Isabela Bensenor

University of São Paulo | USP · Department of Clinical Medicine (VCM)

To investigate the time-dependent effects of traditional risk factors on functional disability in all-cause mortality post-stroke, we evaluated data from a long-term stroke cohort. Baseline cerebrovascular risk factors (CVRF) and functionality at 1 and 6 months were evaluated in survivors from a prospective stroke cohort using the modified Rankin s...

This study aimed to predict dietary recommendations and compare the performance of algorithms based on collaborative filtering for making predictions of personalized dietary recommendations. We analyzed the baseline cross-sectional data (2008–2010) of 12,667 participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The partici...

Background and aims High serum uric acid (sUA) has been associated to coronary artery calcium (CAC) and increased carotid intima-media thickness (cIMT) in people at high cardiovascular risk. However, association is unclear in apparently healthy individuals. Our study aims to evaluate association between sUA and subclinical atherosclerosis measures:...

Purpose The EAT-Lancet Commission released a reference sustainable diet to improve human health and respect the planetary boundaries. The Planetary Health Diet Index (PHDI) was developed with the purpose of evaluate the adherence to this reference diet. The aim of the present study was to evaluate the association between adherence to the EAT-Lancet...

Aim: To estimate the association between consumption of sugar-sweetened soft drinks and unsweetened fruit juice with metabolic syndrome (MetS) and its components in participants of the Brazilian Longitudinal Adult Health Study (ELSA-Brasil) after 4 years of follow-up. Methods: We used data from ELSA-Brasil cohort (N = 15,105). The sample consist...

Patient and Public Involvement and Engagement (PPIE) - sometimes called Community Engagement and Involvement (CEI) - comes as a big challenge but one that can be very helpful for health care professionals and stakeholders in planning better health policies for attending to the main needs of the community. PPIE involves three pillars: public involve...

The American Heart Association (AHA) has developed the concept of “ideal cardiovascular health” (ICH), a seven-component score, which includes health dietary metrics. Higher ultra-processed foods intake is related with several cardiometabolic and cardiovascular diseases. We propose to develop and validate the Cardiovascular Health Diet Index (CHDI)...

A disponibilidade de grandes bancos de dados para análise associada ao desenvolvimento da capacidade de processamento, visualização e integração de diferentes fontes de informação em saúde têm impulsionado a aplicação de modelos baseados em Inteligência Artificial (IA) e no Aprendizado de Máquina para avaliação do consumo alimentar. O presente estu...

Background: Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: We...

BACKGROUND: Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex a...

The EAT-Lancet Commission has proposed a model diet to improve the health of human beings and that of the planet. Recently, we proposed the Planetary Health Diet Index (PHDI) to assess adherence of the population to this model diet. In this study, we aimed to evaluate adherence to the PHDI and obesity outcomes using baseline data from 14,515 partic...

The EAT-Lancet Commission has proposed a planetary health diet. We propose the development of the Planetary Health Diet Index (PHDI) based on this proposed reference diet. We used baseline dietary data obtained through a 114-item FFQ from 14,779 participants of the Longitudinal Study on Adult Health, a multicenter cohort study conducted in Brazil....

The objective of this study was to cross-sectionally analyze the diet quality of active workers and retirees to identify possible differences by gender and subgroups of working and nonworking retirees using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study of employees of six higher education centers...

This study examined the association between coffee consumption and all-cause mortality in patients with a prior acute myocardial infarction or unstable angina. Data were from the prospective study ERICO, totalising 928 patients with Acute Coronary Syndrome (ACS). During 4 years’ follow-up, a total of 111 deaths occurred. Moderate coffee consumption...

Importance Predicting risk of Type 2 Diabetes Mellitus (T2DM) accurately allows allocation of resources to prevent its development. Fasting blood triglycerides are highly predictive for T2DM. Triglyceride remnant lipoproteins (TRL) more accurately reflect pathophysiological changes that underlie progression to T2DM, such as pancreatic steatosis and...

Recent evidence suggests that glaucoma and Alzheimer's disease are neurodegenerative diseases sharing common pathophysiological and etiological features, although findings are inconclusive. We sought to investigate whether self-reported glaucoma patients without dementia present poorer cognitive performance, an issue that has been less investigated...

BACKGROUND: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2...

Body fat distribution predicts cardiovascular events better than body-mass index (BMI). Waist circumference (WC) and neck circumference (NC) are inexpensive anthropometric measurements. We aimed to present the conditional distribution of WC and NC values according to BMI, stratified by age and sex, from the Brazilian Longitudinal Study of Adult Hea...

