Intra- and inter-rater reliability of muscle and fat thickness measurements obtained using portable ultrasonography in older adults

BACKGROUND & AIMS

Ultrasonography (US) is a promising tool for assessing body composition, offering accuracy and accessibility. However, technician skills and equipment characteristics can impact measurement reliability. We aimed to evaluate the intra- and inter-rater reliability of two evaluators using A-mode Portable Ultrasound to measure muscle and fat thickness in Brazilian older adults.

METHODS

Quantitative cross-sectional study carried out with 150 community-dwelling older adults of Campinas-SP-Brazil, recruited in a retirement preparation program and a geriatric outpatient care unit. Scans of nine anatomical points were performed using the portable ultrasound in A-mode (BodyMetrix Pro System BX2000; Livermore, CA), with 6 scans per location and 3 measurements taken by each evaluator. After the selection and analysis of the generated images, muscle and fat thickness were measured. Reliability estimates between measures of the same evaluator (intra-rater) and between evaluators (inter-rater) were assessed using intraclass correlation coefficients (ICC), and differences within and between technicians were assessed using one-way ANOVA. Analyses were carried out for the overall sample and stratified by sex and by nutritional status.

RESULTS

Excellent ICC values (>0.90) were found for subcutaneous fat thickness in intra- and inter-rater reliability analyses. The lowest ICC values were observed for deep abdominal fat thickness measured by evaluator 1 (ICC = 0.90) and evaluator 2 (ICC = 0.87), as well as in the inter-rater analysis (ICC = 0.85). Muscle thickness measurements had satisfactory ICC values for triceps, biceps, anterior thigh, and calf, ranging from moderate to good (ICC 0.50-0.90).

CONCLUSION

A portable A-mode ultrasound demonstrates excellent reliability among both intra- and inter-raters for assessing fat thickness but only moderate for muscle thickness in older adults. Hence, this could prompt inquiries regarding the sole reliance on this tool for quantifying muscle mass and examining sarcopenia in older adults. To our knowledge, this study represents the first assessment of reliability for a portable A-mode ultrasound device conducted with older adults.

Sociodemographic factors associated with Kyasanur forest disease in India - a retrospective study

Objectives

Kyasanur forest disease (KFD) is a tick-borne disease in India affecting humans and two local non-human primate species. A critical knowledge gap in the scientific literature is the lack of information on how people's sociodemographic factors influence KFD occurrence.

Methods

We analyzed available data on KFD from three data sources: (a) 104 peer-reviewed articles using keyword searches on PubMed Central and Google Scholar, (b) 116 Program for Monitoring Emerging Diseases reports, and (c) an acute febrile illness surveillance data set on KFD from a report by the government of India. We performed statistical analyses to calculate the prevalence of KFD by state and differences in KFD cases by sex and age group.

Results

All three data sets used indicate that KFD cases and deaths have occurred predominantly in the 15-64 years age group (literature: 87% cases and 95% deaths, Program for Monitoring Emerging Diseases: 78% cases and 78% deaths, acute febrile illness: 96% cases [no breakdown for acute febrile illness death data]). Data reporting varies across states and is non-standardized.

Conclusions

The inconsistent reporting of sociodemographic data on KFD in India has created a gap in our understanding of its impact on different social groups. Collecting and reporting data on sociodemographic factors is critical to understanding the epidemiology of KFD and designing effective public health interventions.

Doctors' recommendations and healthy lifestyle behaviors among individuals with hypertension in Brazil

Little is known about whether doctors' recommendations encourage healthy behaviors among individuals with hypertension in Brazil. This study examined the biological, social, and health factors related to doctor's recommendations and the associations between doctor's recommendations and healthy behaviors. The sample consisted of individuals with hypertension (N = 18,260) from Brazil's 2019 National Health Survey. The outcomes examined included smoking, drinking, diet, salt intake, physical activity, and doctor visits. Study findings indicated that more than 80% of people with hypertension in Brazil received doctors' recommendations to adhere to medical care and engage in healthy behaviors. Those who received recommendations were more likely to practice healthy eating and exercise regularly but also to be obese/overweight, smoke, and drink excessively. Nonetheless, the findings concerning diet and exercise suggest the value of doctors' recommendations for individuals with hypertension in Brazil.

