Chronic diseases increase among Xingu indigenous people

Once rare or inexistent, these diseases are now increasing in prevalence at alarming rates among the Khisêdjê people.

By Noêmia Lopes

Agência FAPESP – Malaria, respiratory infections and diarrhea were the main causes of death in the Indigenous Xingu Park (PIX) in Mato Grosso in 1965, when the São Paulo Medical School (EPM), now part of Universidade Federal de São Paulo (UNIFESP), began to provide health care to the indigenous people who live there.

Malaria is now under control, and although infectious and parasitic diseases are still relevant in terms of mortality, chronic non-transmissible diseases such as hypertension, glucose intolerance and dyslipidemia (an abnormal increase in lipid levels in the blood) are becoming more common.
 
Given this situation, from 2010 to 2011, researchers from EPM/UNIFESP examined and interviewed 179 Khisêdjê Indians who were residents of the central area of the Xingu park in Mato Grosso.

An analysis of the results showed a 10.3% prevalence of arterial hypertension in both sexes, with 18.7% of women and 53% of men presenting worrisome levels of arterial pressure.

“For arterial pressure values equal to or above 140/90 mmHg, which are indicators of hypertension, the research found prevalence rates of 22.3% to 43.9% in the general population of Brazil,” said Suely Godoy Agostinho Gimeno, a coordinator of study on the Khisêdjê and a researcher at the EPM/UNIFESP’s Department of Preventative Medicine and the São Paulo State Secretariat’s Health Institute.

The study on the Khisêdjê was partly conducted with funding from FAPESP and Project Xingu, an initiative of the Health and Environment Unit of the EPM/UNIFESP’s Preventive Health Department.

The Khisêdjê are experiencing hypertension rates as high as those of other Brazilians, but the situation is delicate because this condition was rare or inexistent in Brazilian villages only a few decades ago.

Glucose intolerance was identified in 30.5% of women (6.9% of the total with diabetes mellitus) and 17% of men (2% of the total with diabetes mellitus). Additionally, dyslipidemia was detected in 84.4% of participants of both sexes.

“We examined the Khisêdjê previously, from 1999 to 2000. Comparing the data from that time with data from the most recent studies, we saw a significant increase in the prevalence of all non-transmissible chronic diseases. Other studies revealed that the same increase applies to other indigenous people in the Xingu region and other areas of the country,” commented Gimeno.

According to the researcher, among the factors that have been transforming the health of Indians are greater proximity to urban centers and intensification of contact with non-indigenous society. Changes include the incorporation of new habits and customs; an increase in the number of individuals who engage in paid professional activities, abandoning traditional subsistence practices, such as agriculture, hunting and fishing; and greater access to consumer goods, such as processed food, electronics and motor boats (which do not require rowing).

The results of the examinations were conveyed to the Khisêdjê individually and in groups, and the UNIFESP health team is monitoring the cases that need medical attention.

Still, the situation worries researchers because disease control requires conditions that are not always available in the villages, such as refrigeration (for insulin), controlled dosage and scheduling for medicine and regular control of glycemia and arterial pressure. According to Gimeno, “stimulating and guaranteeing the preservation of the habits and customs of these peoples would be the best preventive measures.”

Excess weight

Data collection in an effort to outline the nutritional and metabolic profiles of the Khisêdjê was performed over several different periods in 2010 and 2011, when the researchers spent between 15 and 20 days in Ngojwere, the main Khisêdjê village.

The information collected included arm, waist and hip measurements; height; body mass composition (water, lean mass and fatty mass); arterial pressure; biochemical profiles (through exams such as glycemia testing); physical conditions; socioeconomic conditions; eating habits; and agricultural practices.

Another result of this analysis is the prevalence of excess weight (overweight or obese status): 36% among women and 56.8% among men.

“We observed that particularly among the men, the prevalence is due to a greater quantity of muscle mass and not fatty tissue. These data suggest that for the population in question, the identification criteria for overweight individuals are not adequate because these people are muscular, not obese,” said Gimeno.

This conclusion, according to the researcher, is corroborated by physical aptitude tests. “The majority of values reveal muscular strength in the lower extremities, muscular resistance in the upper extremities, flexibility and high cardiorespiratory capacity. Compared with the non-indigenous population, the Khisêdjê have an active or very active profile, contradicting the idea that sedentarism should be associated with the diseases investigated,” she added.

One hypothesis (which has not been empirically proven) that could explain the controversy is that in the past, these Indians were much more active than now. This possible reduction in habitual physical activity could be related to the chronic illnesses.

The team and repercussions

Three doctors, four nurses, five nutritionists, two physical educators, one sociologist and four graduate students (in medicine and nursing) participated in the study though UNIFESP.

Also participating in the team were another nutritionist from the São Paulo State Secretariat’s Health Institute, health agents and indigenous professors who live in the village of Ngojwere and served as interpreters.

The project resulted in six presentations at international conferences and two national summits, three master’s theses and an article published in Cadernos de Saúde Pública, which can be read at www.scielosp.org/pdf/csp/v28n12/11.pdf (in Portuguese).