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Lifestyle factors and multimorbidity among older adults (ELSI-Brazil)

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The objective of the study was to evaluate the association between unhealthy lifestyle factors (individual and combined) and multimorbidity stratified by sex, in a national sample representative of Brazilians aged 50 years or older. Data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline, conducted in 2015–2016, were used. Multimorbidity was defined by the existence of two or more of the 19 chronic diseases. Four unhealthy lifestyle factors were considered: (1) at-risk alcohol consumption, (2) current or past smoking, (3) insufficient physical activity and (4) below-recommended consumption of fruits and vegetables. The association between unhealthy lifestyle factors, individual and combined, was assessed by logistic regression. Among the 7918 study participants, the prevalence of multimorbidity was 75.8% (95% CI 73.7–77.7) among women and 58.7% (95% CI 56.0–61.3) among men. Among women, none of the analyzed behaviors presented an independent and statistically significant association (p < 0.05) with multimorbidity. Among men, at-risk alcohol consumption was associated with lower odds of multimorbidity. On the other hand, current or past smoking and insufficient physical activity were associated with greater odds of this condition. In addition, the presence of three or four unhealthy lifestyle factors was associated with greater odds of multimorbidity among men. The results reinforce the need for interventions to promote healthy behaviors among older men with two or more chronic diseases. In addition, it is evident that the health services need to act in an attempt to modify unhealthy behaviors after medical diagnosis of chronic diseases to reduce the risk of future complications.

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  1. Autenrieth CS, Kirchberger I, Heier M, Zimmermann AK, Peters A, Doring A, Thorand B (2013) Physical activity is inversely associated with multimorbidity in elderly men: results from the KORA-Age Augsburg study. Prev Med 57(1):17–19.

  2. Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P, Baugh V, Bekedam H, Billo N, Casswell S et al (2011) Priority actions for the non-communicable disease crisis. Lancet 377(9775):1438–1447.

  3. Bloom DE, Chatterji S, Kowal P, Lloyd-Sherlock P, McKee M, Rechel B, Rosenberg L, Smith JP (2015) Macroeconomic implications of population ageing and selected policy responses. Lancet 385(9968):649–657.

  4. Boeing H, Bechthold A, Bub A, Ellinger S, Haller D, Kroke A, Leschik-Bonnet E, Müller MJ, Oberritter H, Schulze M, Stehle P, Watzl B (2012) Critical review: vegetables and fruit in the prevention of chronic diseases. Eur J Nutr 51(6):637–663.

  5. Brasil (2015) Fiocruz - Fundação Oswaldo Cruz Manual de Entrevista Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). Accessed 01 June 2019

  6. Cimarras-Otal C, Calderón-Larrañaga A, Poblador-Plou B, González-Rubio F, Gimeno-Feliu LA, Arjol-Serrano JL, Prados-Torres A (2014) Association between physical activity, multimorbidity, self-rated health and functional limitation in the Spanish population. BMC Public Health 14:1170.

  7. Dhalwani NN, O’Donovan G, Zaccardi F, Hamer M, Yates T, Davies M, Khunti K (2016) Long terms trends of multimorbidity and association with physical activity in older English population. Int J Behav Nutr Phys Act 13:8.

  8. Dhalwani NN, Zaccardi F, O’Donovan G, Carter P, Hamer M, Yates T, Davies M, Khunti K (2017) Association between lifestyle factors and the incidence of multimorbidity in an older English population. J Gerontol A Biol Sci Med Sci 72(4):528–534.

  9. Erhardt L (2009) Cigarette smoking: an undertreated risk factor for cardiovascular disease. Atherosclerosis 205(1):23–32.

  10. Fortin M, Stewart M, Poitras ME, Almirall J, Maddocks H (2012) A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med 10(2):142–151.

  11. Fortin M, Haggerty J, Almirall J, Bouhali T, Sasseville M, Lemieux M (2014) Lifestyle factors and multimorbidity: a cross sectional study. BMC Public Health 14:686.

