RESUMO
BACKGROUND: Leptin is a peptide that is strongly correlated with adiposity and is a potential determinant of obesity and its complications. OBJECTIVE: Leptin concentrations from a representative sample of the US population were examined in relation to demographic and anthropometric measures. DESIGN: Fasting serum leptin concentrations were measured in 6303 women and men aged > or =20 y in the third National Health and Nutrition Examination Survey. Anthropometric measures included body mass index, 4 skinfold thicknesses, and 4 body circumferences. Ethnic groups included non-Hispanic whites and blacks and Mexican Americans. RESULTS: The mean serum leptin concentration was much higher in women (12.7 microg/L) than in men (4.6 microg/L). In a multivariate analysis, leptin concentrations were associated with the sum of 4 skinfold thicknesses, waist and hip circumferences, ethnicity, and age. These measures explained most of the variance in leptin concentrations in women (R2 = 0.69) and in men (R2 = 0.67). Triceps skinfold thickness, when substituted for the sum of skinfold thicknesses, performed nearly as well in women (R2 = 0.68) and men (R2 = 0.67). Leptin concentrations were slightly but significantly higher in non-Hispanic blacks than in non-Hispanic whites of both sexes when these anthropometric measures and age were controlled for; Mexican Americans had concentrations that were intermediate compared with the concentrations of non-Hispanic whites and blacks. CONCLUSIONS: In this large, representative sample of the US population, demographic and anthropometric measures predicted serum leptin concentrations in women and men.
Assuntos
Constituição Corporal/etnologia , Etnicidade/estatística & dados numéricos , Leptina/sangue , Obesidade/etnologia , Tecido Adiposo , Adulto , Negro ou Afro-Americano , Fatores Etários , Índice de Massa Corporal , Feminino , Humanos , Masculino , Americanos Mexicanos , México/etnologia , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/sangue , Obesidade/epidemiologia , Análise de Regressão , Fatores Sexuais , Dobras Cutâneas , Estados Unidos/epidemiologia , População BrancaRESUMO
OBJECTIVE: Results of previous studies on diet and gallbladder disease (GBD), defined as having gallstones or having had surgery for gallstones, have been inconsistent. This research examined patterns of food intake in Mexican Americans and their associations with GBD. DESIGN: Cross-sectional. SUBJECTS: The study population included 4641 Mexican Americans aged 20-74 years who participated in the 1988-94 third National Health and Nutrition Examination Survey (NHANES III). GBD was diagnosed by ultrasound. Food intake patterns were identified by principal components analysis based on food frequency questionnaire responses. Component scores representing the level of intake of each pattern were categorized into quartiles, and prevalence odds ratios (POR) were estimated relative to the lowest quartile along with 95% confidence intervals (CI). RESULTS: There were four distinct patterns in women (vegetable, high calorie, traditional, fruit) and three in men (vegetable, high calorie, traditional). After age adjustment, none were associated with GBD in women. However, men in the third (POR = 0.42, 95%CI 0.21-0.85) and fourth (POR = 0.53, 95%CI 0.28-1.01) quartiles of the traditional intake pattern were half as likely to have GBD as those in the lowest quartile. CONCLUSIONS: These findings add to a growing literature suggesting dietary intake patterns can provide potentially useful and relevant information on diet-disease associations. Nevertheless, methods to do so require further development and validation.
Assuntos
Dieta/efeitos adversos , Comportamento Alimentar/etnologia , Doenças da Vesícula Biliar/etnologia , Americanos Mexicanos , Adulto , Idoso , Estudos Transversais , Feminino , Doenças da Vesícula Biliar/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To analyze the influence of parental stature and environmental factors on the stature of adolescents from a national survey sample. METHODS: A nationwide survey was carried out in 1989 among a stratified, two-stage, probability cluster sample of 14,455 Brazilian households to provide estimates of anthropometric deficits for urban and rural populations from the five regions of the country. Stature was measured for 5681 boys and girls age 14-18 years, 78.9% of their fathers, and 93.8% of their mothers. Associations between explanatory variables and adolescent height in centimeters were assessed by fitting multiple linear models to the data. RESULTS: The predicted effects of parental stature and environmental conditions together sum to a total of 17 cm when comparing a boy born to parents with stature below the median and living in the underdeveloped rural Northeast region (1.56 m) with one born to parents with stature above the median and living in the partially industrialized urban South region (1.73 m). For girls, this estimated difference was 12 cm. For boys, the overall influence of parents' stature was 10 cm (R(2)= 0.40) and the sociodemographic factors had an overall influence of 7 cm (R(2) = 0.29). For girls, these values were 7 cm (R(2)= 0.35) for the parental influence and 5 cm (R(2) = 0.11) for the sociodemographic factors. CONCLUSIONS: Mother's stature had the same influence on adolescent's stature as father's stature. Independent of parental stature, environmental factors have a strong influence on adolescent stature, particularly among boys.
