuntos
Ventrículos do Coração/diagnóstico por imagem , Adulto , Idoso , Análise de Variância , Brasil , Ecocardiografia/métodos , Ecocardiografia/normas , Feminino , Ventrículos do Coração/anatomia & histologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos TestesRESUMO
A large number of investigations in experimental, clinical, and epidemiological settings have given support to the idea that consumption of moderate amounts of alcoholic beverages, particularly wine, protects against coronary heart disease (CHD). Biological effects of other components of wine in human beings, however, have been hardly demonstrated, and alcohol itself has several potential adverse effects on the cardiovascular system. Not all epidemiological surveys have found protection from alcoholic beverages and in African-Americans, alcohol consumption was a risk factor for the incidence of CHD. The possibility that the lower risk of drinkers of moderate amounts of wine or other beverages is secondary to a health cohort effect in whites is not negligible, and could be discarded only in a clinical trial. In view of the potential risks of alcohol, a more cautious view about the beneficial effects of alcoholic beverages is warranted.
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Consumo de Bebidas Alcoólicas , Doença das Coronárias/prevenção & controle , Humanos , VinhoRESUMO
OBJECTIVE: To develop and evaluate clinical rules to predict risk for diabetes in middle-aged adults. RESEARCH DESIGN AND METHODS: The Atherosclerosis Risk in Communities is a cohort study conducted from 1987-1989 to 1996-1998. We studied 7,915 participants 45-64 years of age, free of diabetes at baseline, and ascertained 1,292 incident cases of diabetes by clinical diagnosis or oral glucose tolerance testing. RESULTS: We derived risk functions to predict diabetes using logistic regression in a random half of the sample. Rules based on these risk functions were evaluated in the other half. A risk function based on waist, height, hypertension, blood pressure, family history of diabetes, ethnicity, and age was performed similarly to one based on fasting glucose (area under the receiver-operating characteristic curve [AUC] 0.71 and 0.74, respectively; P = 0.2). Risk functions composed of the clinical variables plus fasting glucose (AUC 0.78) and additionally including triglycerides and HDL cholesterol (AUC 0.80) performed better (P < 0.001). Evaluation of scores based on the metabolic syndrome as defined by the National Cholesterol Education Program or with slight variations showed AUCs of 0.75 and 0.78, respectively. Rules based on all these approaches, while identifying 20-56% of the sample as screen positive, achieved sensitivities of 40-87% and specificities of 50-86%. CONCLUSIONS: Rules derived from clinical information, alone or combined with simple laboratory measures, can characterize degrees of diabetes risk in middle-aged adults, permitting preventive actions of appropriate intensity. Rules based on the metabolic syndrome are reasonable alternatives to rules derived from risk functions.
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Arteriosclerose/epidemiologia , Diabetes Mellitus/epidemiologia , Glicemia/metabolismo , Feminino , Seguimentos , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/epidemiologia , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
The authors evaluated the relation between consumption of alcoholic beverages and incidence of coronary heart disease in White and African-American participants in the Atherosclerosis Risk in Communities Study. The average duration of follow-up was 9.8 years between 1987 and 1998. The association was analyzed by means of Cox proportional hazards regression models. The authors found a positive association between ethanol consumption and incident coronary heart disease for Black men (for a 13-g/day increment in ethanol consumption, adjusted hazard ratio (HR) = 1.13, 95% confidence interval (CI): 1.01, 1.28) and an inverse association for White men (HR = 0.88, 95% CI: 0.79, 0.99). There was an inverse association of coronary heart disease with rare drinking (HR = 0.47, 95% CI: 0.28, 0.80) and with consumption of > or =70 g of ethanol per week (HR = 0.49, 95% CI: 0.24, 0.98) in White women and with consumption of > or =210 g/week (HR = 0.56, 95% CI: 0.33, 0.95) in White men. In Black men, the association was positive for consumption of 140-<210 g/week (HR = 2.61, 95% CI: 1.11, 6.17). The contrasting findings in Whites and Black men in this cohort raise the question of whether the cardioprotective effect of alcohol is real or may be confounded by lifestyle characteristics of drinkers.
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População Negra , Doença das Coronárias , Etanol , Estilo de Vida , População Branca , Índice de Massa Corporal , Doença das Coronárias/induzido quimicamente , Doença das Coronárias/epidemiologia , Doença das Coronárias/prevenção & controle , Escolaridade , Etanol/administração & dosagem , Etanol/efeitos adversos , Etanol/uso terapêutico , Feminino , Seguimentos , Nível de Saúde , Humanos , Incidência , Renda , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Undesirable weight gain often follows smoking cessation. We investigated whether weight gain after smoking cessation is greater in those with higher levels of inflammatory markers. RESEARCH METHODS AND PROCEDURES: We studied weight gain and risk of a large gain (> or = 90th percentile) over 3 years in a cohort study of 11,687 U.S. men and women, 45 to 64 years old, with focus on the 2664 who continued and the 493 who quit smoking. RESULTS: Among new quitters, adjusted weight gain for those in the highest (vs. lowest) quartile of leukocytes was 0.56 kg/yr more (95% confidence interval, 0.17 to 0.95); for those in the highest (vs. lowest) quartile of fibrinogen, 0.60 kg/yr more (95% confidence interval, 0.27 to 0.92; p = 0.02 and 0.001 for adjusted smoking status by leukocyte and smoking status by fibrinogen interaction terms, respectively). In adjusted analyses, the odds ratio for a large gain associated with quitting (vs. continuing) was 6.2 for those in the highest quartile of leukocytes vs. 2.2 for those in the lowest leukocyte quartile (p = 0.03 for smoking status by inflammatory marker interaction). Similarly, the odds ratio for a large gain associated with quitting was 4.5 in the highest fibrinogen quartile vs. 2.5 in the lowest (p = 0. 09 for the interaction term). DISCUSSION: Weight gain after smoking cessation is increased in those with higher baseline levels of leukocytes and fibrinogen. These findings suggest a close relationship between inflammatory mediators and regulators of energy balance that may have important clinical implications.