LEANDRO FORNIAS MACHADO DE REZENDE
Projetos de Pesquisa
Unidades Organizacionais
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina
9 resultados
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- Resting heart rate and risk of type 2 diabetes: A prospective cohort study and meta-analysis(2019) LEE, Dong Hoon; REZENDE, Leandro Fornias Machado de; HU, Frank B.; JEON, Justin Y.; GIOVANNUCCI, Edward L.Background Positive association between resting heart rate (RHR) and risk of type 2 diabetes (T2D) has been documented in several studies. However, whether RHR is an independent predictor of T2D and its potential interaction with other risk factors of T2D remain unclear. Methods We conducted a prospective cohort study of 31 156 men from the Health Professionals Follow-up Study (1992-2012). Cox proportional hazard model was used to examine the association between RHR and T2D risk. We further examined whether this association is modified by known risk factors. Lastly, we conducted a meta-analysis of prospective cohort studies. Results During 505 380 person-years of follow-up, we identified 2338 incident T2D cases. The multivariable-adjusted hazard ratio (HR) comparing the highest vs lowest categories of RHR was 1.69 (95% confidence interval [CI], 1.43-2.01). Increase in 10 bpm of RHR was associated with 19% increased risk of T2D in the fully adjusted model (HR, 1.19; 95% CI, 1.14-1.24). The HRs of T2D associated with RHR were stronger among those with normal weight or without hypertension (P interaction < 0.001). Moreover, RHR with other known risk factors cumulatively increased T2D risk. A meta-analysis consistently showed a positive association between RHR and T2D risk (the summary relative risk [RR] for highest vs lowest RHR, 1.53; 95% CI, 1.26-1.86, n = 12, the summary RR per 10 bpm increase, 1.17; 95% CI, 1.09-1.26, n = 13). Conclusions High RHR was independently associated with increased risk of T2D. Our findings suggest that RHR, with other known risk factors, could be a useful tool to predict T2D risk.
- Ultra-processed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study(2019) RAUBER, Fernanda; LOUZADA, Maria Laura da Costa; STEELE, Euridice Martinez; REZENDE, Leandro F. M. de; MILLETT, Christopher; MONTEIRO, Carlos A.; LEVY, Renata B.Objectives To describe dietary sources of free sugars in different age groups of the UK population considering food groups classified according to the NOVA system and to estimate the proportion of excessive free sugars that could potentially be avoided by reducing consumption of their main sources. Design and setting Cross-sectional data from the UK National Diet and Nutrition Survey (2008-2014) were analysed. Food items collected using a 4-day food diary were classified according to the NOVA system. Participants 9364 individuals aged 1.5 years and above. Main outcome measures Average dietary content of free sugars and proportion of individuals consuming more than 10% of total energy from free sugars. Data analysis Poisson regression was used to estimate the associations between each of the NOVA food group and intake of free sugars. We estimated the per cent reduction in prevalence of excessive free sugar intake from eliminating ultra-processed foods and table sugar. Analyses were stratified by age group and adjusted for age, sex, ethnicity, survey year, region and equivalised household income (sterling pounds). Results Ultra-processed foods account for 56.8% of total energy intake and 64.7% of total free sugars in the UK diet. Free sugars represent 12.4% of total energy intake, and 61.3% of the sample exceeded the recommended limit of 10% energy from free sugars. This percentage was higher among children (74.9%) and adolescents (82.9%). Prevalence of excessive free sugar intake increased linearly across quintiles of ultra-processed food consumption for all age groups, except among the elderly. Eliminating ultra-processed foods could potentially reduce the prevalence of excessive free sugar intake by 47%. Conclusion Our findings suggest that actions to reduce the ultra-processed food consumption generally rich in free sugars could lead to substantial public health benefits.
- Proportion of cancer cases and deaths attributable to lifestyle risk factors in Brazil(2019) REZENDE, Leandro Fornias Machado de; LEE, Dong Hoon; LOUZADA, Maria Laura da Costa; SONG, Mingyang; GIOVANNUCCI, Edward; ELUF-NETO, JoseBackground: Lifestyle risk factors (tobacco smoking, alcohol consumption, overweight and obesity, unhealthy diet, and lack of physical activity) have been associated with increased risk of at least 20 types of cancer. We estimated the proportion of cancer cases and deaths that could be potentially avoided by eliminating or reducing lifestyle risk factors in Brazil. Methods: We obtained the distribution of lifestyle risk factors by sex and age groups from recent representative health surveys in Brazil; relative risks from pooled analyses of prospective studies and meta-analyses; and cancer cases and deaths in 2012 from GLOBOCAN. Results: We found that 26.5% (114,497 cases) of all cancer cases and 33.6% (63,371 deaths) of all cancer deaths could be potentially avoided by eliminating lifestyle risk factors in Brazil. Plausible reductions in these exposures based on policy targets and cancer prevention recommendations could have potentially avoided 4.5% (19,731 cases) and 6.1% (11,480 deaths) of all cancer cases and deaths, respectively. Tobacco smoking accounted for most of the preventable cancer cases and deaths, followed by high body mass index and alcohol consumption. Larynx, lung, oropharynx, esophagus and colorectum cancer cases and deaths could be at least halved by eliminating these lifestyle risk factors. Conclusion: Findings from this study may be useful to inform strategies for cancer prevention and control across Brazil.
