Name: Jordana Herzog Siqueira
Type: PhD thesis
Publication date: 22/02/2022
Advisor:

Namesort descending Role
Maria del Carmen Bisi Molina Advisor *

Examining board:

Namesort descending Role
Adriana Lúcia Meireles External Examiner *
Elizabete Regina Araújo de Oliveira Internal Examiner *
Jose Geraldo Mill Internal Examiner *
Maria de Fátima Haueisen Sander External Examiner *
Maria del Carmen Bisi Molina Advisor *

Summary: Consumption of alcoholic and non-alcoholic beverages is common in many societies and their levels of consumption are associated with the occurrence of chronic diseases. In this regard, it is important to investigate the sociodemographic and health profile of consumers of these beverages to support effective public policies. In addition, there are gaps in the literature on the long-term effects of sugary and unsweetened beverage consumption on cardiometabolic health, especially in populations from low- and middle-income countries, which are undergoing rapid nutritional transition. Thus, the aim was to study the consumption of alcoholic and non-alcoholic beverages according to sociodemographic, health, and geographic location data, and to investigate, prospectively, the relationship between the consumption of sugar-sweetened soft drinks and unsweetened fruit juice and cardiometabolic outcomes in participants of the Longitudinal Study of Adult Health (ELSA-Brasil). ELSA-Brasil is a multicentric cohort composed of 15,105 active or retired public servants of both sexes, aged 35 to 74 years, from six public higher education and research institutions (USP, UFMG, UFBA, UFRGS, UFES and Fiocruz). Baseline (2008-2010) and the second evaluation (2012-2014) data were used. Sociodemographic data, life and health habits, medical history, and medication use were collected through a structured questionnaire, in interviews during visits to the research centers. Food consumption was assessed at baseline using a validated food frequency questionnaire. The cumulative incidence of outcomes (hyperuricemia [≥7.0 mg/dL for men and ≥5.7 mg/dL for women] and metabolic syndrome [Joint Interim Statement]) was evaluated after 4 years of follow-up. The results were described in three original articles. The first manuscript aimed to describe the consumption of alcoholic and non-alcoholic beverages at baseline, according to sociodemographic, health, and location variables. It was observed that 8% of the total caloric value came from non-alcoholic beverages (5.6% = sugary drinks), and 4% from alcoholic beverages (2.7% = beer). Men reported higher consumption of alcoholic beverages, and women, higher consumption of non-alcoholic beverages. Consumers of unsweetened and artificially sweetened beverages reported moderate/strong physical activity, were former smokers, and had a higher education. The opposite was found for sugary drinks. Eutrophic people reported higher consumption of sugary beverages and those obese, artificially sweetened beverages and beer. The consumption of alcoholic beverages varied with age (youth: beer; elderly: wine/spirits) and education (low education: beer/spirits; higher
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education: wine). Coffee, fruit juice, and sugar-sweetened soft drinks were the most consumed non-alcoholic beverages and beer was the most prevalent alcoholic beverage. Consumption variation was observed according to geographic location. The second and third manuscripts prospectively evaluated the relationship between the consumption of sugar-sweetened soft drinks, unsweetened fruit juice, and cardiometabolic outcomes (hyperuricemia and metabolic syndrome, respectively). After 4 years of follow-up, regardless of potentially confounding variables, higher sugar-sweetened soft drinks consumption (men: 401 ± 303 mL/day; women: 390 ± 290 mL/day) increased the relative risk of hyperuricemia by 30% (men) and 40 % (women), and was associated with a mean increase in serum uric acid levels (men: &#946; = 0.14 mg/dL; 95%CI = 0.41-0.24; women: &#946; = 0.11 mg/dL; 95%CI = 0.00-0.21). Higher sugar-sweetened soft drinks consumption (&#8805;1 serving/day = 250 mL/day) increased the relative risk of metabolic syndrome (RR = 1.22; 95%CI = 1.04-1.45), elevated fasting glucose (RR = 1.23; 95%CI = 1.01-1.48), and high blood pressure (RR = 1.23; 95%CI = 1.00-1.54). Moderate consumption of this beverage (0.4 to <1 serving/day) increased the relative risk of high waist circumference (RR = 1.21; 95%CI = 1.02-1.42). After 4 years of follow-up, consumption of unsweetened fruit juice was not associated with hyperuricemia and metabolic syndrome and its components. It is concluded that there is an important caloric share of alcoholic and non-alcoholic beverages in the diet of ELSA-Brasil participants and the association of consumption of these beverages with sociodemographic, lifestyle, and location data. Individuals who reported higher consumption of sugar-sweetened soft drinks had worse lifestyle habits and health conditions, and the opposite profile was observed for those who reported higher consumption of unsweetened fruit juice. No prospective association was observed between consumption of unsweetened fruit juice and cardiometabolic outcomes. Higher sugar-sweetened soft drinks consumption was associated with the incidence of hyperuricemia and metabolic syndrome, in a cohort of Brazilian adult and elderly public servants.

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