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BACKGROUND: The proportion of older people living with HIV (PLWH) has increased. Non-communicable diseases occur earlier in PLWH than in the general population. OBJECTIVE: The goal of this study was to estimate the prevalence of comorbidities in PLWH and cancer in a tertiary referral center in Mexico City. MATERIAL AND METHODS: In this retrospective study, we included PLWH > 40 years with a history of cancer, coming to Instituto Nacional de Cancerologia from 2010 through 2019. All patients needed to be on antiretrovirals for at least six months. Data collected included cancer type, comorbidities, frequency of polypharmacy, FRAX score and 10-year cardiovascular risk. Patients were evaluated for depression with the Beck Inventory Depression-II Scale. Variables associated to multimorbidity (2 or more comorbidities) were evaluated. RESULTS: Of 125 patients, 69% had at least one comorbidity; 32% had ≥ 2. Common comorbidities were dyslipidemia (54%), hypertension (19%), obesity (14%) and Diabetes (12%). In patients ≥ 50 years, 29 (62%) already undergone a densitometry and 9 (31%) had osteoporosis; 56 depression questionnaires were used: 30% had mild-to-severe depression. Being ≥ 50 years was associated with multimorbidity (aOR 2.57 (1.18-5.58), p = 0.017). CONCLUSIONS: A high prevalence of multimorbidity and poor screening of bone disease and mental health is reported in patients with PLWH and cancer. A holistic approach to the PLWH in the Infectious Diseases consultation is needed to improve the detection and management of non-communicable diseases, to go beyond viral suppression and towards an improved quality of life.
INTRODUCCIÓN: La proporción de personas mayores que viven con VIH (PVVIH) va en aumento, y las enfermedades no transmisibles ocurren antes en PVVIH comparado con la población general. OBJETIVO: El objetivo de este estudio fue estimar la prevalencia de las comorbilidades en PVVIH con cáncer de un centro de tercer nivel de la Ciudad de México. MÉTODOS: Este estudio retrospectivo incluyó todas las PVVIH > 40 años con cáncer, que acudieron al Instituto Nacional de Cancerología entre 2010 y 2019). Se incluyeron datos sobre el tipo de cáncer, comorbilidades y polifarmacia. Se calcularon la puntuación FRAX, el riesgo cardiovascular a 10 años, y se aplicó un cuestionario para evaluar depresión (Beck Inventory Depression-II Scale). RESULTADOS: De 125 pacientes, 69% tenía al menos una comorbilidad; 32% tenía ≥ 2. Las comorbilidades más comunes fueron dislipidemia (54%), hipertensión (19%), obesidad (14%) y diabetes (12%). En pacientes ≥ 50 años, 29% tenía una densitometría osea; 31% tenía osteoporosis. Se aplicaron 56 cuestionarios: 30% tenía algún grado de depresión. Tener ≥ 50 años se asoció con multimorbilidad (aOR 2.57, 1.18-5.58), p = 0.017. CONCLUSIONES: Se reporta una alta prevalencia de multimorbilidad en PVVIH y cancer, con pobre escrutinio de enfermedad ósea y salud mental. Se requiere un enfoque holístico para las PVVIH en la consulta de infectología, para mejorar el manejo de las enfermedades no transmisibles, yendo más alla de la supresión virológica.
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Infecções por HIV , Multimorbidade , Neoplasias , Humanos , México/epidemiologia , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Infecções por HIV/epidemiologia , Infecções por HIV/tratamento farmacológico , Neoplasias/epidemiologia , Prevalência , Adulto , Idoso , Depressão/epidemiologia , Comorbidade , Fatores EtáriosRESUMO
Objetivo: A obesidade populacional afeta inúmeras nações do mundo, implicando custos econô¬micos, sociais e ambientais severos, comprometendo a condição de desenvolvimento sustentável. Este estudo tem como objetivo analisar a evolução da situação de sobrepeso e obesidade popu¬lacional dos países-membros da OCDE e do Brasil. Métodos: Este estudo analisa dados sobre a prevalência de sobrepeso e obesidade populacional disponibilizados pela OCDE para os seus paí¬ses-membros e pelo sistema Vigitel para o Brasil. Resultados: Os países da OCDE apresentam uma variabilidade grande na prevalência de sobrepeso/obesidade, e a prevalência média está na faixa dos 50%. Para o Brasil, a prevalência de sobrepeso e obesidade populacional aumentou expressiva¬mente nos últimos anos, indo de cerca de 45% em 2010 para 53,5% em 2020. Conclusão: A maioria dos países analisados está classificada em uma condição de taxa média de prevalência de sobrepeso e obesidade superior a 50% e uma tendência de crescimento dessa prevalência. O estudo ainda apresenta algumas ações e políticas públicas promovidas em outros países com o propósito de promover a redução da prevalência de sobrepeso e obesidade, e que poderiam ser adaptadas e implementadas no contexto brasileiro.