Social Network, Food Patterns, Physical Activity and Associations with Overweight and Obesity in Adolescents from a School in Rural Brazil

The objective of this study was to evaluate the social network, food patterns, physical activity, and their associations with overweight/obesity in adolescents from a school in rural Brazil. Students from a rural school in Northeast Brazil (n = 90) completed questionnaires on sociodemographic characteristics, food consumption, physical activity, and a name generator. Social networks were constructed using students' social proximity ties. Principal component analysis was performed to determine food patterns, and logistic models were used to investigate variables associated with overweight/obesity. Most participants were girls (62.9%), and the proportion of overweight/obesity was 30% among adolescents. Students cited 2070 people from their networks (family, friends at school, friends outside of school, and others). Among them, the family had the highest degree of influence (61%) in the network and had the most shared meals with adolescents (47%). Adolescents' perception of their family members' body size as obese, compared to normal or underweight, was prevalent (51%). Adolescents with unhealthy food patterns were 72% more likely to be categorized as overweight/obese, and eigenvector centrality was also associated with overweight/obesity (OR = 5.88, 95% CI = 1.08-32.03). Adolescents presented a social network with strong family influence, in which a high percentage of overweight/obesity was observed. Adolescents with high eigenvector centrality were more likely to be in the overweight/obesity category. Additionally, overweight/obesity was associated with unhealthy food patterns in the family network.

Randomized control trial of a childhood obesity prevention family-based program: "Abriendo Caminos" and effects on BMI

Background

Hispanic individuals are at increased risk for obesity and other chronic health conditions. This article evaluates the effect of a family-based, childhood obesity primary prevention intervention in a community setting.

Methods

A multi-site, randomized controlled trial community program with assessments at pre (T0), post-program (T1), and 6-months post-program (T2). Participating families were recruited from five sites. Only families of Mexican or Puerto Rican heritage with a least one child between 6 and 18 years were included in the study, without weight restrictions. Families were randomized to the intervention and control arms. Intervention families received six-2 h weekly workshops. Control families received printed generic nutrition and wellness information. Heights and weights were measured at the 3-time points to calculate BMI z-scores, BMI-percentiles, and weight status using age- and sex-specific growth charts, according to the CDC guidelines.

Results

There were no differences in BMI-z scores between children in the intervention (n = 239) and control groups (n = 187) at T0. BMI z-scores decreased in the intervention group (-0.03, 95% CI, -0.066, -0.003, p = 0.032) at T1, but not in the control group at T1. Changes in BMI z-scores were not statistically significant at T2.

Conclusion

The Abriendo Caminos intervention effectively prevented unhealthy weight gain in Hispanic children in the short-term, but not at 6-months post-intervention. Younger children and girls benefited more from the program at 6-months post-intervention. Additional efforts are needed to sustain long-term changes. Culturally-tailored programs can provide families with the knowledge to produce short-term changes and a potential pathway for sustainable changes in implementing healthy behaviors.

Setting references for daily intake of micronutrients: A study on magnesium

OBJECTIVES

The Institute of Medicine stratifies the references for daily nutrient intake into age and sex groups, considering that the basal metabolic rate varies according to these aspects, and in most cases, it extrapolates the values calculated for adults to children, because their body weights are different. In this context, this study aimed to evaluate the recommendation for magnesium in children according to energy expenditure.

METHODS

This was an observational study using the database of the Social Changes, Asthma and Allergy in Latin America (SCAALA) cohort, which randomly collected information from 1445 children ages 4 to 11 y. Of these, 480 (33%) were part of the present study (children between 7 and 11 y old with eutrophic body mass index and adequate growth). Information on food intake was obtained from the child's parents or legal guardians through a 24-h recall. The population was characterized using static analyses such as the Student t test, Pearson correlation coefficient, and linear regression.

RESULTS

The mean age of the sample was 8.5 ± 0.96 y, and 54% were males. The mean magnesium intake was 149 ± 70 mg, with a high correlation observed between energy expenditure and magnesium intake (boys: R, 0.716; P <0.001; girls: R, 0.641; P < 0.001).

CONCLUSIONS

The metabolic rate can be considered a reference variable for recommending the daily intake of the studied nutrient, aiming to avoid deficiencies and food poisoning because of poor intake.

A biopsychosocial examination of chronic back pain, limitations on usual activities, and treatment in Brazil, 2019

Background

Chronic back pain is prevalent in Brazil, leading to enormous healthcare costs and social burdens. It also disproportionately affects low-income and less-healthy people.

Objectives

This study examines the associations of chronic back pain with biological, psychological, and social factors; how it limits usual activities; and how chronic back pain influences the use of treatment services.

Methods

Using Brazil’s National Health Survey (PNS-2019), multivariate logistic regressions were conducted to examine how biological, psychological, and social factors correlate with chronic back pain, limitations on usual activities, and pain treatment.

