Abstract

The study evaluates the nutritional and metabolic profile of the adult population of the Xingu Indigenous Territory by gender and base hub. It was developed in 18 villages from 2017 to 2019. Anthropometry and clinical, physical examinations were conducted in loco in individuals over 18. A total of 1,598 Indigenous people were evaluated, with a mean age of 36.7 years. Of these, 50.6% were male, 53.2% lived in the Leonardo Base hub, 22.7% in Diauarum, 12.3% in Pavuru and 11.8% in Wawi. Women had a higher prevalence (p < 0.05) than men, respectively, of underweight (2.0% vs. 0.1%), normal weight (46.1% vs. 37.4%), central obesity (63.4% vs. 21 .8%), low HDL cholesterol (77.7% vs. 72.9%) and Metabolic Syndrome (29.0% vs. 23.5%). In comparison, men had a higher prevalence (p < 0.05) than women, respectively, of overweight (46.3% vs. 37.5%), high triglycerides (34.5% vs. 28.2%) and high blood pressure levels (13.1% vs. 8.6%). The Leonardo and Wawi base hubs had the worst nutritional and cardiometabolic results. Overall, subjects had a high frequency of noncommunicable diseases and cardiometabolic risk. Urgent measures need to be taken to control this situation.

Key words:
Indigenous population; Health of indigenous populations; Noncommunicable diseases; Metabolic syndrome; Nutritional assessment

Introduction

Data released by researchers at the World Health Organization (WHO)¹1 World Health Organization (WHO). Fact sheets - noncommunicable diseases [Internet]. 2022. [cited 2023 maio 19]. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
https://www.who.int/news-room/fact-sheet... in 2022 show that Noncommunicable Diseases (NCDs) were responsible for 74.0% of deaths worldwide. Despite their noncommunicable nature²2 Biblioteca Virtual em Saúde (BVS). Descritores em Ciências da Saúde - DECS/MESH. Doenças não transmissíveis [Internet]. 2023. [acessado 2023 maio 19]. Disponível em: https://tinyurl.com/dey442j9
https://tinyurl.com/dey442j9... , a true epidemic of NCDs has been observed in recent decades, mainly cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes³3 Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr; International Diabetes Federation Task Force on Epidemiology and Prevention; Hational Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120(16):1640-1645.

4 Amini M, Zayeri F, Salehi M. Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017. BMC Public Health 2021; 21(1):401.

5 GBD 2019 Diabetes in the Americas Collaborators. Burden of diabetes and hyperglycaemia in adults in the Americas, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Diabetes Endocrinol 2022; 10(9):655-667.

6 Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, Stein C, Basit A, Chan JCN, Mbanya JC, Pavkov ME, Ramachandaran A, Wild SH, James S, Herman WH, Zhang P, Bommer C, Kuo S, Boyko EJ, Magliano DJ. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 2022; 183:109119.^-77 GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396(10258):1204-1222. Erratum in: Lancet 2020; 396(10262):1562..

Among Indigenous people in 23 countries, including Brazil, social and health conditions were worse than the non-Indigenous population⁸8 Tynan M, Madden R, Bang A, Coimbra CE Jr, Pesantes MA, Amigo H, Andronov S, Armien B, Obando DA, Axelsson P, Bhatti ZS, Bhutta ZA, Bjerregaard P, Bjertness MB, Briceno-Leon R, Broderstad AR, Bustos P, Chongsuvivatwong V, Chu J, Deji, Gouda J, Harikumar R, Htay TT, Htet AS, Izugbara C, Kamaka M, King M, Kodavanti MR, Lara M, Laxmaiah A, Lema C, Taborda AM, Liabsuetrakul T, Lobanov A, Melhus M, Meshram I, Miranda JJ, Mu TT, Nagalla B, Nimmathota A, Popov AI, Poveda AM, Ram F, Reich H, Santos RV, Sein AA, Shekhar C, Sherpa LY, Skold P, Tano S, Tanywe A, Ugwu C, Ugwu F, Vapattanawong P, Wan X, Welch JR, Yang G, Yang Z, Yap L. Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study. Lancet 2016; 388(10040):131-157.. The increase in NCDs has been highlighted in the epidemiological profile of several Indigenous communities around the world and prompted researchers to analyze cardiometabolic risk factors and changes in their lifestyle, although the high prevalence of deficiency and infectious diseases persist⁸8 Tynan M, Madden R, Bang A, Coimbra CE Jr, Pesantes MA, Amigo H, Andronov S, Armien B, Obando DA, Axelsson P, Bhatti ZS, Bhutta ZA, Bjerregaard P, Bjertness MB, Briceno-Leon R, Broderstad AR, Bustos P, Chongsuvivatwong V, Chu J, Deji, Gouda J, Harikumar R, Htay TT, Htet AS, Izugbara C, Kamaka M, King M, Kodavanti MR, Lara M, Laxmaiah A, Lema C, Taborda AM, Liabsuetrakul T, Lobanov A, Melhus M, Meshram I, Miranda JJ, Mu TT, Nagalla B, Nimmathota A, Popov AI, Poveda AM, Ram F, Reich H, Santos RV, Sein AA, Shekhar C, Sherpa LY, Skold P, Tano S, Tanywe A, Ugwu C, Ugwu F, Vapattanawong P, Wan X, Welch JR, Yang G, Yang Z, Yap L. Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study. Lancet 2016; 388(10040):131-157.

9 Boaretto JD, Molena-Fernandes CA, Pimentel GGA. Estado nutricional de indígenas Kaingang e Guarani no estado do Paraná, Brasil. Cien Saude Colet 2015; 20(8):2323-2328.

10 Lagranja ES, Phojanakong P, Navarro A, Valeggia CR. Indigenous populations in transition: an evaluation of metabolic syndrome and its risk factors among the Toba of northern Argentina. Ann Hum Biol 2015; 42(1):84-90.

11 Li M, McCulloch, McDermott. Metabolic syndrome and incident coronary heart disease in Australian Indigenous populations. Obes J 2012; 20(6):1308-1312.

12 Malta DC, Stopa SR, Szwarcwald CL, Gomes NL, Silva-Júnior JB, Reis AAC. A vigilância e o monitoramento das principais doenças crônicas não transmissíveis no Brasil - Pesquisa Nacional de Saúde, 2013. Rev Bras Epidemiol 2015; 18(Supl. 2):3-16.