Objective: Population obesity affects many nations of the world, implying severe economic, social and environmental costs, compromising the condition of sustainable development. This study aims to analyze the evolution of the situation of overweight and obesity in the OECD member countries and Brazil. Methods: This study analyzes data on the prevalence of overweight and obesity made available by the OECD for its member countries, and by the Vigitel System for Brazil. Results: The OECD countries show a great variability in the prevalence of overweight/obesity, with the average prevalence being in the range of 50%. For Brazil, the prevalence of overweight and obesity in the population has increased significantly in recent years, going from about 45% in 2010 to 53.5% in 2020. Conclusion: Most of the countries analyzed are classified in a condition of average prevalence rate of overweight and obesity greater than 50% and a tendency for this prevalence to increase. The study also presents some actions and public policies promoted in other countries with the purpose of promoting the reduction of the prevalence of overweight and obesity, which could be adapted and implemented in the Brazilian context.
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Introduction: The increase in ultra-processed foods (UPFs) intake has raised concerns about its impact on public health. Prospective observational studies have reported significant associations between higher intake of UPFs and adverse health outcomes. The aim of this study is to determine whether these associations could be confirmed in randomized controlled trials (RCTs). Methods: We conducted a systematic review to analyze the evidence on the effects of UPFs intake on health. A systematic search was conducted in Medline, Embase, Web of Science, Scopus, LILACS, and CENTRAL up to April 22, 2024. RCTs in English, Spanish, and Portuguese evaluating the health effects of interventions to modify UPFs intake were included. The certainty of evidence was determined using the GRADE methodology. Results: Three educational intervention studies and one controlled feeding trial were included, evaluating the effect of reducing the consumption of UPFs (455 participants, median follow-up, 12 weeks). No significant effects were observed in 30 out of the 42 outcomes evaluated. The controlled feeding trial in adults with stable weight showed a reduction in energy intake, carbohydrates, and fat (low certainty of evidence), as well as in body weight, total cholesterol, and HDL cholesterol (moderate certainty of evidence). In the educational intervention studies, a reduction in body weight and waist circumference was observed (low certainty of evidence) in women with obesity, as well as improvement in some dimensions of quality of life (very low certainty of evidence). No significant changes were observed in children and adolescents with obesity, while in overweight pregnant women, the consumption of UPFs was not reduced, so the observed benefits could be attributed to other components of the intervention. Conclusion: Interventions aimed at reducing the consumption of UPFs showed benefits on some anthropometric and dietary intake outcomes, although significant effects were not observed for most of the evaluated outcomes. The limited number and significant methodological limitations of the studies prevent definitive conclusions. Further well-designed and conducted RCTs are needed to understand the effects of UPF consumption on health.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023469984.
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Oxidative stress and the activation of the nucleotide-binding domain, leucine-rich-containing family, pyrin domain containing 3 (NLRP3) inflammasome have been linked to insulin resistance in skeletal muscle. In immune cells, the exacerbated generation of reactive oxygen species (ROS) activates the NLRP3 inflammasome, by facilitating the interaction between thioredoxin interacting protein (TXNIP) and NLRP3. However, the precise role of ROS/TXNIP-dependent NLRP3 inflammasome activation in skeletal muscle during obesity-induced insulin resistance remains undefined. Here, we induced insulin resistance in C57BL/6J mice by feeding them for 8 weeks with a high-fat diet (HFD) and explored whether the ROS/TXNIP/NLRP3 pathway was involved in the induction of insulin resistance in skeletal muscle. Skeletal muscle fibers from insulin-resistant mice exhibited increased oxidative stress, as evidenced by elevated malondialdehyde levels, and altered peroxiredoxin 2 dimerization. Additionally, these fibers displayed augmented activation of the NLRP3 inflammasome, accompanied by heightened ROS-dependent proximity between TXNIP and NLRP3, which was abolished by the antioxidant N-acetylcysteine (NAC). Inhibition of the NLRP3 inflammasome with MCC950 or suppressing the ROS/TXNIP/NLRP3 pathway with NAC restored insulin-dependent glucose uptake in muscle fibers from insulin-resistant mice. These findings provide insights into the mechanistic link between oxidative stress, NLRP3 inflammasome activation, and obesity-induced insulin resistance in skeletal muscle.
