JOSE ELUF NETO
Projetos de Pesquisa
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LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Preventable fractions of colon and breast cancers by increasing physical activity in Brazil: perspectives from plausible counterfactual scenarios(2018) REZENDE, Leandro Fornias Machado de; GARCIA, Leandro Martin Totaro; MIELKE, Gregore Iven; LEE, Dong Hoon; WU, Kana; GIOVANNUCCI, Edward; ELUF-NETO, JoseBackground: Physical activity is associated with lower risk of colon and breast cancers. Herein we estimated preventable fractions of colon and breast cancers in Brazil by increasing population-wide physical activity to different counterfactual scenarios. Methods: We used data from a representative national survey in Brazil and corresponding relative risks of colon and postmenopausal breast cancers from a meta-analysis. Estimated cancer incidence was retrieved from GLOBOCAN and Brazilian National Cancer Institute. Five counterfactual scenarios for physical activity were considered: (i) theoretical minimum risk exposure level (>= 8,000 metabolic equivalent of tasks-minute/week-MET-min/week); (ii) physical activity recommendation (>= 600 MET-min/week); (iii) a 10% reduction in prevalence of insufficient physical inactivity (< 600 MET-min/week); (iv) physical activity level in each state equals the most active state in Brazil; (v) closing the gender differences in physical activity. Results: About 19% (3,630 cases) of colon cancers and 12% (6,712 cases) of postmenopausal breast cancers could be prevented by increasing physical activity to >= 8,000 MET-min/week. Plausible counterfactual scenarios suggested the following impact on cancer prevention: reaching physical activity recommendation: 1.7% (1,113 cases) of breast and 6% (1,137 cases) of colon; 10% reduction in physical inactivity prevalence: 0.2% (111 cases) of breast and 0.6% (114 cases) of colon; most active state scenario: 0.3% (168 cases) of breast and 1% (189 cases) of colon; reducing gender differences in physical activity: 1.1% (384 cases) of breast and 0.6% (122 cases) of colon. Conclusions: High levels of physical activity are required to achieve a sizable impact on breast and colon cancer prevention in Brazil.
- Physical activity and cancer: an umbrella review of the literature including 22 major anatomical sites and 770 000 cancer cases(2018) REZENDE, Leandro Fornias Machado de; SA, Thiago Herick de; MARKOZANNES, Georgios; REY-LOPEZ, Juan Pablo; LEE, I-Min; TSILIDIS, Konstantinos K.; IOANNIDIS, John P. A.; ELUF-NETO, JoseObjective To provide an overview of the breadth and validity of claimed associations between physical activity and risk of developing or dying from cancer. Design Umbrella review. Data sources We searched Medline, Embase, Cochrane Database and Web of Science. Eligibility criteria for selecting studies Systematic reviews about physical activity and cancer incidence and cancer mortality in different body sites among general population. Results We included 19 reviews covering 22 cancer sites, 26 exposure-outcome pairs metaanalyses and 541 original studies. Physical activity was associated with lower risk of seven cancer sites (colon, breast, endometrial, lung, oesophageal, pancreas and meningioma). Only colon (a protective association with recreational physical activity) and breast cancer (a protective association with overall physical activity) were supported by strong evidence and highly suggestive evidence, respectively. Evidence from endometrial, lung, oesophageal, pancreas and meningioma presented hints of uncertainty and bias in the literature (eg, not reaching P values < 10(-6)) showing large between-study heterogeneity and/or not demonstrating a definite direction for the effect when 95% prediction intervals were considered. Four of the 26 meta-analyses showed small study effects and 4 showed excess significance. Conclusion Physical activity is associated with a lower risk of several cancers, but only colon and breast cancer associations were supported by strong or highly suggestive evidence, respectively. Evidence from other cancer sites was less consistent, presenting hints of uncertainty and/or bias.
