ABSTRACT Objective: We aimed to analyze the association of diabetes and subclinical hypothyroidism with subclinical atherosclerosis measured by coronary artery calcium (CAC) in the baseline of the ELSA-Brasil study. Materials and methods: CAC was measured using a 64-detector computed tomographic scanner. The association of CAC > 0 was presented as an odds ratio (OR) and 95% confidence intervals (95%CI) in logistic models and as β (95%CI) in linear models after multivariable adjustment for confounders. Results: We analyzed 3,809 participants (mean-age (SD) 50.5 (8.8); 51.7% women). In the main analysis, we did not find an association of diabetes and subclinical hypothyroidism with CAC. However, in stratified analysis according to age strata, we found no significative interaction terms, an important heterogeneity between the groups, with the younger age strata showing an association of the group with both diseases and CAC > 0 (OR 7.16; 95%CI, 1.14; 44.89) with a wide but significative 95%CI, suggesting that the smaller number of participants in the younger group may influence the results. Our findings also showed an association of CAC > 0 and log (CAC+1) with diabetes in logistic (OR, 1.31; 95%CI, 1.05-1.63) and linear models (β, 0.24, 0.16, 0.40), respectively. Diabetes was independently associated with CAC > 0 in linear models. Discussion: In conclusion, our results showed a great heterogeneity in stratified analysis based on age in the younger age strata. Although we found no significant interaction factors, the smaller sample size for the analysis may influence the negative findings. Objective (CAC ELSABrasil ELSA Brasil study methods 64detector detector 64 scanner OR 95 95%CI 95CI CI (95%CI confounders Results 3809 3 809 3,80 meanage mean SD (SD 505 50 5 50. 8.8 88 8 (8.8) 517 51 7 51.7 women. women . women) However terms groups 7.16 716 16 1.14 114 1 14 44.89 4489 44 89 CAC+1 CAC1 (CAC+1 OR, 1.31 131 31 1.051.63 105163 1.05 1.63 05 63 1.05-1.63 β, (β 024 24 0.24 016 0.16 0.40, 040 0.40 , 40 0.40) respectively Discussion conclusion factors 6 9 380 80 3,8 8. (8.8 51. 7.1 71 1.1 11 44.8 448 4 CAC+ (CAC+ 1.3 13 051 1.051.6 10516 105 1.0 163 1.6 1.05-1.6 02 2 0.2 01 0.1 04 0.4 38 3, (8. 7. 1. 44. 1.051. 1051 10 1.05-1. 0. (8 1.051 1.05-1 ( 1.05-

Abstract Introduction: Child health actions in Brazil have their primary focus on early childhood. A new epidemiological profile is emerging for children after the first one thousand days: an increase in non-communicable chronic diseases. This research aimed to analyze the attributes of Primary Health Care comparatively among different age groups, using three years of age as the cutoff point. Methods: The study design was cross-sectional and conducted in three Primary Health Care Units and three Ambulatory Medical Assistance facilities in the Western Region of Sao Paulo. The PCA Tool Brazil was used as the assessment instrument. Results: A total of 311 interviews were conducted with caregivers of children aged 0 to 12 years; 153 children were under three years old, and 158 were three years or older. The attributes that showed statistically significant differences between age groups (< 3 years and > 3 years) were affiliation (4.9 × 3.8), longitudinality (5.7 × 5.2), information system (7.4 × 6.3), and services provided (5.4 × 4.5). Through linear regression analysis, it was observed that there was a trend for better overall and essential scores in the evaluations of the group of children under three years old who attended Primary Health Care Units. Conclusion: The comparative analysis of Primary Health Care attributes among pediatric age groups revealed a trend towards higher scores, according to caregivers’ perceptions, for children under three years old. This study suggests the need for the implementation of programs that can better address the healthcare needs of children beyond early childhood. Introduction childhood days noncommunicable non communicable diseases point Methods crosssectional cross sectional Paulo instrument Results 31 1 15 older < ( 4.9 49 4 9 (4. 3.8, 38 3.8 , 8 3.8) 5.7 57 5 7 (5. 5.2, 52 5.2 2 5.2) 7.4 74 (7. 6.3, 63 6.3 6 6.3) 5.4 54 4.5. 45 4.5 . 4.5) Conclusion perceptions 4. (4 3. 5. (5 7. (7 6.

