Estado de peso corporal, artrite/reumatismo, sintomas depressivos e multimorbidade

Abstract

INTRODUCTION: The total and central body mass amount seems to be related to arthritis/rheumatism, depression and multimorbidity. However, depending on sex, age and race/skin color, these relationships are configured in different ways, reverberating in mechanisms that potentiate adverse health outcomes or not. OBJECTIVE: To investigate the association between the status of body weight in the occurrence of arthritis/rheumatism, depression and multimorbidity, and whether there is an effect modification by sex, age and race/skin color. METHODS: Cross-sectional study, with data from the first and second editions of the National Health Survey - NHS (2013 and 2019). The NHS is a nationwide home-based health survey, aiming to produce information on the population’s health condition. The outcome variables were: (1) self-reported presence of arthritis/rheumatism, (2) presence of depressive symptoms, measured by the Patient Health Questionnaire – PHQ9, and (3) presence of multimorbidity, evaluated by the number of morbidities and by the cardiopulmonary, vascular metabolic and mental-musculoskeletal patterns. The explanatory variable of interest was continuous and categorical BMI (normal weight, underweight, overweight, class I, II and III obesity) and WC (adequate and high). The magnitudes of the associations were estimated using binary logistic regression and multinomial logistic models, obtaining their odds ratios (OR) and respective 95% confidence intervals. Analyzes were performed with sequential adjustments, including sociodemographic variables, behaviors and health conditions, and used Stata 15.0. To confirm the modification of the effect of sex, age and race/skin color on these associations, the interaction term was included in the final models, using the total population. RESULTS: The results of this thesis were presented in the form of three scientific publications. Higher BMI and WC values were associated with the occurrence of arthritis/rheumatism, even after mutual adjustment for these two parameters, suggesting an associated effect of mechanical overload and metabolic/inflammatory of obesity on the occurrence of these diseases (Article 1). Severe obesity (≥35kg/m²) in adults and underweight in the elderly remained associated with the occurrence of depression, and age seems to modify the relationship between body weight and the occurrence of depression (Article 2). Obesity was associated with a higher occurrence of multimorbidity, with a greater magnitude in women, adults and brown people. However, being underweight showed an inverse relationship with the occurrence of mental-musculoskeletal multimorbidity in women, the elderly and those who self-declared white. Sex, age and race/skin color are effect modifiers of this relationship. CONCLUSION: Although an excess of weight is related to the occurrence of arthritis/rheumatism, depression in adults and multimorbidity, being underweight was associated with a higher occurrence of depression in the elderly and protected some groups from mental-musculoskeletal multimorbidity, suggesting that body weight exerts a different influence in the occurrence of adverse health outcomes, depending on sex, age and racial groups. This understanding can support the discussion and decision-making on strategies in the field of public health, considering groups that are more vulnerable to illness. Keywords: Rheumatic Diseases; Arthritis; Depression; Multimorbidity; Body weight