Abstract
INTRODUCTION: Non-Communicable Diseases (NCDs) have become the main cause of disease burden in Brazil. Our objective was to describe trends (1990 to 2019) in prevalence and attributable burden of five modifiable risk factors and related metabolic risk factors in Brazil and its states. METHODS: In Global Burden of Disease 2019 analyses, we described trends in prevalence of modifiable risk factors and their metabolic mediators as percentage change in Summary Exposure Value (SEV). We estimated deaths and disability-adjusted life years (DALYs) attributable to the risk factors. RESULTS: Age-adjusted exposures to alcohol [41.0%, Uncertainty Interval (UI): 24.2 - 63.4], red meat (61.2%, UI: 42.4-92.3), low physical activity (3.9%, UI: -5-17.5) and ambient particulate matter pollution (3.3%, UI: -48.9-128.0) have worsened. Those for smoking (-51.4%, UI: -54.7- - 47.8), diet low in fruits (-28.1%, UI: -39.1- -18.7) and vegetables (-19.6%, UI: -32.7 - -8.7), and household air pollution (-85.3%, UI: -92.9- -74.3) have improved. All mediating metabolic risk factors, except high blood pressure (0.7%, UI: -6.9-8.3), have worsened: BMI (110.2%, UI: 78.6-161.7), hyperglycemia (15.1%, UI: 9.3-21.2), kidney dysfunction (12.0%, UI: 8.4-17.2), and high LDL-c (11.8%, UI: 6.9-17.2). CONCLUSIONS: A variable pattern of progress and failure in controlling modifiable risk factors has been accompanied by major worsening in most metabolic risk factors. The mixed success in public health measures to control modifiable risk factors for NCDs, when gauged by the related trends in metabolic risk factors, alert to the need for stronger actions to control NCDs in the future.
Highlights
Non-Communicable Diseases (NCDs) have become the main cause of disease burden in Brazil
Among the World Health Organization (WHO)-priority modifiable behavioral risk factors, large decreases occurred for smoking [-51.4%, Uncertainty Interval (UI): -54.7 – -47.8], and two components of dietary risk, diet low in fruits (-28.1%, UI: -39.1 – -18.7) and in vegetables (-19.6%, UI: -32.7 – -8.7), and large increases occurred for alcohol consumption (41.0%, UI: 24.2 – 63.4) and the dietary risk component, a diet high in red meat (61.2%, UI: 42.4 – 92.3)
Minor changes occurred for the remaining WHO-priority risk factors, including low physical activity (3.9%, UI: -5.0 – 17.5)
Summary
Non-Communicable Diseases (NCDs) have become the main cause of disease burden in Brazil. The mixed success in public health measures to control modifiable risk factors for NCDs, when gauged by the related trends in metabolic risk factors, alert to the need for stronger actions to control NCDs in the future. Knowledge of current levels of the main NCD risk factors and their trends for over recent decades is key to gauging the success of these efforts and to planning future action. This is especially true as Brazil is not currently on track to achieve the Sustainable Development Goal of www.scielo.br/rsbmt I www.rsbmt.org.br
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