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Proteínas de Transporte , Dieta Hiperlipídica , Glucose , Resistência à Insulina , Músculo Esquelético , Proteína 3 que Contém Domínio de Pirina da Família NLR , Obesidade , Estresse Oxidativo , Espécies Reativas de Oxigênio , Transdução de Sinais , Tiorredoxinas , Animais , Masculino , Camundongos , Proteínas de Transporte/metabolismo , Proteínas de Transporte/genética , Dieta Hiperlipídica/efeitos adversos , Furanos/farmacologia , Glucose/metabolismo , Indenos/farmacologia , Inflamassomos/metabolismo , Insulina/metabolismo , Camundongos Endogâmicos C57BL , Camundongos Obesos , Músculo Esquelético/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Obesidade/metabolismo , Obesidade/patologia , Espécies Reativas de Oxigênio/metabolismo , Sulfonamidas , Tiorredoxinas/metabolismo , Tiorredoxinas/genéticaRESUMO
PURPOSE OF REVIEW: The Amazon region has a high biodiversity of flora, with an elevated variety of fruits, such as Camu-Camu (Myrciaria dúbia), Açaí (Euterpe oleracea Mart.), Tucumã (Astrocaryum aculeatum and Astrocaryum vulgare), Fruta-do-conde (Annona squamosa L.), Cupuaçu (Theobroma grandiflorum), Graviola (Annona muricata L.), Guarana (Paullinia cupana Kunth var. sorbilis), and Pitanga (Eugenia uniflora), among many others, that are rich in phytochemicals, minerals and vitamins with prominent antioxidant and anti-inflammatory potential. RECENT FINDINGS: Studies evaluating the chemical composition of these fruits have observed a high content of nutrients and bioactive compounds. Such components are associated with significant biological effects in treating various non-communicable diseases (NCDs) and related complications. Regular intake of these fruits from Amazonas emerges as a potential therapeutic approach to preventing and treating NCDs as a nutritional strategy to reduce the incidence or mitigate common complications in these patients, which are the leading global causes of death. As studies remain largely unexplored, this narrative review discusses the possible health-beneficial effects for patients with NCDs.
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Frutas , Doenças não Transmissíveis , Humanos , Euterpe/química , Antioxidantes/farmacologia , Compostos Fitoquímicos/farmacologia , Brasil , Annona/química , Anti-Inflamatórios/farmacologiaRESUMO
OBJECTIVE: To estimate the health and economic burden of non-communicable diseases (NCDs) attributed to alcohol consumption in 2019 for the Brazilian Unified Health System (SUS) stratified by states. STUDY DESIGN: Observational, descriptive, and ecological study. METHODS: We used population attributable fractions (PAFs) of NCDs due to alcohol consumption from the Global Burden of Disease study. We applied the PAFs to the costs of hospitalizations and outpatient procedures of medium to high complexity paid by SUS for each outcome, obtained from official databases. We also calculated the disability-adjusted life years (DALYs) and mortality caused by alcohol-related NCDs. We converted the costs into international dollars (Int$) using the purchasing parity power in 2019. RESULTS: Alcohol-related NCDs accounted for 8.48% of deaths and 7.0% of DALYs among men, and 1.33% of deaths and 1.6% of DALYs among women. The main diseases were substance use, digestive, and neoplastic diseases. The SUS spent Int$202.0 million on alcohol-related NCDs, mostly on hospitalizations. The highest health burden was observed in the states of the Northeast region, and the highest expenses in the states from the South. The burden and cost values varied by sex, age group, and state. CONCLUSION: The study showed that alcohol consumption has a significant impact on Brazilian population morbidity and mortality and SUS expenditures, especially among men. These results can support policies for the prevention and control of alcohol consumption and health promotion at the subnational level, prioritizing strategies that are more appropriate to local realities.
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Consumo de Bebidas Alcoólicas , Efeitos Psicossociais da Doença , Doenças não Transmissíveis , Humanos , Brasil/epidemiologia , Doenças não Transmissíveis/epidemiologia , Masculino , Feminino , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Pessoa de Meia-Idade , Adulto , Idoso , Programas Nacionais de Saúde/estatística & dados numéricos , Anos de Vida Ajustados por Deficiência , Carga Global da Doença , Hospitalização/estatística & dados numéricos , Adulto Jovem , AdolescenteRESUMO
La diversidad cultural es el resultado de un proceso que se conforma en el marco de las relaciones sociales, económicas y culturales. Se hace imprescindible que los profesores universitarios estén preparados para atender la diversidad cultural de sus estudiantes, teniendo en cuenta las particularidades de su cultura nacional y la de otros grupos de diferentes procedencias que coexisten en un mismo escenario educativo. La diversidad cultural es un reto de la comunidad educativa y debe estar contemplada en la formación permanente de los profesores de las universidades médicas fundamentalmente por sus contextos, los ambientes socioeconómicos y los problemas de salud, sobre todo por las enfermedades crónicas no trasmisibles debido a su alta prevalencia y su repercusión en el individuo y su familia, en los que influyen los factores de riesgo y las determinantes sociales, condicionados por sus orígenes, creencias, vivencias y representaciones que matizan los contextos interculturales actuales a nivel mundial.