13 Santos KM, Tsutsui MLS, Galvão PPO, Mazzucchetti L, Rodrigues D, Gimeno SGA. Grau de atividade física e síndrome metabólica: um estudo transversal com indígenas Kisêdjê do Parque Indígena do Xingu, Brasil. Cad Saude Publica 2012; 28(12):2327-2338.

14 Kramer CK, Leitão CB, Viana LV. The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registry. Lancet 2022; 400(10368):2074-2083.

15 Alves FTA, Prates EJS, Carneiro LHP, Sá ACMGN, Pena ED, Malta DC. Mortalidade proporcional nos povos indígenas no Brasil nos anos 2000, 2010 e 2018. Saude Debate 2021; 45(130):691-706.

16 Welch JR, Ferreira AA, Tavares FG, Lucena JRM, Gomes de Oliveira MV, Santos RV, Coimbra Jr CEA. The Xavante Longitudinal Health Study in Brazil: objectives, design, and key results. Am J Hum Biol 2020; 32(2):e23339.

17 Lima JFB, Silva RAR, D'Eça Júnior A, Batista RFL, Rolim ILTP. Analysis of the mortality trend in the indigenous population of Brazil, 2000-2016. Public Health 2020; 186:87-94.^-1818 Tallman PS, Valdes-Velasquez A, Sanchez-Samaniego G. The "Double Burden of Malnutrition" in the Amazon: dietary change and drastic increases in obesity and anemia over 40 years among the Awajún. Ecol Food Nutr 2021; 61(1):20-42..

The relationship between Indigenous societies and the national society, considering different settings and historical moments, shaped behaviors and determined changes in how Indigenous peoples live and eat, mainly due to the exploitation and expropriation of their territories by agricultural, logging, and mining expansion fronts¹⁹19 Schmidt MI, Duncan BB, Azevedo e Silva G, Menezes AM, Monteiro CA, Barreto SM, Chor D, Menezes PR. Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet 2011; 377(9781):1949-1961.

20 Atix, ISA, RCA. Protocolo de consulta dos povos do Território Indígena do Xingu. Canarana: Editora Atix, ISA, RCA; 2019.

21 Welch JR, Ferreira AA, Souza MC, Coimbra CEA Jr. Food profiles of Indigenous households in Brazil: results of the First National Survey of Indigenous Peoples' Health and Nutrition. Ecol Food Nutr 2021; 60(1):4-24.

22 Welch JR, Coimbra CEA Jr. A'uw? (Xavante) views of food security in a context of monetarization of an indigenous economy in Central Brazil. PLoS One 2022; 17(2):e0264525.

23 Gimeno SGA, Rodrigues D, Pagliaro H, Cano EN, Lima EE de S, Baruzzi RG. Perfil metabólico e antropométrico de índios Aruák: Mehináku, Waurá e Yawalapití, Alto Xingu, Brasil Central, 2000/2002. Cad Saude Publica 2007; 23(8):1946-1954.

24 Gimeno SG, Rodrigues D, Canó EN, Lima EE, Schaper M, Pagliaro H, Lafer MM, Baruzzi RG. Cardiovascular risk factors among Brazilian Karib indigenous peoples: Upper Xingu, Central Brazil, 2000-3. J Epidemiol Community Health 2009; 63(4):299-304.^-2525 Mazzucchetti L, Galvão PPO, Tsutsui MLS, Santos KM, Rodrigues DA, Mendonça SB, Gimeno SG. Incidence of metabolic syndrome and related diseases in the Khisêdjê indigenous people of the Xingu, Central Brazil, from 1999-2000 to 2010-2011. Cad Saude Publica 2014; 30(11):2357-2367..

The impacts of these environmental and behavioral changes can be identified through the emergence of NCDs in Brazilian Indigenous people. Studies conducted in the country in recent decades show a rapid and progressive increase in the prevalence of obesity, dyslipidemia, systemic arterial hypertension (SAH), and metabolic syndrome (MS), revealing a high risk for cardiovascular diseases (CVD) and diabetes mellitus (DM) in both genders^{9,13,16, 23-34}. Studies with people from the Xingu Indigenous Territory (TIX) show an increase in NCDs such as obesity, reduced high-density lipoproteins (HDLc), elevated triglycerides, and even the emergence of other previously non-existent diseases such as DM¹³13 Santos KM, Tsutsui MLS, Galvão PPO, Mazzucchetti L, Rodrigues D, Gimeno SGA. Grau de atividade física e síndrome metabólica: um estudo transversal com indígenas Kisêdjê do Parque Indígena do Xingu, Brasil. Cad Saude Publica 2012; 28(12):2327-2338.^,2323 Gimeno SGA, Rodrigues D, Pagliaro H, Cano EN, Lima EE de S, Baruzzi RG. Perfil metabólico e antropométrico de índios Aruák: Mehináku, Waurá e Yawalapití, Alto Xingu, Brasil Central, 2000/2002. Cad Saude Publica 2007; 23(8):1946-1954.

24 Gimeno SG, Rodrigues D, Canó EN, Lima EE, Schaper M, Pagliaro H, Lafer MM, Baruzzi RG. Cardiovascular risk factors among Brazilian Karib indigenous peoples: Upper Xingu, Central Brazil, 2000-3. J Epidemiol Community Health 2009; 63(4):299-304.^-2525 Mazzucchetti L, Galvão PPO, Tsutsui MLS, Santos KM, Rodrigues DA, Mendonça SB, Gimeno SG. Incidence of metabolic syndrome and related diseases in the Khisêdjê indigenous people of the Xingu, Central Brazil, from 1999-2000 to 2010-2011. Cad Saude Publica 2014; 30(11):2357-2367.^,3232 Salvo VLMA, Rodrigues D, Baruzzi RG, Pagliaro H, Gimeno SGA. Perfil metabólico e antropométrico dos Suyá: Parque Indígena do Xingu, Brasil Central. Rev Bras Epidemiol 2009; 12(3):458-468.