Results

PNS-2019 data showed that 23.4% (95% CI 22.8–24.0) of Brazilian adults aged over 20 reported back pain. A higher prevalence of chronic back pain was associated with biological factors (older age, being female, overweight or obese, current smoking, and having more chronic conditions), lower social conditions (low education, low per capita household income, non-married, and living in rural areas), and poor psychological health (more depressive symptoms). Chronic back pain is more likely to limit usual activities among those with low social conditions (lower education, lower income), poor physical and behavioral health (obese, current smokers, and those with a greater number of chronic conditions), and worse psychological health (more depressive symptoms). However, married people and those who do not consume alcohol were also more likely to report limited activities. Among those with back pain, 68% received at least one form of treatment. Those with intense limitations on their usual activities were 2.2 times as likely to report treatment. People with higher social conditions (higher income, college education, and private health insurance) were more likely to receive treatment.

Conclusion

The results show significant biological, psychological, and social disparities in the prevalence of chronic back pain in Brazil. The findings point to the need for tailored policies and prevention programs with attention to vulnerable groups. Even though Brazil has universal health care, those with better socioeconomic conditions are more likely to receive treatment.

Higher hemoglobin levels are associated with better physical performance among older adults without anemia: a longitudinal analysis

Background

Anemia is the most common hematological abnormality among older adults, and it is associated with decreased physical performance. But the role of hemoglobin in the absence of anemia remains unclear. Thus, this study aimed to assess the impact of hemoglobin levels on physical performance in Brazilian older adults without anemia.

Methods

The study is longitudinal in that it relies on two waves of the Saúde, Bem-Estar e Envelhecimento (SABE; Health, Well-being, and Aging) study: 2010 and 2015-2016. Mixed-effects linear regression was used to determine the effects of the hemoglobin concentrations on the Short Physical Performance Battery-SPPB over time among the 1,023 who had complete data and did not have anemia in 2010. In the follow-up, there were 567 without anemia.

Results

In analyses adjusted for age, education, comorbidities, body mass index, and physical inactivity, we found a differential association between hemoglobin concentration and SBBP by sex, with a positive interaction (β Hb*female= 0.20, 95% CI 0.04,0.37). At lower levels of hemoglobin, women have lower levels of SPPB than men, but at higher levels of hemoglobin concentration, there are no sex differences in physical performance. In addition, higher age was negatively associated with SPPB levels and cardiometabolic diseases, other diseases, and physical inactivity. Education was positively associated with physical performance.

Conclusion

Our study demonstrates that higher hemoglobin levels were associated with better physical performance among older adults without anemia in Brazil. However, there were sex differences in this association. This finding is important because, in clinical practice, most health professionals focus on the World Health Organization definition of anemia. Our study suggests the importance of hemoglobin levels among older adults, even those without anemia, and highlights sex differences.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02937-4.

Reducing Obesogenic Eating Behaviors in Hispanic Children through a Family-Based, Culturally-Tailored RCT: Abriendo Caminos

Family-based interventions that incorporate culturally-tailored multi-component curricula and are grounded on evidence-based information and theoretical frameworks can help reduce the prevalence of obesity among Hispanic children. Abriendo Caminos: Clearing the Path to Hispanic Health is a multi-site culturally-tailored randomized control trial that aims to reduce obesity rates in Hispanic families by delivering education on nutrition, family wellness, and physical activity. This study evaluated the effect of the Abriendo Caminos six-week intervention on dietary behaviors of Hispanic children (6–18 years). Mothers (n = 365) reported their child’s eating behavior intake using the U.S. Department of Education’s Early Childhood Longitudinal Study protocol (ECLS). Pre/post dietary changes were evaluated using separate generalized estimating equation models adjusted for site, child sex, and child age group. Findings indicate a reduction in the frequency of sugar-sweetened beverages (OR 0.55, 95% CI 0.35, 0.87, p = 0.01), French fries (OR 0.56, 95% CI 0.36, 0.86, p = 0.009), and fast food (OR 0.55, 95% CI 0.36, 0.84, p = 0.006) consumption among children in the intervention arm. Additionally, children in the intervention arm increased their frequency of vegetable consumption (OR 1.84, 95% CI 1.08, 3.12, p = 0.03). The Abriendo Caminos intervention effectively improved four of eight eating behaviors in a short-term intervention.

Coresidence increases the risk of testing positive for COVID-19 among older Brazilians

Background

Brazil is among the countries hit hardest by COVID-19, and older adults are among the vulnerable groups. Intergenerational coresidence and interdependence among family members, both prevalent in Brazil, likely increase social and physical contact and thus potential infection.

Methods

Using nationally representative data from the COVID-19 module of the Brazilian National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios), collected between July and November of 2020, we examined the association between living arrangements and exposure to and testing for COVID-19 among 63,816 Brazilians aged 60 years and older. We examine whether living arrangements influence self-reported COVID-19 symptoms as an indicator of subjective health assessment, testing as an indicator of health care service use, and a positive COVID-19 test result as an objective indicator of exposure to the disease.