Assuntos
Adolescente/fisiologia , Estatura/fisiologia , Pais , Fatores Socioeconômicos , Antropometria , Viés , Brasil , Análise por Conglomerados , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Lineares , Masculino , Valor Preditivo dos Testes , Características de Residência , Saúde da População Rural , Caracteres Sexuais , Distribuição por Sexo , Saúde da População UrbanaRESUMO
OBJECTIVES: This research sought to describe the association between country of birth and gallbladder disease (GBD) in Mexican Americans, identify subgroups at especially high risk, and identify risk factors that may mediate a birthplace-GBD association. DESIGN: Cross-sectional. METHODS: Our study population included 4157 Mexican Americans aged 20-74 who participated in the 1988-94 third National Health and Nutrition Examination Survey. GBD was diagnosed by ultrasound. Information on country of birth, education, income, and selected GBD risk factors was obtained from interviews. Prevalence odds ratios (POR) for GBD in Mexico- vs. US-born Mexican Americans were estimated by unconditional logistic regression, along with 95% confidence intervals (CI). To evaluate the extent to which GBD risk factors mediated the birthplace-GBD association, PORs for country of birth were compared in models with and without additional covariates. RESULTS: Age-adjusted GBD prevalence was lower in Mexico- than in US-born Mexican-American women (POR = 0.70, 95% CI 0.50, 0.98) and men (POR = 0.63, 95% CI 0.40, 0.97). The difference was especially pronounced among subjects of lower socioeconomic status. Despite substantial differences in GBD risk factor distributions by birthplace, none could completely explain the prevalence difference. CONCLUSIONS: The observation that GBD prevalence is higher among US-born Mexican Americans is consistent with research showing poorer health in this group. Further research is needed to identify strategies for reducing morbidity from GBD in Mexican Americans.
Assuntos
Doenças da Vesícula Biliar/etnologia , Doenças da Vesícula Biliar/epidemiologia , Americanos Mexicanos , Adulto , Idoso , Emigração e Imigração , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Classe Social , Estados Unidos/epidemiologiaRESUMO
Gallbladder disease is a common source of morbidity in the Mexican American population. Genetic heritage has been proposed as a possible contributor, but evidence for this is limited. Because gallbladder disease has been associated with Native American heritage, genetic admixture may serve as a useful proxy for genetic susceptibility to the disease in epidemiologic studies. The objective of our study was to examine the possibility that gallbladder disease is associated with greater Native American admixture in Mexican Americans. This study used data from the Hispanic Health and Nutrition Examination Survey and was based on 1,145 Mexican Americans who underwent gallbladder ultrasonography and provided usable phenotypic information. We used the GM and KM immunoglobulin antigen system to generate estimates of admixture proportions and compared these for individuals with and without gallbladder disease. Overall, the proportionate genetic contributions from European, Native American, and African ancestries in our sample were 0.575, 0.390, and 0.035, respectively. Admixture proportions did not differ between cases and noncases: Estimates of Native American admixture for the two groups were 0.359 and 0.396, respectively, but confidence intervals for estimates overlapped. This study found no evidence for the hypothesis that greater Native American admixture proportion is associated with higher prevalence of gallbladder disease in Mexican Americans. Reasons for the finding that Native American admixture proportions did not differ between cases and noncases are discussed. Improving our understanding of the measurement, use, and limitations of genetic admixture may increase its usefulness as an epidemiologic tool as well as its potential for contributing to our understanding of disease distributions across populations.