Cultural diversity is the result of a process that is formed within the framework of social, economic and cultural relations. It is essential that university professors are prepared to address the cultural diversity of their students, taking into account the particularities of their national culture and that of other groups of different origins that coexist in the same educational setting. Cultural diversity is a challenge for the educational community and must be considered in the ongoing training of professors at medical universities, fundamentally due to their contexts, socioeconomic environments and health problems, especially chronic non-communicable diseases due to their high prevalence and its impact on the individual and his or her family, influenced by risk factors and social determinants, conditioned by their origins, beliefs, experiences and representations that color current intercultural contexts worldwide.
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Nigeria is one of the developing countries with a major burden of non-communicable diseases (NCDs) without a disease self-management program in its healthcare system. Thus, this study was aimed to assess the baseline self-efficacy levels of Nigerian patients with chronic NCDs at tertiary level hospitals. This is a cross sectional study of 286 NCD patients attending tertiary level clinics from 26 July to 27 October 2023. Patients were interviewed on a 10 Self-Efficacy to Manage Chronic Disease (SEMCD) item scales that were considered suitable for the Nigerian population. The 10 SEMCD questions covered: (i) Exercise regularly scale, (ii) Help from community, family and friends scale, (iii) Communication with Physician scale, (iv) Manage disease scale and (v) Manage symptom self-efficacy domains. Data were analyzed both descriptively and statistically using Student's t-tests and Chi-square tests as appropriate. The results showed that more female (59.4%) than males (40.6%) attended clinics during the study, and the mean age of the patients did not differ between gender (P > .05). About 40% of all the patients manage their NCDs with medications alone, a trend that is similar in male and female patients (P > .05). While all the patients had a relatively lower self-efficacy scores under regular exercise scale (52%-55%) and manage disease symptoms scale (53%-55%), they tended toward higher self-efficacy scores under getting assistance from community, family, and friends (79%-80%) and communication with attending physicians (81%-85%). It is concluded that Nigeria literate NCD patients registered at tertiary level institution routine clinics are less than optimal in disease self-management care. We recommend that this study population will benefit from introduction and implementation of disease self-management program in the healthcare system.
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Doenças não Transmissíveis , Autoeficácia , Humanos , Masculino , Feminino , Nigéria , Estudos Transversais , Pessoa de Meia-Idade , Doenças não Transmissíveis/terapia , Doença Crônica , Adulto , Idoso , Exercício Físico , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Mexico and other low- and middle-income countries (LMICs) present a growing burden of non-communicable diseases (NCDs), with gender-differentiated risk factors and access to prevention, diagnosis and care. However, the political agenda in LMICs as it relates to health and gender is primarily focused on sexual and reproductive health rights and preventing violence against women. This research article analyses public policies related to gender and NCDs, identifying political challenges in the current response to women's health needs, and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care in Mexico. METHODS: We carried out a political mapping and stakeholder analysis during July-October of 2022, based on structured desk research and interviews with eighteen key stakeholders related to healthcare, gender and NCDs in Mexico. We used the PolicyMaker V5 software to identify obstacles and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care, from the perspective of the political stakeholders interviewed. RESULTS: We found as a political obstacle that policies and stakeholders addressing NCDs do not take a gender perspective, while policies and stakeholders addressing gender equality do not adequately consider NCDs. The gendered social and economic aspects of the NCD burden are not widely understood, and the multi-sectoral approach needed to address these aspects is lacking. Economic obstacles show that budget cuts exacerbated by the pandemic are a significant obstacle to social protection mechanisms to support those caring for people living with NCDs. CONCLUSIONS: Moving towards an effective, equity-promoting health and social protection system requires the government to adopt an intersectoral, gender-based approach to the prevention and control of NCDs and the burden of NCD care. Despite significant resource constraints, policy innovation may be possible given the willingness among some stakeholders to collaborate, particularly in the labour and legal sectors. However, care will be needed to ensure the implementation of new policies has a positive impact on both gender equity and health outcomes. Research on successful approaches in other contexts can help to identify relevant learnings for Mexico.