33 Haquim VM. Perfil nutricional e metabólico de adultos do Povo Kawaiwete (Kaiabi) da aldeia Kwarujá, Parque Indígena do Xingu, Brasil [dissertação]. São Paulo: Universidade Federal de São Paulo; 2017.^-3434 Mendonça SBM. Mudança e permanência no modo de viver, comer e adoecer entre os Khisêdjê: tecendo novas práticas, saberes e significados [tese]. São Paulo: Universidade Federal de São Paulo; 2021..

Other factors have contributed to changes in how Indigenous peoples live and eat, including the monetization and diversification of their economy and the emergence of new social roles. Welch et al. documented statistically significant associations between household income, health conditions, and anthropometric measurements indicative of obesity in Xavante adults of both genders¹⁶16 Welch JR, Ferreira AA, Tavares FG, Lucena JRM, Gomes de Oliveira MV, Santos RV, Coimbra Jr CEA. The Xavante Longitudinal Health Study in Brazil: objectives, design, and key results. Am J Hum Biol 2020; 32(2):e23339.^,2222 Welch JR, Coimbra CEA Jr. A'uw? (Xavante) views of food security in a context of monetarization of an indigenous economy in Central Brazil. PLoS One 2022; 17(2):e0264525..

Government programs for income transfer and distribution of staple food baskets, generally with an inadequate composition for local diets, also encourage the consumption of industrialized and ultra-processed foods to the detriment of traditional foods, contributing to the emergence of NCDs among Indigenous peoples²¹21 Welch JR, Ferreira AA, Souza MC, Coimbra CEA Jr. Food profiles of Indigenous households in Brazil: results of the First National Survey of Indigenous Peoples' Health and Nutrition. Ecol Food Nutr 2021; 60(1):4-24.

22 Welch JR, Coimbra CEA Jr. A'uw? (Xavante) views of food security in a context of monetarization of an indigenous economy in Central Brazil. PLoS One 2022; 17(2):e0264525.

23 Gimeno SGA, Rodrigues D, Pagliaro H, Cano EN, Lima EE de S, Baruzzi RG. Perfil metabólico e antropométrico de índios Aruák: Mehináku, Waurá e Yawalapití, Alto Xingu, Brasil Central, 2000/2002. Cad Saude Publica 2007; 23(8):1946-1954.

24 Gimeno SG, Rodrigues D, Canó EN, Lima EE, Schaper M, Pagliaro H, Lafer MM, Baruzzi RG. Cardiovascular risk factors among Brazilian Karib indigenous peoples: Upper Xingu, Central Brazil, 2000-3. J Epidemiol Community Health 2009; 63(4):299-304.^-2525 Mazzucchetti L, Galvão PPO, Tsutsui MLS, Santos KM, Rodrigues DA, Mendonça SB, Gimeno SG. Incidence of metabolic syndrome and related diseases in the Khisêdjê indigenous people of the Xingu, Central Brazil, from 1999-2000 to 2010-2011. Cad Saude Publica 2014; 30(11):2357-2367..

In 2015, the United Nations (UN) proposed the establishment of “Sustainable Development Goals - SDGs” to its members, including Brazil. One target of the Health and Well-being goal is “to reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and well-being by 2030”³⁵35 Organização das Nações Unidas (ONU). Sobre o nosso trabalho para alcançar os Objetivos de Desenvolvimento Sustentável no Brasil [Internet]. 2022. [acessado 2023 maio 19]. Disponível em: https://brasil.un.org/pt-br/sdgs
https://brasil.un.org/pt-br/sdgs... . In 2021, a new “Strategic Action Plan to Combat Chronic Diseases and Noncommunicable Diseases in Brazil, 2021-2030 (Dant Plan)” was drawn up per the global and national SDGs and is in force³⁶36 Brasil. Ministério da Saúde (MS). Plano de ações estratégicas para o enfrentamento das doenças crônicas e agravos não transmissíveis no Brasil 2021-2030. Brasília: MS; 2021.. Also, in this context, in 2018, the Ministry of Health (MS) defined NCDs and studies on Indigenous populations’ health as priorities on the national health research agenda³⁷37 Brasil. Ministério da Saúde (MS). Agenda de prioridades de pesquisa do Ministério da Saúde [Internet]. 2018. [acessado 2023 maio 19]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/agenda_prioridades_pesquisa_ms.pdf
https://bvsms.saude.gov.br/bvs/publicaco... .

Considering that NCDs are the leading causes of death in the world, that they reduce the quality of life and can lead to premature deaths, that they negatively impact the socioeconomic aspects of families and communities, that they are relevant given the SDGs agreed upon by the country and the programs to combat these diseases in force; and the priority in the national research agenda on this topic and the health of Indigenous populations, we deem it is appropriate to conduct this work, whose objective was to evaluate the nutritional and metabolic profile of the TIX adult population by gender and base hub.

This research is unprecedented regarding the number and ethnic diversity of Indigenous people assessed in the TIX, besides the analysis by base hub, which is a territorial subdivision belonging to the Special Indigenous Health District (DSEI). This stratification was selected for analysis because each base hub has significant particularities, mainly the differences related to access to the territory and health services, the history of contact of each ethnic group by region, and the cultural diversity expressed in these spaces that make up the TIX; the analysis by gender was based on biological issues. The results are expected to support policies that aim to reduce NCDs in the country, especially for Indigenous peoples.

Methods

This cross-sectional observational study used primary data collected directly from the adult and older adult population of the Xingu Indigenous Territory (TIX), Mato Grosso (MT), Brazil (11°14’41.4”S 53°12’26.3”W). According to the Socio-Environmental Institute (ISA), this space has a total of 2.8 million demarcated and approved hectares²⁰20 Atix, ISA, RCA. Protocolo de consulta dos povos do Território Indígena do Xingu. Canarana: Editora Atix, ISA, RCA; 2019.. The TIX currently comprises four Indigenous Lands (TI): the Xingu Indigenous Park TI, Wawi TI, Batovi TI, and Pequizal do Naruvotu TI²⁰20 Atix, ISA, RCA. Protocolo de consulta dos povos do Território Indígena do Xingu. Canarana: Editora Atix, ISA, RCA; 2019.. In 2017, the TIX was home to 93 villages and 16 ethnic groups, totaling 6,616 individuals, of which 3,025 were aged 18 or over³⁸38 Brasil. Ministério da Saúde (MS). Censo populacional 2017. Canarana: MS; 2017..

