Healthy lifestyle and recommendations in health care among hypertensive and diabetic patients in Brazil, 2019

Szwarcwald, Célia Landmann; Souza Júnior, Paulo Roberto Borges de; Damacena, Giseli Nogueira; Stopa, Sheila Rizzato; Barros, Marilisa Berti de Azevedo; Malta, Deborah Carvalho

doi:10.1590/1980-549720210017.supl.2

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Brasil

Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. Epidemiol. 24 (suppl 2) • 2021 • https://doi.org/10.1590/1980-549720210017.supl.2 copy

Healthy lifestyle and recommendations in health care among hypertensive and diabetic patients in Brazil, 2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To estimate prevalence of healthy behaviors among individuals aged 30 years or more, diagnosed with arterial hypertension and diabetes mellitus, using information from the National Health Survey, 2019.

Methods:

Cross-sectional study with cluster sampling and simple random sampling in three stages. Individuals were aggregated according the following conditions: having arterial hypertension; arterial hypertension only; diabetes mellitus; diabetes mellitus only; arterial hypertension and diabetes mellitus only; without chronic non-communicable diseases. Poisson regression models and crude and adjusted prevalence ratios for sex, age group, and schooling were used. The proportion of recommendations received by patients with arterial hypertension and diabetes mellitus was estimated by type of care (public/private).

Results:

A total of 69,285 individuals aged 30 years or more was analyzed. Compared to individuals without non-communicable diseases, prevalence of consumption of fruits and vegetables ≥5 days a week was significantly higher among individuals with arterial hypertension (39.9% - 95%CI 38.8–41.0) and those with diabetes mellitus (42.8% - 95%CI 40.7–44.9). However, estimates of not having consumed ultra-processed food were low, 19.7% (95%CI 18.9–20.6) and 21.9% (95%CI 20,3–23.5), respectively. Prevalence of not smoking reached values close to 90% and significant prevalence ratios, whereas the practice of physical activity had levels below 30% and non-significant prevalence ratios. The proportion of healthy eating recommendations reached 90%, but it was close to 70% for not smoking.

Conclusions:

It is necessary to encourage the practice of healthy lifestyles and provide information about the benefits of physical activity and the harmful effects of unhealthy eating for well-being and aging with quality.

Keywords:
Healthy lifestyle; Health promotion; Health Care; Longevity; Quality of life; Brazil

Behaviors	AH		Only AH		DM		Only DM		No NCD
Behaviors	%	95%CI	%	95%CI	%	95%CI	%	95%CI	%	95%CI
Consumption of fruits and vegetables ≥5 weekdays	39.9	38.8–41.0	37.7	35.9–39.5	42.8	40.7–44.9	44.3	3.,9–48.8	32.6	31.7–33.6
Did not consume ultra-processed foods *	19.7	18.9–20.6	19.7	18.2–21.4	21.9	20.3–23.5	21.6	18.4–25.1	15.5	14.8–16.2
Did not consume sweets*	57.1	55.9–58.3	56.3	54.4–58.2	61.5	59.5–63.5	61.5	57.1–65.7	53.6	52.5–54.7
Did not drink soft drinks*	75.3	74.2–76.3	72.9	71.2–74.6	76.4	74.4–78.4	76.6	72.2–80.5	66.9	65.9–67.8
Adequate/low perception of salt consumption	41.3	40.0–42.5	38.3	36.5–40.2	41.0	39.0–43.0	28.5	24.9–32.3	22.8	22.1–23.6
Weight verification for at least 1 month	56.9	55.8–58.0	56.9	54.9–58.8	58.6	56.6–60.6	60.2	55.8–64.5	58.5	57.4–59.6
Practice of physical activity**	22.6	21.5–23.6	26.9	25.2–28.7	20.2	18.6–21.9	23.8	20.3–27.7	31.1	30.1–32.1
Not drinking heavily***	94.8	94.3–95.3	93.4	92.5–94.2	96.7	95.9–97.3	96.1	94.3–97.4	92.3	91.8–92.8
Currently not smoking tobacco products	89.0	88.3–89.8	88.8	87.3–90.1	89.6	88.2–90.9	88.4	85.0–91.1	86.7	86.0–87.4
Former smokers of tobacco products	37.1	35.9–38.3	30.5	28.9–32.2	39.4	37.4–41.4	30.8	27.0–34.9	22.6	21.8–23.5