- 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.
- Mortality on the first day of life: trends, causes of death and avoidability in eight Brazilian Federative Units, between 2010 and 2015(2019) TEIXEIRA, Joao Alexandre Mendes; ARAUJO, Waleska Regina Machado; MARANHAO, Ana Goretti Kalume; CORTEZ-ESCALANTE, Juan Jose; REZENDE, Leandro Fornias Machado de; MATIJASEVICH, AliciaObjective: to calculate mortality rates on the first day of life from 2010 to 2015 in eight Brazilian Federative Units providing better quality information, to assess associated factors and to classify deaths by underlying causes and avoidability. Methods: this was a descriptive study; mortality rates were compared according to maternal and child characteristics; avoidability analysis used the 'Brazilian list of avoidable causes of death'. Results: 21.6% (n=20,791) of all infant deaths occurred on the first day of life; the mortality rate reduced from 2.7 to 2.3 deaths/1,000 live births; rates were higher in live births with low birthweight and preterm births, and among babies born to mothers with no schooling; main causes of death were respiratory distress syndrome (8.9%) and extreme immaturity (5.2%); 66.3% of causes of death were avoidable. Conclusion: 2/3 of deaths on the first day of life could have been avoided with adequate care for women during pregnancy and delivery and adequate care for live births.
- Association of type and intensity of physical activity with plasma biomarkers of inflammation and insulin response(2019) LEE, Dong Hoon; REZENDE, Leandro Fornias Machado de; ELUF-NETO, Jose; WU, Kana; TABUNG, Fred K.; GIOVANNUCCI, Edward L.Several biological mechanisms linking physical activity with cancer have been proposed. However, the influence of specific components of physical activity (volume, type and intensity), and their interaction with adiposity and diet, on cancer-related biomarkers remain unclear. We used cross-sectional data on 7,219 men in the Health Professionals Follow-up Study (1992-1994) with C-reactive protein (CRP), interleukin-6 (IL6), tumor necrosis factor alpha receptor 2 (TNF alpha R2), adiponectin, C-peptide and triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL). Details on physical activity, diet and adiposity were assessed by questionnaires. We used multivariable-adjusted linear regression analyses to estimate relative concentrations of biomarkers by physical activity. Total physical activity was favorably associated with all biomarkers in a fairly linear manner. Comparing the highest (63+ metabolic equivalent (MET)-hr/week) to the lowest (0-8.9 MET-hr/week) physical activity groups, the percent relative difference in concentration of biomarkers was -31% for CRP, -22% for IL6, -8% for TNF alpha R2, +9% for adiponectin, -22% for C-peptide, and -20% for TG/HDL. These differences were modestly attenuated after adjustment for adiposity. For the same total MET-hours of physical activity, the association was stronger for men engaging in both aerobic and resistance exercises compared to those engaging in aerobic only. However, no difference was found between those engaging in vigorous activities (>= 20% of total MET-hours) compared to those who did smaller amount of vigorous activities. Physical activity showed similar associations for these biomarkers regardless of adiposity and dietary pattern. In conclusion, high physical activity, preferably aerobic plus resistance training, was associated with favorable cancer-related biomarkers.
- Physical activity during adolescence and risk of colorectal adenoma later in life: results from the Nurses' Health Study II(2019) REZENDE, Leandro Fornias Machado de; LEE, Dong Hoon; KEUM, NaNa; NIMPTSCH, Katharina; SONG, Mingyang; LEE, I-Min; ELUF-NETO, Jose; OGINO, Shuji; FUCHS, Charles; MEYERHARDT, Jeffrey; CHAN, Andrew T.; WILLETT, Walter; GIOVANNUCCI, Edward; WU, KanaBACKGROUND: Physical activity during adulthood has been consistently associated with lower risk of colorectal cancers, but whether physical activity during adolescence may also play a role in colorectal carcinogenesis is unclear. METHODS: We included 28,250 women in the Nurses' Health Study II who provided data on physical activity during adolescence (ages 12-22 years) in 1997 and underwent lower bowel endoscopy (1998-2011). We used logistic regression models for clustered data to examine the association between physical activity during adolescence and risk of adenoma later in life. RESULTS: Physical activity during adolescence was inversely associated with risk of colorectal adenoma (2373 cases), independent of physical activity during adulthood. The multivariable-adjusted odds ratio (OR) of adenoma was 0.89 (95% CI 0.77-1.02; P-trend = 0.03) comparing women with >= 72 metabolic equivalent of tasks-hours/week (MET-h/week) to < 21 MET-h/week. Women with high physical activity during both adolescence (>= 53.3 MET-h/week) and adulthood (>= 23.1 MET-h/week) had significantly lower risk of adenoma (all adenomas: OR 0.76; 95% CI 0.66-0.88; advanced adenoma: OR 0.61; 95% CI 0.45-0.82) compared to women with low physical activity during both stages of life. CONCLUSIONS: Our findings suggest that physical activity during adolescence may lower the risk of colorectal adenoma later in life.