ABSTRACT Objective: To determine the relationship between psoriasis, thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triodothyronine (FT3), thyroid peroxidase antibodies (TPOAb), and subclinical thyroid dysfunctions in middle-aged and older adults. Materials and methods: Cross-sectional analyses included a self-reported medical diagnosis of psoriasis and thyroid function from the 3rd visit (2017-2019) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). TSH, FT4, and FT3 levels were analyzed as continuous variables and quintiles, and TPOAb positivity and subclinical hypothyroidism as a yes/no variable. Logistic regression models were built as crude and adjusted by main confounders (age, sex, education level, race/ethnicity, and smoking). Results: From 9,649 participants (52.3% women; 59.2 ± 8.7 years old), the prevalence of psoriasis was 2.8% (n = 270). TSH, FT4, TPOAb positivity, and subclinical hypothyroidism were not associated with psoriasis in the main analyses. In the stratified analysis, our findings showed positive associations of the lowest (OR = 2.01; 95% CI 1.05-3.84; p = 0.036) and the highest (OR = 2.13; 95% CI 1.12-4.05; p = 0.022) quintiles of FT4 and a protective association of TPOAb positivity (OR = 0.43; 95% CI 0.19-0.98; p = 0.046) with prevalent psoriasis in women. In the logistic regression for FT3, participants in the 1st quintile showed a statistically significant association with psoriasis for the whole sample (OR = 1.66; 95% CI 1.11-2.46; p = 0.013) and for men (OR = 2.25; 95% CI 1.25-4.04; p = 0.007) in the sex-stratified analysis. Conclusions: The present study showed that the association of FT4 levels with psoriasis are different according to sex, with a possible U-shaped curve in women but not in men. Although there were some associations of FT3 with psoriasis, they may be a consequence of non-thyroidal illness syndrome. Further prospective data may clarify the association of thyroid function and psoriasis. Objective thyroidstimulating stimulating TSH , (TSH) FT (FT4) (FT3) TPOAb, (TPOAb) middleaged middle aged adults methods Crosssectional Cross sectional selfreported self reported rd 20172019 2017 2019 (2017-2019 ELSABrasil. ELSABrasil ELSA Brasil . (ELSA-Brasil) yesno yes no variable age, age (age sex level raceethnicity race ethnicity race/ethnicity smoking. smoking smoking) Results 9649 9 649 9,64 52.3% 523 52 3 (52.3 592 59 2 59. 87 8 7 8. old, old old) 28 2.8 n 270. 270 270) analysis OR 2.01 201 01 95 1.053.84 105384 1.05 3.84 1 05 84 1.05-3.84 0.036 0036 0 036 2.13 213 13 1.124.05 112405 1.12 4.05 12 4 1.12-4.05 0.022 0022 022 0.43 043 43 0.190.98 019098 0.19 0.98 19 98 0.19-0.98 0.046 0046 046 st 1.66 166 66 1.112.46 111246 1.11 2.46 11 46 1.11-2.46 0.013 0013 013 2.25 225 25 1.254.04 125404 1.25 4.04 04 1.25-4.04 0.007 0007 007 sexstratified Conclusions Ushaped U shaped nonthyroidal non thyroidal syndrome (TSH (FT4 (FT3 (TPOAb 2017201 (2017-201 (ELSA-Brasil 964 64 9,6 52.3 5 (52. 2. 27 2.0 20 053 1.053.8 10538 105 1.0 384 3.8 1.05-3.8 0.03 003 03 2.1 21 124 1.124.0 11240 112 1.1 405 4.0 1.12-4.0 0.02 002 02 0.4 190 0.190.9 01909 019 0.1 098 0.9 0.19-0.9 0.04 004 1.6 16 6 1.112.4 11124 111 246 2.4 1.11-2.4 0.01 001 2.2 22 254 1.254.0 12540 125 1.2 404 1.25-4.0 0.00 000 00 (FT 201720 (2017-20 96 9, 52. (52 1.053. 1053 10 1. 38 3. 1.05-3. 0.0 1.124. 1124 40 4. 1.12-4. 0. 0.190. 0190 09 0.19-0. 1.112. 1112 24 1.11-2. 1.254. 1254 1.25-4. 20172 (2017-2 (5 1.053 1.05-3 1.124 1.12-4 0.190 0.19-0 1.112 1.11-2 1.254 1.25-4 (2017- ( 1.05- 1.12- 0.19- 1.11- 1.25- (2017 (201 (20 (2

Abstract Introduction: The association of diabetes with subclinical thyroid diseases may increase the risk of cardiovascular diseases. We analyzed the association of subclinical hypothyroidism, diabetes, and both diseases with carotid Intima-Media Thickness (cIMT) as a surrogate maker for early cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: Cross-sectional analysis with data from the 3rd visit (2017‒2019). Linear regression models were used to evaluate the association of subclinical hypothyroidism, diabetes and of both diseases with a cIMT presented as Beta (95% Confidence Interval – 95% CI) without adjustment, with adjustment for sociodemographic variables (Model 1) and multivariable adjustment (Model 1 more cardiovascular risk factors). We also used logistic regression models to analyze the Odds Ratio (OR) and 95% CI for the association of both diseases using cIMT > P75%. Results: After the exclusion of patients with previous cardiovascular disease, 5,077 participants with no diseases, 1578 with diabetes, 662 with subclinical hypothyroidism, and 234 with both diseases were included in the analysis. Linear regression models showed an association of cIMT with only diabetes (β = 0.019; 95% CI 0.012 to 0.027; p < 0.0001) and subclinical hypothyroidism more diabetes (β = 0.03; 95% CI 0.010‒0.047, p < 0.0001). The logistic regression model reported an association between diabetes and CIMT higher than P75% (OR = 1.49, 95% CI 1.30‒1.71). No interaction between diabetes and subclinical hypothyroidism was detected using cIMT respectively as a continuous (p = 0.29) or as a categorical variable (p = 0.92). Discussion: Diabetes was associated with higher cIMT values. However, no additive effect of subclinical hypothyroidism associated with diabetes over cIMT was detected. Introduction IntimaMedia Intima Media (cIMT ELSABrasil. ELSABrasil ELSA Brasil . (ELSA-Brasil) Methods Crosssectional Cross sectional rd 2017‒2019. 20172019 2017‒2019 2017 2019 (2017‒2019) 95 (95 Model factors. factors factors) OR P75 P Results 5077 5 077 5,07 157 66 23 β 0.019 0019 0 019 0012 012 0.01 0.027 0027 027 0.0001 00001 0001 0.03 003 03 00100047 010 047 0.010‒0.047 0.0001. 149 49 1.49 1.30‒1.71. 130171 1.30‒1.71 30 71 1.30‒1.71) 0.29 029 29 0.92. 092 0.92 92 0.92) Discussion values However (ELSA-Brasil 2017201 2017‒201 201 (2017‒2019 9 (9 P7 507 07 5,0 15 6 2 001 01 0.0 0.02 002 02 0.000 0000 000 00 0010004 04 0.010‒0.04 14 4 1.4 13017 1.30‒1.7 3 7 0.2 09 0.9 201720 2017‒20 20 (2017‒201 ( 50 5, 0. 0.00 001000 0.010‒0.0 1. 1301 1.30‒1. 20172 2017‒2 (2017‒20 00100 0.010‒0. 130 1.30‒1 2017‒ (2017‒2 0010 0.010‒0 13 1.30‒ (2017‒ 0.010‒ 1.30 (2017 0.010 1.3 (201 (20 (2

