LIVING CONDITIONS AND HEALTH OF KAINGANG INDIGENOUS PEOPLE WITH DIABETES^*

ABSTRACT

Objective:

To analyze the living conditions and health of Kaingang indigenous people with type 2 Diabetes Mellitus.

Method:

A cross-sectional study carried out through interviews and consultation of medical records with indigenous people of the Kaingang ethnic group living in an indigenous land in the northern region of Paraná-Brazil. Student’s t-test and the chi-square test were used to analyze the data.

Results:

The average age of the 45 participants was 56.3 ± 12.4 years. Most women were overweight, and their waist circumference was higher than the risk indicator. The average glycated hemoglobin was 9.6 ± 2.7%, and venous glycemia was 189.1 ± 95.3 mg/dL.

Conclusion:

analyzing the living conditions and health of Kaingang indigenous people provides information for planning early screening, prevention, and monitoring of chronic conditions in the indigenous population.

KEYWORDS:
Diabetes Mellitus; Indigenous Peoples; Anthropometry; Sedentary Behavior.

RESUMO:

Objetivo:

analisar as condições de vida e saúde de indígenas Kaingang com Diabetes Mellitus tipo 2.

Método:

estudo transversal, realizado por meio de entrevista e consulta aos prontuários com indígenas da etnia Kaingang, residentes em uma terra indígena localizada na região norte do Paraná-Brasil. Para análise dos dados, utilizaram-se os testes t de Student e do qui-quadrado.

Resultados:

a idade média dos 45 participantes foi de 56,3 ± 12,4 anos. A maioria apresentou excesso de peso e a medida da circunferência da cintura das mulheres foi superior ao indicativo de risco. A média de hemoglobina glicada foi de 9,6 ± 2,7%; e de glicemia venosa foi de 189,1 ± 95,3 mg/dL.

Conclusão:

analisar as condições de vida e saúde de indígenas Kaingang gera subsídios para o planejamento de ações de rastreamento precoce, prevenção e acompanhamento das condições crônicas na população indígena.

DESCRITORES:
Diabetes Mellitus; Povos Indígenas; Antropometria; Comportamento Sedentário.

RESUMEN

Objetivo:

Analizar las condiciones de vida y la salud de los indígenas Kaingang con diabetes mellitus de tipo 2. Material y método: estudio transversal realizado mediante entrevistas y consulta de historias clínicas con indígenas de la etnia Kaingang que viven en una tierra indígena situada en la región norte de Paraná-Brasil. Para analizar los datos se utilizaron la prueba t de Student y la prueba chi-cuadrado.

Resultados:

La edad media de las 45 participantes era de 56,3 ± 12,4 años. La mayoría de las mujeres tenían sobrepeso y su perímetro de cintura era superior al indicador de riesgo. La hemoglobina glucosilada media fue de 9,6 ± 2,7% y la glucemia venosa de 189,1 ± 95,3 mg/dL.

Conclusión:

El análisis de las condiciones de vida y de salud de los indígenas kaingang ayuda a planificar acciones de detección precoz, prevención y seguimiento de las afecciones crónicas en la población indígena.

DESCRIPTORES:
Diabetes mellitus; pueblos indígenas; antropometría; comportamiento sedentario.

HIGHLIGHTS

1. Non-indigenous people influenced Indigenous traditions and customs.

2. Indigenous women with diabetes have an altered waist circumference.

3. The importance of screening strategies for diabetes in indigenous people.

INTRODUCTION

There are more than 305 indigenous peoples in Brazil, and according to the last census, around 896,000 people declared themselves to be indigenous in the country¹. Of these, around 36.2% live in cities and 63.8% in rural areas, corresponding to approximately 0.47% of the country’s total population².

Indigenous people are considered a vulnerable population in national society. The change in the lifestyle of indigenous people, resulting from increasingly frequent contact with the urban population, combined with low economic and educational levels and restricted access to health care, has contributed to an increase in the prevalence of chronic non-communicable diseases (CNCD) in this population³.

Brazil is in sixth place with the highest number of people with diabetes mellitus (DM), and this is projected to increase over the coming decades. It has multifactorial causes such as low schooling, limited access to health goods and services and lifestyle habits⁴. In the indigenous population, DM is an emerging CNCD associated with traditional risk factors (smoking and alcoholism), changes in eating habits from subsistence to industrialized foods, and increasingly frequent contact with the non-indigenous population. It should be noted that low levels of schooling, communication difficulties, and the lack of professionals trained in health services to deal with the indigenous population can contribute both to underreporting and adequate treatment and follow-up³.

One way of monitoring people with DM is to measure the anthropometric variables of body mass and height, as these help to assess the process of nutrition and health. In addition, they are used to fill the gaps in knowledge regarding the food and nutritional transition in indigenous populations, with body mass index (BMI) often used to assess nutritional status. Studies show an increase in the prevalence of overweight and obesity in indigenous populations³,⁵-⁶.

It should be noted that obesity is associated with other cardiovascular risk factors besides DM, such as hypertension⁷. In addition, obesity and DM are complex diseases with an increasing prevalence worldwide, and the interaction between genetic and environmental factors6 determines both.