  12. Gulliford MC (2001) Low rates of detection and treatment of hypertension among current cigarette smokers. J Hum Hypertens 15(11):771–773

  13. Harrison C, Britt H, Miller G, Henderson J (2014) Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice. BMJ Open 4(7):e004694.

  14. Kolb H, Martin S (2017) Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes. BMC Med 15(1):131.

  15. Lima-Costa MF, de Andrade FB, de Souza PRB, Jr NeriAL, Duarte YAO, Castro-Costa E, de Oliveira C (2018) The Brazilian longitudinal study of aging (ELSI-Brazil): objectives and design. Am J Epidemiol 187(7):1345–1353.

  16. Macinko J, Mullachery P, Silver D, Jimenez G, Neto OLM (2015) Patterns of alcohol consumption and related behaviors in Brazil: evidence from the 2013 National Health Survey (PNS 2013). PLoS ONE 10(7):e0134153.

  17. Malta DC, Neto OLM, Junior JBS (2011) Presentation of the strategic action plan for coping with chronic diseases in Brazil from 2011 to 2022. Epidemiol Serv Saúde 20(4):425–438.

  18. Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, Fratiglioni L (2011) Aging with multimorbidity: a systematic review of the literature. Ageing Res Ver 10(4):430–439.

  19. Matheson EM, King DE, Everett CJ (2012) Healthy lifestyle habits and mortality in overweight and obese individuals. J Am Board Fam Med 25(1):9–15.

  20. Matsudo S, Araújo T, Matsudo V, Andrade D, Andrade E, Oliveira LC, Braggion G (2001) International physical activity questionnaire (IPAQ): study of validity and reliability in Brazil. Rev Bras Ativ Fis Saude 6(2):5–18.

  21. Mendoza-Sassi R, Béria JU (2001) Health services utilization: a systematic review of related factors. Cad Saude Publica 17(4):819–832.

  22. Molander RC, Yonker JA, Krahn DD (2010) Age-related changes in drinking patterns from mid- to older age: results from the Wisconsin longitudinal study. Alcohol Clin Exp Res 34(7):1182–1192.

  23. National Institute on Alcohol Abuse and Alcoholism (NIAAA) (2010) Rethinking drinking: alcohol and your health. National Institutes of Health. Accessed 05 June 2019

  24. Noronha BP, Nascimento-Souza MA, Costa MF, Peixoto SV (2019) Alcohol consumption patterns and associated factors among elderly Brazilians: National Health Survey (2013). Cien Saude Colet 24(11):4171–4180.

  25. Nunes BP, Batista SRR, Andrade FB, Souza PRB, Lima-Costa MF, Facchini LA (2018) Multimorbidade em indivíduos com 50 anos ou mais de idade: ELSI-Brasil. Saúde Pública 52(2):10S.

  26. Patel K, Schlundt D, Larson C, Wang H, Brown A, Hargreaves M (2009) Chronic illness and smoking cessation. Nicotine Tob Res 11(8):933–939.

  27. Peixoto SV, Firmo JOA, Lima-Costa MF (2006) Health conditions and smoking among older adults in two communities in Brazil (The Bambuí and Belo Horizonte Health Surveys). Cad Saúde Pública 22(9):1925–1934.

  28. Peixoto SV, Mambrini JVM, Firmo JOA, Loyola Filho AI, Souza Junior PRB, Andrade FB, Lima-Costa MF (2018) Physical activity practice among older adults: results of the ELSI-Brazil. Rev Saude Publica 52(2):5s.

  29. Portes LH, Machado CV, Turci SRB, Figueiredo VC, Cavalcante TM, Silva VLDCE (2018) Tobacco control policies in Brazil: a 30-year assessment. Cien Saude Colet 23(6):1837–1848.

