Qualidade da alimentação, potencial inflamatório da dieta e resistência à insulina e diabetes mellitus no ELSA-Brasil
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Data
2025-03-14
Autores
Aprelini, Carla Moronari de Oliveira
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Universidade Federal do Espírito Santo
Resumo
Insulin resistance (IR) is considered an independent predictor of diabetes mellitus (DM), which is currently a global emergency. Its determinants are complex and include, among other factors, behavioral ones. Chronic subclinical inflammation participates in the pathogenesis of IR and DM through different mechanisms, and there is evidence that diet interferes with these processes. Therefore, this thesis aims to propose a new diet quality index and analyze the association between the inflammatory potential of the diet and the occurrence of IR and DM. The analyses were conducted using data from three waves of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): baseline (2008-2010), second follow-up (2017-2019), and the Covid wave (2020-2021), and are presented in three articles. Socioeconomic information and lifestyle habits were collected through structured questionnaires, and standardized clinical and physical examinations. The first article developed and validated Food Quality Score (FQS) using a qualitative Food Frequency Questionnaire. Pearson correlation, Principal Component Analysis, and Cronbach's alpha were used to test validity and reliability. Women and older individuals who engaged in more physical activity and had higher income levels exhibited higher FQS, in contrast to those who reported higher alcohol consumption and smoking. Cronbach's alpha coefficient was 0.47. The DQS demonstrated satisfactory validity and reliability and was associated with socioeconomic and lifestyle variables. The second article examined the relationship between the Inflammatory Food Index (IFI) and socioeconomic conditions and lifestyle habits. Multiple Correspondence Analysis and Multinomial Logistic Regression were used, with p < 0.05 considered statistically significant. Groups with more anti- or proinflammatory dietary patterns were expressed in a bidimensional graph. Low-income individuals, smokers, males, sedentary individuals, those diagnosed with obesity and those under 60 years of age were more likely to have a pro-inflammatory diet. The third article evaluated the prospective association between the inflammatory potential of the diet, estimated by the IFI, and the risk of IR and DM. Adjusted Cox regression models were used, considering a bilateral p-value of < 0.05. Incident cases of IR and DM were identified in 19.6% and 10.1% of participants, respectively. Being in the highest quintiles (greater dietary inflammatory potential) at the beginning of the study increased the risk of IR and DM in both sexes. Individuals who maintained a high score across the analyzed periods had a 1.5-fold increased risk for IR (95% CI 1.2-1.9; and 1.2-1.8, for men and women, respectively). These results contribute to a better understanding of the life and health aspects that impact dietary patterns and, consequently, the development of chronic diseases, enabling the improvement of dietary prescriptions focused on the prevention and treatment of IR and DM. Furthermore, the developed IFI allows for the analysis and comparison of the diet across other waves of ELSA-Brasil, contributing to the investigation of associations between eating habits, social determinants, and health outcomes within the context of nutritional epidemiology
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Características da população , Doenças crônicas não transmissíveis , Resposta inflamatória inata