Results

Living arrangements shape older adults’ vulnerabilities to COVID-19 exposure and testing. Specifically, those living alone were more likely to report having symptoms and having had a test for COVID-19. However, older adults in multigenerational and skipped generation households were more likely than solo-dwellers to test positive for COVID-19. Those with symptoms were more likely to test, regardless of their living arrangement. Among older adults without symptoms, those living alone had a higher probability of testing than those living in multigenerational or skipped-generation households.

Conclusions

Overall, our findings suggest that coresidence with younger family members puts older adults’ health at risk in the context of COVID-19. As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population.

Factors associated with body mass index changes among older adults: a ten-year follow-up

To examine changes in body mass index (BMI) among older Brazilian adults and associated factors. Longitudinal, population-based study, conducted in São Paulo, Brazil. Adults aged 60 years or over (n = 1,796) from the first wave of data collection from the Health, Well-Being, and Aging Study (SABE Project) conducted from 2000 to 2010. Repeated mixed-effects linear regression was used to analyze longitudinal changes in BMI and to examine whether sociodemographic characteristics, health conditions, and social behaviors were associated with these changes. Mean BMI decreased after 70 years. Men had lower BMI than women (β = -1.86, 95%CI: -2.35; -1.37). Older adults who consumed alcohol (β = 0.30, 95%CI: 0.06; 0.54), had more than one chronic disease (β = 0.19, 95%CI: 0.26; 0.72) and who did not perform physical activity (β = 0.56, 95%CI: 0.38; 0.74) had higher BMI. Subjects who smoked (β = -0.40, 95%CI: -0.76; -0.04) and who reported having eaten less food in recent months (β = -0.48, 95%CI: -0.71; -0.24) had lower BMI. In older Brazilians, several sociodemographic characteristics, health conditions, and behaviors predict BMI. Increasing prevalence of chronic diseases and growing sedentary behaviors in Brazil may have detrimental effects on BMI at older ages.

Life-course risk factors are associated with activity of daily living disability in older adults

BACKGROUND

Multiple risk factors accumulate over the life-course and contribute to higher rates of disability at older ages. This study investigates whether three life-course risk factors (low educational attainment, poor health in childhood and multimorbidity) are associated with increased risk of disability [defined as any limitation in basic activities of daily living (BADL)] in older adults and whether this relationship is moderated by the national socioeconomic context, measured by the Human Development Index (HDI).

METHODS

Data include 100 062 adults (aged 50 and over) participating in longitudinal studies of aging conducted in 19 countries. Analyses include multivariable Poisson models with robust standard errors to assess the associations between HDI, life-course risk factors and other individual-level control variables (sex and age) with any BADL disability.

RESULTS

In country-specific analyses, both educational attainment and multimorbidity are independently associated with disability in nearly every country. The interaction between these risk factors further increases the magnitude of this association. In pooled regression analyses, the relationship between life-course risk factors and disability is moderated by a country's HDI. For individuals with all three life-course risk factors, the predicted probability of disability ranged from 36.7% in the lowest HDI country to 21.8% in the highest HDI country.

CONCLUSIONS

Social and health system policies directed toward reducing the development of life-course risk factors are essential to reduce disability in all countries, but are even more urgently needed in those with lower levels of socioeconomic development.

Optimizing Dementia Care for Mexicans and Mexican-Origin U.S. Residents

In this article, we report on the recommendations of a bi-national conference that examined the institutional capacities and future ability of Mexico and the United States to address the need for affordable and sustainable dementia care that results from growing older adult populations. These recommendations reflect the large difference in resources between the two nations and each country's political and institutional capacity. Progress in both countries will require an expansion of programs or generation of new ones, to meet the needs of older adults, including improving access to services and actively managing the dementia care burden. A comprehensive federal health care safety net will be required in both nations, but economic realities will constrain its implementation. Both nations suffer from a persistent shortage of geriatric primary care physicians and geriatricians, especially in rural areas. Advances in diagnosis, treatment and care management require additional knowledge and skills of general and specialized staff in the healthcare workforce to deliver evidence-based, culturally and linguistically appropriate long-term care, and human rights-oriented services. We conclude with a discussion of recommendations for bi-national dementia care policy and practice.