This territory is divided into four regions: Alto, Médio, Baixo, and Leste Xingu. Each region has a base hub, a “territorial subdivision of the DSEI, serving as the base for the Multidisciplinary Indigenous Health Teams to organize technically and administratively the healthcare of the assigned Indigenous population”³⁹39 Brasil. Ministério da Saúde (MS). Portaria nº 1.317, de 3 de agosto de 2017. Adequa o registro das informações relativas a estabelecimentos que realizam ações de Atenção à Saúde para populações indígenas no CNES. Diário Oficial da União 2017; 4 ago. (art. 2, III). The TIX base hubs are: Diauarum (Baixo Xingu), Leonardo (Alto Xingu), Pavuru (Médio Xingu), and Wawi (Leste Xingu). Each ethnic group has particularities related to the history of contact with the surrounding society, interactions with other Indigenous peoples, access to surrounding municipalities, and traditional rules and knowledge, agricultural technologies, mother tongue, among other specificities⁴⁰40 Baruzzi RG, Junqueira C. Parque Indígena do Xingu: saúde, cultura e história. São Paulo: Terra Virgem; 2005..

This work was conducted in 18 villages and included all ethnic groups from 2017 to 2019 during four annual trips. The villages were selected based on the most significant number of residents and ethnic diversity, with no probabilistic sampling process or even a search for a sample representative of the TIX. However, we aimed to continue with on-site assessments in other villages, but the COVID-19 pandemic hampered this process.

At the time of assessments, adults over 18 of both genders in the villages who agreed to participate in the research were evaluated. The exclusion criteria were being pregnant, not having weight or height measurements, and not having at least 80% of the clinical exams available. Data were collected from 1,612 Indigenous people, but 1,598 were included considering the exposed eligibility criteria, representing a sample of 52.8% against the total available for the age group (n = 3,025). Figure 1 shows the villages evaluated in the TIX.

The primary project for this study was developed with two components: one with an epidemiological focus and the other with an ethnographic nature, conducted with participant observation techniques, individual and collective interviews, home visits, discussion groups, and cooking workshops, together with the systematized researchers’ experiences. Only epidemiological data were used for this manuscript.

The physical examinations, including anthropometry and clinical tests, were performed in the villages by professionals adequately trained for such tasks. The research team comprised doctors, nurses, nutritionists, dentists, medical and nursing students, Indigenous health and sanitation workers, nursing technicians, Indigenous teachers, and educators.

Sociodemographic information on the name, sex, and age of the Indigenous people was obtained through the demographic census provided by the DSEI Xingu. Anthropometric measurements (weight and height) were performed in duplicate and followed the procedures recommended by the WHO⁴¹41 World Health Organization (WHO). Physical status: the use and interpretation of anthropometry, report of a WHO Expert Committee. Geneva: WHO; 1995.. A portable electronic scale (KRATOS-CAS) with a maximum capacity of 150 kg and a scale of 50g was used to measure body weight (kg). All individuals wore light clothing and were barefoot during the assessment.

A portable stadiometer with a platform from AlturaExata, with a scale from 1 mm to 213 cm, was employed to measure height. The mobile part of the stadiometer was positioned at the highest point of the individual’s head, with the arms extended along the body, the heels and knees together, and the body and head in contact with the measuring ruler.

The body mass index (BMI) was obtained using the formula of weight divided by height squared. WHO criteria⁴¹41 World Health Organization (WHO). Physical status: the use and interpretation of anthropometry, report of a WHO Expert Committee. Geneva: WHO; 1995. were adopted to assess nutritional status, which classifies BMI as underweight (BMI < 18.5 kg/m²), eutrophy (BMI ≥ 18.5 and < 25.0 kg/m²), overweight (BMI ≥ 25.0 and < 30.0 kg/m²), and obesity (BMI ≥ 30.0 ​​kg/m²).

Abdominal circumference (AC) was measured with an inelastic anthropometric tape measure at the midpoint between the lower edge of the last rib and the upper edge of the iliac crest⁴¹41 World Health Organization (WHO). Physical status: the use and interpretation of anthropometry, report of a WHO Expert Committee. Geneva: WHO; 1995.. Central obesity (CO) was characterized by AC values ​​greater than 94 cm and 80 cm for men and women, respectively⁴²42 Zimmet P, Magliano D, Matsuzawa Y, Alberti G, Shaw J. The metabolic syndrome: a global public health problem and a new definition. J Atheroscler Thromb 2005; 12(6):295-300.^,4343 World Health Organization (WHO). Obesity: preventing and managing the global epidemic: report of a WHO Consultation. Geneva: WHO; 2000..

The lipid profile [total cholesterol (TC), high-density lipoprotein (HDLc), low-density lipoprotein (LDL-c), and triglycerides (TG)] and fasting glucose (FG) were determined by the fingerstick method of capillary blood collection using the portable automated equipment Cholestech LDX (Alere, Waltham, MA - USA) through reflectance photometry. TC concentrations > 200 mg/dL or TG > 150 mg/dL or LDLc > 130 mg/dL or HDLc < 40 mg/dL for men and < 50 mg/dL for women were considered altered⁴³43 World Health Organization (WHO). Obesity: preventing and managing the global epidemic: report of a WHO Consultation. Geneva: WHO; 2000.^,4444 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285(19):2486-2497..

In order to classify individuals according to their level of glucose tolerance, individuals with FBG <100 mg/dL were considered normal, individuals with altered FBG (pre-diabetics) were those with values ​​between ≥ 100 and < 126 mg/dL, and diabetics with FBG ≥ 126 mg/dL³3 Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr; International Diabetes Federation Task Force on Epidemiology and Prevention; Hational Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120(16):1640-1645.^,4545 Rodacki M, Cobas RA, Zajdenverg L, Silva Júnior WS, Giacaglia L, Calliari LE, Noronha RM, Valerio C, Custódio J, Scharf M, Barcellos CRG, Almeida-Pititto B, Negrato CA, Gabbay M, Bertoluci M. Diagnóstico do diabetes e rastreamento do diabetes tipo 2. Diretriz Oficial da Sociedade Brasileira de Diabetes 2022; DOI: 10.29327/5412848.2024-1
https://doi.org/10.29327/5412848.2024-1... .