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Política de Saúde , Doenças não Transmissíveis , Humanos , Feminino , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/prevenção & controle , México , Acessibilidade aos Serviços de Saúde , Direitos HumanosRESUMO
OBJECTIVES: The prevalence of overweight increases the risk of several non-communicable diseases (NCDs) and, consequently, the costs of health care systems. In this study, we aimed to project the economic burden of NCDs attributable to overweight in Brazil between 2021 and 2030. METHODS: A cohort simulation of adults (17-117 years) using multistate lifetable modeling was used to estimate the costs of NCDs attributable to overweight in Brazil. The projections of direct health care costs (outpatient and inpatient expenses in the Unified Health System) and indirect costs (years of productive life lost) considered different trajectories of the prevalence of overweight between 2021 and 2030. RESULTS: In 2019, the prevalence of overweight was 55.4% in the adult Brazilian population. We estimate that around 1.8 billion international dollars (Int$) would be spent on the direct health care cost of NCDs between 2021 and 2030, through the continued increase in overweight prevalence observed between 2006 and 2020. The indirect costs over the same time would be approximately 20.1 billion Int$. We estimate that halving the annual increase in body mass index slope from the beginning of 2021 until 2030 would save 20.2 million Int$ direct and indirect costs by 2030. In the scenario of keeping the prevalence of overweight observed in 2019 constant until 2030, the savings would be 40.8 million Int$. Finally, in the scenario of a 6.7% reduction in the prevalence of overweight observed in 2019 (to be achieved gradually until 2030), 74.1 million Int$ would be saved. CONCLUSIONS: These results highlight the high economic burden of overweight in the Brazilian adult population.
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Doenças não Transmissíveis , Sobrepeso , Adulto , Humanos , Sobrepeso/epidemiologia , Brasil/epidemiologia , Estresse Financeiro , Doenças não Transmissíveis/epidemiologia , Efeitos Psicossociais da Doença , Custos de Cuidados de SaúdeRESUMO
AIMS: Machine learning models can use image and text data to predict the number of years since diabetes diagnosis; such model can be applied to new patients to predict, approximately, how long the new patient may have lived with diabetes unknowingly. We aimed to develop a model to predict self-reported diabetes duration. METHODS: We used the Brazilian Multilabel Ophthalmological Dataset. Unit of analysis was the fundus image and its meta-data, regardless of the patient. We included people 40â¯+ years and fundus images without diabetic retinopathy. Fundus images and meta-data (sex, age, comorbidities and taking insulin) were passed to the MedCLIP model to extract the embedding representation. The embedding representation was passed to an Extra Tree Classifier to predict: 0-4, 5-9, 10-14 and 15â¯+ years with self-reported diabetes. RESULTS: There were 988 images from 563 people (mean ageâ¯=â¯67 years; 64â¯% were women). Overall, the F1 score was 57â¯%. The group 15â¯+ years of self-reported diabetes had the highest precision (64â¯%) and F1 score (63â¯%), while the highest recall (69â¯%) was observed in the group 0-4 years. The proportion of correctly classified observations was 55â¯% for the group 0-4 years, 51â¯% for 5-9 years, 58â¯% for 10-14 years, and 64â¯% for 15â¯+ years with self-reported diabetes. CONCLUSIONS: The machine learning model had acceptable accuracy and F1 score, and correctly classified more than half of the patients according to diabetes duration. Using large foundational models to extract image and text embeddings seems a feasible and efficient approach to predict years living with self-reported diabetes.
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Diabetes Mellitus , Fundo de Olho , Aprendizado de Máquina , Valor Preditivo dos Testes , Autorrelato , Humanos , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Fatores de Tempo , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Brasil/epidemiologia , Adulto , Bases de Dados Factuais , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Mineração de Dados/métodos , Reprodutibilidade dos Testes , Interpretação de Imagem Assistida por ComputadorRESUMO
PURPOSE OF REVIEW: This narrative review will discuss how the intake of specific protein sources (animal and vegetable) providing specific amino acids can modulate the gut microbiota composition and generate toxins. A better understanding of these interactions could lead to more appropriate dietary recommendations to improve gut health and mitigate the risk of complications promoted by the toxic metabolites formed by the gut microbiota. RECENT FINDINGS: Gut microbiota is vital in maintaining human health by influencing immune function and key metabolic pathways. Under unfavorable conditions, the gut microbiota can produce excess toxins, which contribute to inflammation and the breakdown of the integrity of the intestinal barrier. Genetic and environmental factors influence gut microbiota diversity, with diet playing a crucial role. Emerging evidence indicates that the gut microbiota significantly metabolizes amino acids from dietary proteins, producing various metabolites with beneficial and harmful effects. Amino acids such as choline, betaine, l-carnitine, tyrosine, phenylalanine, and tryptophan can increase the production of uremic toxins when metabolized by intestinal bacteria. The type of food source that provides these amino acids affects the production of toxins. Plant-based diets and dietary fiber are associated with lower toxin formation than animal-based diets due to the high amino acid precursors in animal proteins.