Este estudo visa avaliar a não-aditividade dos efeitos de gênero, raça e escolaridade na saúde cardiovascular ideal entre os participantes do Estudo Longitudinal de Saúde do Adulto - ELSA-Brasil. Trata-se de um estudo transversal utilizando dados da linha de base do ELSA-Brasil, realizado entre 2008-2010. A Associação Americana do Coração definiu a pontuação de saúde cardiovascular ideal (ICH) como a soma dos indicadores da presença de sete fatores e comportamentos favoráveis à saúde: não fumante, índice de massa corporal ideal, atividade física e dieta saudável, níveis adequados de colesterol total, pressão arterial normal e ausência de diabetes mellitus. Interações multiplicativas e aditivas entre gênero, raça e escolaridade foram avaliadas usando o modelo de Poisson, como uma abordagem para discutir a interseccionalidade. A pontuação média de saúde cardiovascular foi de 2,49 (DP = 1,31). Este estudo encontrou uma interação positiva entre gênero e escolaridade (mulheres com Ensino Médio e Superior), tanto na escala aditiva quanto na escala multiplicativa, para a pontuação de saúde cardiovascular ideal. Houve tendência para maiores valores médios de saúde cardiovascular com o aumento da escolaridade, com diferença acentuada entre as mulheres. As pontuações mais baixas de saúde cardiovascular observadas reforçam a importância de compreender-se as experiências psicossociais que influenciam as atitudes em relação aos serviços de saúde, ao acesso à saúde e às escolhas de estilo de vida saudável, que afetam a ICH, para reduzir as desigualdades em saúde e propor políticas públicas mais adequadas como uma estratégia de assistência e prevenção das doenças cardiovasculares.

This study aims to assess the non-additivity effects of gender, race, and schooling on ideal cardiovascular health among participants of the Brazilian Longitudinal Study of Adult Health - ELSA-Brasil. This is a cross-sectional study using data from the baseline of ELSA-Brasil, conducted from 2008 to 2010. The American Heart Association defined a score of ideal cardiovascular health (ICH) as the sum of indicators for the presence of seven favorable health factors and behaviors: non-smoking, ideal body mass index, physical activity and healthy diet, adequate levels of total cholesterol, normal blood pressure, and absence of diabetes mellitus. Multiplicative and additive interactions between gender, race, and schooling were assessed using the Poisson regression model to discuss intersectionality. The mean cardiovascular health score was 2.49 (SD = 1.31). This study showed a positive interaction between gender and schooling (women with high school and higher education) in both additive and multiplicative scales for the score of ideal cardiovascular health. We observed a trend towards higher mean values of cardiovascular health for increased schooling, with a marked difference among women. The lowest cardiovascular health scores observed reinforce the importance of understanding the psychosocial experiences that influence health attitudes, access to health care, and healthy lifestyle choices, which affect ICH, to reduce inequities in health and propose more adequate public policies that assist and prevent cardiovascular diseases.