Systolic blood pressure (SBP) and diastolic blood pressure (DBP) values ​​were measured using an automatic arm monitor (model HEM 741C-INT; OMRON, China). For the classification of blood pressure (BP) clinically, SBP < 140 mmHg and DBP < 90 mmHg were considered normal, and SBP ≥ 140 mmHg or DBP ≥ 90 mmHg were considered high blood pressure levels⁴⁶46 Barroso WKS, Rodrigues CIS, Bortolotto LA, Mota-Gomes MA, Brandão AA, Feitosa AD, Machado CA, Poli-de-Figueiredo CE, Forjaz CLM, Amodeo C, Mion Júnior D, Nobre F, Pio-Abreu A, Pierin AMG, Nilson EAF, Cesarino EJ, Marques F, Baptista FS, Silva GV, Almeida MQ, Klein MRST, Koch VHK. Diretrizes Brasileiras de Hipertensão Arterial - 2020. Arq Bras Cardiol 2021; 116(3):516-568.. To evaluate MS criteria, SBP ≥ 130 mmHg or DBP ≥ 85 mmHg were considered high blood pressure levels³3 Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr; International Diabetes Federation Task Force on Epidemiology and Prevention; Hational Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120(16):1640-1645..

MS was identified under the diagnostic criteria defined by Alberti et al.³3 Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr; International Diabetes Federation Task Force on Epidemiology and Prevention; Hational Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120(16):1640-1645.. The syndrome’s diagnosis occurred in the presence of at least three of the following components: increased abdominal circumference, high fasting glucose, high blood pressure levels, reduced high-density lipoproteins and high triglycerides; and the use of medication to treat the pathologies mentioned characterize its diagnosis.

The data description used absolute (n) and relative (%) frequencies for qualitative variables and measures of central tendency and dispersion for quantitative variables. Normality was identified by the Shapiro-Wilk test. Pearson’s chi-square test of independence assessed the association; the post hoc residual analysis with Bonferroni adjustment and the Z test were used⁴⁷47 Sharpe D. Chi-square test is statistically significant: now what? Pract Assess Res Evaluation 2015; 20(8):1-10.^,4848 MacDonald, P. L., Gardner, R. C. (2000). Type I error rate comparisons of post hoc procedures for I × J chi-square tables. Educ Psychological Measurement 2000; 60(5):735-754. in contingency tables greater than 2 x 2, where statistical significance was identified. Student’s t-test was used to compare the means by gender, and Analysis of Variance (ANOVA) was employed to evaluate the base hub with the Bonferroni post hoc test. The significance level used in the research was 5% (p < 0.05). The prevalence per point and interval with 95% confidence were calculated for the nutritional status variables and altered metabolic diseases. The Excel program was adopted to prepare the database, and the SPSS 20.0 software (IBM®) was used for data analysis.

This study is nested in the project “New health problems: Assessment of the Nutritional and Metabolic Profile of Indigenous People in the Xingu Indigenous Territory”, developed by the Xingu Project, an extension program of the Paulista School of Medicine of the Federal University of São Paulo, which has been developing healthcare, research and teaching activities in the Xingu Indigenous Territory (TIX) since 1965⁴⁰40 Baruzzi RG, Junqueira C. Parque Indígena do Xingu: saúde, cultura e história. São Paulo: Terra Virgem; 2005..

The planning phase was conducted through meetings with the participation of several leaders and social stakeholders from each community. Indigenous Health Workers and teachers from each community participated in the entire process of implementing the project and translating it into their native language, with the participants’ consent. The preliminary results were consolidated, presented, and discussed with the community during the research. All diagnosed alterations were discussed with the medical team and each patient for appropriate therapeutic referral.

The results were sent to and discussed with the Xingu Special Indigenous Health District. This study was approved by the National Research Ethics Commission (CONEP) CAAE: 65147817.4.0000.5505 and UNIFESP Human Research Ethics Committee (CEP) (nº 0140.0088.02-2017 and 2.185.654).

Results

In this study, a total of 1,598 Indigenous people were evaluated; 850 lived in Leonardo, 363 in Diauarum, 197 in Pavuru, and 188 in Wawi. Fifteen ethnic groups were identified, the most frequent being Kaiabi, Kamaiurá, and Kisêdjê. Table 1 shows that the most frequent ethnic groups in Diauarum were Kaiabi and Yudja; in Leonardo, they were Kamaiurá and Kuikuro; in Pavuru, they were Ikpeng and Trumai; and in Wawi, they were Kisêdjê and Kamaiurá.

The evaluation of ethnic groups by gender identified 808 (50.6%) men and 790 (49.4%) women. Among females, the most frequent ethnic groups were Kaiabi and Kamaiurá; among males, they were Kaiabi and Kisêdjê. The base hub with the most significant ethnic diversity was Leonardo (11; 73.3%), and the one with the least was Diauarum (4; 26.7%). The Wawi base hub (57.7%) had the highest frequency of individuals evaluated compared to the population eligible for the research.

The mean age of the 1,598 individuals evaluated was 36.7 years (SD: 15.3 years and ranged from 18.0 to 87.1 years). There was no statistically significant difference in mean age between genders (p = 0.3103), female (Mean: 36.3 years; SD: 15.1 years) and male (Mean: 37.1 years; SD: 15.5 years), and between the base hubs (p = 0.229), Diauarum (Mean 36.1 years; SD: 16.3 years), Leonardo (Mean: 37.2 years; SD: 15.0 years), Pavuru (Mean: 35.4 years; SD: 14.8 years) and Wawi (Mean: 37.0 years; SD: 15.3 years). Figure 2 shows that the most frequent age group among those evaluated was 20 to 29 years (35.2%); the age groups were similar in the distribution by gender.

The prevalence of changes in nutritional status among those evaluated was 1.1% (95%CI 0.6-1.7%) underweight; 41.9% (95%CI 39.5-44.4%) overweight; 15.3% (95%CI 13.6-17.2%) obesity. Metabolic changes were 42.4% (95%CI 39.9-44.8%) central obesity; 22.8% (95%CI 20.8-25.0%) high total cholesterol; 31.4% (95%CI 29.1-33.8%) high triglycerides; 75.3% (95%CI 73.1-77.4%) low HDLc; 24.5% (95%CI 22.3-26.8%) high LDLc; 9.9% (95%CI 8.5-11.5%) prediabetes; 2.1% (95%CI 1.5-3.0%) DM; 10.9% (95%CI 9.4-12.5%) high blood pressure levels and 26.2% (95%CI 24.2-28.4%) MS.