With the process of nutritional transition and urbanization in indigenous communities under sociodemographic, socioeconomic, and sociocultural influences, a health reality has emerged with the intense emergence of chronic non-communicable diseases (CNCD)⁸. A diet rich in carbohydrates and industrialized foods can contribute to an increase in obesity among indigenous people and, consequently, influence the glycemic profile. In addition, indigenous people in restricted areas have had their subsistence economy altered, leading to a sedentary lifestyle, which is one of the factors behind obesity in this population³.

Given this context, studies that present the characteristics of the living conditions and health of the indigenous population are needed to direct care actions that meet their ethnic and cultural specificities.

This study aimed to analyze the living conditions and health of Kaingang indigenous people with Type 2 Diabetes Mellitus.

METHOD

This descriptive, analytical, cross-sectional, quantitative study is conducted through semi-structured interviews and consultation of the health unit’s medical records.

The study included Kaingang indigenous people with DM living in an Indigenous Land (IL) with three villages (Apucaraninha, Água Branca, and Serrinha), located in the northern region of Paraná, of both sexes, aged over 20 and registered at the Family Health Unit (FHU) of the Apucaraninha IL. In turn, those who were absent from the community during the data collection period, bedridden, hospitalized, with sequelae that prevented them from communicating, and had difficulties traveling to the FHU for an oral health assessment were excluded.

According to the Indigenous health care information system in 2022, the IL under study has a population of 1,989 Indigenous people. The predominant ethnic group in the IL is the Kaingang (97.36%), and 100% of the indigenous people from this ethnic group have been diagnosed with DM. However, there are some Xokléng, Guaranis, other ethnic groups of Guaranis, and non-indigenous people living in the area. The Kaingang language belongs to the Jê linguistic group, which is part of the Macro-Jê linguistic trunk, and they are considered to be descendants of the ancient Guayaná⁹. At the start of the study, there were 48 indigenous people registered with type 2 diabetes mellitus (DM2) at the FHU in the main village.

The data was collected between August and October 2022, and the interviews were carried out by the main researcher and an oral health assistant, both duly trained in the care of the indigenous population.

For sociodemographic characterization, the following variables were considered: age group (categorized as adult and elderly), gender, village (1, 2, and 3), marital status (with or without a partner), schooling (none, 1 - 4 years, 5 - 9 years and >10 years) and social class (C, D or E) according to the Brazilian Economic Classification Criterion (CCEB), bilingual (no or yes), religion (no, Catholic or Evangelical), social benefit (no or yes).

The variables relating to health behaviors were smoking (no or yes); alcoholism (no or yes) according to the validated instrument Alcohol Use Disorder Identification Test (AUDIT); and physical activity (sedentary, irregularly active, or active/very active), verified using the International Physical Activity Questionnaire (IPAQ) short version.

The variables for characterizing health conditions collected in the interview were polypharmacy (no or yes), which was defined as the use of five or more drugs concomitantly¹⁰, time since diagnosis (< 5 years, ≥ 5 years or unknown), amputation due to DM (no or yes), retinopathy (no or yes), insulin use (no or yes) and hypertension (no or yes). The health condition variables, with emphasis on the data collected in the medical records, were total cholesterol (normal or altered), triglycerides (normal or altered), urea (normal or altered), and creatinine (normal or altered).

Anthropometric characterization included body mass index [eutrophy (< 24.9 kg/m²), overweight (25 to 29.9 kg/m²) and obesity (≥ 30kg/m2)]¹¹; waist circumference [below the cut-off point or equal to/greater than the cut-off point of 102 cm for men and 88 cm for women]11; conicity index [below the cut-off point or equal to/surpassing the cut-off point of ≥ 1.25 and ≥ 1.18 for men and women respectively]¹²; and waist-to-height ratio [below the cut-off point or equal to/surpassing the cut-off point of ≥ 0.50]¹¹. The information in the medical records was used to determine the risk stratum of the person with DM (low, medium, and high risk).

For metabolic analysis, glycated hemoglobin (HbA1c) was categorized as normal (<5.7%) and altered (≥5.7%), and fasting venous glucose was considered normal (70 to 99 mg/dL) and altered (≥ 100 mg/dL)⁴.

The data was entered into Microsoft Office Excel spreadsheets and transferred to the Statistical Package for Social Sciences (SPSS)® version 25.0 for analysis. Student’s t-test and Pearson’s chi-squared test were used for statistical analysis. It was also associated with anthropometric measurements with a 95% CI according to gender and about the Brazilian population. The same association was made with gender and age group. Finally, the distribution of risk for DM2 complications was based on sociodemographic and behavioral characteristics. Quantitative variables were expressed as means, and categorical variables as frequencies and percentages.

This study was approved by the Research Ethics Committee (CEP) of the Universidade Federal do Mato Grosso do Sul (UFMS) and by the Comissão Nacional de Ética em Pesquisa (CONEP), according to opinion no^. 5.176.634.

RESULTS

Of the 48 eligible indigenous people, two were excluded for not coming to the FHU twice in a row for data collection and one for not presenting the results of follow-up laboratory tests (in the last six months) and refusing to collect them. A total of 45 Kaingang indigenous people took part, with an average age of 56.3 ± 12.4 years, ranging from 32 to 88 years.