Este estudio tiene como objetivo evaluar los efectos no aditivos de género, raza y educación en la salud cardiovascular ideal entre los participantes del Estudio Longitudinal de Salud del Adulto -ELSA-Brasil. Se trata de un estudio transversal realizado a partir de datos de línea de base de ELSA-Brasil entre 2008-2010. La Asociación Americana del Corazón definió el puntaje ideal de salud cardiovascular (ICH) como la suma de indicadores de la presencia de siete factores y comportamientos favorables a la salud: no fumador, índice de masa corporal ideal, actividad física y alimentación saludable, niveles adecuados de colesterol total, presión arterial normal y ausencia de diabetes mellitus. Las interacciones multiplicativas y aditivas entre género, raza y educación se evaluaron utilizando el modelo de Poisson como un enfoque para discutir la interseccionalidad. La puntuación media de salud cardiovascular fue de 2,49 (DE = 1,31). Este estudio encontró una interacción positiva entre el género y la educación (mujeres con educación secundaria y universitaria), tanto en la escala aditiva como en la escala multiplicativa, para puntajes ideales de salud cardiovascular. Hubo una tendencia a valores medios más altos de salud cardiovascular conforme aumenta el nivel de educación, con una marcada diferencia entre las mujeres. Los puntajes más bajos de salud cardiovascular refuerzan la importancia de comprender las experiencias psicosociales que influyen en las actitudes hacia la salud, el acceso a la salud y la elección de un estilo de vida saludable, que inciden en el ICH, para reducir las desigualdades en salud y proponer políticas públicas más adecuadas como estrategia de asistencia y prevención de enfermedades cardiovasculares.

Resumo Introdução: as condições estressantes do trabalho estão associadas ao aumento dos níveis glicêmicos, mas pouco se conhece sobre o papel da escolaridade neste contexto. Objetivos: analisar a associação entre o estresse psicossocial no trabalho e os níveis de hemoglobina glicada (HbA1c) e a influência da escolaridade como modificador de efeito. Métodos: estudo transversal com dados de 11.922 trabalhadores ativos da linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). O estresse psicossocial no trabalho foi avaliado pelo modelo demanda-controle. Foram empregadas a regressão logística multinomial e interações multiplicativas. Resultados: em trabalhadoras do sexo feminino com baixa escolaridade, observou-se associação entre baixo uso de habilidades no trabalho (OR 1,56; IC95% 1,09-2,24) e HbA1c elevada. A baixa autonomia no trabalho foi relacionada à HbA1c limítrofe (OR 1,21; IC95% 1,01-1,45) e elevada (OR 1,73; IC95% 1,19-2,51). Entre trabalhadores do sexo masculino com baixa escolaridade, o trabalho de alto desgaste (OR 1,94; IC95% 1,18-3,21), o baixo uso de habilidades (OR 2,00; IC95% 1,41-2,83) e a baixa autonomia no trabalho (OR 1,58; IC95% 1,13-2,21) foram associados à HbA1c elevada. Conclusão: o estresse psicossocial no trabalho foi associado a níveis limítrofes e elevados de HbAlc para trabalhadores com baixa escolaridade de ambos os sexos. Assim, ações para modificar as relações de trabalho e prevenir doenças crônicas devem ser priorizadas.

Abstract Introduction: stressful work conditions are associated to increased glycemic levels, but little is known about the role of educational attainment in this association. Objectives: to analyze the association between psychosocial stress at work, levels of glycated hemoglobin (HbA1c), and the role of educational attainment as an effect modifier. Methods: a cross-sectional study with baseline data from 11,922 active workers who participated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Psychosocial stress at work was measured via the Demand-Control model. Multinomial logistic regression and multiplicative interactions were performed. Results: among female workers with low educational attainment, there was an association of low skill discretion and elevated HbA1c (OR 1.56; 95% CI 1.09-2.24). Low decision authority was associated to borderline (OR 1.21; 95% CI 1.01-1.45) and high (OR 1.73; 95% CI 1.19-2.51) HbA1c. Among male workers with low educational attainment, high strain (OR 1.94; 95% CI 1.18-3.21), low skill discretion (OR 2.0; 95% CI 1.41-2.83), and low decision authority (OR 1.58; 95% CI 1.13-2.21) were associated to high HbA1c. Conclusion: Stress at work was associated to high and borderline levels of HbAlc in workers from both genders with low educational attainment. Actions to modify work relations and to prevent chronic diseases should be prioritized for this group.

This study aims to assess the non-additivity effects of gender, race, and schooling on ideal cardiovascular health among participants of the Brazilian Longitudinal Study of Adult Health - ELSA-Brasil. This is a cross-sectional study using data from the baseline of ELSA-Brasil, conducted from 2008 to 2010. The American Heart Association defined a score of ideal cardiovascular health (ICH) as the sum of indicators for the presence of seven favorable health factors and behaviors: non-smoking, ideal body mass index, physical activity and healthy diet, adequate levels of total cholesterol, normal blood pressure, and absence of diabetes mellitus. Multiplicative and additive interactions between gender, race, and schooling were assessed using the Poisson regression model to discuss intersectionality. The mean cardiovascular health score was 2.49 (SD = 1.31). This study showed a positive interaction between gender and schooling (women with high school and higher education) in both additive and multiplicative scales for the score of ideal cardiovascular health. We observed a trend towards higher mean values of cardiovascular health for increased schooling, with a marked difference among women. The lowest cardiovascular health scores observed reinforce the importance of understanding the psychosocial experiences that influence health attitudes, access to health care, and healthy lifestyle choices, which affect ICH, to reduce inequities in health and propose more adequate public policies that assist and prevent cardiovascular diseases.