Assuntos
Doenças da Vesícula Biliar/genética , Genética Populacional , Hispânico ou Latino/genética , Indígenas Norte-Americanos/genética , Adulto , Idoso , Feminino , Doenças da Vesícula Biliar/epidemiologia , Doenças da Vesícula Biliar/etnologia , Predisposição Genética para Doença , Humanos , Imunoglobulinas/análise , Imunoglobulinas/imunologia , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
Elevated activities of serum aminotransferases are a common sign of liver disease and are observed more frequently among diabetics than in the general population. Whether this association is due to confounding factors is unknown. The authors investigated whether diabetes was significantly associated with elevated serum activity of alanine aminotransferase (ALT) after adjustment for factors common to both diabetes and raised ALT. Data from 2,999 men and women aged 20-74 years representative of the Mexican American population of the southwestern United States were obtained from the Hispanic Health and Nutrition Examination Survey (1982-1984). Approximately 6% of men and 2% of women had elevated serum ALT activity (>43 IU/liter). The odds ratio for diabetes as a predictor of elevated ALT was 4.1 (95% confidence interval 2.3-7.6) adjusted for age and sex, which decreased to 3.0 (95% confidence interval 0.92-9.74) after adjustment for age, sex, body mass index, alcohol consumption, and other factors. In addition to diabetes, body mass index was also significantly (p < 0.05) associated with elevated ALT activity. Heavier alcohol consumption and male sex increased the likelihood of elevated ALT, whereas coffee consumption reduced it. Diabetes and liver injury appear to be associated, even with control for factors in common.
Assuntos
Alanina Transaminase/sangue , Diabetes Mellitus/enzimologia , Americanos Mexicanos , Adulto , Distribuição por Idade , Idoso , Consumo de Bebidas Alcoólicas/sangue , Consumo de Bebidas Alcoólicas/etnologia , Intervalos de Confiança , Fatores de Confusão Epidemiológicos , Diabetes Mellitus/etnologia , Feminino , Humanos , Hepatopatias/enzimologia , Hepatopatias/etnologia , Masculino , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Distribuição por Sexo , Sudoeste dos Estados Unidos/epidemiologiaRESUMO
Obesity during adolescence is considered a strong predictor of adult obesity, and obesity and overweight have been increasing among Brazilian adults. To gauge the relative frequency of overweight among adolescents in Brazil, we compared the distributions of body mass index (kg/m2) and stature in national population based samples of the U.S. and Brazil. U.S. adolescents were on average about 10 cm taller than Brazilians, although growth spurts occurred at the same age for both populations. Brazilian adolescents were leaner than their U.S. counterparts. This difference was reduced among girls in the postpubertal period. At age 17 years, U.S. boys were about 10 kg heavier than Brazilian boys, but the difference among girls was only 2 kg. In families above the poverty level in the more developed South region, body mass index distribution for boys was closer to that of the U.S., and older girls tended to have higher body mass index than U.S. girls. Within Brazil, body mass index varied by ethnicity with Mulattos, but not Blacks, of both sexes having lower body mass index than Whites of the same age. Urban adolescents had higher body mass index than those living in rural areas. In general, the patterns seen among Brazilian adults were found among children. Among girls, in particular, overweight has become an identifiable problem during adolescence.