  30. Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O’Donnell M, Sullivan R, Yusuf S (2015) The burden of disease in older people and implications for health policy and practice. Lancet 385(9967):549–562.

  31. Ruel G, Shi Z, Zhen S, Zuo H, Kroger E, Sirois C, Levesque JF, Taylor AW (2013) Association between nutrition and the evolution of multimorbidity: the importance of fruits and vegetables and whole grain products. Clin Nutr 33(3):513–520.

  32. Salomon JA, Wang H, Freeman MK, Vos T, Flaxman AD, Lopez AD, Murray CJ (2012) Healthy life expectancy for 187 countries 1990–2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet 380(9859):2144–2162.

  33. Sasazuki S, Inoue M, Iwasaki M, Sawada N, Shimazu T, Yamaji T, Tsugane S (2012) Combined impact of five lifestyle factors and subsequent risk of cancer: the Japan Public Health Center Study. Prev Med 54(2):112–116.

  34. Shield KD, Parry C, Rehm J (2013) Chronic diseases and conditions related to alcohol use. Alcohol Res 35(2):155–173

  35. Silsbury Z, Goldsmith R, Rushton A (2015) Systematic review of the measurement properties of self-report physical activity questionnaires in healthy adult populations. BMJ Open 5(9):e008430.

  36. Silva LES, Claro RM (2019) Time trends in the consumption of fruits and vegetables among adults in Brazilian state capitals and the Federal District 2008–2016. Cad Saúde Pública 35(5):00023618.

  37. Violan C, Foguet-Boreu Q, Flores-Mateo G, Salisbury C, Blom J, Freitag M, Glynn L, Muth C, Valderas JM (2014) Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies. PLoS ONE 9(7):e102149.

  38. Wolle CC, Sanches M, Zilberman ML, Caetano R, Zaleski M, Laranjeira RR et al (2011) Differences in drinking patterns between men and women in Brazil. Rev Bras Psiquiatr 33(4):367–373.

  39. World Health Organization (1995) Physical status: the use and interpretation of anthropometry. In: Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva: World Health Organization 1995. Accessed 20 June 2019

  40. World Health Organization (2002) Reducing risks, promoting healthy. The world health report. Accessed 28 June 2019

  41. World Health Organization (2003) Diet, nutrition and the prevention of chronic diseases. In: Report of the joint WHO/FAO expert consultation WHO Technical Report Series, No. 916.;jsessionid=4FCC71377A160E6E42B9F1996AA92FD7?sequence=1.Accessed 23 June 2019

  42. World Health Organization (2010a) Global recommendations on physical activity for health.Switzerland: World Health Organization. Accessed 23 June 2019

  43. World Health Organization (2010b) Global status report on noncommunicable diseases. Accessed 23 June 2019

  44. World Health Organization (‎2016)‎ Multimorbidity. World Health. Organization. Accessed 23 June 2019

  45. Wu F, Guo Y, Chatterji S, Zheng Y, Naidoo N, Jiang Y, Biritwum R, Yawson A, Minicuci N, Salinas-Rodriguez A (2015) Common risk factors for chronic non-communicable diseases among older adults in China, Ghana, Mexico, India, Russia and South Africa: the study on global ageing and adult health (SAGE) wave 1. BMC Public Health 15:88.

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Correspondence to Mary Anne Nascimento-Souza.

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The authors declare no conflict of interest.

Ethical approval

Brazilian Longitudinal Study of Aging was approved by Research Ethics Committee of the Fundação Oswaldo Cruz, Minas Gerais (Process No 34649814.3.0000.5091) (in Portuguese, Comitê de Ética em Pesquisa). The participants signed a consent form.

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de Almeida, M.G.N., Nascimento-Souza, M.A., Lima-Costa, M.F. et al. Lifestyle factors and multimorbidity among older adults (ELSI-Brazil). Eur J Ageing (2020).

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  • Ageing
  • Lifestyle
  • Risk factors
  • Chronic diseases
  • Multimorbidity