ObjectiveTo assess the association between indicators of psychosocial stress and central adiposity in adult users of the Unified Health System (SUS) from Southeast of Brazil.MethodsThis cross-sectional study was conducted with 384 adults (20 to 59 years old) from the city of Alegre, Southeastern Brazil. The simple random sample represented the population using the public health system of the municipality. The prevalence of obesity was based on the Body Mass Index, and central adiposity (dependent variable) was measured by waist circumference in centimeters. The independent variables were the following indicators of psychosocial stress: food and nutrition insecurity (yes/no), serum cortisol (μg/dL), symptoms suggestive of depression using the Beck Depression Inventory-II ≥ 17 (yes/no), and altered blood pressure ≥ 130/85 mmHg (yes/no). Univariate linear regression was performed between central adiposity and each stress indicator, and later the models were adjusted for socioeconomic, health, and lifestyle variables. All analyses were made separately by rural and urban location.ResultsThe prevalence of weight excess, by the classification of the Body Mass Index ≥ 25.0 kg/m2, was 68.3% and, by waist circumference, 71.5% of individuals presented an increased risk for metabolic complications related to central adiposity. Mean waist circumference scores for the rural and urban population were 89.3 ± 12.7 cm and 92.9 ± 14.7 cm, respectively (p = 0.012). Indicators of stress that were associated with central adiposity were: cortisol in the rural population (β = -0.60; 95% CI = -1.09;-0.11) and altered blood pressure in the urban population (β = 6.66; 95% CI = 2.14;11.18). This occurred both in the raw analysis and in the models adjusted for confounding factors.ConclusionCentral adiposity was inversely associated with cortisol in the rural population and directly associated with higher arterial blood pressure in the urban population, suggesting a local influence on how individuals react to stress.

30 Objective: To assess the association between indicators of psychosocial stress 31 and central adiposity in adult users of the Unified Health System (SUS) from 32 Southeast of Brazil. 33 Methods: This cross-sectional study was conducted with 384 adults (20 to 59 34 years old) from the city of Alegre, Southeastern Brazil. The simple random 35 sample represented the population using the public health system of the 36 municipality. The prevalence of obesity was based on the Body Mass Index, 37 and central adiposity (dependent variable) was measured by waist 38 circumference in centimeters. The independent variables were the following 39 indicators of psychosocial stress: food and nutrition insecurity (yes/no), serum 40 cortisol (μg/dL), symptoms suggestive of depression using the Beck Depression 41Inventory-II ≥ 17 (yes/no), and altered blood pressure ≥ 130/85 mmHg (yes/no). 42Univariate linear regression was performed between central adiposity and each 43 stress indicator, and later the models were adjusted for socioeconomic, health, 44 and lifestyle variables. All analyses were stratified by rural and urban location. 45Results: The prevalence of weight excess was 68.3%, and 71.5% of individuals 46 presented an increased risk for metabolic complications related to central 47 adiposity. Mean waist circumference scores for the rural and urban population 48 were 89.3 ± 12.7 cm and 92.9 ± 14.7 cm, respectively (p = 0.012). Indicators of 49 stress that were associated with central adiposity were: cortisol in the rural 3 50 population and altered blood pressure in the urban population. This occurred 51 both in the raw analysis and in the models adjusted for confounding factors. 52 Conclusion: The associations between stress and adiposity were different 53 between rural (cortisol -inverse association) and urban (altered blood pressure) 54 lifestyles, confirming the influence of local and psychosocial subsistence on the 55 modulation of stress and on how individuals react or restrain stressors. Stress 56 reduction strategies can be useful in public health programs designed to 57 prevent or treat obesity. 58 59 60 61 62 Introduction 63 Overweight and obesity are defined as abnormal or excessive 64 accumulation of fat that can be detrimental to health.(1) Weight excess affects 65 all regions of the world and is now appearing as a global epidemic. According to 66 the World Health Organization (WHO), 38.9% of the world population aged 18 67 or more present weight excess and of these, 13.1% are obese.(2) Compared to 68 other WHO regions, the prevalence of weight excess is higher in the Americas 69 (62% for overweight in both sexes, and 26% for obesity in adults over 20 years 70 of age).(3) The prevalence is higher in the United States of America, Mexico, 71 and Chile, where weight excess affects between six and seven out of 10 72 adults.(3, 4) In Brazil, the National Health Survey (NHS) presented a similar 73 scenario, with 56.9% of overweight adults.(5) 4 74 The term stress has already been mentioned in the literature over t...