Assuntos
Índice de Massa Corporal , Crescimento/fisiologia , Obesidade/epidemiologia , Obesidade/fisiopatologia , Adolescente , Antropometria , Brasil/epidemiologia , Brasil/etnologia , Criança , Feminino , Humanos , Masculino , Obesidade/etnologia , Grupos Raciais , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Estados Unidos/etnologiaRESUMO
OBJECTIVES: Population-based data on body mass index for developing countries are scarce. Body mass index data from two Brazilian surveys were examined to determine regional and temporal variations in the prevalences of underweight, overweight, and obesity. METHODS: Nationwide surveys in 1974/75 and 1989 collected anthropometric data in Brazil from 55,000 and 14,455 households, respectively. Trained interviewers used the same methods to measure weight and stature in both surveys, and survey designs were identical. Prevalences of underweight, overweight, and obesity were determined for persons 18 years of age and older. RESULTS: In the 1989 survey, body mass index varied greatly according to region of the country, urbanization, and income. In the wealthier South, the prevalence of overweight/obesity was the highest and the prevalence of underweight was the lowest; in the poorer rural Northeast, these patterns were reversed. For both surveys, overweight/obesity was more common among women than among men and peaked at age 45 to 64 years in both sexes. Over the 15 years between surveys, the prevalence of both overweight and obesity increased strikingly. CONCLUSIONS: In contrast to findings in developed countries, obesity in Brazil was positively associated with income and was much more prevalent among women than among men. For Brazilian women, the overall prevalence of overweight was nearly as high as that among women in the United States.
Assuntos
Índice de Massa Corporal , Obesidade/epidemiologia , Magreza/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Peso Corporal , Brasil/epidemiologia , Demografia , Feminino , Humanos , Renda , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Saúde da População Rural , Estados Unidos/epidemiologia , Saúde da População UrbanaRESUMO
Mortality due to chronic diseases has been increasing in all regions of Brazil with corresponding decreases in mortality from infectious diseases. The geographical variation in proportionate mortality for chronic diseases for 17 Brazilian state capitals for the year 1985 and their association with socio-economic variables and infectious disease was studied. Calculations were made of correlation coefficients of proportionate mortality for adults of 30 years or above due to ischaemic heart disease, stroke and cancer of the lung, the breast and stomach with 3 socio-economic variables, race, and mortality due to infectious disease. Linear regression analysis included as independent variables the % of illiteracy, % of whites, % of houses with piped water, mean income, age group, sex, and % of deaths caused by infectious disease. The dependent variables were the % of deaths due to each one of the chronic diseases studied by age-sex group. Chronic diseases were an important cause of death in all regions of Brazil. Ischaemic heart diseases, stroke and malignant neoplasms accounted for more than 34% of the mortality in each of the 17 capitals studied. Proportionate cause-specific mortality varied markedly among state capitals. Ranges were 6.3-19.5% for ischaemic heart diseases, 8.3-25.4% for stroke, 2.3-10.4% for infections and 12.2-21.5% for malignant neoplasm. Infectious disease mortality had the highest (p < 0.001) correlation with all the four socio-economic variables studied and ischaemic heart disease showed the second highest correlation (p < 0.05). Higher socio-economic level was related to a lower % of infectious diseases and a higher % of ischaemic heart diseases.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Mortalidade , Adulto , Distribuição por Idade , Idoso , Brasil , Causas de Morte , Doença Crônica/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Fatores SocioeconômicosRESUMO
We compared five recent relative weight classifications based on body mass index for their estimates of prevalence of underweight and overweight in the adult population of the United States and for their ability to predict subsequent morbidity and mortality. The sources of the classifications were: the 1990 Dietary Guidelines for Americans of the US Departments of Agriculture and Health and Human Services, the National Academy of Sciences, the National Center for Health Statistics, the World Health Organization, and the Canadian Minister of National Health and Welfare. These classifications were applied to the body mass index distributions of the second National Health and Nutrition Examination Survey (1976-1980) and to the Hispanic Health and Nutrition Examination Survey (1982-1984). Depending on classification, a wide range of prevalence for the total population was found: 9-17% of the US population were categorized as underweight, and 25-45% were categorized as overweight. White women had the highest prevalence of underweight in all but the National Center for Health Statistics classification. Black and Mexican American women had the highest prevalence of overweight under all classifications (range: 38.4-58.6%). Associations with health outcomes were determined using all cause hospitalization and mortality in the 1971-1987 follow-up of the first National Health and Nutrition Examination Survey. Underweight and overweight as defined by the National Academy of Sciences classification had the highest population attributable risk for hospitalization and death: 5.0% of hospitalizations and 11.0% of deaths among men and 4.2% of hospitalizations and 11.4% of deaths among women were associated with weights outside the healthy range. Under this classification a greater proportion of both hospitalizations and mortality were associated with overweight than underweight. For all classifications, a higher proportion of hospitalizations were associated with overweight than underweight. All classifications performed better at predicting death than hospitalization.
