Background

Indigenous Brazilian peoples have faced an unparalleled increase in the rate of cardiovascular diseases following rapid nutritional transition to more urban diets. We aimed to conduct a systematic review and meta-analysis to evaluate the association between urbanisation (including data from Amazon rainforest deforestation) and cardiometabolic risk factors and outcomes.

Methods

In this systematic review and meta-analysis, we searched Pubmed, Embase, Web of Science, and Scopus for articles published in any language between the year 1950 and March 10, 2022. Studies conducted in Indigenous Brazilian adults that evaluated metabolic health were included. Data for deforestation was obtained by the Amazon Deforestation Monitoring Project. Cardiovascular mortality was obtained from the Brazilian Health registry. Two independent reviewers evaluated studies for risk of bias, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The main outcomes assessed were the prevalence of obesity and related cardiometabolic risk factors among Indigenous Brazilian peoples and its association with urbanisation. Summary data were extracted from published reports for the meta-analyses. We calculated pooled estimates of the prevalence of each cardiometabolic outcome by using a random-effects model (DerSimonian–Laird method). This study is registered with the International Prospective Register of Systematic Reviews, CRD42021285480.

Findings

46 studies were identified, including a total of 20 574 adults from at least 33 Indigenous Brazilian ethnicities. Meta-analyses of the prevalence of obesity showed that there were higher rates of obesity (midwest region: 23% [95% CI 17–29]; and south region 23% [13–34]) and hypertension (south region: 30% [10–50]) in Indigenous peoples living in urban regions of Brazil, while the lowest rates of obesity (11% [95% CI 8–15]) and hypertension (1% [1–2]) were observed in those in the less urbanised (north) regions of Brazil. The prevalence of obesity was 3·5 times higher in participants living in urbanised Indigenous territories (28%) than in those living in lands with >80% native Amazon rainforest (8%). In meta-analyses that evaluated blood pressure level, there was no incremental change in blood pressure with ageing in Indigenous peoples who lived according to traditional lifestyle, in contrast to those living in urbanised regions. For Indigenous men with traditional lifestyles, systolic blood pressure changed from 109·8 mm Hg to 104·4 mm Hg between the youngest (<30 years) and the oldest (>60 years) age groups, and diastolic blood pressure changed from 69·8 mm Hg to 66·1 mm Hg. For Indigenous women with traditional lifestyles, systolic blood pressure was 100·0 mm Hg for the youngest age group with no changes for older age groups, and diastolic blood pressure was 62 mm Hg for the youngest age group with no changes for older age groups. For Indigenous men with urbanised lifestyles, systolic blood pressure changed from 117·3 mm Hg to 124·9 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 72·7 mm Hg to 76·4 mm Hg. For Indigenous women with urbanised lifestyles, systolic blood pressure changed from 110·0 mm Hg to 116·0 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 68·3 mm Hg to 74·0 mm Hg. For the years 1997 and 2019, the cardiovascular mortality rate in individuals living in the southeast region (the most urbanised) was 2·5 times greater than that observed in the north. Conversely, the incremental rise in cardiovascular mortality in the past two decades among Indigenous Brazilians living in the north or northeast (2·7 times increase) stands in stark contrast to the stable rates in those living in already urbanised regions.

Interpretation

The macrosocial changes of Indigenous peoples’ traditional ways of living consequent to urbanisation are associated with an increased prevalence of adverse cardiometabolic outcomes. These data highlight the urgent need for environmental policies to ensure the conservation of the natural ecosystem within Indigenous territories, as well as the development of socio-health policies to improve the cardiovascular health of Indigenous Brazilians peoples living in urban areas.

Funding

None.

中文翻译：

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城市化对巴西原住民心脏代谢健康的影响：系统评价和荟萃分析以及巴西健康登记处的数据

背景

随着营养迅速转向城市饮食，巴西原住民的心血管疾病发病率空前增加。我们的目的是进行系统回顾和荟萃分析，以评估城市化（包括亚马逊雨林砍伐的数据）与心脏代谢风险因素和结果之间的关联。

方法

在这项系统综述和荟萃分析中，我们检索了 Pubmed、Embase、Web of Science 和 Scopus，查找 1950 年至 2022 年 3 月 10 日期间以任何语言发表的文章。其中包括在巴西土著成年人中进行的评估代谢健康的研究。森林砍伐数据由亚马逊森林砍伐监测项目获得。心血管死亡率来自巴西卫生登记处。两名独立评审员根据系统评审和荟萃分析建议的首选报告项目评估了研究的偏倚风险。评估的主要结果是巴西原住民肥胖率和相关心脏代谢危险因素及其与城市化的关系。摘要数据是从已发表的荟萃分析报告中提取的。我们使用随机效应模型（DerSimonian-Laird 方法）计算了每种心脏代谢结果发生率的汇总估计值。本研究已在国际前瞻性系统评价登记册中注册，CRD42021285480。

发现

共确定了 46 项研究，其中包括来自至少 33 个巴西土著民族的总共 20 574 名成年人。对肥胖患病率的荟萃分析表明，肥胖率较高（中西部地区：23％[95％CI 17-29]；南部地区23％[13-34]）和高血压（南部地区：30％） [10–50]) 居住在巴西城市地区的原住民中，肥胖率最低 (11% [95% CI 8–15]) 和高血压率 (1% [1–2])巴西城市化程度较低的（北部）地区。居住在城市化原住民地区的参与者 (28%) 的肥胖患病率比居住在原生亚马逊雨林超过 80% 的地区的参与者 (8%) 高出 3·5 倍。在评估血压水平的荟萃分析中，与生活在城市化地区的原住民相比，按照传统生活方式生活的原住民的血压没有随着年龄的增长而发生增量变化。对于采用传统生活方式的原住民男性，最年轻（<30岁）和最年长（>60岁）年龄组之间的收缩压从109·8 mm Hg变为104·4 mm Hg，舒张压从69·8 mm Hg变为104·4 mm Hg。 8 毫米汞柱至 66·1 毫米汞柱。对于传统生活方式的原住民妇女，最小年龄组的收缩压为100·0 mm Hg，较大年龄组没有变化，最小年龄组的舒张压为62 mm Hg，较大年龄组没有变化。对于具有城市化生活方式的原住民男性，最年轻和最年长年龄组之间的收缩压从117·3 mm Hg 变为124·9 mm Hg，舒张压从72·7 mm Hg 变为76·4 mm Hg。对于具有城市化生活方式的原住民妇女，最年轻和最大年龄组之间的收缩压从110·0 mm Hg 变化到116·0 mm Hg，舒张压从68·3 mm Hg 变化到74·0 mm Hg。1997年和2019年，居住在东南部地区（城市化程度最高）的居民心血管死亡率是北方地区的2·5倍。相反，在过去二十年中，生活在北部或东北部的巴西原住民的心血管死亡率逐渐上升（增加了 2·7 倍），这与生活在已经城市化地区的居民的稳定死亡率形成鲜明对比。

解释

城市化带来的原住民传统生活方式的宏观社会变化与不良心脏代谢结果发生率的增加有关。这些数据凸显了迫切需要制定环境政策，以确保保护土著领土内的自然生态系统，并制定社会健康政策，以改善居住在城市地区的巴西土著人民的心血管健康。

资金

没有任何。