BACKGROUND: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. METHODS: We reviewed results for injuries from the GB...

Objective: to investigate the effect of general alcohol consumption and of the type of alcoholic beverage consumed, in different lipid measurements. Method: the effect of alcohol consumption as well as that of the type of alcoholic beverage consumed were investigated, in different lipid measurements, for the participants in the Longitudinal Study o...

We investigated whether high adherence to the DASH diet was independently associated with lower risk of incident hypertension. Participants included 5,632 adults, without hypertension at the baseline (2008-2010) of the Longitudinal Study of Adult Health (ELSA-Brasil), who took part in the second follow-up visit (2012-2014). Adherence to the DASH di...

BACKGROUND: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the associati...

Background: The mechanisms that underlie the link between migraine and cardiovascular diseases are not clear and arterial stiffness could play a role in that association. We analyzed the association between migraine and vascular stiffness measured by carotid-to-femoral pulse wave velocity (PWV-cf). Methods: In a cross-sectional analysis of a wel...

Background: Relations between diet and mental health continue to be a subject for controversy and an increasing numbers of studies. Recent literature is represented by papers that examine overall diet by way of dietary patterns and its association with depression, replacing previous studies about nutrients. The aim of this cross-sectional study is...

Objective: We investigated whether ideal cardiovascular health (ICH), a metric proposed by the American Heart Association, predicts depression development. Methods: Cohort analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Adults with no current depression and other common mental disorders, cardiovascular diseases, and...

Introduction: It is unclear how aging and menopause-induced lipid changes contribute to the elevated cardiovascular risk in menopausal women. We examined the association between lipid profiles and menopausal status and duration of menopause in the Longitudinal Study of Adult Health (ELSA-Brasil). Methods: This is a cross-sectional analysis of ba...

Na oportunidade da recente adaptação de uma versão brasileira do software GloboDiet, desenvolvido pela Agência Internacional de Pesquisa do Câncer (IARC) como plataforma padronizada de coleta de recordatórios alimentares de 24 horas (RA24h), um estudo de validação está em andamento, de maneira a estimar a acurácia e os erros associados à esta ferra...

This study aimed to investigate factors associated with orthostatic hypotension in 14,833 individuals 35-74 years of age. This was a cross-sectional study of baseline data (2008-2010) from the Longitudinal Study of Adult Health (ELSA-Brasil). Postural testing was performed after 20 minutes resting in supine position and active adoption of orthostat...

Background: The Martin/Hopkins low-density lipoprotein cholesterol equation (LDL-CN) was previously demonstrated as more accurate than Friedewald LDL-C estimation (LDL-CF) in a North American database not able to take race into account. Objectives: We hypothesized that LDL-CN would be more accurate than LDL-CF and correlate better with LDL parti...

Background: OSA and short sleep duration (SSD) are frequently associated with daytime symptoms and cardiometabolic deregulation. However, the vast majority of studies addressing OSA have not evaluated SSD, and vice versa. Our aim was to evaluate the association of OSA, SSD, and their interactions with sleepiness and cardiometabolic risk factors in...

Objective: Adiposity is a well-established risk factor for obstructive sleep apnea (OSA) but the existence of a preferable anthropometric measurement is not established or whether the combination of measurements may improve the accuracy to detect OSA. This study aimed to compare the accuracies of body mass index (BMI), several surrogate markers of...

Background: seizures and their consequences contribute to the burden of epilepsy because they can cause health loss (premature mortality and residual disability). Data on the burden of epilepsy are needed for health-care planning and resource allocation. The aim of this study was to quantify health loss due to epilepsy by age, sex, year, and locati...

Background and cognitive impairment share pathophysiological paths and risk factors. Our aim was to investigate the association of sarcopenia and its defining components with cognitive performance in middle-aged and older adults. Methods This cross-sectional analysis included 5038 participants from the ELSA-Brasil Study, aged ≥ 55 years. Muscle ma...

Introduction: Insulin resistance and low-grade inflammation are pathophysiological mechanisms shared by type 2 diabetes and dementia. A cluster of biomarkers that could help diagnosing cognitive dysfunction prior to the installation of insulin resistance is desirable. This ELSA sub-study examined whether a cluster of selected inflammatory biomarke...

Summary Background Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide i...

Depression and cognitive impairment are common conditions following stroke. We aimed to evaluate stroke laterality as predictor of post-stroke depression (PSD) and cognitive impairment (PCI) in a stroke cohort. Major depression (Patient Health Questionnaire-9, score ≥ 10) and cognitive impairment (Modified Telephone Interview for Cognitive Status,...