Table 1 shows the distribution of risk frequencies for DM complications according to the sociodemographic and behavioral characterization of the Kaingang indigenous people participating in the study. This stratification shows different degrees of risk that corroborate the development of DM complications in this population.

Table 1
Distribution of risk frequencies for diabetes mellitus complications according to Kaingang indigenous people’s sociodemographic and behavioral characteristics. Campo Grande, MS, Brazil, 2023.

VARIABLE	RISK OF DIABETES MELLITUS COMPLICATIONS
	Bass n (%)	Moderate n (%)	High n (%)
Sociodemographic characteristics
Age group
Adults	3 (8,8)	3 (8,8)	28 (82,4)
Elderly	2 (18,2)	1 (9,1)	8 (72,7)
Sex
Female	2 (8,3)	4 (16,7)	18 (75,0)
Male	3 (14,3)	0 (0,0)	18 (85,7)
Village
Apucaraninha	3 (8,6)	3 (8,6)	29 (82,9)
Água Branca	1 (11,1)	1 (11,1)	7 (77,8)
Barreiro	1 (100,0)	0 (0,0)	0 (0,0)
Marital status
Without a partner	0 (0,0)	0 (0,0)	4 (100,0)
With a partner	5 (12,5)	4 (9,8)	32 (78,0)
Schooling (years)
None	0 (0,0)	1 (5,9)	16 (94,1)
1-4	4 (20,0)	3 (15,0)	13 (65,0)
5-9	0 (0,0)	0 (0,0)	4 (100,0)
>10	1 (25,0)	0 (0,0)	3 (75,0)
Social class
C	2 (15,4)	1 (7,7)	10 (76,9)
D or E	3 (9,4)	3 (9,4)	26 (81,3)
Bilingual
No	4 (13,8)	2 (6,9)	23 (79,3)
Yes	1 (6,3)	2 (12,5)	13 (81,3)
Religion
None	0 (0,0)	0 (0,0)	1 (100,0)
Catholic	3 (13,6)	2 (9,1)	17 (77,3)
Evangelical	2 (9,1)	2 (9,1)	18 (81,8)
Do you receive social benefits?
No	2 (22,2)	0 (0,0)	7 (77,8)
Yes	3 (8,3)	4 (11,1)	29 (80,6)
Behavioral characteristics
Smoking
No	4 (11,1)	2 (5,6)	30 (83,3)
Yes	1 (11,1)	2 (22,2)	6 (66,7)
Alcoholism
No	5 (12,5)	3 (7,5)	32 (80,0)
Yes	0 (0,0)	1 (20,0)	4 (80,0)
Physical activity
Sedentary lifestyle	1 (7,7)	0 (0,0)	12 (93,2)
Irregularly active	2 (10,5)	3 (15,8)	14 (73,7)
Active/very active	2 (15,4)	1 (7,7)	10 (76,9)

Source: The authors (2023).

The average time since diagnosis of DM was 5.9 ± 6.6 years (minimum of 0.1 and maximum of 30 years). Among the clinical characteristics, the mean HbA1c was 9.6 ± 2.7% (minimum of 6.0 and maximum of 15.3%); 189.1 ± 95.3 mg/dL (minimum of 81 and maximum of 423 mg/dL) of venous glycemia; 297.2 ± 332.1 mg/dL (minimum of 90 and maximum of 2.315 mg/dL) of triglycerides; 187.4 ± 52.8 mg/dL (minimum of 109 and maximum of 411 mg/dL) of total cholesterol; 0.9 ± 1.5 mg/dL (minimum of 0.60 and maximum of 1.55 mg/dL) of creatinine and 30.5 ± 9.9 mg/dL (minimum of 12 and maximum of 70 mg/dL) of urea.

Table 2 shows the study participants’ clinical characterization and health status frequency distribution.

Table 2
Frequency distribution of the clinical characterization and health status of the Kaingang indigenous people participating in the study. Campo Grande - MS, Brazil, 2023.

VARIABLE	n (%)
Health Condition Characteristics
Polypharmacy	39 (86,7)
No	6 (13,3)
Yes
Time to diagnosis of Diabetes Mellitus
< 5 years	22 (48,9)
≥ 5 years	21 (46,7)
Unknown	2 (4,4)
Diabetic Foot
No	40 (88,9)
Yes	5 (11,1)
Amputation due to Diabetes Mellitus
No	41 (91,1)
Yes	4 (8,9)
Retinopathy
No	41 (91,1)
Yes	4 (8,9)
Use of insulin
No	37 (82,2)
Yes	8 (17,8)
Hypertension
No	17 (37,8)
Yes	28 (62,2)
Body mass index
Eutrophy	4 (8,9)
Overweight	19 (42,2)
Obesity	22 (48,9)
Clinical Characteristics
Total Cholesterol
Normal	33 (73,3)
Amended	12 (26,7)
Triglycerides
Normal	8 (17,8)
Amended	37 (82,2)
Urea
Normal	41 (91,1)
Amended	4 (8,9)
Creatinine
Normal	40 (88,9)
Amended	5 (11,1)

Source: The authors (2023).