Este estudo visa avaliar a não-aditividade dos efeitos de gênero, raça e escolaridade na saúde cardiovascular ideal entre os participantes do Estudo Longitudinal de Saúde do Adulto - ELSA-Brasil. Trata-se de um estudo transversal utilizando dados da linha de base do ELSA-Brasil, realizado entre 2008-2010. A Associação Americana do Coração definiu a pontuação de saúde cardiovascular ideal (ICH) como a soma dos indicadores da presença de sete fatores e comportamentos favoráveis à saúde: não fumante, índice de massa corporal ideal, atividade física e dieta saudável, níveis adequados de colesterol total, pressão arterial normal e ausência de diabetes mellitus. Interações multiplicativas e aditivas entre gênero, raça e escolaridade foram avaliadas usando o modelo de Poisson, como uma abordagem para discutir a interseccionalidade. A pontuação média de saúde cardiovascular foi de 2,49 (DP = 1,31). Este estudo encontrou uma interação positiva entre gênero e escolaridade (mulheres com Ensino Médio e Superior), tanto na escala aditiva quanto na escala multiplicativa, para a pontuação de saúde cardiovascular ideal. Houve tendência para maiores valores médios de saúde cardiovascular com o aumento da escolaridade, com diferença acentuada entre as mulheres. As pontuações mais baixas de saúde cardiovascular observadas reforçam a importância de compreender-se as experiências psicossociais que influenciam as atitudes em relação aos serviços de saúde, ao acesso à saúde e às escolhas de estilo de vida saudável, que afetam a ICH, para reduzir as desigualdades em saúde e propor políticas públicas mais adequadas como uma estratégia de assistência e prevenção das doenças cardiovasculares.

Este estudio tiene como objetivo evaluar los efectos no aditivos de género, raza y educación en la salud cardiovascular ideal entre los participantes del Estudio Longitudinal de Salud del Adulto -ELSA-Brasil. Se trata de un estudio transversal realizado a partir de datos de línea de base de ELSA-Brasil entre 2008-2010. La Asociación Americana del Corazón definió el puntaje ideal de salud cardiovascular (ICH) como la suma de indicadores de la presencia de siete factores y comportamientos favorables a la salud: no fumador, índice de masa corporal ideal, actividad física y alimentación saludable, niveles adecuados de colesterol total, presión arterial normal y ausencia de diabetes mellitus. Las interacciones multiplicativas y aditivas entre género, raza y educación se evaluaron utilizando el modelo de Poisson como un enfoque para discutir la interseccionalidad. La puntuación media de salud cardiovascular fue de 2,49 (DE = 1,31). Este estudio encontró una interacción positiva entre el género y la educación (mujeres con educación secundaria y universitaria), tanto en la escala aditiva como en la escala multiplicativa, para puntajes ideales de salud cardiovascular. Hubo una tendencia a valores medios más altos de salud cardiovascular conforme aumenta el nivel de educación, con una marcada diferencia entre las mujeres. Los puntajes más bajos de salud cardiovascular refuerzan la importancia de comprender las experiencias psicosociales que influyen en las actitudes hacia la salud, el acceso a la salud y la elección de un estilo de vida saludable, que inciden en el ICH, para reducir las desigualdades en salud y proponer políticas públicas más adecuadas como estrategia de asistencia y prevención de enfermedades cardiovasculares.

ABSTRACT OBJECTIVE To compare the incidence of hearing loss among adults stratified by the occurrence of hypertension, and to investigate the association between hypertension and hearing loss. METHODS Longitudinal observational study, part of the Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil, Longitudinal Study on Adult’s Health). Data from the first and second waves were analyzed, including information from audiological assessment and general health of the subjects. As outcome, we considered the presence of hearing loss (hearing thresholds above 25 dBHL at frequencies from 500 Hz to 8 kHz) and, as exposure variable, hypertension (report of medical diagnosis of hypertension; and/or use of drugs to treat hypertension; and/or pressure systolic blood pressure ≥ 140 mmHg; or diastolic blood pressure ≥ 90 mmHg). As covariables for adjustment were considered: sex, age, education, race / ethnicity, income, smoking, diabetes, and occupational exposure to noise. Poisson regression analysis was conducted, estimating the crude and adjusted relative risks, with 95% confidence intervals, in order to assess the factors associated with hearing loss. RESULTS In crude analyses, the incidence of hearing loss was higher for subjects with hypertension (9.7% versus 5.4%). The crude relative risks for hearing loss was almost double (1.93; 95%CI: 1.10–3.39) for subjects with hypertension in the right ear. In the adjusted analyses, the relative risks was not significant for the hypertension variable (1.42; 95%CI: 0.75–2.67). Being 60 years or older (RR: 5.41; 95%CI: 2.79–10.50) showed a statistically significant association with hearing loss, indicating that older adults have higher relative risks for hearing loss. CONCLUSION In the adjusted analyses controlled for multiple risk factors there was no association between hypertension and hearing loss. The dichotomous variable age (being 60 years or older), on the other hand, has shown a significant association with hearing loss.