- Prevalence of chronic spinal pain and identification of associated factors in a sample of the population of Sao Paulo, Brazil: cross-sectional study(2016) DEPINTOR, Jidiene Dylese Presecatan; BRACHER, Eduardo Sawaya Botelho; CABRAL, Dayane Maia Costa; ELUF-NETO, JoseCONTEXT AND OBJECTIVE: Chronic spinal pain, especially low-back pain and neck pain, is a leading cause of years of life with disability. The aim of the present study was to estimate the prevalence of chronic spinal pain among individuals aged 15 years or older and to identify the factors associated with it. DESIGN AND SETTING: Cross-sectional epidemiological study on a sample of the population of the city of Sao Paulo. METHOD: Participants were selected using random probabilistic sampling and data were collected via face-to-face interviews. The Hospital Anxiety and Depression Scale (HADS), EuroQol-5D, Alcohol Use Disorders Identification Test (AUDIT), Fagerstrom test for nicotine dependence and Brazilian economic classification criteria were used. RESULTS: A total of 826 participants were interviewed. The estimated prevalence of chronic spinal pain was 22% (95% confidence interval, CI: 19.3-25.0%). The factors independently associated with chronic spinal pain were: female sex, age 30 years or older, schooling level of four years or less, symptoms compatible with anxiety and high physical exertion during the main occupation. Quality of life and self-rated health scores were significantly worse among individuals with chronic spinal pain. CONCLUSION: The prevalence of chronic spinal pain in this segment of the population of Sao Paulo was 22.0%. The factors independently associated with chronic pain were: female sex, age 30 years or older, low education, symptoms compatible with anxiety and physical exertion during the main occupation.
- Survival analysis of young adults from a Brazilian cohort of non-small cell lung cancer patients(2021) NICOLAU, Jessica Silva; LOPEZ, Rossana Veronica Mendoza; LUIZAGA, Carolina Terra de Moraes; RIBEIRO, Karina Braga; ROELA, Rosimeire Aparecida; MAISTRO, Simone; KATAYAMA, Maria Lucia Hirata; NATALINO, Renato Jose Mendonca; JR, Gilberto de Castro; NETO, Jose Eluf; FOLGUEIRA, Maria Aparecida Azevedo KoikeBackground: The influence of age at diagnosis in non-small cell lung cancer (NSCLC) prognosis is unclear. Objectives: To compare in a Brazilian cohort of NSCLC patients of different age groups: 1) The overall survival; 2) Clinical features and treatment options. Methods: This is a retrospective cohort study using a hospital-based registry, for NSCLC patients registered in years 2000-2009. Patients were grouped into three age groups: Young adults (YA: < 40 years), middle-aged (MA: 40-64 years) and elderly (E: >= 65 years). Kaplan-Meier was used to estimate overall survival and Cox regression for hazard ratios (HRs) and 95% confidence intervals. Results: 17,422 NSCLC patients were included: 370 YA (2.1%), 8,697 MA (49.9%) and 8,355 E (48.0%). Compared with older age groups, the YA group had a higher proportion of females, patients diagnosed with adenocarcinoma and metastatic disease (63.2%). Overall survival was longer in YA in the entire cohort and in all clinical stages (CSs) (p < 0.001). For YA, higher education level was a good prognosis factor (compared with illiterate and incomplete elementary); advanced or metastatic disease (compared with early-stage disease) and treatment based in radiotherapy or chemotherapy (CT) (without surgery), compared with treatment combinations with surgery, were poor prognostic factors. Young men (but not women) had lower HR of death compared with older groups; YA had lower HR of death in all CSs compared with patients from older groups. A higher percentage of YA were treated with surgery or CT in early-stage disease compared with older groups. Besides that, YA and MA patients treated with surgery or CT had a better prognosis than elderlies. Conclusions: In this Brazilian cohort of NSCLC patients, most young individuals were diagnosed with metastatic disease. YA presented longer survival than older age groups in all CSs, but mainly in CS I/II and III, where some patients may achieve long remissions or cure.