Table 3 shows the summary statistics of the Student’s t-test for anthropometric measurements: the average waist circumference among women (98.8), the taper index for men (1.31), and the waist-to-height ratio for both sexes (male 0.61 and female 0.66) were significantly higher concerning the cut-off points established in the literature (p<0.001), and the average taper index for women (1.32) was significantly lower (p=0.008).

Table 3
Summary statistics of the Student’s t-test of anthropometric measurements, according to gender, about the Brazilian population. Campo Grande - MS, Brazil, 2023.

VARIABLE	n	x*(DP) †	Student’s t-test
			p‡	1-β§	x1-x2|| (IC95%)¶
Waist circumference**
Female	24	98,8 (10,2)	<0,001	73,43	10,83 (6,5 ; 15,2)
Male	21	100,4 (8,9)	0,426	17,86	-1,57 (-5,6 ; 2,5)
Conicity index††
Female	24	1,32 (0,06)	0,008	51,71	-0,04 (-0,07 ; -0,01)
Male	21	1,31 (0,05)	<0,001	81,82	0,069 (0,04 ; 0,09)
Waist to height ratio‡‡
Female	24	0,66 (0,07)	<0,001	88,71	0,13 (0,10 ; 0,16)
Male	21	0,61 (0,05)	<0,001	86,76	0,09 (0,06 ; 0,11)

• ^*
  Mean; † Standard deviation; ‡ p-value (probability of significance); § Power of the test; || Difference of means; ¶ 95% confidence interval;
• ^**
  Reference of 102cm for men and 88cm for women; †† Reference of 1.25 for men and 1.36 for women; ‡‡Reference of 0.52 for men and 0.53 for women. Significance value (α=0.05).
Source: The Authors (2023).

Table 4 shows the summary statistics of Pearson’s chi-square test for anthropometric measurements. There was an association between gender and waist circumference, in which there was a higher prevalence of women with a waist circumference higher than that reported in the literature (p=0.002), and between gender and the conicity index, in which 88.9% of women had measurements lower than those reported in the literature (p<0.001).

Table 4
Summary statistics from Pearson’s chi-square test of anthropometric measurements about gender and age group. Campo Grande - MS, Brazil, 2023.

VARIABLE	Pearson’s chi-square test
	SEX		p	AGE GROUP		p
	Male n (%)	Female n (%)		Adult n (%)	Elderly n (%)
Body mass index
Eutrophy	2 (50,0)	2 (50,0)		2 (50,0)	2 (50,0)
Overweight	11 (57,9)	8 (42,1)	0,383	14 (73,7)	5 (26,3)	0,383
Obesity	8 (36,4)	14 (63,6)		14 (81,8)	4 (18,2)
Waist circumference*
Below the reference	13 (76,5)	4 (23,5)		13 (76,5)	4 (23,5)
			0,002			1,000
Equal to or greater than the reference	8 (28,6)	20 (71,4)		21 (75,0)	7 (25,0)
Conicity index†
Below the reference	2 (11,1)	16 (88,9)		13 (72,2)	5 (27,8)
			<0,001			0,732
Equal to or greater than the reference	19 (70,4)	8 (29,6)		21 (77,8)	6 (22,2)
Razão cintura e estatura‡
Below the reference	1 (100,0)	0 (0,0)		0 (0,0)	1 (100,0)
			0,467			0,244
Equal to or greater than the reference	20 (45,5)	24 (54,5)		34 (77,3)	10 (22,7)

• ^*
  Reference of 102cm for men and 88cm for women; †Reference of 1.25 for men and 1.36 for women; ‡Reference of 0.52 for men and 0.53 for women. Significance value (α=0.05).).
Source: The authors (2023).

DISCUSSION

It should be noted that indigenous peoples differ from one another. One reason is the distinctions between ethnic groups, territorial areas, socio-economic inequalities, and the length of contact with the surrounding society. When they have closer contact with this society, they absorb behaviors that replace their traditions and customs³.

Although historical and cultural manifestations strongly influence smoking among indigenous peoples, the high prevalence of this habit is a risk behavior that favors the development of chronic diseases³,¹³. Even though little is known about national epidemiological data to quantify the trend of alcoholism and smoking, studies show that their frequency has intensified¹³.

Despite all the advances in health care, managing DM2 is still far from adequate¹⁴. It should be noted that maintaining the HbA1c level at 7% is considered one of the main goals for glycemic control in most individuals with DM¹⁵. Therefore, the biggest challenge in the management of DM2 is to achieve this HbA1c parameter due to the difficulty in controlling glycemia due to the disproportion between the absorption of carbohydrates and the action of insulin¹⁴.

A study indicated that the main aggravating factors to the condition of vulnerability and restricted access to health services among the indigenous population were low socioeconomic and educational levels¹⁶. Similarly, another study revealed that low schooling and income are of great relevance to understanding the health-disease process of indigenous peoples since they are elements that interfere with accessibility to health services and, consequently, illness¹⁷. Another study found that individuals from lower socioeconomic classes have poor housing conditions, fewer opportunities for education, and less access to health care¹⁸.