ABSTRACT OBJECTIVE To compare the incidence of hearing loss among adults stratified by the occurrence of hypertension, and to investigate the association between hypertension and hearing loss. METHODS Longitudinal observational study, part of the Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil, Longitudinal Study on Adult’s Health). Data from the first and second waves were analyzed, including information from audiological assessment and general health of the subjects. As outcome, we considered the presence of hearing loss (hearing thresholds above 25 dBHL at frequencies from 500 Hz to 8 kHz) and, as exposure variable, hypertension (report of medical diagnosis of hypertension; and/or use of drugs to treat hypertension; and/or pressure systolic blood pressure ≥ 140 mmHg; or diastolic blood pressure ≥ 90 mmHg). As covariables for adjustment were considered: sex, age, education, race / ethnicity, income, smoking, diabetes, and occupational exposure to noise. Poisson regression analysis was conducted, estimating the crude and adjusted relative risks, with 95% confidence intervals, in order to assess the factors associated with hearing loss. RESULTS In crude analyses, the incidence of hearing loss was higher for subjects with hypertension (9.7% versus 5.4%). The crude relative risks for hearing loss was almost double (1.93; 95%CI: 1.10–3.39) for subjects with hypertension in the right ear. In the adjusted analyses, the relative risks was not significant for the hypertension variable (1.42; 95%CI: 0.75–2.67). Being 60 years or older (RR: 5.41; 95%CI: 2.79–10.50) showed a statistically significant association with hearing loss, indicating that older adults have higher relative risks for hearing loss. CONCLUSION In the adjusted analyses controlled for multiple risk factors there was no association between hypertension and hearing loss. The dichotomous variable age (being 60 years or older), on the other hand, has shown a significant association with hearing loss.

ABSTRACT Objective: Although some previous data have suggested a high iodine intake in Brazil, the prevalence of antithyroperoxidase antibodies (TPOAb) in the country is compatible with rates from countries with adequate iodine intake. This observation emphasizes the importance of knowing the incidence of TPOAb in Brazil. Materials and methods: This prospective analysis included euthyroid participants with negative TPOAb at baseline and a thyroid function assessment at a 4-year follow-up. TPOAb was measured by electrochemiluminescence and considered positive when titers were ≥34 IU/mL. TSH and free T4 (FT4) levels were determined by a third-generation immunoenzymatic assay. The incidence of TPOAb is expressed in percentage per year or as a cumulative incidence within the 4-year follow-up period. Results: Of 8,922 euthyroid participants (mean age 51.1 years; 50.9% women) with a negative TPOAb test at baseline, 130 presented incident TPOAb at the 4-year follow-up, yielding an annual incidence of TPOAb of 0.38%/year (95% confidence interval [95% CI], 0.37-0.39%/year) and a cumulative incidence over 4 years of 1.46% (95% CI, 1.21-1.71%). In men, the annual incidence was 0.32% (95% CI, 0.31-0.33%), and the cumulative incidence over 4 years was 1.23% (95% CI, 0.90-1.56%). In women, the annual incidence was 0.43%/year (95% CI, 0.42-0.44%/year) and the cumulative incidence over 4 years was 1.67% (95% CI, 1.30-2.04%). The only factor associated with incident TPOAb was the occurrence of thyroid diseases at follow-up. No differences in TPOAb incidence were detected across ELSA-Brasil research centers. Conclusion: Based on the results of this study, the incidence of TPOAb per year and at a 4-year follow-up period are compatible with those of a country with adequate iodine intake.

ABSTRACT BACKGROUND: Cardiovascular risk factors can mediate the association between depression and cardiovascular diseases. OBJECTIVE: To evaluate cardiovascular risk factors in adult individuals with and without histories of major depression in the metropolitan region of São Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study in São Paulo (SP), Brazil. METHODS: This study evaluated 423 individuals without any lifetime diagnosis of major depression and 203 individuals with a previous diagnosis of major depression (n = 626). The participants underwent a psychiatric evaluation using a structured clinical interview (SCID-1), an anthropometric evaluation and a clinical evaluation that included blood pressure measurement and assessment of fasting blood glucose, lipid profile and physical activity levels. RESULTS: Individuals with histories of major depression were more likely to be female (P < 0.0001). Individuals with lifetime diagnoses of major depression were more likely to be current smokers (odds ratio, OR 1.61; 95% confidence interval, CI 1.01-2.59) and to have diabetes (OR 1.79; 95% CI 1.01-3.21); and less likely to be obese (OR 0.58; 95% CI 0.35-0.94). CONCLUSION: Individuals with major depression had higher odds of presenting tobacco smoking and diabetes, and lower odds of being obese. Healthcare professionals need to be aware of this, so as to increase the rates of diagnosis and treatment in this population.

ABSTRACT Objective: To evaluate incidence of subclinical and overt hyperthyroidism and hypothyroidism. Subjects and methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study of 15,105 civil servants, examined at baseline and over a 4-year follow-up. This analysis included 9,705 participants with normal thyroid function at baseline, follow-up information about thyroid function and with no report of using drugs that may interfere in the thyroid function. Thyroid function was defined by TSH/FT4 levels or routine use of thyroid hormones/anti-thyroid medications. Annual and cumulative (over 4-year) incidence rates were presented as percentages (95% Confidence Intervals). Results: The incidence of all overt and subclinical thyroid disease was 6.7% (1.73%/year): 0.19% for overt hyperthyroidism (0.048%/year), 0.54% for subclinical hyperthyroidism (0.14%/year), 1.98% for overt hypothyroidism (0.51%/year), and 3.99% for subclinical hypothyroidism (1.03%/year). The incidence of all thyroid diseases was higher in women, when compared to men, with a low women:men ratio (1.36). For Blacks the highest incidence was for overt hyperthyroidism, while for Whites, the highest incidence was for overt hypothyroidism. However, the highest incidence of overt hyperthyroidism was detected in Asian descendants. The presence of antithyroperoxidase antibodies at baseline was associated with higher incidence of overt thyroid diseases. Conclusion: These results showed a high incidence of hypothyroidism, which is compatible with a country with a more-than-adequate iodine intake. The low women:men ratio of the incidence of thyroid dysfunction highlights the importance of the diagnosis of thyroid diseases among men in Brazil.

