From degeneration to infection/inflammation,

From degeneration to infection/inflammation,
and from individual-centered to ecologic
approaches to investigation of evolving patterns
of diseases occurrences in populations
Da degeneração à infecção e da abordagem centrada
no indivíduo à investigação ecológica dos padrões
de ocorrência de enfermidades nas populações
Maria Inês Reinert Azambuja
Abstract Variation in attributes of CHD cases
over time suggests a temporal change in the source
sub-population of cases. It is proposed that an
early 20th century expansion of a CHD-prone
sub-population, characterized by high-serum cholesterol
phenotype and high case-fatality – and
which contributed with most of the CHD cases
and deaths during the 1960s – may have followed
the 1918 Influenza Pandemic. The extinction of
those birth-cohorts would have resulted in a relative
increase in cases coming from a second source
sub-population, characterized by insulin resistance
and chronic expression of low grade inflammation
markers, comparatively less vulnerable to
acutely die from CHD. This re-interpretation of
the CHD trend, and the abandonment of the idea
of degeneration for inflammation/infection calls
for a change in epidemiology. Besides exposures
(diet, infection...), temporal variations in proportional
representations of inherited and acquired
phenotypes associated with individual resistance/
vulnerability, would be important determinants
of evolving patterns of diseases occurrences
in populations...............