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Editorial
REVISTA PAULISTA DE MEDICIN AIncre asing Obe sity in Brazil: Pre dicting a
Ne w Pe ak of Cardiovascular Mortality
• Paulo Andrade Lo tufo
During the 1980s, cardio vascular mo rtality rates o bserved in Brazilian metro po litan areas were ranked am o ng the highe st in a c o m p ariso n with c e rtain s e le c te d c o untrie s .1 Ho we ve r, s inc e the n, the s e
Brazilian rates have been decreasing with a peculiar pattern. During the 1990s, mo rtality rates fro m stro ke fo llo wed a do wnwards trend, but mo rtality rates fro m co ro nary heart diseases (CHD) are no w reaching a plateau witho ut any evidence o f a fall (Figure 1).
On the o ther hand, three natio nal cro ss-sec-tio nal studies perfo rmed in 1973-74, 1988 and 1996 sho wed an alarming and impressive increase in the prevalence o f o besity, especially amo ng city-dwellers.2
Over this perio d, the prevalence o f o besity (bo dy mass index greater than o r equal to 30 kg/m2) increased fro m
2.4% (1973-74) to 6.9% (1996) amo ng men, and fro m 7.0% (1973-74) to 12.5% amo ng wo men (Figure 2).
The natural co nseq uence o f the o b esity epi-demic is an increase in the prevalence o f diabetes mellitus, as pro ven in the United States, where diabe-tes prevalence radiabe-tes jumped fro m 4.9% in 1990 to 6.5% in 1998 (+33%). This increase in diabetes prevalence acco mpanying the rise in o besity prevalence rates was o bserved in bo th sexes, all ages, all ethnic gro ups, and at all educatio nal levels. The prevalence o f diabetes was highly co rrelated with the prevalence o f o b esity amo ng American states (r = 0.64, P < 0.001).3
Recently, o ne o bservatio nal study has detected that the decline in CHD mo rtality deaths in the USA has been slo wer amo ng patients with diabetes than amo ng tho se witho ut it.4 Other data fro m a co ho rt o f
American nurses has sho wn that the increase in bo dy mass index explained an 8% increase in the incidence o f CHD events.5
Sao Paulo Med J/Rev Paul Med 2000; 118(6):161-2. Figure 1. Age-adjusted mortality rates from CHD and Stroke for men
and women aged 40 to 79 years in metropolitan areas of Brazil during the period from 1979 to 1998.
Figure 2. Obesity trends detected in three national cross-sectional studies in Brazil (reference #2).
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It is reaso nable to speculate that the slo wdo wn in the decline o f CHD deaths in Brazil has been due to an increasing prevalence o f bo th o besity and diabe-tes. Co nsidering this fact, the epidemic o f o besity must be halted, o r else there will very pro bably be a new peak o f co ro nary deaths in Brazil, in spite o f the
im-Sao Paulo Med J/Rev Paul Med 2000; 118(6):161-2.
pro vements regarding smo king restrictio ns and hyper-te ns io n aware ne s s and c o ntro l that have b e e n o bserved o ver the last few years.
1. Lo tufo PA. Mo rtalid ad e Pre c o c e p o r Do e nç as d o Co raç ão no Bra s i l . Co m p a ra ç ã o c o m o u tro s p a í s e s . Arq Bra s Ca rd i o l 1998;70:321- 5.
2. Mo nteiro CA, Benicio MH, Co nde W, Po pkin B. Shifting o besity trends in Brazil. Eur J Clin Nutr 2000;54:342-6.
3. Mo kdad AH, Fo rd ES, Bo wman BA, et al. Diabetes trends in the US:
References
1990-1998. Diabetes Care 2000;23:1278-83.
4. Gu K, Co wie CC, Harris MI. Diabetes and decline in heart disease mo rtality in US adults. JAMA 1999;281:1291-7.
5. Hu FB, Stampfer MJ, Manso n JE, et al. Trends in the incidence o f co ro nary heart disease and changes in diet and lifestyle in wo men.N Engl J Med 2000;343:530-7.