Furthermore, a study with the indigenous Mura population of Autazes (Amazonas) revealed that 60.2% received income from some social benefit from the federal government, and 59.4% had a family income of less than one minimum wage¹³. In the Munduruku indigenous group, 61.7% received social benefits, and 40.3% received less than the minimum wage⁵. This ethnic group showed a risk of DM2 associated with low income⁵. In a study of the Xavante population in Mato Grosso, a third of the sample had an income of up to one minimum wage, and 10% had no income¹⁹. In this study, 80% of Kaingang indigenous people received social benefits, and 71.1% belonged to socioeconomic class D or E, reinforcing the social vulnerability of this population group. In this context, the relationship between vulnerability and low socioeconomic status, factors that influence health-disease conditions and are related to the epidemiological transition and rapid urbanization, is reiterated³.

A study identified a high prevalence of overweight, especially among indigenous women of the Xikrin (Mebengôkre) ethnic group, who deserve in-depth research to facilitate intervention programs²⁰. Therefore, the literature shows that the factors associated with overweight and obesity are different between the sexes²⁰-²¹, similar to what was observed in this study.

In other studies on chronic non-communicable diseases (CNCDs), the predominance of females in seeking primary care services has been pointed out in a similar way to the Brazilian population in general²¹. This was also reflected in the anthropometric data of this study, in which women were at greater risk of cardiovascular disease. Therefore, developing strategies with early diagnosis and treatment actions to reduce the risk factors for DM2 complications is essential to serve these indigenous populations and encourage a national popular education policy based on sociocultural aspects and health determinants²².

Several studies indicate that the increase in the incidence and prevalence of DM2 is associated with an aging population, growing urbanization, and lifestyles such as sedentary lifestyles, inadequate diet, and obesity, which are also observed among indigenous people. They also pointed out that age is an important indicator of risk factors for chronic diseases³,⁵,⁷. In addition, the occurrence of chronic non-communicable diseases increases throughout life, which can lead to a demand for medium and high-complexity procedures, rehabilitation services, hospitalization, and long-term care²³.

These people’s way of subsisting has changed through contact with non-indigenous people, leading to physical inactivity or a sedentary lifestyle, which is an important risk factor for the development of chronic diseases. Therefore, knowing the risk factors is important to understand the epidemiological picture in detail²⁴.

A sedentary lifestyle can make it difficult to manage DM2 and contributes to the accumulation of body fat, leading to an association with various chronic diseases. In this study, physical activity, sedentary lifestyles, and being irregularly active were present in 32 (71.1%). It is known that regular physical activity combined with a balanced and healthy diet helps to control body weight and reduce visceral fat, the risk of DM, and cardiovascular diseases. This was also reflected in another study, which identified a high prevalence of overweight and obesity (33.5% and 14.8%, respectively)²⁵.

Body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) are used to assess the risk of developing chronic diseases²⁶. WC, for example, has been proposed as one of the recommended anthropometric predictors of visceral fat and risk of metabolic diseases²⁷.

The relevance of this study is noteworthy, but the literature lacks information on the association of anthropometric variables with sociodemographic aspects, living conditions, and types of food consumed by Brazilian indigenous peoples. There is also a lack of specific anthropometric and metabolic cut-off points for indigenous peoples, which makes it impossible to compare results between ethnic groups.

Several studies in specific communities point to a high prevalence of overweight and obesity in indigenous adults³,⁵,⁷. Obesity is associated with an increased risk of heart disease and stroke²⁸.

On the other hand, a study of indigenous Guarani and Terena women found that 40.3% were overweight and 30.9% were obese³. In addition, abdominal adiposity was present in 57.7% of the women studied, indicating a very high risk of cardiovascular disease. In another study among the Xavantes, a high frequency of 35% overweight and 50% obesity was identified⁶. These findings align with other studies on indigenous peoples in Brazil and worldwide, showing that excess weight is associated with accelerated nutritional transition¹³,²⁵.

Among these variables, the nutritional assessment showed that indigenous people of the Mura ethnic group from Autazes -AM showed higher neck circumference, waist-to-hip ratio, conicity index, body age relative to real age, and body fat percentage¹³.

In the National Health and Nutrition Survey of Indigenous Peoples, conducted in Brazil in 2008/2009, the average BMI for all indigenous women in Brazil was higher (25.2 kg/m²) than the BMI limit considered adequate. Concerning BMI values by macro-region, the lowest average was found in the North (23.7 kg/m²), while the highest was found in the South/Southeast (26.2 kg/m²). The proportion of women with some degree of overweight was 45.9%, with a higher frequency of overweight (30.2%) compared to obesity (15.7%)²⁹.

In the results of the study of the indigenous Mura, waist circumference (WC) was increased by 48.6%, and in hypertensive patients, it increased to 74.4%. The average conicity index (CI) was 1.2¹³. The study of indigenous Xavantes found that the increased risk of metabolic complications was more prevalent among men (38.8%) than women (16.0%)³⁰. In the present study, anthropometric data and parameters were increased, indicating cardiovascular risk and the need for educational strategies. It must be considered that the indigenous population is economically vulnerable, with its cultural and social specificities, making the risk even greater.