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Aminoácidos , Proteínas Alimentares , Microbioma Gastrointestinal , Humanos , Proteínas Alimentares/metabolismo , Aminoácidos/metabolismo , Dieta , Animais , Toxinas Urêmicas , Fibras na Dieta , Proteínas de Vegetais Comestíveis , Toxinas BiológicasRESUMO
Introducción: Las enfermedades periodontales tienen efectos locales y sistémicos sobre algunas enfermedades sistémicas. Propósito: Identificar cambios después de una jornada informativa preventiva sobre la relación de las EP y las enfermedades sistémicas en un ambiente universitario de carreras del área de la salud. Materiales y métodos: Estudio transversal no analítico cuyo objeto de estudio fue el cambio de la información obtenida por los participantes de una jornada de educación en salud en una muestra no aleatoria de 264 individuos de facultades de salud diferentes a odontología quienes recibieron encuestas "antes y después". Las variables de los cambios en los conocimientos se evaluaron mediante una escala Likert. Resultados: Antes de la estrategia, el 51,6% consideraban poco importante o que podría ser importante la salud oral como estilo de vida saludable vs un 99.2% al final. El 67.8 % de los sujetos, consideraban que la enfermedad periodontal no compartía factores de riesgo con condiciones sistémicas vs un 92.9%. Se incrementó de un 67.75% a 93.2% el reconocimiento del control del riesgo periodontal como estrategia para incidir en las enfermedades sistémicas. Conclusión: Una estrategia educativa sensibilizar positivamente sobre la importancia de la prevención de las enfermedades periodontales y las condiciones sistémicas.
Introduction: Periodontal diseases have local and systemic effects on some systemic diseases. Purpose: Identify changes after a preventive information session on the relationship between PD and systemic diseases in health faculties. Materials and methods: Non-analytical cross-sectional study whose object was the change in the information obtained by the participants of a health education session in a non-random sample of 264 individuals from health faculties other than dentistry who received "before and after" surveys. The variables were evaluated using a Likert scale. Results: Before the strategy, 51.6% considered oral health to be important for a healthy lifestyle vs. 99.2% at the end of the session. 67.8% of the subjects considered that periodontal disease shared risk factors with systemic conditions before the session vs. 92.9% after it. The recognition of periodontal risk control as a strategy to influence systemic diseases increased from 67.75% to 93.2%. Conclusion: An educational strategy raises a positive awareness of the importance of preventing periodontal diseases and systemic conditions.
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Humanos , Masculino , Feminino , Periodontite , Estudantes de Ciências da Saúde , Saúde Bucal , Estudos TransversaisRESUMO
Abstract Objectives To present observational studies investigating associations between the consumption of ultra-processed foods and health outcomes in childhood and adolescence. Data source Observational, cross-sectional, or longitudinal studies were considered, and identified in the Scopus, Web of Science, Pubmed and Scielo databases, without date restrictions. Data synthesis The most frequent combinations of risk factors in children and adolescents involved an unhealthy diet, with regular consumption of ultra-processed foods to the detriment of a diet based on fresh or minimally-processed foods and insufficient levels of physical activity; records on alcohol and tobacco use were identified. Combined, these practices contribute to the findings that indicate an increase in the prevalence of obesity in children and adolescents and a sedentary lifestyle, with a decrease in physical activity, in addition to representing a risk for the development of chronic non-communicable diseases, such as cardiovascular diseases and periodontal disease in childhood and adolescence. Conclusions The present study maps the current literature on the topic and indicates the direction of the approach for health promotion and prevention of NCDs in children and adolescents. Among the different risk factors that negatively affect the full development of this population, frequently eating breakfast and practicing physical activity is most strongly associated with a lower consumption of ultra-processed foods and should be part of an integrated approach to promoting eating practices that favor the reduction of diseases also in adult life.
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Obesity is a global health issue characterized by the excessive fat accumulation, leading to an increased risk of chronic noncommunicable diseases (NCDs), including metabolic dysfunction-associated fatty liver disease (MAFLD), which can progress from simple steatosis to steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Currently, there are no approved pharmacological protocols for prevention/treatment of MAFLD, and due the complexity lying beneath these mechanisms, monotherapies are unlikely to be efficacious. This review article analyzes the possibility that NCDs can be prevented or attenuated by the combination of bioactive substances, as they could promote higher response rates, maximum reaction results, additive or synergistic effects due to compounds having similar or different mechanisms of action and/or refraining possible side effects, related to the use of lower doses and exposures times than monotherapies. Accordingly, prevention of mouse MAFLD is observed with the combination of the omega-3 docosahexaenoic acid with the antioxidant hydroxytyrosol, whereas attenuation of mild cognitive impairment is attained by folic acid plus cobalamin in elderly patients. The existence of several drawbacks underlying published monotherapies or combined trials, opens space for adequate and stricter experimental and clinical tryouts to achieve meaningful outcomes with human applicability.
