Browsing by Author "Santos, Maria"
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- Anthropometric Indices and Cardiovascular Risk: A Cross-Sectional Study in PortugalPublication . Santos, Maria; Sousa-Uva, Mafalda; Namorado, Sónia; Gonçalves, Teresa; Matias Dias, Carlos; Gaio, VâniaIntroduction: The relationship between abdominal obesity and cardiovascular risk is well established. The objective of this study was to determine the best anthropometric index to assess cardiovascular risk in the Portuguese population aged 40-69 years. Materials and methods: Data from the 1st National Health Examination Survey 2015 were used. The analyzed anthropometric indices included Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Height Ratio (WHtR), Waist-to-Hip Ratio (WHR), and A Body Shape Index (ABSI). The subsample consisted of 2780 individuals who met the inclusion criteria: aged 40-69 years, not pregnant, available information on sex, age, smoking status, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and anthropometric measures (weight, height, WC, hip circumference). Individuals receiving cancer treatment were not included in the study. Those with a previous diagnosis of acute myocardial infarction, stroke, diabetes, chronic kidney disease, or undergoing medication therapy for these conditions were excluded from the analysis due to their already high or very high cardiovascular risk, being the use of SCORE2 inappropriate. The area under the curve (AUC) of the receiver operating characteristic (ROC) was calculated, stratified by sex, to determine the best index for assessing cardiovascular risk. Results: In females, WHR exhibited the highest discriminatory power with an AUC of 0.67 (95% CI: 0.63 to 0.71), closely followed by WHtR with an AUC of 0.66 (95% CI: 0.61 to 0.70) and ABSI with an AUC of 0.65 (95% CI: 0.60 to 0.70). In males, WHtR displayed the highest discriminatory power with an AUC of 0.64 (95% CI: 0.59 to 0.68), closely followed by WHR with an AUC of 0.63 (95% CI: 0.58 to 0.67), and WC had an AUC of 0.62 (95% CI: 0.57 to 0.67). Discussion: Previous research has produced diverse findings regarding the choice of anthropometric indices, with variations across genders. In the present study the AUC values for the analyzed indices encountered for both genders had overlapping confidence intervals, indicating no statistically significant difference in predictive power. Conclusion: In women, the best index was WHR, and in men it was WHtR. However, due to a lack of statistical significance, it was not possible to determine which index had the best predictive ability. Nevertheless, this doesn't invalidate the previously well-established link between abdominal obesity and cardiovascular risk. Cardiovascular disease has a multifactorial etiology, and attempting to find only one variable that predicts the risk of a cardiovascular event can be overly simplistic and limiting.
- Oral health behavior associated with cardiometabolic outcomes: A nationally representative cross-sectional study in PortugalPublication . Santos, Maria; Gaio, Vânia; Matias Dias, CarlosBackground: Oral diseases are associated with the development of cardiometabolic diseases. This study aimed to evaluate the relationship between oral health behaviors (tooth brushing and oral health appointments) with cardiometabolic diseases. Methods: Data from the First National Health Examination Survey were used. Participants aged 25-74 years and diagnosis of acute myocardial infarction (n = 4442), stroke (n = 4441), hypertension (n = 4450) and diabetes (n = 4327) were analyzed. A fifth subsample (n = 2555) included participants aged 40-69 for calculating cardiovascular risk. Poor oral health behavior was defined as brushing once a day or less and having the last oral health appointment at 12 months or more. Poisson regression models assessed the relationship between poor oral health behavior and these cardiometabolic outcomes. Results: Among 4.450 participants, 20.5 % had poor oral health behavior. A statistically significant association was found between poor oral health behavior with diabetes (PR: 1.44 [95 % CI: 1.10-1.98], and high/very high cardiovascular risk (PR: 1.42 [95 % CI: 1.25-1.62]). In the sensitivity analysis the association with diabetes and high/very high cardiovascular risk persisted when considering only brushing behavior but not when considering only oral health appointments at 12 months or more. Conclusions: Individuals with poor oral health behavior had a higher prevalence of diabetes and high/very high cardiovascular risk. Sensitivity analysis suggested that regular tooth brushing may be the main behavior for preventing diabetes and cardiovascular risk. The results suggest that regular tooth brushing may act in prevention for diabetes and cardiovascular risk.
- Prevalence of abdominal obesity in the Portuguese populationPublication . Santos, Maria; Sousa-Uva, Mafalda; Namorado, Sónia; Gonçalves, Teresa; Matias Dias, Carlos; Gaio, VâniaIntroduction: Overweight and obesity cause 1.2 million deaths annually and contribute to 7% of Years Lived with Disability in the World Health Organization (WHO) European Region, increasing the risk of cardiovascular diseases, diabetes, and various cancers. This study aimed to estimate and characterize the prevalence of abdominal obesity (AO) in the Portuguese population aged 25-74 years in 2015, using different anthropometric measures as a proxy of AO: waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and a body shape index (ABSI). Materials and methods: Data from the 1st National Health Examination Survey (INSEF) in 2015 were used. The subsample consisted of 4812 individuals who met the inclusion criteria: age 25-74 years, absence of pregnancy and available data on anthropometric measurements (weight, height, WC, hip circumference). Individuals undergoing cancer treatment were excluded from the analysis. The prevalence of abdominal obesity was stratified by sex, age group, marital status, education level, occupational activity, degree of urbanization, health region, and income quintile. Results: In Portugal, in 2015, the prevalence of abdominal obesity according to each considered anthropometric measure was 40.3% (95% CI: 38.0 - 42.5), 43.6% (95% CI: 40.1 - 47.0), 65.2% (95% CI: 62.8 - 67.5) and 75.5% (95% CI: 74.1 - 76.9) when considering WC, ABSI, WHR and WHtR, respectively. The prevalence was higher in women for WC and ABSI, while it was higher in men for WHR and WHtR. The most affected individuals had 60-74 years old. Regarding education, the highest prevalence was observed among individuals with no formal education or only primary education. In terms of occupation, the prevalence was higher among individuals engaged in low-skilled occupations (e.g., farmers, industrial workers, and construction workers). These findings remain consistent, regardless of the index under consideration. Discussion: In 2015, INSEF reported 38.9% of Portuguese adults had overweight, and 28.7% were obese. According to the WHO European Regional Obesity Report 2022, Portugal had a 57.5% prevalence of overweight and 20.8% of obesity in 2016. Within the WHO European Region, 58.7% of adults were overweight, and 23.3% were obese. The high prevalence of abdominal obesity in Portugal is a significant public health concern and is in line with European Region obesity trends. To determine the most accurate anthropometric index for assessing abdominal obesity, further research using imaging methods like computed tomography and nuclear magnetic resonance would be essential among the INSEF 2015 participants, as no gold standard index currently exists. Conclusion: The prevalence of abdominal obesity ranged from 40.3% for WC to 75.5% for WHtR. Nonetheless, irrespective of the index employed, the prevalence remains significantly elevated. The prevalence of abdominal obesity was higher in older age groups, individuals with lower education levels, and those engaged in less skilled occupations. Early identification of abdominal obesity in Primary Healthcare is essential for the most susceptible groups, as well as providing nutritional support, mainly for individuals in socioeconomic vulnerability.