Expectativa de vida com e sem multimorbidade entre idosos brasileiros: Pesquisa Nacional de Saúde 2013

O objetivo do presente estudo é analisar diferenças na expectativa de vida com e sem  multimorbidade (duas ou mais condições crônicas) entre idosos nos estados brasileiros, segundo sexo e idade. Foram utilizados os dados de mortalidade do Sistema de Informações sobre Mortalidade e projeções populacionais do Instituto Brasileiro de Geografia e Estatística (IBGE) para elaborar tábuas de vida para os estados, por sexo. Informação sobre a prevalência de multimorbidade foi obtida a partir da Pesquisa Nacional de Saúde (PNS) de 2013. A partir do método de Sullivan, estimaram-se a expectativa de vida com e sem multimorbidade e a proporção de anos vividos com multimorbidade. A amostra de idosos da PNS possuía um total de 11.697 entrevistados, cuja idade média foi de 70,08 anos (DP 0,09 ano). A proporção de anos a serem vividos com multimorbidade aumenta com a idade (53,6% aos 60 anos e 57,3% aos 75 anos). Mulheres possuem expectativa de vida maior do que os homens, mas convivem mais com multimorbidade. Aos 60 anos, as mulheres brasileiras esperam viver, em média, 13,5 anos com multimorbidade e os homens 8,3 anos. Constatou-se grande diferença na expectativa de vida com multimorbidade quando comparadas as unidades da federação, com amplitude de 8,2 a 14,2 anos (aos 60 anos de idade). É importante considerar estas diferenças na priorização de ações e grupos para intervenção em saúde pública.

Education-Related Inequalities in Dental Services Use among Older Adults in 23 Countries

This study aimed to measure the magnitude of education-related inequalities in the use of dental services among older adults (aged 50 y or older) from a sizable multicountry sample of 23 upper-middle- and high-income countries. This study used cross-sectional data from nationally representative surveys of people aged 50 y and over. Countries included in the Health and Retirement Study surveys were the following: Brazil, China, South Korea, Mexico, United States, Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Italy, Israel, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland. The dependent variable was the use of dental services, based on the self-report of having had a dental visit within the previous year, except for the United States and South Korea, which used 2-y recall periods. Educational level was used as the measure of socioeconomic position and was standardized across countries. Multivariate logistic regression modeling was used to evaluate the factors associated with the use of dental services, and the magnitude of education inequalities in the use of dental services was assessed using the slope index of inequality (SII) to measure absolute inequalities and the relative index of inequality for relative inequalities. The pooled prevalence of the use of dental services was 31.7% and ranged from 18.7% in China to 81.2% in Sweden. In the overall sample, the absolute difference in the prevalence of use between the lowest and highest educational groups was 20 percentage points. SII was significant for all countries except Portugal. Relative educational inequalities were significant for all countries and ranged from 3.2 in Poland to 1.2 in Sweden. There were significant education-related inequalities in the use of dental care by older adults in all countries. Monitoring these inequalities is critical to the planning and delivery of dental services.

Healthy life-expectancy and multimorbidity among older adults: Do inequality and poverty matter?

Multimorbidity among older adults increases with age. There are large socioeconomic differences across states in Brazil. We believe that estimates of healthy life expectancy differ according to poverty and income inequality status. The objective of the study is to describe patterns of life expectancy with multimorbidity with distinct levels of poverty and inequality in Brazil. We constructed life tables for Brazilian states and estimated the prevalence of multimorbidity for populations aged 60 and over, and divided the states into three groups according to poverty and inequality status and compare them. The group with high poverty and inequality lives fewer years with multimorbidity than the group with lower poverty and inequality. We believe this approach can be used to compare estimates between populations and to identify health inequalities within the country that require attention, optimizing resources, and planning interventions to improve population health, mainly through primary health care.

The Influence of Evidence-Based Exercise and Age Reattribution on Physical Function in Hispanic Older Adults: Results From the ¡Caminemos! Randomized Controlled Trial

Older Hispanics routinely exhibit unhealthy beliefs about "normal" aging trajectories, particularly related to exercise and physical function. We evaluated the prospective effects of age reattribution on physical function in older Hispanics. Participants (n = 565, ≥60 years) were randomly assigned into (a) treatment group-attribution-retraining, or (b) control group-health education. Each group separately engaged in four weekly 1-hr group discussions and 1-hr exercise classes, followed by monthly maintenance sessions. The Short Physical Performance Battery (SPPB) measured physical function throughout the 24-month intervention. No significant difference in physical function between intervention arms was evident over time. However, both groups experienced significant improvements in physical function at 24 months (β = 0.43, 95% confidence interval [CI] = [0.16, 0.70]). Participating in the exercise intervention was associated with improvements in physical function, although no additional gains were apparent for age attribution-retraining. Future research should consider strengthening or modifying intervention content for age reattribution or dosage received.

The impact of exercise on depressive symptoms in older Hispanic/Latino adults: results from the '¡Caminemos!' study

OBJECTIVES

We examined the prospective effects of an evidence-based exercise intervention on depressive symptoms in older Hispanics/Latinos and the potential synergistic effects (if any) of an attribution-retraining component to counter negative ascriptions to the aging process.

