FELIPPE LAZAR NETO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina
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- Prevalence and predictors of overweight and obesity in Brazilian immigrants in Massachusetts(2020) KLABUNDE, Rachel A.; NETO, Felippe Lazar; LOUZADA, Andressa; MOURA, Ricardo Fae de; CALIXTO, Fernando Morelli; DANAEI, Goodarz; CASTRO, Marcia C.BackgroundOverweight and obesity are important risk factors for chronic non-communicable diseases, and their prevalence is on the rise worldwide. This study seeks to describe the prevalence and predictors of overweight and obesity in Brazilian immigrants living in Massachusetts, United States of America (USA).MethodsModeled after a survey on behavioral risk factors for chronic disease conducted annually in Brazil (Vigilancia de Fatores de Risco e ProtecAo para Doencas Cronicas por Inquerito Telefonico: Vigitel), Brazilian immigrants aged 18+ (n=361) were surveyed between December 2013 and March 2014. Information was obtained from consenting participants regarding their demographic characteristics, physical activity, dietary and lifestyle habits, and other behavioral risk factors. Weight status was estimated from body mass index (BMI), calculated from self-reported height and weight data. Participants were categorized as overweight/obese if their BMI was >= 25; overweight and obese categories were combined to ensure appropriate sample size. Prevalence of overweight/obesity was estimated using STATA, and significant predictors were identified via multi-variable logistic regression. Odds ratio (OR), 95% confidence intervals (95% CI) and p-values were determined.ResultsThe overall prevalence of overweight/obesity in the sample was 47.6%. Significant predictors of overweight and obesity were gender (men OR 2.30, 95% CI: 1.10, 3.78; women are comparison group), working in the 3months prior to the survey (OR 2.90, 95% CI: 1.01, 8.30), and longer duration living in the USA (OR per additional year 1.06, 95% CI: 1.02, 1.11). Significant dietary predictors of overweight/obesity included 5 or more days per week of consumption of red meat (OR red meat 3.70, 95% CI: 1.47, 9.26) or of sweetened beverages, like soft drinks also known as soda (OR soda 2.40, 95% CI: 1.00, 5.78) compared with less frequent consumption of these foods.ConclusionsThis study suggests that long duration of time lived in the USA increases odds of overweight and obesity for Brazilian immigrants living in Massachusetts. Efforts to curb increases in overweight and obesity in this population should focus not only on the men and those who work but also the women. Possible intervention measures should target soda (soft drink) and red meat consumption in Brazilian immigrants.
- Depression and Its Correlates Among Brazilian Immigrants in Massachusetts, USA(2018) LAZAR-NETO, Felippe; LOUZADA, Andressa C. Sposato; MOURA, Ricardo Fae de; CALIXTO, Fernando Morelli; CASTRO, Marcia C.The goal of this paper is to assess the frequency of depression symptoms among Brazilian immigrants living in Massachusetts, the second largest Brazilian immigrant population in the United States, and to identify correlates of depression. A convenience sample of Brazilian immigrants aged 18 or older residing in Massachusetts was used. Data were collected from December 2013 to March 2014, in the Consulate General of Brazil in Boston and in three religious events, using a structure questionnaire and the Center for Epidemiological Studies Depression Scale (CES-D). Depression symptoms were observed in 35.3% of the respondents, with equal distribution by sex. Correlates of depression were low income, being single, poor English proficiency, and poor self-perception of health. These results suggest a need for community outreach, sensitization, and counseling, in Portuguese and adapted to the culture of Brazilian immigrants.
- Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study(2021) TAVARES, Caio Assis Moura; SAMESIMA, Nelson; NETO, Felippe Lazar; HAJJAR, Ludhmila Abrahao; GODOY, Lucas C.; PADRAO, Eduardo Messias Hirano; FACIN, Mirella; FILHO, Wilson Jacob; FARKOUH, Michael E.; PASTORE, Carlos AlbertoBackground Advanced age is associated with both left bundle branch block (LBBB) and hypertension and the usefulness of ECG criteria to detect left ventricular hypertrophy (LVH) in patients with LBBB is still unclear. The diagnostic performance and clinical applicability of ECG-based LVH criteria in patients with LBBB defined by stricter ECG criteria is unknown. The aim of this study was to compare diagnostic accuracy and clinical utility of ECG criteria in patients with advanced age and strict LBBB criteria. Methods Retrospective single-center study conducted from Jan/2017 to Mar/2018. Patients undergoing both ECG and echocardiogram examinations were included. Ten criteria for ECG-based LVH were compared using LVH defined by the echocardiogram as the gold standard. Sensitivity, specificity, predictive values, likelihood ratios, AUC, and the Brier score were used to compare diagnostic performance and a decision curve analysis was performed. Results From 4621 screened patients, 68 were included, median age was 78.4 years, (IQR 73.3-83.4), 73.5% with hypertension. All ECG criteria failed to provide accurate discrimination of LVH with AUC range between 0.54 and 0.67, and no ECG criteria had a balanced tradeoff between sensitivity and specificity. No ECG criteria consistently improved the net benefit compared to the strategy of performing routine echocardiogram in all patients in the decision curve analysis within the 10-60% probability threshold range. Conclusion ECG-based criteria for LVH in patients with advanced age and true LBBB lack diagnostic accuracy or clinical usefulness and should not be routinely assessed.
- Clinical applicability and diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy diagnosis in older adults(2021) TAVARES, Caio de Assis Moura; SAMESIMA, Nelson; HAJJAR, Ludhmila Abrahao; GODOY, Lucas C.; PADRAO, Eduardo Messias Hirano; LAZAR NETO, Felippe; FACIN, Mirella; JACOB-FILHO, Wilson; FARKOUH, Michael E.; PASTORE, Carlos AlbertoRecently, a new ECG criterion, the Peguero-Lo Presti (PLP), improved overall accuracy in the diagnosis of left ventricular hypertrophy (LVH)-compared to traditional ECG criteria, but with few patients with advanced age. We analyzed patients with older age and examined which ECG criteria would have better overall performance. A total of 592 patients were included (83.1% with hypertension, mean age of 77.5 years) and the PLP criterion was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL) and Romhilt-Estes criteria (cutoffs of 4 and 5 points, RE4 and RE5, respectively) using LVH defined by the echocardiogram as the gold standard. The PLP had higher AUC than the CV, RE and SL (respectively, 0.70 vs 0.66 vs 0.64 vs 0.67), increased sensitivity compared with the SL, CV and RE5 (respectively, 51.9% [95% CI 45.4-58.3%] vs 28.2% [95% CI 22.6-34.4%], p<0.0001; vs 35.3% [95% CI 29.2-41.7%], p<0.0001; vs 44.4% [95% CI 38.0-50.9%], p=0.042), highest F1 score (58.3%) and net benefit for most of the 20-60% threshold range in the decision curve analysis. Overall, despite the best diagnostic performance in older patients, the PLP criterion cannot rule out LVH consistently but can potentially be used to guide clinical decision for echocardiogram ordering in low-resource settings.