Behaviors	AH				Only AH
Behaviors	PR	95%CI	PR^#	95%CI	PR	95%CI	PR*	95%CI
Consumption of fruits and vegetables ≥5 weekdays	1.22^a	1.18–1.27	1.05^a	1.00–1.10	1.15^a	1.09–1.22	1.03	0.97–1.09
Did not consume ultra-processed foods *	1.27^a	1.20–1.35	1.01	0.95–1.44	1.27^a	1.16–1.40	1.05	0.95–1.17
Did not consume sweets*	1.08^a	1.04–1.11	1.00	0.96–1.04	1.06^a	1.01–1.10	0.98	0.93–1.03
Did not drink soft drinks*	1.25^a	1.22–1.29	1.06^a	1.01–1.12	1.18^a	1.12–1.24	1.05	0.98–1.12
Adequate/low perception of salt consumption	1.81^a	1.73–1.89	1.43^a	1.36–1.51	1.68^a	1.59–1.78	1.39^a	1.30–1.48
Weight verification for at least 1 month	0.97	0.95–1.00	1.11^a	1.08–1.14	0.97	0.94–1.01	1.08^a	1.04–1.12
Practice of physical activity**	0.73^a	0.69–0.76	0.95	0.90–1.01	0.87^a	0.81–0.93	1.04	0.97–1.12
Not drinking heavily***	1.33^a	1.24–1.41	0.87	0.70–1.02	1.14	1.01–1.26	0.83^a	0.64–1.00
Currently not smoking tobacco products	1.17^a	1.10–1.24	1.19^a	1.11–1.27	1.15^a	1.03–1.27	1.23^a	1.10–1.34
Former smokers of tobacco products	1.64^a	1.56–1.72	1.22^a	1.15–1.29	1.34^a	1.26–1.44	1.04	0.97–1.11

Behaviors	DM				Only DM
Behaviors	PR	95%CI	PR^#	95%CI	PR	95%CI	PR*	95%CI
Consumption of fruits and vegetables ≥5 days a week	1.31^a	1.24–1.39	1.16^a	1.09–1.24	1.36^a	1.22–1.51	1.26^a	1.13–1.40
Did not consume ultra-processed foods*	1.41^a	1.30–1.53	1.08	0.99–1.19	1.39^a	1.18–1.63	1.15	0.97–1.35
Did not consume sweets*	1.17^a	1.12–1.22	1.09^a	1.03–1.14	1.17^a	1.07–1.26	1.10	0.99–1.20
Did not consume soft drinks*	1.29^a	1.23–1.35	1.09	1.00–1.17	1.30^a	1.16–1.41	1.19^a	1.04–1.33
Adequate/low perception of salt consumption	1.80^a	1.70–1.90	1.34^a	1.25–1.43	1.25^a	1.09–1.43	1.03	0.90–1.18
Weight verification for at least 1 month	1.00	0.97–1.04	1.19^a	1.14–1.24	1.03^a	0.96–1.11	1.15	1.07–1.24
Practice of physical activity at the recommended level**	0.65^a	0.60–0.71	0.92	0.84–1.01	0.77^a	0.66–0.89	0.94	0.80–1.10
Not drinking heavily***	1.57^a	1.47–1.65	1.26^a	1.06–1.41	1.50^a	1.25–1.67	1.34^a	1.00–1.56
Currently not smoking tobacco products	1.22^a	1.10–1.32	1.29^a	1.18–1.40	1.23^a	1.11–1.35	1.06	0.90–1.20
Former smokers of tobacco products	1.74^a	1.63–1.85	1.22^a	1.14–1.32	1.36^a	1.19–1.56	1.05	0.92–1.20