Background: Transcranial direct current stimulation (tDCS) is a promising intervention for major depression. However, its clinical effects are heterogeneous. We investigated, in a subsample of the randomized, clinical trial Escitalopram versus Electrical Direct Current Therapy for Depression Study (ELECT-TDCS), whether the volumes of left and righ...

Importance: Understanding causes and correlates of health loss among children and adolescents can identify areas of success, stagnation, and emerging threats and thereby facilitate effective improvement strategies. Objective: To estimate mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and ter...

Objective: In this study, we aimed to describe the prevalence and distribution of positive antithyroperoxidase antibodies (TPOAb) according to sex, age strata, and presence of thyroid dysfunction using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Materials and methods: Thyroid hormone tests were obtained fro...

Background: Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated. This study aimed to evaluate the consumption of major foods and nutrients across 195 countries and to quantify the impact of their suboptimal intake on NCD mortal...

Supplement to: GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; published online March 14. http://dx.doi.org/10.1016/S1474-4422(18)30499-X.

Summary Background Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide inf...

Blood pressure (BP) is a strong cardiovascular risk factor, predicting cardiovascular mortality in the general population. High salt consumption is a major contributor of increased BP and hypertension. However, there is a controversy on whether BP response to salt intake would be sex‐specific. Thus, we aimed to verify the changes in BP according to...

Background Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information...

Introduction: Branched-chain amino acids (isoleucine, leucine, and valine) are associated with new-onset diabetes and incident coronary heart disease and stroke. However, the impact of elevated serum branched-chain amino acids on lipids and lipoproteins remains a matter of investigation. Hypothesis: branched-chain amino acids are independent predic...

Introduction: Although epidemiologic studies have associated subclinical thyroid disorders with coronary heart disease, the role of lipoprotein levels are not well defined as a mediator or moderator of this association. Purpose: To test the association of lipoprotein particle concentration and size measured by nuclear magnetic resonance with subcli...

Introduction: Although studies have evaluated the association between the lipid profile measured by nuclear magnetic resonance (NMR) and the diagnosis of diabetes, scarce data are available addressing the association of lipoprotein particles and lipoprotein size among people with impaired fasting glucose and impaired glucose tolerance. Hypothesis:...

Introduction: Migraine with aura has been associated with cardiovascular events however the mechanisms are unclear. Arterial stiffness is a validated predictor of cardiovascular events and could play a role in that association. Hypothesis: We tested the hypothesis that migraine is associated with arterial stiffness in a well-defined middle-aged pop...

Introduction: The relationship between the level of religiosity and health-adverse outcomes has been controversial. One reason should be that how "religiosity" is measured or by a self-declaration (meaning more a cultural variable than a manifestation of the spirituality) of by regular religious practices attendance. Several studies pointed out tha...

Introduction: The prevalence of diabetes has risen dramatically in the last decades. Prediabetes, or intermediate hyperglycemia, represents an early stage of diabetes development. Structured diabetes prevention programs can lead to regression of prediabetes, but observational studies may reflect better a real-world scenario for public health planni...

Introduction: Perceived stress (including work-related stress) is associated with cardiovascular health. We studied the association between work-family conflict and AHA’s ideal cardiovascular health (ICH) score at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline. Hypothesis: Individuals with more frequent work-family conflict...

Introduction: Lifetime stressful conditions have been related to a higher risk of coronary heart diseases events. One recognized way is related to the disbalance of a parasympathetic and sympathetic system that can be mediated by several humoral factors, including thyroid hormones. Although the role of thyroid hormones on cardiovascular system regu...

Introduction: An auto-immune process strongly determines subclinical thyroid disorders generating a high grade of inflammation. However, the evidence from epidemiologic studies of the association between subclinical thyroid disorders with coronary heart disease has not been reported as mediated or moderated by a traditional inflammatory marker such...

Chronic diseases are often comorbid and present a weighty burden for communities in the 21st century. The present investigation depicted patterns of multimorbidity in the general population and examined its association with the individual- and area-level factors in an urban sample of non-elderly adults of Brazil. Data were from the cross-sectional...

Background: Post-stroke depression (PSD) and cognitive impairment (PCI) are common conditions. This study aims to describe the protocol and preliminary findings of an investigation into factors associated with PSD and PCI 1–3 months after stroke (subacute phase) in survivors from the Study of Stroke Mortality and Morbidity (EMMA study). Methods: St...