Therefore, it is essential to develop educational, early diagnosis, and self-care actions culturally adapted to each indigenous population to provide strategies for improving the quality of life of individuals with DM and, above all, reducing risk behaviors. In this sense, it is recommended that public health policies be promoted that raise awareness and encourage changes in lifestyles and behavior, as well as environmental and social changes among indigenous peoples.

As the study’s main methodological limitations, it is worth emphasizing that making more precise inferences about the foods consumed was impossible because this study did not address eating habits. In addition, the lack of specific anthropometric and metabolic cut-off points for indigenous peoples makes comparison difficult.

CONCLUSION

The findings of this study show a high prevalence of overweight among Kaingang indigenous people with DM2, especially among women. The average waist circumference among women, the conicity index for men, and the waist-to-height ratio for both sexes were significantly higher than the cut-off points established in the literature. There was also an association between gender and waist circumference, with a higher prevalence of women with a waist circumference higher than that predicted in the literature.

Further studies are needed to gather information on indigenous peoples, covering demographic, epidemiological, and anthropometric aspects. Furthermore, the scarcity of more robust studies, coupled with the lack of methodological standardization applied in current studies, makes it impossible to substantiate these issues in a detailed and precise manner.

Finally, it is necessary to implement strategies to prevent and control overweight among indigenous people. These strategies should aim to maintain healthy eating habits and traditional lifestyles and emphasize the importance of physical activity.

• *
  Article extracted from master’s thesis: “CONDIçõES DE VIDA E SAúDE DE INDíGENAS KAINGANG COM DIABETES MELLITUS”, Universidade Federal do Mato Grosso do Sul, Campo Grande, MS, Brasil, 2023.

• HOW TO REFERENCE THIS ARTICLE:

  Benedito JC de S, Marcon SS, Medeiros A de A, Batiston AP, Haddad M do CL, Teston EF. Living conditions and health of Kaingang indigenous people with diabetes. Cogitare Enferm. [Internet]. 2024 [cited in “insert year, month, day”]; 29. Available from: https://doi.org/10.1590/ce.v29i0.94963.