OBJECTIVES: To investigate the association among hypertension, tinnitus, and sensorineural hearing loss and evaluate the influence of other covariates on this association. METHODS: Baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were analyzed. Altogether, 900 participants were evaluated. The baseline assessment consisted of a 7-hour examination to obtain clinical and laboratory variables. Hearing was measured using pure-tone audiometry. RESULTS: Overall, 33.3% of the participants had hypertension. Participants with hypertension were more likely to be older, male, and diabetic compared to those without hypertension. The prevalence of tinnitus was higher among hypertensive participants and the odds ratio for tinnitus was higher in participants with hypertension than in those without hypertension. However, the difference was not significant after adjusting for age. Audiometric results at 250-8,000 Hz were worse in participants with hypertension than in those without hypertension in the crude analysis; however, the differences were not significant after adjustment for age, sex, diagnosis of diabetes, and exposure to noise. No significant difference was observed in hearing thresholds among participants having hypertension for <6 years, those having hypertension for ≥6 years, and individuals without hypertension. CONCLUSION: Hearing thresholds were worse in participants with hypertension. However, after adjusting for age, sex, diagnosis of diabetes, and exposure to noise, no significant differences were observed between participants with and without hypertension. A higher prevalence of tinnitus was observed in participants with hypertension compared to those without hypertension, but without significance after adjusting for age.

ABSTRACT Background: Most studies that analyze the association between serum folate levels and cognitive function either restrict their assessments to specific clinical scenarios or do not include middle-aged individuals, to whom strategies for preventing cognitive impairment may be more feasible. Objective: To examine the association between serum folate levels and cognitive function in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment. Methods: Data from 4,571 ELSA-Brasil participants who live in the state of São Paulo, aged 35-74 years, were analyzed. The word list learning, delayed recall, word recognition, verbal fluency, and Trail Making Test Part B consisted in the cognitive tests. For each test, age, sex, and education-specific standardized scores and a global cognitive score were calculated. Crude and adjusted linear regression models were used to examine the associations of serum folate levels with cognitive test scores. Results: In multivariable-adjusted models, serum folate was not associated with global cognitive score (β=-0.043; 95% confidence interval [95%CI] -0.135 to 0.050 for lowest vs. highest quintile group), nor with any cognitive test performance. We did not find associations between serum folate and global cognitive scores in subgroups stratified by age, sex, or use of vitamin supplements either. Conclusions: We did not find significant associations between serum folate and cognitive performance in this large sample, which is characterized by a context of food fortification policies and a consequent low frequency of folate deficiency. Positive results from previous studies may not apply to the increasingly common contexts in which food fortification is implemented, or to younger individuals. Background middleaged middle individuals feasible Objective ELSABrasil ELSA Brasil (ELSA-Brasil assessment Methods 4571 4 571 4,57 Paulo 3574 35 74 35-7 years analyzed learning recall recognition fluency tests age sex educationspecific education calculated Results multivariableadjusted multivariable β=0.043 β0043 β β= 0.043 0 043 (β=-0.043 95 95%CI 95CI CI [95%CI 0.135 0135 135 -0.13 0050 050 0.05 vs group, group , group) Conclusions sample deficiency implemented 457 57 4,5 357 3 7 35- β=0.04 β004 0043 0.04 04 (β=-0.04 9 0.13 013 13 -0.1 005 05 0.0 45 5 4, β=0.0 β00 004 (β=-0.0 0.1 01 1 -0. 00 0. β=0. β0 (β=-0. -0 β=0 (β=-0 - (β=- (β= (β