METHOD

We analyzed baseline, 1-, 12-, 24-month data collected from Hispanics/Latinos ≥ 60 years participating in an exercise intervention ("¡Caminemos!") across 27 senior centers (N = 572). All participants were given 4 weekly 1-hour group-based exercise classes targeting strength training, endurance, balance and flexibility. In addition, they were randomly assigned to one of two conditions: a) treatment group-a 1-hour attribution retraining session where participants were taught that aging does not mean one inevitably becomes sedentary, or b) control group-generic health education. The Geriatric Depression Scale was used to assess depressive symptoms. Covariates included age, sex, education, income, marital status, acculturation, and number of chronic conditions.

RESULTS

In prospective analyses, participants in both trial arms displayed lower scores for depressive symptoms at 12- (β1 = -0.17, p = 0.04) and 24-months (β2 = -0.33, p < 0.001) when compared to baseline values.

CONCLUSION

Given expected growth of the older Hispanic/Latino adult population, exercise programs are a promising strategy in promoting favorable mental health.

Socioeconomic Inequalities in Oral Health-Related Quality of Life among Brazilians: A Cross-Sectional Study

Objective: Assess the magnitude of the socioeconomic inequalities related to the impact of oral health on quality of life among adults and elderly individuals. Methods: This was a cross-sectional study with data from the most recent oral health survey from the state of Minas Gerais, Brazil. The sample included data on 2288 individuals—1159 adults in the 35–44 age group and 1129 adults in the 65–74 age group. Socioeconomic inequalities in Oral Impacts on Daily Performance ratings were measured using two inequality measures: the slope index of inequality (SII) and the relative index of inequality (RII). Results: The prevalence of negative impact of oral health on quality of life was 42.2% for the total sample, 44.9% among adults and 37.5% among elderly individuals. Significant absolute and relative income inequalities were found for the total sample (SII −27.8; RII 0.52) and both age groups (adults: SII −32.4; RII 0.49; elderly: SII −18.3; RI 0.63), meaning that individuals in the lowest income level had the highest prevalence of negative impacts. Regarding schooling, no significant differences were observed among the elderly. Conclusion: There were significant socioeconomic inequalities related to the negative impact of oral health-related quality of life in Brazil among both age groups.

Neighborhood stressors and psychological distress among U.S. Latinos: Measuring the protective effects of social support from family and friends

We examined whether social support from family and friends, separately, reduce the deleterious effect of neighborhood stressors on psychological distress among Latinos by subgroup. Utilizing data from a nationally representative sample of 2,524 Latinos (National Latino and Asian American Survey), we found that neighborhood stressors were associated with higher distress among people with low and average levels of family support, although there was no significant association between neighborhood stressors and distress among those with high levels of family support. Although both family and friend support reduced the deleterious mental health impact of neighborhood stressors, when mutually adjusted, only family support remained statistically significant as a stress buffer and only for Mexicans and Cubans.

Differences in quality of life among older adults in Brazil according to smoking status and nicotine dependence

BACKGROUND

Research on quality of life QOL is limited in Brazil and few studies have examined the association between smoking status and quality of life. This study addresses this gap and also examines the association between smoking, nicotine dependence, and duration of smoking cessation on (QOL) among older adults in an urban area in Brazil.

METHODS

Data are from a household survey conducted in urban areas of Uberaba, Brazil, in 2012 (n = 980). Multivariable linear regressions were used to evaluate the association between smoking, nicotine dependence based on Fageström test, and smoking cessation on the World Health Organization Quality of Life WHOQOL-BREF and Quality of Life Assessment for Older Adults WHOQOL-OLD.

RESULTS

The mean age of older adults in the study was 74.0 (SD = 6.9 years) and 64% of participants were women. The majority, 55% had never smoked, 12.4% were current smokers, and 32.7% were past-smokers. Current smokers had lower scores for social participation (β = - 2.6) and intimacy (β = - 3.8) than never smokers. Smokers with high or very high dependence reported higher levels of fear and concern about death and pain before death than those with low or very low dependence (β = - 10.6). However, smokers with medium levels of nicotine dependence had higher scores on social relationship. Longer cessation time was positively associated with higher scores for psychological health.

CONCLUSIONS

Except for the positive association between medium levels of nicotine dependence and better social relationships, smoking and higher levels of nicotine dependence were associated with worse QOL among older adults in Brazil. Nonetheless, smoking cessation had positive effects in QOL. Campaigns targeting older adults should point to the negative impact of tobacco use on QOL and the benefits of smoking cessation.

Inequalities in basic activities of daily living among older adults: ELSI-Brazil, 2015

OBJECTIVE

To evaluate the magnitude of wealth-related inequalities in basic activities of daily living among community-dwelling Brazilian older adults and to determine the contribution of demographic, socioeconomic, and health conditions to the inequality.