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Carcinoma Hepatocelular , Ácidos Graxos Ômega-3 , Neoplasias Hepáticas , Hepatopatia Gordurosa não Alcoólica , Doenças não Transmissíveis , Idoso , Humanos , Animais , Camundongos , Doenças não Transmissíveis/prevenção & controle , Antioxidantes , Hepatopatia Gordurosa não Alcoólica/prevenção & controleRESUMO
AIM: Investigating the association between sugar-sweetened beverages (SSBs) and periodontitis and whether the awareness of diabetes modifies this relationship. MATERIALS AND METHODS: Cross-sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES III) data involving US adults aged 30-50. Periodontitis was classified according to the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC-AAP), and SSB consumption as dichotomous (<5 or ≥5, <7 or ≥7 and <14 or ≥14 times/week), ordinal and continuous variables. Confounders included family income poverty ratio, education, race/ethnicity, sex, age, food energy intake, smoking and alcohol. Odds ratios (ORs) were obtained by logistic regressions using inverse probability weighting. Effect modification analysis was performed considering self-reported diabetes. RESULTS: Among 4473 cases analysed, 198 self-reported diabetes. SSBs were associated with periodontitis when individuals consumed ≥5 (OR 1.64; 95% confidence interval [CI] = 1.30-2.06), ≥7 (OR 1.92; 95% CI = 1.50-2.46) and ≥14 (OR 2.19; 95% CI = 1.50-3.18) times/week. The combined effect of consuming SSBs (≥5 and ≥14 times/week) and self-reported diabetes had less impact than the cumulative effect. CONCLUSIONS: SSB consumption was associated with higher odds of periodontitis, and the estimates were reduced among those with awareness of diabetes.
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Inquéritos Nutricionais , Periodontite , Bebidas Adoçadas com Açúcar , Humanos , Estudos Transversais , Masculino , Feminino , Periodontite/epidemiologia , Adulto , Pessoa de Meia-Idade , Bebidas Adoçadas com Açúcar/efeitos adversos , Bebidas Adoçadas com Açúcar/estatística & dados numéricos , Estados Unidos/epidemiologia , Diabetes Mellitus/epidemiologia , Fatores de RiscoRESUMO
INTRODUCTION: Immune reconstitution following antiretroviral therapy (ART) initiation is crucial to prevent AIDS and non-AIDS-related comorbidities. Patients with suppressed viraemia who fail to restore cellular immunity are exposed to an increased risk of morbidity and mortality during long-term follow-up, although the underlying mechanisms remain poorly understood. We aim to describe clinical outcomes and factors associated with the worse immune recovery and all-cause mortality in people living with HIV (PLWH) from Latin America following ART initiation. METHODS: Retrospective cohort study using the CCASAnet database: PLWH ≥18 years of age at ART initiation using a three drug-based combination therapy and with medical follow-up for ≥24 months after ART initiation and undetectable viral load were included. Patients were divided into four immune recovery groups based on rounded quartiles of increase in CD4 T-cell count at 2 years of treatment (<150, [150, 250), [250, 350] and >350 cells/mm3 ). Primary outcomes included all-cause mortality, AIDS-defining events and non-communicable diseases that occurred >2 years after ART initiation. Factors associated with an increase in CD4 T-cell count at 2 years of treatment were evaluated using a cumulative probability model with a logit link. RESULTS: In our cohort of 4496 Latin American PLWH, we found that patients with the lowest CD4 increase (<150) had the lowest survival probability at 10 years of follow-up. Lower increase in CD4 count following therapy initiation (and remarkably not a lower baseline CD4 T-cell count) and older age were risk factors for all-cause mortality. We also found that older age, male sex and higher baseline CD4 T-cell count were associated with lower CD4 count increase following therapy initiation. CONCLUSIONS: Our study shows that PLWH with lower increases in CD4 count have lower survival probabilities. CD4 increase during follow-up might be a better predictor of mortality in undetectable PLWH than baseline CD4 count. Therefore, it should be included as a routine clinical variable to assess immune recovery and overall survival.