RESUMO Introdução: A maioria dos estudos que analisam a associação entre os níveis séricos de folato e a função cognitiva restringem suas avaliações a cenários clínicos específicos ou não incluem indivíduos de meia idade, nos quais estratégias preventivas para a função cognitiva podem ser mais viáveis. Objetivo: Examinar a associação entre os níveis séricos de folato e a função cognitiva na avaliação inicial do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). Métodos: Foram analisados dados de 4.571 participantes do ELSA-Brasil em São Paulo, com idades entre 35 e 74 anos. Os testes cognitivos foram aprendizagem, recordatório tardio e reconhecimento de lista de palavras; fluência verbal e teste de trilhas parte B. Calculamos, para cada teste e globalmente, escores padronizados para idade, sexo e educação. Foram utilizados modelos de regressão linear para examinar as associações dos níveis séricos de folato com o desempenho nos testes cognitivos. Resultados: Em modelos ajustados para múltiplas variáveis, o folato sérico não esteve associado ao escore cognitivo global (β=-0,043; intervalo de confiança de 95%: [IC95%] -0,135 a 0,050 para 1º vs. 5º quintil), ou desempenho em qualquer teste cognitivo. Também não encontramos associações entre folato sérico e escores cognitivos globais em subgrupos estratificados por idade, sexo ou uso de suplementos vitamínicos. Conclusões: Não encontramos associações significativas entre folato sérico e desempenho cognitivo nesta grande amostra, caracterizada por um cenário sob políticas de fortificação alimentar e consequente baixa frequência de deficiência de folato. Resultados positivos de estudos anteriores podem não se aplicar às situações cada vez mais comuns em que a fortificação de alimentos é implementada, ou a indivíduos mais jovens. Introdução idade viáveis Objetivo ELSABrasil. ELSABrasil ELSA Brasil . (ELSA-Brasil) Métodos 4571 4 571 4.57 Paulo 3 7 anos aprendizagem palavras B Calculamos globalmente educação variáveis β=0,043 β0043 β β= 0,043 0 043 (β=-0,043 95% 95 IC95% IC95 IC [IC95% 0,135 0135 135 -0,13 0050 050 0,05 º vs quintil, quintil , quintil) vitamínicos Conclusões amostra implementada jovens (ELSA-Brasil 457 57 4.5 β=0,04 β004 0043 0,04 04 (β=-0,04 9 IC9 [IC95 0,13 013 13 -0,1 005 05 0,0 45 5 4. β=0,0 β00 004 (β=-0,0 [IC9 0,1 01 1 -0, 00 0, β=0, β0 (β=-0, [IC -0 β=0 (β=-0 - (β=- (β= (β

Resumo Fundamento: A adiposidade abdominal é um fator de risco para doença cardiovascular. Objetivo: Determinar a magnitude da associação entre a adiposidade abdominal, segundo cinco diferentes indicadores, e a espessura médio-intimal de carótidas (EMI-C). Métodos: Usou-se dados de 8.449 participantes de 35 a 74 anos do ELSA-Brasil. Foi avaliado o efeito da circunferência da cintura (CC), razão cintura quadril (RCQ), índice de conicidade (Índice C), produto da acumulação lipídica (LAP) e índice de adiposidade visceral (IAV) sobre EMI-C. Os dados foram estratificados por sexo e analisados por meio de regressões linear e logística multivariadas. Foi adotado nível de significância de 5%. Resultados: Participantes com EMI-C acima do P75 mostraram maior frequência de adiposidade abdominal (homens acima de 72% e mulheres acima de 66%) em comparação aos participantes com EMI-C abaixo do P75. A adiposidade abdominal foi associada com a média da EMI-C, principalmente por meio da CC entre homens (0,04 IC95%: 0,033; 0,058). A adiposidade abdominal identificada pelos indicadores CC, RCQ, LAP e IAV entre as mulheres mostrou efeito de 0,02 mm sobre a EMI-C (CC: 0,025 IC95%: 0,016; 0,035; RCQ: 0,026 IC95%: 0,016; 0,035; LAP: 0,024 IC95%: 0,014; 0,034; IAV: 0,020 IC95%: 0,010; 0,031). Na regressão logística múltipla a adiposidade abdominal diagnosticada pela CC mostrou importante efeito sobre a EMI-C em ambos os sexos (homens: OR = 1,47; IC95%: 1,22-1,77; mulheres: OR = 1,38; IC95%: 1,17-1,64). Conclusão: A adiposidade abdominal, identificada por meio da CC, RCQ, LAP e IAV, foi associada à EMI-C em ambos os sexos, com destaque para o tradicional indicador antropométrico CC.

Abstract Background: Abdominal adiposity is a risk factor for cardiovascular disease. Objective: To determine the magnitude of the association between abdominal adiposity, according to five different indicators, and the carotid intima-media thickness (CIMT). Methods: Data from 8,449 participants aged 35 to 74 years from the ELSA-Brazil study were used. The effect of waist circumference (WC), waist-to-hip ratio (WHR), conicity index (C index), lipid accumulation product (LAP) and visceral adiposity index (VAI) on CIMT were evaluated. Data were stratified by gender and analyzed using multivariate linear and logistic regressions. A significance level of 5% was considered. Results: Participants with CIMT > P75 showed a higher frequency of abdominal adiposity (men >72% and women >66%) compared to those with CIMT < P75. Abdominal adiposity was associated with the mean CIMT, mainly through WC in men (0.04; 95%CI: 0.033; 0.058). The abdominal adiposity identified by the WC, WHR, LAP, and VAI indicators in women showed an effect of 0.02 mm on the CIMT (WC: 0.025, 95%CI: 0.016, 0.035; WHR: 0.026, 95%CI: 0.016, 0.035; LAP: 0.024, 95%CI: 0.014; 0.034; VAI: 0.020, 95%CI: 0.010, 0.031). In the multiple logistic regression, the abdominal adiposity diagnosed by WC showed an important effect on the CIMT in both genders (men: OR = 1.47, 95%CI: 1.22-1.77, women: OR = 1.38; 95%CI: 1.17-1.64). Conclusion: Abdominal adiposity, identified through WC, WHR, LAP, and VAI, was associated with CIMT in both genders, mainly for the traditional anthropometric indicator, WC.