METHODS

We used data from the 2015 Brazilian Longitudinal Study of Aging (ELSI-Brazil) with a nationally representative sample of adults aged 50 years or older. We assessed wealth-related inequalities in basic activities of daily living by the concentration index. Concentration index was decomposed to determine the contribution of demographic, health, and socioeconomic factors to wealth-related inequalities in basic activities of daily living.

RESULTS

The prevalence of disability in the sample was 15.7% (95%CI 14.9–17.6). The concentration index was -0.145 (95%CI -0.194– -0.097), which indicates that disability is concentrated in the poorest individuals in Brazil. Inequalities in basic activities of daily living disability are primarily explained by socioeconomic status (wealth and own education) not by demographic or health factors.

CONCLUSIONS

There are avoidable wealth-related inequities for those with a disability in Brazil. The strong contribution of the socioeconomic status highlights the need for new public health policies that promote equity, universality, and integrality, in addition to the expansion of home nursing public services.

Serum Lipid Concentrations and FADS Genetic Variants in Young Mexican College Students: The UP-AMIGOS Cohort Study

BACKGROUND

Recent genome-wide association studies in the Mexican population have identified several genetic loci associated with blood lipid levels in adults. However, studies focusing on the fatty acid desaturase (FADS) gene cluster have been understudied in this population, even though it seems associated with lipid profiles in other ethnicities. The aim of this study was to test associations between single nucleotide polymorphisms (SNPs) in the FADS cluster (rs174546, rs1535, rs174548, rs174550, rs174450, and rs174618) and serum lipid profiles in young Mexicans.

METHODS

Anthropometrics, serum lipid profiles, and FADS SNPs were measured in 998 subjects in the UP-AMIGOS cohort study. Genotype-phenotype (total cholesterol [TC], triglyceride [TG], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], and very-low-density lipoprotein [VLDL]) associations were assessed using PLINK adjusted for sex, age, and body mass index (BMI).

RESULTS

Among 6 FADS SNPs, we found that carriers of the C-allele of the FADS1-rs174546 showed a significant association with lower TG concentrations (β = -12.6 mg/dL, p = 0.009) and lower VLDL concentrations (β = -2.52 mg/dL, p = 0.005). We found that rs174546, rs1535, and rs174550 were in high linkage disequilibrium (r2 > 0.80). There were no significant associations between rs174550, rs174548, and rs174618 and lipid profiles.

CONCLUSION

A genetic variant in the FADS1 (rs174546) gene is a major contributor of plasma TG and VLDL concentrations in healthy young Mexicans.

Increasing educational inequalities in self-rated health in Brazil, 1998-2013

The objectives of this study are to analyze the associations between educational levels and poor self-rated health (SRH) among adults in Brazil and to assess trends in the prevalence of poor self-rated health across educational groups between 1998 and 2013. Individual-level data came from the 1998, 2003 and 2008 Brazilian National Household Survey and the 2013 National Health Survey. We estimate prevalence rates of poor SRH by education. Using multivariable regressions, we assess the associations between educational levels and poor self-rated health. We use these regressions to predict the estimated ratios between the prevalence rates of those in low vs. high education in order to assess if relative changes in poor SRH have narrowed over time. Finally, we tested for statistically significant time trends in adult chronic disease inequalities by education. Results indicate a clear educational gradient in poor SRH. Prevalence ratios show that Brazilian adults with no education have levels of poor SRH that are 7 to 9 times higher than those with some college or more. The difference between those with lowest and highest education increased from 1998 to 2013. Compared to those with no education, there were increases in the prevalence of poor SRH among those with primary and secondary incomplete as well as among those with secondary complete in 2008 and 2013. In conclusion, there is a positive association between poor SRH and low education. Brazil has many social and geographic inequalities in health. Even though educational levels are increasing, there is no improvement in the general subjective health of Brazilians. Health inequalities by race and region highlight the need to improve the health of socially disadvantaged groups in Brazil. Addressing chronic conditions and mental health is needed to improve self-perceptions of health in Brazil as well.

Circulating Triglycerides and the Association of Triglycerides with Dietary Intake Are Altered by Alpha-2-Heremans-Schmid Glycoprotein Polymorphisms

BACKGROUND

Circulating fetuin-A (FetA) inhibits insulin receptor signaling and activates the toll-like receptor 4 proinflammatory cascade; thus, it may contribute to metabolic syndrome. Polymorphisms in alpha-2-Heremans-Schmid glycoprotein (AHSG), the gene which codes FetA, may influence metabolic syndrome progression in higher-risk ethnic groups. We aimed to identify whether individual variation in AHSG influences biomarkers of metabolic disease and obesity in young Mexican adults.

