Is the increment of diabetes mellitus in Brazil associated with the consumption of artificially sweetened beverages? A time trend analysis with 757,386 adults from 2006 to 2020

OBJECTIVE

To describe trends in the prevalence of diabetes mellitus (DM) in Brazil and to analyze its association with the consumption of artificially sweetened beverages among individuals aged 18 years or older.

STUDY DESIGN

This was a repeated cross-sectional study.

METHODS

Annual data from VIGITEL surveys (2006-2020) were used, which included adults from all Brazilian state capitals. The outcome was the prevalence of DM (type 1 and type 2). The main exposure variable was consuming beverages like soft drinks and artificial juices, either in its 'diet, light, or zero' form. Covariates included sex, age, sociodemographic characteristics, smoking, alcohol consumption, physical activity, fruit consumption, and obesity. The temporal trend in the indicators and the etiological fraction (population attributable risk [PAR]) were calculated. Analyses were performed using Poisson regression. The association between DM and consumption of beverages was tested, excluding the year 2020 due to the pandemic; restricting the analysis to the final three years (2018-2020).

RESULTS

Overall, 757,386 subjects were included. The prevalence of DM increased from 5.5% to 8.2%, with an annual growth of 0.17 percentage points (95% CI 0.11-0.24). Among those who consumed diet/light/zero beverages, the annual percentage change of DM was four times greater. The PAR corresponding to the consumption of diet/light/zero beverages on the occurrence of DM was 17%.

CONCLUSIONS

An increasing prevalence of DM was observed, while diet/light/zero beverages consumption remains stable. A substantial reduction in the annual percentage change of DM could be observed if people stopped consuming diet/light soda/juice.

What factors explain the increase in obesity in Brazil? An ecological analysis of contextual and behavioural components

OBJECTIVES

It has been suggested that contextual factors may be related to obesity; however, they have not yet been widely investigated. The main objective of this ecological time-series study was to analyse factors associated with the increase in obesity in the adult and elderly population in Brazil from 2006 to 2020.

STUDY DESIGN

This is an ecological time-series study. Data were collected by the Surveillance System for Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL), the main health survey in Brazil.

METHODS

The outcome was the annual obesity growth rate (in percentage points). Independent variables were behavioural and contextual factors. Data analysis was performed using Prais-Winsten regression for temporal analyses, and Spearman correlation and crude and adjusted linear regression (beta and 95% confidence intervals [CIs]).

RESULTS

The annual obesity growth rate was 0.58 percentage points (p.p.) (95% CI: 0.54; 0.63) per year. Demographic density and the percentage of the population employed showed an inverse association with the growth of obesity. Variables such as Gross Domestic Product (GDP) per capita, Gini coefficient, urbanisation rate, percentage of the population with low level of education and percentage of the population without an income were directly associated with the increase in obesity rates. The variables maintained in the final model explained 81% of the growth in obesity in Brazil over the last 15 years (2006-2020).

CONCLUSIONS

The growth of obesity in Brazil was mostly explained by contextual factors, especially those of a socio-economic nature. Therefore, interventions to mitigate the increase in obesity must go beyond behavioural factors.

Physical fitness measures among children and adolescents: are they all necessary?

AIM

The aim of this paper was to investigate the relationship among health and skill-related physical fitness variables, and with anthropometric measures in a sample of children and adolescents.

METHODS

A cross-sectional study was conducted with 526 Brazilian students aged 7-15 years. Physical fitness abilities/skills were assessed through a battery of eight tests: sit-and-reach, standing long jump, 1-minute curl-up, modified pull-up, medicine-ball throw, 9-minute run, 20-meter run and 4 meter shuttle-run. Anthropometric measures considered were weight, height, body mass index (BMI) and wingspan. Analyses included descriptive statistics, Pearson correlations, multiple linear regression and principal component analysis.

RESULTS

Anthropometric measures were directly associated between each other. Weight and BMI were negatively associated with the performance in all physical tests requiring propulsion or lifting of the body mass. Direct associations between tests persisted after adjustments for sex, age, type of school and geographic region of school.

CONCLUSION

Results from the principal component analysis evidenced that all physical abilities/motor skills, except flexibility, are strongly associated with each other, suggesting that one test can reflect the overall fitness among youth. Although it is unclear from these analyses which test would be the single choice indicator, previous work on the health impact of cardiorespiratory fitness would suggest that.

Childhood body mass index and risk of asthma in adolescence: a systematic review

Asthma and obesity, both of which are considered global health issues, affect approximately 300 million individuals worldwide. The observation that asthma and obesity tend to increase in parallel may indicate a potential link between these two conditions. The aim of this systematic review of the literature was to investigate the relationship between childhood nutritional status and incidence or persistence of asthma during adolescence. The principal eligibility criteria for selection of articles were including longitudinal analysis, and which measured of exposure during childhood or adolescence and outcome during adolescence. The systematic search initially returned 1563 unique articles. After inspection of titles and reading the abstracts of these articles, we chose 27 for full reading. Of these, 10 were selected to be included in the present review. Of the 10 selected studies, eight showed positive associations between overweight/obesity and asthma. Of these, two were independent of sex, three were found only among men and another three only among women. The present study shows strong evidence that, although the role of sex is not clear, obesity precedes, and is associated with, the persistence and intensity of symptoms of asthma.

Caesarean sections and risk of wheezing in childhood and adolescence: data from two birth cohort studies in Brazil

Background

There is evidence from two meta-analyses that children born through caesarean section (C-section) may have an increased risk of developing asthma compared with those born through vaginal delivery.

Objective

To evaluate the association between mode of delivery and wheezing (current and persistent) in childhood and adolescence, in two birth cohort studies in Brazil.

Methods

The outcome variable was based on the International Study of Allergy and Asthma questionnaire, which collects information about wheezing within the 12 months before the interview. Persistent wheezing was defined when it was present in more than one follow-up at different ages, in the 1993 cohort. The questions were asked to mothers when children were aged 4 years (1993 and 2004 cohorts) and directly to cohort participants at 11 and 15 years (1993 cohort). Mode of delivery was collected by the research team of each cohort when children were born.

Results

Response rates in the last follow-up visit of the 1993 and 2004 cohorts were 85% and 92%, respectively. The prevalence of current wheezing increased from 20% to 28% at 4 years from 1993 to 2004; at 11 and 15 years, the prevalence was around 14% and 12%, in the 1993 cohort. The proportion of C-sections increased from 30.5% to 45% between 1993 and 2004. In each cohort, the prevalence of current wheezing was similar among children born through vaginal and C-section. The risk for persistent wheezing in the 1993 cohort was higher among girls born through C-section than boys.

Conclusion

Despite the increase in the proportion of C-section in two cohorts in Southern Brazil, we found no evidence of an association between mode of delivery and the subsequent risk of wheezing. Among girls, although there was no statistical significance, the risk was higher for those born by C-section, especially regarding persistent wheezing.

Validation and Reliability of Visual Assessment with a Shade Guide for Tooth-Color Classification

The results of this study showed that the visual assessment of tooth color using the Vitapan Classical shade guide is a valid method for distinguishing between light and dark tooth colors.