Table 2 shows the prevalence rates of nutritional status and metabolic diseases by gender. Women had a higher prevalence (p < 0.05) than men of underweight, normal weight, central obesity, low HDLc, and MS. Men showed a higher prevalence (p < 0.05) than women of overweight, high triglycerides, and high blood pressure levels.

Table 3 shows the prevalence rates related to nutritional status and metabolic diseases by base hub, and only the variables of high total cholesterol and LDLc did not show a statistically significant association (p > 0.05). The Leonardo hub had a higher frequency (p < 0.05) of overweight (Leonardo 45.3% vs. Pavuru 31.4%), obesity (19.8% vs. Diauarum 9.6% vs. Pavuru 5.6%), central obesity (48.7% vs. Diauarum 36.4% vs. Pavuru 27.9%), high triglycerides (31.4% vs. Pavuru 23.8%), prediabetes (12.8% vs. Diauarum 4.5%) and MS (28.8% vs. Pavuru 19.3%). At the Wawi base hub, a higher frequency of obesity (16.5% vs. Diauarum 9.6% vs. Pavuru 5.6%), high triglycerides (44.9% vs. Leonardo 31.4% vs. Diauarum 28.1% vs. Pavuru 23.8%), low HDLc (89.1% vs. Leonardo 71.7% vs. Diauarum 70.8%) was observed than the others. Pavuru showed a higher frequency of underweight (3.1% vs. Leonardo 0.2%), low HDLc (86.2% vs. Leonardo 71.7% vs. Diauarum 70.8%) and prediabetes (10.6% vs. Diauarum 4.5%). Diauarum had a higher frequency of high blood pressure levels (16.3% vs. Leonardo 9.5% vs. Wawi 8.0%), and it was the base hub with the lowest NCD frequencies.

Discussion

Studies with different ethnic groups of the TIX have been conducted to understand health conditions over the years. The first one, identified in 1964⁴⁹49 Pazzanese D, Ramos OL, Lanfranchi W, Portugal OP, Finatti AA, Barreto HP, Sustovich DR. Serum-lipid levels in a Brazilian Indian population. Lancet 1964; 2(7360):615-617., aimed to evaluate the prevalence of atherosclerosis in 53 Indigenous people from the Tupi, Gê, Arawak, and Caraibas (sic) ethnic groups and showed that the levels of lipid fractions were lower than any other reported for Indigenous adults and much lower than non-Indigenous people. All lipid fractions were significantly higher in women, with no evidence of atherosclerosis. The Indigenous people did not show malnutrition, and men had good muscle development.

In 1981, Baruzzi and Franco⁵⁰50 Baruzzi R, Franco L. Amerindians of Brazil. In: Trowel HC, Burkitt DP, editors. Western diseases: their emergence and prevention. Cambridge: Harvard University Press; 1981. p. 138-153. assessed 392 Indigenous people from the TIX. They found that the highest average weight and height were among the Suya, Txukahamaye, and Kren-akarore peoples (eastern Xingu), and the lowest means were among the Kaiabi peoples (lower Xingu). Men had little subcutaneous fat and good muscle development. Hypertension was rare and did not increase with age. These results were related to constant physical activity, preservation of a traditional diet, and low stress levels.

In 1989, an international multicenter study called INTERSALT⁵¹51 Carvalho JJ, Baruzzi RG, Howard PF, Poulter N, Alpers MP, Franco LJ, Marcopito LF, Spooner VJ, DyerAR, Elliott P. Blood pressure in four remote populations in the INTERSALT Study. Hypertension 1989; 14(3):238-246. included a sample of ten ethnic groups from the TIX (n = 198) and did not identify any overweight cases. Women showed a mean BMI of 22.6 kg/m² and men 24.2 kg/m². Regarding hypertension, they found a frequency of 1.0%, with no increase in blood pressure with age.

In 2007, among the 201 Indigenous people of the Aruak group (Mehinaku, Waurá, and Yawalapiti) (upper Xingu), prevalence rates of 51.8% overweight, 15.0% obesity, 52.1% central obesity, 77.1% dyslipidemia, 6.7% changes in blood pressure levels, 4.9% altered fasting glucose, and no DM²³23 Gimeno SGA, Rodrigues D, Pagliaro H, Cano EN, Lima EE de S, Baruzzi RG. Perfil metabólico e antropométrico de índios Aruák: Mehináku, Waurá e Yawalapití, Alto Xingu, Brasil Central, 2000/2002. Cad Saude Publica 2007; 23(8):1946-1954. were observed.

In 2009, among the 251 Indigenous people from the Karib group (Kalapalo, Kuikuro, Matipu, Nahukuá) (upper Xingu), the prevalence of overweight was 39.3%, obesity 6.8%, central obesity 41.8%, high total cholesterol 20.8%, low HDLc 48.0%, high LDLc 20.4%, high triglycerides 23.4%, changes in blood pressure levels 2.6%, altered fasting glucose 5.5%, without DM and MS 15.5%²⁴24 Gimeno SG, Rodrigues D, Canó EN, Lima EE, Schaper M, Pagliaro H, Lafer MM, Baruzzi RG. Cardiovascular risk factors among Brazilian Karib indigenous peoples: Upper Xingu, Central Brazil, 2000-3. J Epidemiol Community Health 2009; 63(4):299-304..

In 2009, 86 Indigenous people among the Kisêdjê (Suyá) people (eastern Xingu) were evaluated, and 33.7% were overweight, 12.8% were obese, 38.4% had central obesity, 3.5% had altered blood pressure levels, 63.9% had dyslipidemia, 4.0% had altered fasting glucose levels, without DM, and 21.9% had MS³²32 Salvo VLMA, Rodrigues D, Baruzzi RG, Pagliaro H, Gimeno SGA. Perfil metabólico e antropométrico dos Suyá: Parque Indígena do Xingu, Brasil Central. Rev Bras Epidemiol 2009; 12(3):458-468..