Behaviors	Prevalence (%)		Prevalence ratio
Behaviors	%	95%CI	RP	95%CI	RP*	95%CI
Consumption of fruits and vegetables ≥5 days a week	39.2	35.3–43.3	1.20^a	1.08–1.33	1.07	0.96–1.19
Did not consume ultra-processed foods*	23.9	20.8–27.4	1.55^a	1.34–1.78	1.17^a	1.00–1.36
Did not consume sweets*	67.8	64.1–71.2	1.31^a	1.23–1.38	1.24^a	1.14–1.32
Did not consume soft drinks*	78.5	74.9–81.8	1.35^a	1.24–1.45	1.18^a	1.03–1.31
Adequate/low perception of salt consumption	43.5	39.5–47.6	1.92^a	1.74–2.11	1.40^a	1.26–1.56
Weight verification for at least 1 month	54.3	50.5–58.1	0.93	0.86–1.00	1.12^a	1.04–1.21
Practice of physical activity at the recommended level**	2.5	18.5–24.9	0.69^a	0.59–0.80	0.99	0.85–1.56
Not drinking heavily***	95.4	93.3–96.9	1.42^a	1.14–1.60	1.00	0.52–1.33
Currently not smoking tobacco products	89.1	86.0–91.7	1.18	1.20–1.37	1.31^a	1.09–1.48
Former smokers of tobacco products	34.0	30.4–37.7	1.50^a	1.34–1.68	1.02	0.90–1.14

Recommendations	Type of Service	Hypertensive		Diabetics
Recommendations	Type of Service	%	95%CI	%	95%CI
Healthy diet	SUS	85.6	84.4–86.8	93.9	92.6–95.0
	Not SUS	90.4	89.0–91.7	96.6	95.4–97.5
	Total	87.3	86.3–88.2	94.8	93.9–95.6
Keeping an adequate weight	SUS	82.5	81.2–83.7	91.3	89.9–92.5
	Not SUS	88.2	86.7–89.5	93.7	91.8–95.2
	Total	84.4	83.4–85.4	92.1	91.0–93.1
Consuming less salt	SUS	87.3	86.0–88.5	–	–
	Not SUS	88.8	87.0–90.4	–	–
	Total	87.8	86.8–88.8	–	–
Avoiding sugar	SUS	–	–	92.1	90.7–93.2
	Not SUS	–	–	94.3	92.6–95.7
	Total	–	–	92.8	91.7–93.8
Reducing the intake of pasta and bread	SUS	–	–	88.3	86.6–89.7
	Not SUS	–	–	89.7	87.4–91.7
	Total	–	–	88.8	87.4–90.0
Practicing physical activities	SUS	78.9	77.5–80.2	82.6	80.6–84.5
	Not SUS	86.8	85.2–88.2	89.1	86.5–91.3
	Total	81.6	80.6–82.6	84.8	83.2–86.3
Not smoking	SUS	66.1	64.3–67.7	70.6	68.0–73.1
	Not SUS	69.1	66.9–71.2	73.1	69.7–76.3
	Total	67.1	65.7–68.5	71.4	69.4–73.4
Not drinking heavily	SUS	64.9	63.2–66.6	69.8	67.2–72.2
	Not SUS	69.2	67.0–71.2	74.8	71.5–77.7
	Total	66.4	65.0–67.8	71.5	69.5–73.4
Regular follow-up with a health professional	SUS	84.0	82.7–85.2	76.8	74.8–78.7
	Not SUS	87.9	86.4–89.4	81.8	78.8-84.3
	Total	85.3	84.3–86.3	78.5	76.8–80.1

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[1] Corresponding author: Célia Landmann Szwarcwald. Avenida Brasil, 4365, Manguinhos, CEP: 21040-360, Rio de Janeiro (RJ), Brasil. E-mail: celia_ls@hotmail.com