REFERÊNCIAS

• ¹
  Instituto Brasileiro de Geografia e Estatística (IBGE). Censo Brasileiro de 2010 [Internet]. Rio de Janeiro: IBGE; 2012 [cited 2023 Oct 13]. Disponível em: https://censo2010.ibge.gov.br/
  » https://censo2010.ibge.gov.br/
• ²
  Wenczenovicz TJ. Saúde indígena: reflexões contemporâneas. Cad. Ibero-Amer. Dir. Sanit. [Internet]. 2018 [cited 2022 Oct. 10]; 7(1):63-82. Available from: https://doi.org/10.17566/ciads.v7i1.428
  » https://doi.org/10.17566/ciads.v7i1.428
• ³
  Freitas GA de, Souza MCC de, Lima R da C. Prevalência de diabetes mellitus e fatores associados em mulheres indígenas do Município de Dourados, Mato Grosso do Sul, Brasil. Cad. Saúde Públic, Rio de Janeiro. [Internet]. 2016 [cited 2022 Oct. 15]; 32(8):e00023915. Available from: https://doi.org/10.1590/0102-311X00023915
  » https://doi.org/10.1590/0102-311X00023915
• ⁴
  Sociedade Brasileira de Diabetes. Diretrizes da Sociedade Brasileira de Diabetes 2019-2020. [Internet]. São Paulo: Clannad; 2019. 491 p. [cited 2022 Sept. 07]. Available from: https://edisciplinas.usp.br/pluginfile.php/5730478/mod_resource/content/0/Diretrizes-SBD-2019-2020.pdf
  » https://edisciplinas.usp.br/pluginfile.php/5730478/mod_resource/content/0/Diretrizes-SBD-2019-2020.pdf
• ⁵
  Gomes HLM, Sombra NM, Cordeiro ED de O, Souza Filho ZA de, Toledo N das N, Mainbourg EMT, et al. Glycemic profile and associated factors in indigenous Munduruku, Amazonas. PLOS ONE. [Internet]. 2021 [cited 2022 Sept. 10]; 16(9):e0255730. Available from: https://doi.org/10.1371/journal.pone.0255730
  » https://doi.org/10.1371/journal.pone.0255730
• ⁶
  Leite LCG, Santos MC, Duarte NE, Horimoto ARVR, Crispim F, Vieira Filho JPB, et al. Association of fat mass and obesity-associated (FTO) gene rs9939609 with obesity-related traits and glucose intolerance in an indigenous population, the Xavante. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, Índia. [Internet]. 2022 [cited 2022 Nov. 18]; 16(1):102358. Available from: https://doi.org/10.1016/j.dsx.2021.102358
  » https://doi.org/10.1016/j.dsx.2021.102358
• ⁷
  Soares LP, Dal Fabbro AL, Silva AS, Sartorelli DS, Franco LF, Kuhn PC, et al. Cardiovascular risk in Xavante indigenous population. Arq Bras Cardiol. [Internet]. 2018 [cited 2022 Oct. 20]; 110(6):542-50. Available from: https://doi.org/10.5935/abc.20180090
  » https://doi.org/10.5935/abc.20180090
• ⁸
  Stein AT. Cardiovascular diseases in indigenous populations: an indicator of inequity. Arq Bras Cardiol. [Internet]. 2018 [cited 2022 Sept. 11]; 110(3):246-47. Available from: https://dx.doi.org/10.5935/abc.20180045
  » https://dx.doi.org/10.5935/abc.20180045
• ⁹
  Cimbaluck L. A criação da aldeia Água Branca na Terra Indígena Kaingang Apucaraninha: “Política interna”, moralidade e cultura [Dissertation]. Curitiba (PR): Universidade Federal do Paraná; 2013. 252 p. Available from: http://biblioteca.funai.gov.br/media/pdf/TESES/MFN-36600.pdf
  » http://biblioteca.funai.gov.br/media/pdf/TESES/MFN-36600.pdf
• ¹⁰
  Silva AF da, Silva J de P. Polifarmácia, automedicação e uso de medicamentos potencialmente inapropriados: causa de intoxicações em idosos. Rev Med Minas Gerais. [Internet]. 2022 [cited 2022 Nov. 14]; 32:e-32101. Available from: https://doi.org/10.5935/2238-3182.2022e32101
  » https://doi.org/10.5935/2238-3182.2022e32101
• ¹¹
  Associação brasileira para o estudo da obesidade e da síndrome metabólica. Diretrizes brasileiras de obesidade [Internet]. 4. ed. São Paulo: ABESO; 2016 [cited 2022 Sept. 07]. Available from: https://abeso.org.br/wp-content/uploads/2019/12/Diretrizes-Download-Diretrizes-Brasileiras-de-Obesidade-2016.pdf
  » https://abeso.org.br/wp-content/uploads/2019/12/Diretrizes-Download-Diretrizes-Brasileiras-de-Obesidade-2016.pdf
• ¹²
  Pitanga FJG, Lessa I. Associação entre indicadores antropométricos de obesidade e risco coronariano em adultos na cidade de Salvador, Bahia, Brasil. Rev. bras. epidemiol. [Internet]. 2007 [cited 2022 Oct. 10]; 10(2):239-49. Available from: https://doi.org/10.1590/S1415-790X2007000200011
  » https://doi.org/10.1590/S1415-790X2007000200011
• ¹³
  Souza Filho ZA, Ferreira AA, Santos J, Meira KC, Pierin AMG. Cardiovascular risk factors with an emphasis on hypertension in the Mura Indians from Amazonia. BMC Public Health. [Internet]. 2018 [cited 2022 Sept. 15]; 18(1). Available from: https://doi.org/10.1186/s12889-018-6160-8
  » https://doi.org/10.1186/s12889-018-6160-8
• ¹⁴
  Campos LP, Lobo LMC. Efeitos da restrição de carboidratos no manejo do diabetes mellitus: revisão de literatura. Demetra, Goiânia. [Internet]. 2020 [cited 2022 Oct. 16]; 15:e43534. Available from: http://dx.doi.org/10.12957/demetra.2020.43534
  » http://dx.doi.org/10.12957/demetra.2020.43534
• ¹⁵
  Sociedade Brasileira de Diabetes. Atualização sobre hemoglobina glicada (a1c) para avaliação do controle glicêmico e para o diagnóstico do diabetes: aspectos clínicos e laboratoriais [Internet]. 2018 [cited 2021 Feb. 06]. Available from: https://www.saudedireta.com.br/docsupload/1332104952Hemoglobina%20Glicada.pdf
  » https://www.saudedireta.com.br/docsupload/1332104952Hemoglobina%20Glicada.pdf
• ¹⁶