- Co-occurrence and clustering of the four major non-communicable disease risk factors in Brazilian adolescents: Analysis of a national school-based survey(2019) RICARDO, Camila Zancheta; AZEREDO, Catarina Machado; REZENDE, Leandro Fornias Machado de; LEVY, Renata BertazziBackground The major non-communicable chronic diseases (NCD) are associated with a small group of modifiable lifestyle-related risk factors, including smoking, insufficient physical activity, unhealthy eating, and alcohol abuse. In this study, we evaluated the co-occurrence and clustering of the major NCD risk factors among Brazilian adolescents. Methods This cross-sectional study analyzed data of 101,607 adolescents from the Brazilian National Survey of School Health (PeNSE) 2015. The risk factors included were: regular consumption of ultra-processed foods, irregular consumption of fruits and vegetables, insufficient physical activity, smoking, and alcohol consumption. Clustering was defined through the ratio between observed and expected prevalences of combination of risk factors greater than 1. Expected prevalence of the co-occurrence of risk factors was calculated from the joint probability of the behaviors. Additionally, we examined the presence of at least four risk factors according to socioeconomic characteristics. Results Of the 32 combinations of risk factors, 13 corresponded to clustering. We observed a strong correlation between alcohol consumption and smoking, which were found together in 8 of the 13 clusters identified. The most frequent combinations of risk factors involved unhealthy eating and insufficient physical activity. Only 2.9% of the adolescents did not present any risk behaviors, while 38.0%, 32.9%, 9.4% and 1.8% accumulated two, three, four and five risk factors, respectively. The accumulation of risk factors was higher in girls, older adolescents, those who did not live with both parents, children of less-educated mothers, students attending public school, and residents of cities in more developed urban areas of the country. Conclusions The main risk factors for NCD are frequent and not randomly distributed among Brazilian adolescents. Our results provide information for policymakers to target specific groups and joint behavioral risk factors for health improvement in adolescents.
- Progress and setbacks in socioeconomic inequalities in adolescent health-related behaviours in Brazil: results from three cross-sectional surveys 2009-2015(2019) AZEREDO, Catarina Machado; REZENDE, Leandro F. M. de; MALLINSON, Poppy Alice Carson; RICARDO, Camila Zancheta; KINRA, Sanjay; LEVY, Renata B.; BARROS, Aluisio J. D.Objectives Despite some progress, Brazil is still one of the most unequal countries, and the extent of socioeconomic inequalities in adolescent health is unclear. We assessed trends in socioeconomic inequalities in adolescent's health-related behaviours in Brazil between 2009 and 2015. Design We used cross-sectional data from the Brazilian National Survey of School Health carried out in 2009, 2012 and 2015. Setting Brazilian state capitals. Participants Students attending ninth grade from public and private schools in Brazilian state capitals in 2009 (60 973 students), 2012 (61 145 students) and 2015 (51 192 students). Main outcome measure We assessed 12 health-related behaviours (irregular fruit, vegetables and bean consumption; regular soft drink consumption; irregular physical activity; alcohol, drug and tobacco use; unsafe sex; involvement in gun fights; bullying victimisation and domestic violence victimisation), under the broad domains of lifestyle risk behaviours, engagement in risky activities and exposure to violence. Socioeconomic status was assessed through an asset-based wealth index derived from principal component analysis. Absolute and relative inequalities in these health behaviours and inequalities trends were investigated. Results From 2009 to 2015, prevalence of certain harmful health-related behaviours increased, such as unsafe sex (21.5% to 33.9%), domestic violence (9.5% to 16.2%), bullying victimisation (14.2% to 21.7%) and irregular consumption of beans (37.5% to 43.7%). Other indicators decreased: alcohol use (27.1% to 23.2%), irregular physical activity (83.0% to 75.6%) and consumption of soft drinks (37.2% to 28.8%). Over the period, we found consistent evidence of decreasing health inequalities for lifestyle behaviours (fruit, bean and soft drink consumption) and alcohol use, set against increasing inequalities in violence (domestic violence, fights using guns and bullying victimisation). Conclusion Socioeconomic inequality increased in the violence domain and decreased for lifestyle behaviours among Brazilian adolescents. Widening gaps in violence domain urge immediately policy measures in Brazil.