- Ethnicity and Cutaneous Melanoma in the City of Sao Paulo, Brazil: A Case-Control Study(2012) LUIZ, Olinda C.; GIANINI, Reinaldo Jose; GONCALVES, Fernanda T.; FRANCISCO, Guilherme; FESTA-NETO, Cyro; SANCHES, Jose Antonio; GATTAS, Gilka J. F.; CHAMMAS, Roger; ELUF-NETO, JoseBackground: Over the last century the incidence of cutaneous melanoma has increased worldwide, a trend that has also been observed in Brazil. The identified risk factors for melanoma include the pattern of sun exposure, family history, and certain phenotypic features. In addition, the incidence of melanoma might be influenced by ethnicity. Like many countries, Brazil has high immigration rates and consequently a heterogenous population. However, Brazil is unique among such countries in that the ethnic heterogeneity of its population is primarily attributable to admixture. This study aimed to evaluate the contribution of European ethnicity to the risk of cutaneous melanoma in Brazil. Methodology/Principal Findings: We carried out a hospital-based case-control study in the metropolitan area of Sao Paulo, Brazil. We evaluated 424 hospitalized patients (202 melanoma patients and 222 control patients) regarding phenotypic features, sun exposure, and number of grandparents born in Europe. Through multivariate logistic regression analysis, we found the following variables to be independently associated with melanoma: grandparents born in Europe-Spain (OR = 3.01, 95% CI: 1.03-8.77), Italy (OR = 3.47, 95% CI: 1.41-8.57), a Germanic/Slavic country (OR = 3.06, 95% CI: 1.05-8.93), or >= 2 European countries (OR = 2.82, 95% CI: 1.06-7.47); eye color-light brown (OR = 1.99, 95% CI: 1.14-3.84) and green/blue (OR = 4.62; 95% CI 2.22-9.58); pigmented lesion removal (OR = 3.78; 95% CI: 2.21-6.49); no lifetime sunscreen use (OR = 3.08; 95% CI: 1.03-9.22); and lifetime severe sunburn (OR = 1.81; 95% CI: 1.03-3.19). Conclusions: Our results indicate that European ancestry is a risk factor for cutaneous melanoma. Such risk appears to be related not only to skin type, eye color, and tanning capacity but also to others specific characteristics of European populations introduced in the New World by European immigrants.
- Risk factors associated with the development of gastric cancer - case-control study(2018) RAMOS, Marcus Fernando Kodama Pertille; RIBEIRO JUNIOR, Ulysses; VISCONDI, Juliana Kodaira Yukari; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; ELUF-NETO, Jose
- Mendelian Randomization and mediation analysis of leukocyte telomere length and risk of lung and head and neck cancers(2019) KACHURI, Linda; SAARELA, Olli; BOJESEN, Stig Egil; SMITH, George Davey; LIU, Geoffrey; LANDI, Maria Teresa; CAPORASO, Neil E.; CHRISTIANI, David C.; JOHANSSON, Mattias; PANICO, Salvatore; OVERVAD, Kim; TRICHOPOULOU, Antonia; VINEIS, Paolo; SCELO, Ghislaine; ZARIDZE, David; WU, Xifeng; ALBANES, Demetrius; DIERGAARDE, Brenda; LAGIOU, Pagona; MACFARLANE, Gary J.; ALDRICH, Melinda C.; TARDON, Adonina; RENNERT, Gad; OLSHAN, Andrew F.; WEISSLER, Mark C.; CHEN, Chu; GOODMAN, Gary E.; DOHERTY, Jennifer A.; NESS, Andrew R.; BICKEBOELLER, Heike; WICHMANN, H-Erich; RISCH, Angela; FIELD, John K.; TEARE, M. Dawn; KIEMENEY, Lambertus A.; HEIJDEN, Erik H. F. M. van der; CARROLL, June C.; HAUGEN, Aage; ZIENOLDDINY, Shanbeh; SKAUG, Vidar; WUNSCH-FILHO, Victor; TAJARA, Eloiza H.; MOYSES, Raquel Ayoub; NUNES, Fabio Daumas; LAM, Stephen; ELUF-NETO, Jose; LACKO, Martin; PETERS, Wilbert H. M.; MARCHAND, Loic Le; DUELL, Eric J.; ANDREW, Angeline S.; FRANCESCHI, Silvia; SCHABATH, Matthew B.; MANJER, Jonas; ARNOLD, Susanne; LAZARUS, Philip; MUKERIYA, Anush; SWIATKOWSKA, Beata; JANOUT, Vladimir; HOLCATOVA, Ivana; STOJSIC, Jelena; MATES, Dana; LISSOWSKA, Jolanta; BOCCIA, Stefania; LESSEUR, Corina; ZONG, Xuchen; MCKAY, James D.; BRENNAN, Paul; AMOS, Christopher I.; HUNG, Rayjean J.Background: Evidence from observational studies of telomere length (TL) has been conflicting regarding its direction of association with cancer risk. We investigated the