  Ribeiro LSF, Santos JN, Vieira CL, Caramelli B, Ramalho LM, Cury PR. Association of dental infections with systemic diseases in Brazilian Native Indigenous: a cross-sectional study. J Am Soc Hypertens. [Internet]. 2016 [cited 2022 Oct. 15]; 10(5):413-9. Available from: https://doi.org/10.1016/j.jash.2016.02.012
  » https://doi.org/10.1016/j.jash.2016.02.012
• ¹⁷
  Gomes SC, Esperidião MA. Acesso dos usuários indígenas aos serviços de saúde de Cuiabá, Mato Grosso, Brasil. Cad. Saúde Pública. [Internet]. 2017 [cited 2022 Nov. 18]; 33(5):e00132215. Available from: https://doi.org/10.1590/0102-311X00132215
  » https://doi.org/10.1590/0102-311X00132215
• ¹⁸
  Atrash HK. Health disparities: Challenges, opportunities, and what you can do about it. J. Hum. Growth Dev. [Internet]. 2018 [cited 2022 June 10]; 28(3):223-31. Available from: https://doi.org/10.7322/jhgd.152156
  » https://doi.org/10.7322/jhgd.152156
• ¹⁹
  Wa-Rovêdenê LPS, Souza MR de, Martins MA, Eid LP, Araujo MAN de, Souza JC. Rastreando doenças crônicas na comunidade indígena. São Paulo: Rev Recien. [Internet]. 2021 [cited 2022 Sept. 10]; 11(33):270-79. Available from: https://doi.org/10.24276/rrecien2021.11.33.270-279
  » https://doi.org/10.24276/rrecien2021.11.33.270-279
• ²⁰
  Barbosa CC, Sacuena ESR, Pinto AM, Costa GLC, Guerreiro JF. Anthropometric and metabolic profile of a Brazilian Amerindian group: The Xikrin (Mebengôkre). Am J Hum Biol. [Internet]. 2019 [cited 2022 Nov. 18]; 31(4):e23255. Available from: https://dx.doi.org/10.1002/ajhb.23255
  » https://dx.doi.org/10.1002/ajhb.23255
• ²¹
  Corrêa PKV, Trindade FA, Nascimento CCL do, Araújo ACC, Souza IKY, Nogueira LMV. Prevalência da hipertensão arterial sistêmica e diabetes mellitus entre indígenas. Cogitare Enferm. [Internet]. 2021 [cited 2022 Oct. 10]; 26:e72820. Available from: https://doi.org/10.5380/ce.v26i0.72820
  » https://doi.org/10.5380/ce.v26i0.72820
• ²²
  Ministério da Saúde (BR). Gabinete do Ministro. Portaria No 2.761, de 19 de novembro de 2013 [Internet]. Brasília: Ministério da Saúde; 2013 [cited 2023 Feb. 25]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt2761_19_11_2013.html
  » https://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt2761_19_11_2013.html
• ²³
  Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas e Estratégicas. Orientações técnicas para a implementação de linha de cuidado para atenção integral à saúde da pessoa idosa no Sistema Único de Saúde - SUS [Internet]. Brasília: Ministério da Saúde; 2018 [cited 2022 Oct. 28]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/linha_cuidado_atencao_pessoa_idosa.pdf
  » http://bvsms.saude.gov.br/bvs/publicacoes/linha_cuidado_atencao_pessoa_idosa.pdf
• ²⁴
  Santos AD dos, Silva CRA da, Medeiros JD de, Panazzolo GLG, Silva HCTA, Rosa Filho AAMR, et al. Perfil epidemiológico de pacientes com diabetes mellitus. Brazilian Journal of Surgery and Clinical Research. [Internet]. 2018 [cited 2022 Sept. 10]; 24(2):40-46. Available from: https://www.mastereditora.com.br/periodico/20181006_153113.pdf
  » https://www.mastereditora.com.br/periodico/20181006_153113.pdf
• ²⁵
  Fávaro TR, Santos RV, Cunha GM da, Leite I da C, Coimbra Júnior CEA. Obesidade e excesso de peso em adultos indígenas Xukuru do Ororubá, Pernambuco, Brasil: magnitude, fatores socioeconômicos e demográficos associados. Cad. Saúde Pública, Rio de Janeiro. [Internet]. 2015 [cited 2022 Oct. 15]; 31(8):1685-97. Available from: https://doi.org/10.1590/0102-311X00086014
  » https://doi.org/10.1590/0102-311X00086014
• ²⁶
  Rato Q. Índice de conicidade: uma medida antropométrica a avaliar. Rev. Port. Cardiol. [Internet]. 2017 [cited 2022 Nov. 19]; 36(5):365-66. Available from: https://doi.org/10.1016/j.repc.2017.02.003
  » https://doi.org/10.1016/j.repc.2017.02.003
• ²⁷
  Silveira EA, Pagotto V, Barbosa LS, Oliveira C de, Pena G das G, Melendez GV. Acurácia de pontos de corte de IMC e circunferência da cintura para a predição de obesidade em idosos. Cien Saude Colet. [Internet]. 2020 [cited 2022 Nov. 15]; 25(3):1073-82. Available from: https://doi.org/10.1590/1413-81232020253.13762018
  » https://doi.org/10.1590/1413-81232020253.13762018
• ²⁸
  Reho JJ, Rahmouni K. Oxidative and inflammatory signals in obesity-associated vascular abnormalities. Clin Sci (Lond). [Internet]. 2017 [cited 2022 Oct. 20]; 131(14):1689-700. Available from: https://doi.org/10.1042/CS20170219
  » https://doi.org/10.1042/CS20170219
• ²⁹
  Abrasco AB. I Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas. Scribd. [Internet]. 2009 [cited 2022 Oct. 28]. Available from: http://pt.scribd.com/doc/47810839/I-INQUERITO-NACIONAL-DE-SAUDE-E-NUTRICAO-DOS-POVOS-INDIGENAS-ABRASCO
  » http://pt.scribd.com/doc/47810839/I-INQUERITO-NACIONAL-DE-SAUDE-E-NUTRICAO-DOS-POVOS-INDIGENAS-ABRASCO
• ³⁰
  Welch JR, Ferreira AA, Tavares FG, Lucena JRM, Oliveira MVG, Santos RV, et al. The xavante longitudinal health study in Brazil: objectives design, and key results. Am J Hum Biol. [Internet]. 2020 [cited 2022 Nov. 18]; 32:e23339. Available from: https://doi.org/10.1002/ajhb.23339
  » https://doi.org/10.1002/ajhb.23339

Associate editor: Dra. Luciana Nogueira

Publication Dates

• Publication in this collection
  21 June 2024
• Date of issue
  2024

History

• Received
  17 Aug 2023
• Accepted
  31 Jan 2024