Assuntos
Índice de Massa Corporal , Obesidade/epidemiologia , Magreza/epidemiologia , Adulto , Idoso , População Negra , Cuba/etnologia , Feminino , Hispânico ou Latino , Humanos , Masculino , Americanos Mexicanos , Pessoa de Meia-Idade , Morbidade , Obesidade/etnologia , Obesidade/mortalidade , Prevalência , Modelos de Riscos Proporcionais , Porto Rico/etnologia , Fatores de Risco , Fatores Sexuais , Magreza/etnologia , Magreza/mortalidade , Estados Unidos/epidemiologia , População BrancaRESUMO
The 1982-1984 Hispanic Health and Nutrition Examination Survey used ultrasonography to investigate risk factors for gallstone disease (gallstones or cholecystectomy). Mexican American, Cuban American, and Puerto Rican men (n = 968) and women (n = 1,325) aged 20-74 years were selected from household samples in nine states. Among men, the risk of gallstone disease increased with age, education, and subscapular skinfold thickness. Among women, the risk of gallstone disease increased with age, body mass index, four skinfold measures, diabetes, impaired glucose tolerance, and oral contraceptive usage, but not with parity. Women currently using oral contraceptives were also found to be at increased risk of current gallstones. Menopause was a risk factor for gallstone disease and cholecystectomy. Alcohol consumption was negatively related to the risk of gallstone disease. In men, the cholesterol/high density lipoprotein cholesterol ratio was positively related to gallstone disease and, in women, this ratio was negatively related. This interaction between the effect of sex and the cholesterol/high density lipoprotein cholesterol ratio on gallstone disease was highly significant (p = 0.002). Mexican Americans were at increased risk of gallstone disease even when other risk factors were controlled in multiple logistic regression analysis.
Assuntos
Colelitíase/epidemiologia , Hispânico ou Latino , Ultrassonografia , Adulto , Idoso , Consumo de Bebidas Alcoólicas , Colelitíase/sangue , Colelitíase/diagnóstico , HDL-Colesterol/sangue , Cuba/epidemiologia , Cuba/etnologia , Feminino , Teste de Tolerância a Glucose , Humanos , Masculino , México/epidemiologia , México/etnologia , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Porto Rico/etnologia , Distribuição Aleatória , Fatores de Risco , Fatores SexuaisRESUMO
Low rates of gallbladder disease among blacks have been reported but not systematically studied. The authors investigated the rate of hospitalization with a diagnosis of gallbladder disease in the follow-up in 1982-1984 of the first National Health and Nutrition Examination Survey, a population-based study conducted across the United States in 1971-1975. Based on hospital discharge diagnoses of gallbladder disease, 368 cases were identified for the period 1971-1984 among 10,551 persons, aged 25-74 years, who denied gallbladder disease at the baseline examination. The crude incidence of gallbladder disease per 1,000 person-years was 2.59 for white men, 1.45 for black men, 4.09 for white women, and 2.35 for black women. Controlling for obesity, parity, ethanol consumption, use of diuretics, use of oral contraceptives, and two indicators of socioeconomic status, the authors found that the hazard rate of hospitalization with gallbladder disease increased with age for white women and decreased for black women. The hazard ratio for black women compared with white women at 30 years of age was 0.71 with a 95% confidence interval of 0.52-0.96, but at age 70, it was 0.18 with a 95% confidence interval of 0.09-0.37. For women, obesity and parity were important risk factors for gallbladder disease (p less than or equal to 0.001), and the use of diuretics was marginally associated (p = 0.08). Black men compared with white men had a hazard rate of gallbladder disease of 0.53 with a 95% confidence interval of 0.24-1.16. For men, increasing age was related to gallbladder disease (p less than 0.001), and obesity was weakly related (p = 0.06). The black/white hazard ratios decreased further when controlling for socioeconomic status, persisted if the study population was limited to those hospitalized during follow-up, and increased slightly for cases with an acute complication of gallbladder disease. Thus, differential access to medical care may not explain the lower rate among blacks.