causal relevance of TL for lung and head and neck cancers using Mendelian Randomization (MR) and mediation analyses. Methods: We developed a novel genetic instrument for TL in chromosome 5p15.33, using variants identified through deep-sequencing, that were genotyped in 2051 cancer-free subjects. Next, we conducted an MR analysis of lung (16 396 cases, 13 013 controls) and head and neck cancer (4415 cases, 5013 controls) using eight genetic instruments for TL. Lastly, the 5p15.33 instrument and distinct 5p15.33 lung cancer risk loci were evaluated using two-sample mediation analysis, to quantify their direct and indirect, telomere-mediated, effects. Results: The multi-allelic 5p15.33 instrument explained 1.49-2.00% of TL variation in our data (p = 2.6 x 10(-9)). The MR analysis estimated that a 1000 base-pair increase in TL increases risk of lung cancer [odds ratio (OR) = 1.41, 95% confidence interval (CI): 1.20-1.65] and lung adenocarcinoma (OR = 1.92, 95% CI: 1.51-2.22), but not squamous lung carcinoma (OR = 1.04, 95% CI: 0.83-1.29) or head and neck cancers (OR = 0.90, 95% CI: 0.70-1.05). Mediation analysis of the 5p15.33 instrument indicated an absence of direct effects on lung cancer risk (OR = 1.00, 95% CI: 0.95-1.04). Analysis of distinct 5p15.33 susceptibility variants estimated that TL mediates up to 40% of the observed associations with lung cancer risk. Conclusions: Our findings support a causal role for long telomeres in lung cancer aetiology, particularly for adenocarcinoma, and demonstrate that telomere maintenance partially mediates the lung cancer susceptibility conferred by 5p15.33 loci.
- Physical activity and preventable premature deaths from non-communicable diseases in Brazil(2019) REZENDE, Leandro Fornias Machado de; GARCIA, Leandro Martin Totaro; MIELKE, Gregore Iven; LEE, Dong Hoon; GIOVANNUCCI, Edward; ELUF-NETO, JoseBackground Studies on the impact of counterfactual scenarios of physical activity on premature deaths from non-communicable diseases (NCDs) are sparse in the literature. We estimated preventable premature deaths from NCDs (diabetes, ischemic heart disease, stroke, and breast and colon cancers) in Brazil by increasing population-wide physical activity (i) to theoretical minimum risk exposure levels; (ii) reaching the physical activity recommendation; (iii) reducing insufficient physical activity by 10%; and (iv) eliminating the gender differences in physical activity. Methods Preventable fractions were estimated using data from a nationally representative survey, relative risks from a meta-analysis and number of premature deaths (30-69 years) from the Brazilian Mortality Information System. Results Physical activity could potentially avoid up to 16 700 premature deaths from NCDs in Brazil, corresponding to 5.75 and 3.23% of premature deaths from major NCDs and of all-causes, respectively. Other scenarios suggested the following impact on premature deaths: reaching physical activity recommendation (5000 or 1.74% of major NCDs); 10% reduction in insufficient physical activity (500 or 0.17% of major NCDs); eliminating gender differences in physical activity (1000 or 0.33% of major NCDs). Conclusions Physical activity may play an important role to reduce premature deaths from NCD in Brazil.
- Fração atribuível populacional: planejamento de ações de prevenção de doenças no Brasil(2016) REZENDE, Leandro Fornias Machado de; ELUF-NETO, JoseEpidemiology is the study of occurrence, distribution and determinants of health-related events, including the application of that knowledge to the prevention and control of health problems. However, epidemiological studies, in most cases, have limited their research questions to determinants of health outcomes. Research related to the application of knowledge for prevention and control of diseases have been neglected. In this comment, we present a description of how population attributable fraction estimates can provide important elements for planning of prevention and control of diseases in Brazil.