METHODS

The participants were Mexican college applicants (18-25 years, n = 641). Dietary intake, anthropometric data, and blood for the analysis of biomarkers and genetics were collected. Single nucleotide polymorphisms (SNPs) in AHSG (rs2518136 and rs4917) were genotyped.

RESULTS

Neither AHSG SNP was associated with body mass index (BMI) or waist circumference. rs4917 C allele carriers had lower triglycerides (TG) than T allele homozygotes (98.85 ± 2.3 vs. 112.2 ± 5.2 mg/dL, p = 0.0113). BMI was strongly associated with TG (p < 0.0001) regardless of genotype. The relationship between circulating TG and dietary intake of carbohydrates and saturated fat was significant in rs4917 CT allele heterozygotes only (p = 0.03 and p = 0.02, respectively).

CONCLUSIONS

rs4917 T allele carriers had higher TG. This relationship was exaggerated in individuals with overweight and obesity. Dietary intake was significantly associated with TG in only those with heterozygosity at rs4917, suggesting that these individuals may be more susceptible to dietary interventions.

Validation of the SCOFF questionnaire for screening of eating disorders among Mexican university students

PURPOSE

To evaluate the criterion validity and diagnostic utility of the SCOFF, a brief eating disorder (ED) screening instrument, in a Mexican sample.

METHODS

The study was conducted in two phases in 2012. Phase I involved the administration of self-report measures [the SCOFF and the Eating Disorder Inventory-2, (EDI-2)] to 1057 students aged 17-56 years (M age = 21.0, SD = 3.4; 67 % female) from three colleges at the Universidad Autónoma de San Luis Potosí, Mexico. In Phase II, a random subsample of these students (n = 104) participated in the eating disorder examination, a structured interview that yields ED diagnoses. Analyses were conducted to evaluate the SCOFF's criterion validity by examining (a) correlations between scores on the SCOFF and the EDI-2 and (b) the SCOFF's ability to differentiate diagnosed ED cases and non-cases.

RESULTS

EDI-2 subscales showed high correlations with the SCOFF scores proving initial evidence of criterion validity. A score of two points on the SCOFF optimized the sensitivity (78 %) and specificity (84 %). With this cutoff, the SCOFF correctly classified over half the cases (PPV = 58 %) and screened out the majority of non-cases (NPV = 93 %) providing further evidence of criterion validity. Analyses were repeated separately for men and women, yielding gender-specific information on the SCOFF's performance.

CONCLUSIONS

Taken as a whole, results indicated that the SCOFF can be a useful tool for identifying Mexican university students who are at risk of eating disorders.

One-year follow-up changes in weight are associated with changes in blood pressure in young Mexican adults

OBJECTIVE

Increasing overweight and obesity rates in Mexico have been associated with increases in mortality from cardiovascular disease (CVD). This study assessed changes in body mass index (BMI) and body weight over 1 year, and explored whether these were associated with changes in CVD risk factors of blood pressure and fasting glucose in a cohort of young Mexican adults.

STUDY DESIGN

Longitudinal data were obtained from a cohort of young Mexican adults applying to college.

METHODS

Data were collected from college applicants for the 2008 academic year who re-applied in 2009. In total, 795 college applicants aged 18-20 years, of both sexes (48% males and 52% females), were included in the study. The screen included height, weight, and systolic (SBP) and diastolic (DBP) blood pressure measurements plus a blood draw following an overnight fast for fasting glucose.

RESULTS

At baseline, 31.8% of the participants were overweight or obese. The mean 1-year change in body weight and BMI were 0.80 kg and 0.35 kg/m(2), respectively. One-year changes in body weight and BMI were associated with increased SBP and DBP for both men and women (P < 0.05), independent of baseline BMI. A weight gain of 5% or more was positively associated with increases in blood pressure among women (P < 0.05), but not among men. A weight loss of 5% or more was associated with reductions in SBP among women.

CONCLUSIONS

One-year changes in weight were associated with changes in blood pressure.

Weight status misperception among Mexican young adults

Individuals who misperceive their body size are at risk for eating disorders, unhealthy weight control practices, and obesity-related diseases. This study assessed the prevalence and demographic, behavioral, and psychosocial correlates of agreement between perceived (self-reported) and actual (measured) body mass index categories in a sample of Mexican college applicants aged 18-20 years (N=3622; 52% female). Under two thirds (63.1%) accurately reported their weight status categories. Reporting accuracy was lower among overweight and obese participants. In multivariate analyses, overestimating was associated with female gender, younger age, lower level of parent education, and more hours of daily TV viewing; underestimating was associated with male gender and older age. In within-gender analyses, overestimating was associated with hours of TV among men and underestimating was positively associated with depressive symptoms among women. This study adds to a growing international literature on body weight status misperception among adolescents and young adults.