Thyroid disorders are common diseases, both in Brazil and worldwide. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study that investigates cardiovascular diseases, diabetes, and associated factors, including non-classical cardiovascular risk factors such as thyroid function. Thyroid function was classified a...

OBJECTIVES: To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016. DESIGN: Systematic analysis. MAIN OUTCOMES MEASURES: Crude and age standa...

Introduction We aimed to analyze the association of nitrotyrosine (N-TYR) levels and long-term survival in an ongoing coronary heart disease (CHD) prospective cohort, the Acute Coronary Syndrome Registry Strategy (ERICO study). Methods N-TYR levels collected during acute and subacute phase from onset of acute coronary syndrome (ACS) symptoms (myoc...

OBJECTIVES To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016. DESIGN Systematic analysis. MAIN OUTCOME MEASURES Crude and age standardis...

Background: The burden of diabetes is increasing worldwide and diabetes can be prevented with intervention in people with impaired glucose tolerance (IGT). Intermediate hyperglycaemia defined without an oral glucose tolerance test as impaired fasting glucose (IFG) and high HbA1c are also used to characterise risk. We aimed to assess the prognostic...

Subclinical hypothyroidism (SCHypo) is associated with autonomic disturbances that can interfere in physiological responses. This study was designed to evaluate linear and nonlinear variables of heart rate variability (HRV) following postural change, comparing subjects with SCHypo to euthyroid subjects. HRV analyses were performed in 5-minute time...

Background The efficacy of transcranial direct current stimulation (tDCS) as a continuation therapy for the maintenance phase of the depressive episode is low and insufficiently investigated in literature. We investigated whether it could be enhanced by using a more intensive treatment regimen compared to previous reports. Methods Twenty‐four pati...

Background: Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from a...

Carotid artery assessment by ultrasound is a non-invasive evaluation of subclinical atherosclerosis and a predictor of cardiovascular events. However, ultrasound examinations are operator-dependent. In the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), ultrasound images have been acquired from more than 10,000 participants. In this art...

Background: Inflammation has been weakly associated with coronary artery calcium (CAC) in the overall population. However, it is currently unknown whether this varies according to the cardio-metabolic profile. We evaluated the association between GlycA, a unique composite biomarker of pro-inflammatory acute phase glycoproteins, high sensitivity C-...

Background Lifetime stroke risk has been calculated in a limited number of selected populations. We determined lifetime risk of stroke globally and at the regional and country level. Methods Using Global Burden of Disease Study estimates of stroke incidence and the competing risks of non-stroke mortality, we estimated the cumulative lifetime risk...

Background Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and prog...

Background Neck circumference (NC) is associated with traditional cardiovascular risk factors (CVRF), but its usefulness to identify earlier atherogenic risk has been scarcely examined. Associations of NC with non-traditional CVRF were investigated in participants at low-to-moderate risk from the Brazilian Longitudinal Study of Adult Health (ELSA-B...

Aim: We aimed to analyze the influence of myeloperoxidase (MPO) activity on mortality in the Acute Coronary Syndrome Registry Strategy (ERICO) study. Methods: MPO activity levels were evaluated in 342 patients. We performed survival analyses using Kaplan-Meier curves and Cox regression with respective hazard ratios, 95% CI, according to MPO tert...

Background: Through the Global Burden of Diseases, Injuries, and Risk Factors (GBD) studies, headache has emerged as a major global public health concern. We aimed to use data from the GBD 2016 study to provide new estimates for prevalence and years of life lived with disability (YLDs) for migraine and tension-type headache and to present the meth...

Objectives: To investigate the association of sarcopenia and its defining components with depression in Brazilian middle-aged and older adults. Design: Cross-sectional study. Setting and participants: This analysis included 5927 participants from the ELSA-Brasil Study second data collection, aged 55 years and older, with complete data for expo...

eAppendix. eTables 1 through 16. eFigures 1 through 72.

IMPORTANCE: The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments ha...

Inflammation is very important in Acute Coronary Syndrome (ACS) as well as in cardiac remodeling after an acute myocardial infarction (MI). Our study examined the prognostic value of Chemokine (C-C motif) ligand 2 (CCL2) in patients with ACS in the ERICO (Strategy of Registry of Acute Coronary Syndrome) study. We evaluated serum samples from 803 pa...

Background and aims: Familial hypercholesterolemia (FH) is a genetic disorder associated with high cardiovascular burden of disease. FH prevalence may vary widely across populations and data in race/ethnically diverse and admixed populations is scarce. ELSA-Brasil epidemiology may be widely generalizable in this regard, and we calculated the ELSA-...

BACKGROUND: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016,...