In the following decade, a new study was conducted with the Khisêdjê people, and we identified unprecedented incidence measures in the TIX. Among the 78 Indigenous people evaluated simultaneously in 1999/2000 and 2010/2011, we observed the cumulative incidence of 30.4% of overweight, 32.0% of central obesity, 29.1% of high total cholesterol, 25.0% of low HDLc, 10.4% of high LDLc, 47.4% of high triglycerides, 38.9% of hypertension, 2.9% of type 2 DM, and 37.5% of MS was observed. Unlike what was found by Baruzzi and Franco⁵⁰50 Baruzzi R, Franco L. Amerindians of Brazil. In: Trowel HC, Burkitt DP, editors. Western diseases: their emergence and prevention. Cambridge: Harvard University Press; 1981. p. 138-153. and Pazzanese et al.⁴⁹49 Pazzanese D, Ramos OL, Lanfranchi W, Portugal OP, Finatti AA, Barreto HP, Sustovich DR. Serum-lipid levels in a Brazilian Indian population. Lancet 1964; 2(7360):615-617., age was identified as a risk factor for the incidence of hypertension, DM, and high LDLc, regardless of gender²⁵25 Mazzucchetti L, Galvão PPO, Tsutsui MLS, Santos KM, Rodrigues DA, Mendonça SB, Gimeno SG. Incidence of metabolic syndrome and related diseases in the Khisêdjê indigenous people of the Xingu, Central Brazil, from 1999-2000 to 2010-2011. Cad Saude Publica 2014; 30(11):2357-2367.. Still, regarding the Khisêdjê, two other studies evaluated the Indigenous people’s physical conditions and had satisfactory cardiometabolic results¹³13 Santos KM, Tsutsui MLS, Galvão PPO, Mazzucchetti L, Rodrigues D, Gimeno SGA. Grau de atividade física e síndrome metabólica: um estudo transversal com indígenas Kisêdjê do Parque Indígena do Xingu, Brasil. Cad Saude Publica 2012; 28(12):2327-2338.^,5252 Tsutsui MLS, Santos KM dos, Mazzucchetti L, Galvão PPO, Rodrigues DR, Maia RRP. Aptidão física e estado nutricional dos indígenas Khisêdjê. Parque Indígena do Xingu. DeC Foco 2017; 1(2):5-26..

In 2013, among the Kawaiwete (lower Xingu) (n=62), 35.5% were overweight, 4.8% were obese, 58.1% had central obesity, 22.5% had high total cholesterol, 67.7% had low HDLc, 29.0% had high LDLc, 17.7% had high triglycerides, 25.8% had altered fasting glucose, 24.2% had high blood pressure, and 25.8% had MS³³33 Haquim VM. Perfil nutricional e metabólico de adultos do Povo Kawaiwete (Kaiabi) da aldeia Kwarujá, Parque Indígena do Xingu, Brasil [dissertação]. São Paulo: Universidade Federal de São Paulo; 2017..

Like the present research, the studies mentioned above published between 2007 and 2017¹³13 Santos KM, Tsutsui MLS, Galvão PPO, Mazzucchetti L, Rodrigues D, Gimeno SGA. Grau de atividade física e síndrome metabólica: um estudo transversal com indígenas Kisêdjê do Parque Indígena do Xingu, Brasil. Cad Saude Publica 2012; 28(12):2327-2338.^,2323 Gimeno SGA, Rodrigues D, Pagliaro H, Cano EN, Lima EE de S, Baruzzi RG. Perfil metabólico e antropométrico de índios Aruák: Mehináku, Waurá e Yawalapití, Alto Xingu, Brasil Central, 2000/2002. Cad Saude Publica 2007; 23(8):1946-1954.

24 Gimeno SG, Rodrigues D, Canó EN, Lima EE, Schaper M, Pagliaro H, Lafer MM, Baruzzi RG. Cardiovascular risk factors among Brazilian Karib indigenous peoples: Upper Xingu, Central Brazil, 2000-3. J Epidemiol Community Health 2009; 63(4):299-304.^-2525 Mazzucchetti L, Galvão PPO, Tsutsui MLS, Santos KM, Rodrigues DA, Mendonça SB, Gimeno SG. Incidence of metabolic syndrome and related diseases in the Khisêdjê indigenous people of the Xingu, Central Brazil, from 1999-2000 to 2010-2011. Cad Saude Publica 2014; 30(11):2357-2367.^,3232 Salvo VLMA, Rodrigues D, Baruzzi RG, Pagliaro H, Gimeno SGA. Perfil metabólico e antropométrico dos Suyá: Parque Indígena do Xingu, Brasil Central. Rev Bras Epidemiol 2009; 12(3):458-468.^,3333 Haquim VM. Perfil nutricional e metabólico de adultos do Povo Kawaiwete (Kaiabi) da aldeia Kwarujá, Parque Indígena do Xingu, Brasil [dissertação]. São Paulo: Universidade Federal de São Paulo; 2017.^,5252 Tsutsui MLS, Santos KM dos, Mazzucchetti L, Galvão PPO, Rodrigues DR, Maia RRP. Aptidão física e estado nutricional dos indígenas Khisêdjê. Parque Indígena do Xingu. DeC Foco 2017; 1(2):5-26., with different Indigenous ethnic groups from Xingu, identified an increased prevalence of NCDs and, consequently, a deteriorated cardiometabolic profile, when considering the studies published between 1964 and 1986⁴⁹49 Pazzanese D, Ramos OL, Lanfranchi W, Portugal OP, Finatti AA, Barreto HP, Sustovich DR. Serum-lipid levels in a Brazilian Indian population. Lancet 1964; 2(7360):615-617.

50 Baruzzi R, Franco L. Amerindians of Brazil. In: Trowel HC, Burkitt DP, editors. Western diseases: their emergence and prevention. Cambridge: Harvard University Press; 1981. p. 138-153.^-5151 Carvalho JJ, Baruzzi RG, Howard PF, Poulter N, Alpers MP, Franco LJ, Marcopito LF, Spooner VJ, DyerAR, Elliott P. Blood pressure in four remote populations in the INTERSALT Study. Hypertension 1989; 14(3):238-246..