Assuntos
Síndrome da Imunodeficiência Adquirida , Fármacos Anti-HIV , Infecções por HIV , Humanos , Masculino , Estudos Retrospectivos , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Fatores de Risco , Quimioterapia Combinada , Contagem de Linfócito CD4 , Carga Viral , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta AtividadeRESUMO
OBJECTIVES: This study aimed to estimate the economic costs of excessive sodium consumption in terms of hospitalizations and outpatient procedures of medium and high complexity (OPMHC) for the Brazilian Unified Health System (SUS) and its states in 2019. STUDY DESIGN: Ecological study. METHOD: This study used population attributable fractions (PAFs) of excessive sodium consumption estimated by the Global Burden of Disease study based on the theoretical minimum risk exposure level (3 g of sodium per day), the average population consumption, and relative risks of sodium-outcome pairs. PAFs were applied to the total costs of hospitalizations and OPMHC paid by SUS for each outcome obtained from the Outpatient and Hospital Information Systems. The costs per 10,000 inhabitants in all the Brazilian states were calculated and converted into international dollars (Int$), considering the purchasing parity power in the year 2019. RESULTS: Excessive sodium consumption resulted in Int$ 98,882,386.36 (95% uncertainty interval: Int$ 3,398,343.53-312,065,319.80) in hospitalizations and OPMHC costs in Brazil in 2019. Males and the 55- to 69-year-old age group had the highest expenditures attributable to excessive sodium consumption. Cardiovascular diseases were the most significant contributors to the costs associated with the risk factor. Southern and southeastern states had the highest costs of diseases attributable to sodium. CONCLUSION: Excessive sodium consumption has a significant economic burden on SUS, particularly among men and more developed states. This underscores the inequalities in socio-economic factors and access to health services throughout the country. Economic analyses at the subnational level can provide evidence for public policy planning to define the most appropriate actions for the population's sociodemographic reality.
Assuntos
Estresse Financeiro , Sódio , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Brasil/epidemiologia , Custos e Análise de Custo , Fatores de Risco , Custos de Cuidados de SaúdeRESUMO
BACKGROUND: Health risk behaviors often emerge or intensify during adolescence and tend to co-occur, exposing individuals to an even greater risk for the development of non-communicable diseases (NCDs). The likelihood of exhibiting multiple health risk factors also increases throughout life and is associated with sociodemographic characteristics contributing to their escalation and severity. In this context, the objective of this study was to analyze the association between sociodemographic characteristics and multiple behavioral risk factors for non-communicable diseases among the adolescent population in Brazil. METHODS: This cross-sectional study utilized data from the Brazilian National Survey of School Health 2019. The sample comprised 121,580 adolescents aged 13 to 17. The analyzed variables included irregular intake of fruits and vegetables, regular consumption of soft drinks and treats, insufficient physical activity, sedentary lifestyle, cigarette smoking, and alcohol consumption. To analyze MBRFs, a classification ranging from zero to five was created, and associations were estimated using Odds Ratio (OR) with the respective 95% confidence interval (CI). The Backward method was employed for the multivariate regression model, utilizing ordinal logistic regression. RESULTS: Adolescents without behavioral risk factors for NCDs constituted only 3.9% (95% CI 3.7-4.1). The most prevalent categories were two and three MBRFs, accounting for 28.3% (95% CI: 27.7-28.8) and 27.0% (95% CI: 26.5-27.5), respectively. Adolescents aged 16 and 17 (ORadj: 1.39; 95% CI: 1.32-1.48), residing in the Brazilian Southeast (ORadj: 1.66; 95% CI: 1.52-1.81), and those reporting poor or very poor self-rated health (ORadj: 2.05; 95% CI: 1.87-2.25) were more likely to exhibit multiple behavioral risk factors. Conversely, male adolescents (adjusted OR: 0.65; 95% CI: 0.62-0.69), those of mixed race (adjusted OR: 0.92; 95% CI: 0.87-0.97), and residents of rural areas (adjusted OR: 0.76; 95% CI: 0.70-0.84) were less likely to manifest MBRFs for NCDs. CONCLUSION: The majority of adolescents displayed MBRFs for NCDs, positively associated with age, region, and perceived health status. This underscores the necessity for healthcare promotional interventions throughout the life cycle, as these behaviors may persist into adulthood.
Assuntos
Doenças não Transmissíveis , Humanos , Masculino , Adolescente , Brasil/epidemiologia , Doenças não Transmissíveis/epidemiologia , Estudos Transversais , Fatores de Risco , Exercício FísicoRESUMO
The discovery of metabolically active brown adipose tissue (BAT) in human adults and the worldwide increase in obesity and obesity-related chronic noncommunicable diseases (NCDs) has made BAT a therapeutic target in the last two decades. The potential of BAT to oxidize fatty acids rapidly and increase energy expenditure inversely correlates with adiposity, insulin and glucose resistance, and cardiovascular and metabolic diseases. Currently, BAT is recognized by a new molecular signature; several BAT-derived molecules that act positively on target tissues have been identified and collectively called batokines. Bioactive compounds present in foods are endowed with thermogenic properties that increase BAT activation signaling. Understanding the mechanisms that lead to BAT activation and the batokines secreted by it within the thermogenic state is fundamental for its recruitment and management of obesity and NCDs. This review contributes to recent updates on the morphophysiology of BAT, its endocrine role in obesity, and the main bioactive compounds present in foods involved in classical and nonclassical thermogenic pathways activation.