In the Heart of the Amazon: Noncommunicable Diseases and Apolipoprotein E4 Genotype in the Riverine Population

Abstract

The Amazon River basin is the largest tropical forest in the world. Most of the Amazon belongs to Brazil, a developing country that currently faces huge challenges related to the consolidation of its universal healthcare system. Noncommunicable diseases (NCDs) are the leading cause of death in Brazil, accounting for 74% of all deaths, and NCDs are probably underestimated in Amazonian population because of their geographical isolation and the precariousness of riverine communities. Important risk factors, such as genetic susceptibility, remain undetermined in the riverine population. This study performed fasting blood sugar (FBS) and blood pressure measurements and investigated the presence of the ε4 allele of apolipoprotein E (APOE4) to determine the prevalence of diabetes, hypertension and the genetic risk of NCDs. FBS and APOE4 were measured in blood samples from 763 participants using spectrometry and real-time PCR; 67.5% showed altered measurements, and 57.9% had never been diagnosed or treated. Altered FBS was found in 28.3% of the participants, hypertension in 57.6% and APOE4 in 32.0%. The health profile of the riverine population appears to differ from that of urban population in the Amazon. Additional risk factors for NCDs, such as environmental contamination and nutritional transition, may contribute more than increased genetic susceptibility to the prevalence of altered FBS and hypertension. Our results will help guide the development of preventive strategies and governmental actions for more effective management of NCDs in the Amazon area.

Eating in the Amazon: Nutritional Status of the Riverine Populations and Possible Nudge Interventions

“…In this work, the NC revealed that more than 60% of the participants were at risk for possible metabolic complications in both regions, and that the prevalence of men with a risk related to these complications is higher than that of women ( Figure 3 ). These data would explain the previous findings of the significantly higher median blood pressure and hypertension prevalence in men compared to women [ 10 ]. However, additional studies are needed to better understand the higher prevalence of women at risk showed by the other anthropometric parameters.…”

“…A higher proportion of women participated in our study, especially in the Tapajós region (71% of all participants) ( Table 2 ). This is frequent in epidemiological studies of Amazonian populations, and it has been attributed to a higher concern about health [ 10 ], with women self-reporting more symptoms of illness [ 33 ]. Our data about occupation, showing a high frequency of housekeepers in both regions ( Figure 2 ), confirm previous descriptions of Amazonian populations observing that women were responsible for all domestic work, in addition to child care [ 7 ].…”

“…or “dourada” (gilded catfish, Brachyplatystoma flavicans ), several times a week [ 24 , 25 ]. Human exposure to this metal has been associated with cardiovascular changes [ 52 , 53 ], and a high prevalence of NCDs, such as hypertension and DM, were recently described in these populations [ 10 ], making it even more important to monitor the nutritional status of these populations when this environmental factor is present.…”

“…Low- and middle-income countries face a rapid change in the nutrition transition toward increases in non-communicable diseases (NCDs) [ 9 ]. Dietary factors could be especially influencing the cardiovascular risk of Amazonian populations, since a recent report demonstrated a high prevalence (as high as 58%) of NCDs, such as hypertension and diabetes mellitus (DM) [ 10 ]. Interestingly, this prevalence was higher than that described for the urban population of the Amazon [ 10 ], making the evaluation of the nutritional status of the riverine population and the collection of dietary information urgent, which can support the design of tailored behavioral interventions for improving the nutritional status of this population.…”

Towards Therapeutic Alternatives for Mercury Neurotoxicity in the Amazon: Unraveling the Pre-Clinical Effects of the Superfruit Açaí (Euterpe oleracea, Mart.) as Juice for Human Consumption

“…This is due to the characteristics of these populations (precarious health care system, low purchasing power, geographical isolation, etc.) [2,5,7,8,63,72], similar to those of other vulnerable populations in the world. Thus, the use of endemic plants is a more realistic alternative for these populations to protect themselves against MeHg-induced neurotoxicity.…”