Comparing studies conducted with other Indigenous peoples requires great care due to the different criteria and samples. However, a systematic review and meta-analysis published in 2022 evaluated the impact of urbanization on the cardiometabolic health of Indigenous Brazilians and, considering its scope, could serve as a reference parameter. The research included 46 studies, with a total of 20,574 Indigenous people from at least 33 ethnicities and found for the total population and for the Midwest (MW), where the TIX is located, respectively, 57.0% and 64.0% of excess weight (overweight + obesity); 18.0% and 23.0% of obesity; 58.0% and 58.0% of central obesity; 31.0% (MW without information) of high triglycerides; 53.0% (MW without information) of low HDLc; 40.0% (MW without information) of dyslipidemia; 23.0% and 24.0% of prediabetes (altered fasting glucose); 5.0% and 8.0% of DM; and 11.0% and 19.0% of high blood pressure levels. The prevalence of obesity among Indigenous people living in urbanized areas was 3.5 times that identified among those living in native lands (28.0% vs. 8.0%, respectively). The authors also found that, between 1997 and 2019, the crude cardiovascular mortality rate of Indigenous people living in the Southeast (more urbanized) was 2.5 times that observed among residents of the North (less urbanized) (1,942 vs. 758 cases for every 100,000 inhabitants, respectively), with the same pattern identified in the standardized rates. Finally, the authors conclude that changes in the traditional way of life of Indigenous people, especially those related to urbanization, are associated with a higher prevalence and risk of adverse cardiovascular events¹⁴14 Kramer CK, Leitão CB, Viana LV. The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registry. Lancet 2022; 400(10368):2074-2083.. These results corroborate those found in this TIX research and reinforce the need to analyze the specificities of each region and ethnic group.

The analyses by gender of the TIX show a troubling cardiometabolic profile, and it is not possible to single out one of them as less affected. Regarding the analyses by base hub, the differences in the frequencies of NCDs stand out. The Leonardo and Wawi base hubs showed worse metabolic indicators than Pavuru and Diauarum. Diauarum had the lowest frequencies of indicators and NCDs. These differences may be related to factors such as more frequent access to cities, non-traditional foods, reduced physical activity patterns, and socioeconomic and environmental changes that TIX communities have been experiencing in recent decades¹⁶16 Welch JR, Ferreira AA, Tavares FG, Lucena JRM, Gomes de Oliveira MV, Santos RV, Coimbra Jr CEA. The Xavante Longitudinal Health Study in Brazil: objectives, design, and key results. Am J Hum Biol 2020; 32(2):e23339.^,2121 Welch JR, Ferreira AA, Souza MC, Coimbra CEA Jr. Food profiles of Indigenous households in Brazil: results of the First National Survey of Indigenous Peoples' Health and Nutrition. Ecol Food Nutr 2021; 60(1):4-24.^,3434 Mendonça SBM. Mudança e permanência no modo de viver, comer e adoecer entre os Khisêdjê: tecendo novas práticas, saberes e significados [tese]. São Paulo: Universidade Federal de São Paulo; 2021.. However, further studies are needed to identify associations between factors implicated in the increase in NCDs by region and ethnicity.

A study published in 2021 with Indigenous people from the Kisêdjê ethnic group highlights that, besides identifying NCDs, it is essential to associate them with the meaning of these diseases for each population. Implementing collective strategies based on participatory or collaborative methodologies, ensuring dialogue and interconnection between concepts, practices, and knowledge, can mobilize processes to reverse many health problems. This requires the involvement and implication of all subjects in producing health, prevention, and the possibility of changing the course of these new diseases³⁴34 Mendonça SBM. Mudança e permanência no modo de viver, comer e adoecer entre os Khisêdjê: tecendo novas práticas, saberes e significados [tese]. São Paulo: Universidade Federal de São Paulo; 2021..

The studies above show a continuous growth trend in health problems related to chronic and noncommunicable conditions in the TIX over the years. Urban growth and growing surrounding roads, the deteriorated food insecurity during the COVID-19 pandemic, and changes in lifestyle and eating habits may signal an even more severe outlook in the coming years. Monitoring this health situation is essential.

One limitation of this study is that data do not allow in-depth discussion of the determinants and factors influencing the increase in NCDs. The qualitative data collected but not analyzed in this study may help to understand these determinants a posteriori. The second issue refers to the collection of data from 52.8% of the Indigenous people of the TIX, which could be minimized by evaluating the 95%CI of the outcomes of interest, which showed for the population values ​​very close to those identified at the time.

As a strength, this is the most extensive study with Indigenous people from the TIX. The analysis by base hub identified relevant differences in the profile of NCDs in the same Indigenous territory. The results are similar to the realities of other territories and contribute to a greater understanding of the epidemiological transformations and vulnerability Brazilian Indigenous peoples experience.

In macropolitics, in 2023, the creation of a Ministry for Indigenous Peoples and the restructuring of the National Foundation for Indigenous Peoples (FUNAI) were significant achievements to resume protection of Indigenous territories after several years of attacks on Indigenous rights achieved and guaranteed by the Federal Constitution. Since these issues require an intersectoral approach, all institutions involved in the care of the people living in the TIX must structure territorial protection actions, including actions for the management and valorization of traditional foods.

Regarding the health sector, besides studies such as this one, which seek a better understanding and visibility of NCDs in this territory, proposals related to the training of multidisciplinary teams on how to tackle these issues in the territory and constant dialogue with communities must be continued in the TIX. Organizing workshops to promote traditional food and the appropriate use of non-traditional foods are also some successful strategies for the communities in this territory. We should underscore that the health surveillance model becomes essential in this territory to address this complex issue, and the information produced in this study will assist in planning and evaluating the services of the Xingu DSEI, identifying priorities and strategies more relevant to the reality.

Finally, we would like to answer the question “How long will Indigenous people, in intermittent contact with non-Indigenous people, be able to maintain their traditional characteristics of food, health, and life?” posed in 1981⁵⁰50 Baruzzi R, Franco L. Amerindians of Brazil. In: Trowel HC, Burkitt DP, editors. Western diseases: their emergence and prevention. Cambridge: Harvard University Press; 1981. p. 138-153. by two pioneering authors in Indigenous health care, Roberto Baruzzi and Laércio Franco - in memoriam. Unfortunately, this situation has changed significantly and resulted in significant losses over approximately four decades. Public policies that recognize the right of Indigenous people to their lands and protect their traditional way of life need to be implemented urgently so that this health situation identified can be controlled and the harm to the native peoples of this land can be minimized.

References

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History