Excesso de peso entre indígenas das etnias Mura e Munduruku do Amazonas

Abstract

Introduction: Overweight and obesity are health problems that condition the development of so-called cardiovascular diseases (CVDs), responsible for almost a third of deaths in Brazil and is the leading cause of mortality. Such cardiovascular risk factors (CRFs) are frequently found among indigenous people, as a result of the urbanization process and lifestyle. Objective: To assess the prevalence of cardiovascular risk factors and their associations with overweight among two indigenous ethnic groups in the Amazon. Methods: This is an epidemiological and cross-sectional study, carried out from the combination of two research macroprojects, one with the Mura ethnic group, from the municipality of Autazes-AM and the other with the Munduruku ethnic group, from Borba-AM. Data were collected, respectively, in 2016 and 2018. The databases resulted in a sample of 914 indigenous people (Mura: n=455; Munduruku n=459). Participants were characterized by sociodemographic variables related to ethnicity, sex, age, education, marital status, family income and economic class. As for the anthropometric parameters, neck, waist and hip circumferences were measured and the waist-to-hip ratio, conicity index and body mass index were calculated. Based on bioimpedance, the percentage of body fat and visceral fat was evaluated. The assessment of the lipid profile considered total cholesterol and triglycerides. Measurements of blood pressure levels met the recommendations of the VII Brazilian Guidelines on Hypertension and the classification of capillary blood glucose and the Brazilian Guidelines on Diabetes. To assess the lifestyle, the “International Physical Activity Questionnaire – IPAQ was used and to analyze alcohol consumption, the “Test for Identification of Problems Related to Alcohol Use – AUDIT”. Data analyzes made use of a database in the Excel program and the R 3.5.1 software (R Core Team, 2018). Categorical variables were presented in tables, containing absolute (n) and relative (%) frequencies, continuous variables in mean and standard deviation. For bivariate analyses, Student's t-test was used and Pearson's chi-square test was used for categorical analyses. The prevalence of overweight and obesity and the association of cardiovascular risk factors for each ethnicity were also calculated for the categories of each independent variable. The crude and adjusted Odds Ratio (OR) or Odds Ratio of all variables was used, with a 95% confidence interval and p≤0.05. The research projects were duly approved by the Research Ethics Committee of the Manaus School of Nursing – EEM/UFAM and by the National Research Ethics Committee – CONEP, respecting all the prerogatives of the Resolution of the National Health Council nº 466/2012. Results: Excess weight between the two ethnic groups was 54.5%, with 54.8% of the Munduruku indigenous being overweight and 63.3% of the Mura being obese. As for sociodemographic characteristics, the Munduruku stand out, where 57.7% were male and among the Mura, 57.2% were female; age range from 19 to 39 years old (54.2%); low schooling in both ethnic groups, for the Mura (55%), where the majority belonged to class D-E (85.5%). Regarding the prevalence of cardiovascular risk factors, pre-hypertension stands out in 11.4% of the indigenous people, hypertension (17.1%), pre-diabetes (37.7%), diabetes (7.8%) , hypertriglyceridemia (39.8%) and hypercholesterolemia (29.3%). As for habits and lifestyle, 11.2% were sedentary, 4.7% classified as likely dependent on the use of alcoholic beverages. Factors associated with overweight were Munduruku ethnicity (OR = 0.75; 95%CI 0.57-0.99); Age range from 50 to 59 years (OR = 29.90; 95%CI 6.10-540.78); has completed higher education (OR = 2.17; 95%CI 1.23-3.86); Having a partner - living together (OR = 1.65; 95%CI 1.12-2.46), married (OR = 2.48; 95%CI 1.69-3.69). Among the anthropometric variables, the following were associated: increased neck circumference (OR = 4.68; 95%CI 3.26-6.85); increased waist-to-hip ratio (OR = 2.24; 95%CI 1.66-3.04), increased conicity index (OR = 1.68; 95%CI 1.25-2.26); Percentage of skeletal muscle (OR = 0.98; 95%CI 0.96-0.99); High visceral fat (OR = 5.12; 95%CI 3.69-7.15). Among the clinical conditions evaluated, the following were associated with overweight: hypertriglyceridemia (OR = 1.87; 95%CI 1.42-2.46), pre-diabetes (OR = 1.38; 95%CI 1.04-1.85) and diabetes (OR = 2.17; 95%CI 1.31-3.60) and probable alcohol dependence (OR = 0.41; 95%CI 0.18-0.88). As for the factors associated with obesity, the Mura ethnicity stood out (OR = 1.98; 95%CI 1.42-2.79); male gender (OR = 0.49; 95%CI 0.35-0.68); being ≥60 years old (OR = 6.42; 95%CI 1.81-40.88); having completed primary education or incomplete secondary education (OR = 0.42; 95%CI 0.22-0.74); marital status – married (OR = 2.09; 95%CI 1.28-3.50). Anthropometric variables associated with obesity were increased waist-to-hip ratio (OR = 18.53; 95%CI 9.24-44.12); increased conicity index (OR = 10.96; 95%CI 6.12-21.74); percentage of skeletal muscle (OR = 0.85; 95%CI 0.82-0.88); very high visceral fat (OR = 37.33; 95%CI 19.54-76.77). Having stage 2 hypertension (OR = 9.38; 95%CI 4.42-20.14); hypertriglyceridemia (OR = 3.13; 95%CI 2.24-4.42); hypercholesterolemia (OR = 2.07; 95% CI 1.47-2.91); pre-diabetes (OR = 0.63; 95%CI 0.43-0.90), physical inactivity (OR = 2.10; 95%CI 1.11-4.03). Conclusion: Cardiovascular risk factors among the surveyed indigenous people were high in relation to excess weight. The Munduruku showed a higher prevalence of overweight and the Mura, a high prevalence of obesity, with a tenfold greater chance of developing more cardiovascular risk factors. Thus, it is important to highlight that the indigenous peoples of the northern region of Brazil present new profiles of morbidities, with NCDs as a prevalent reality.