Physical activity patterns among adolescents in Latin America and the Caribbean region.

BACKGROUND: Physical activity implies different patterns, but many studies have focused on physical inactivity and sedentary behaviors. This study aimed to estimate the prevalence of different physical activity patterns among adolescents in Latin America and the Caribbean region. METHODS: Pooled analysis of the most updated data of the Global School-based Student Health surveys. Age-standardized prevalence of 4 outcomes was estimated using information from the last 7 days: physical inactivity (0 d of at least 60 min/d), insufficient physical activity (<5 d of at least 60 min/d), commuting physical activity (≥5 d of walking or biking to school), and sedentary behavior (≥3 h/d of sitting time). RESULTS: A total of 132,071 records (33 countries) were analyzed, mean age 14.6 years, 51.2% girls. Pooled age-standardized prevalence of physical inactivity was 22.3%, greater among girls (25.4%) than boys (19.1%); insufficient physical activity was present in 67.7%, greater in girls (73.6%) than boys (61.5%); commuting physical activity was seen in 43.7%, similar between girls (43.3%) and boys (44.1%); and sedentary behavior was present in 43.4%, greater among girls (45.4%) than boys (41.3%). CONCLUSIONS: In Latin America and the Caribbean region, almost two-thirds of adolescents are insufficiently physically active, ≥40% are sedentary, and ≥20% are physically inactive, and these behaviors are more frequent among girls than boys

Urbanization, altitude and cardiovascular risk

Background: There is limited information regarding the variation of the cardiovascular (CV) risk, that combines multiple risk factors in one metric, according to urbanization and altitude. Objective: To assess and disentangle the potential association between urbanization and altitude with absolute CV risk using Peruvian nationally-representative surveys. Methods: Pooled analysis of Peruvian Demographic Health Surveys (from 2014 to 2020), including subjects aged between 40 and 74 years, was conducted. The outcome of interest was the 10-year predicted absolute CV risk based on the non-laboratory version of the World Health Organization (WHO) and split into <10% and ≥10%. The exposures were urbanization (rural or urban) and altitude (<500 meters above the sea level [m.a.s.l.], between 500 and 2,499 m.a.s.l, between 2,500 and 3,499 m.a.s.l., and ≥3,500 m.a.s.l.). Crude and adjusted Poisson regression models were built to assess the associations of interest, reporting prevalence ratios (PR) and 95% confidence intervals (95% CI). Results: Data of 80,409 subjects, mean age 54.3 (SD: 8.8) and 42,640 (54.4%) females were analyzed. Regarding urbanization, 30,722 (25.4%) subjects were from rural areas, and 60.6% lives at <500 m.a.s.l., whereas only 9.3% lives at ≥3500 m.a.s.l. The 10-year predicted absolute CV risk mean was 4.5% (SD: 3.1), and 7.8% had a CV risk ≥10%. In multivariable model, urbanization, mainly rurality (PR=0.89; 95%CI: 0.81–0.97) and altitude (PR=0.82; 95%CI: 0.75–0.90 for those living between 2,500–3,490 m.a.s.l. and PR=0.68; 95%CI: 0.60–0.76 for those living ≥3,500 m.a.s.l) were factors independently associated with CV risk. Urbanization was an effect modifier of the association between altitude and CV risk with a greater effect in urban settings. Conclusion Urbanization, specifically rurality, and high-altitude, mainly ≥2,500 m.a.s.l., were factors independently associated with lower predicted CV risk

Blood-free risk scores and neuropathy assessment tools to detect undiagnosed type 2 diabetes in Peru.

The prevalence of type 2 diabetes mellitus is rising, especially in low- and middle-income countries, where the situation is worsened because around half of cases are unaware of the disease. Universal screening utilizing blood markers can be challenging in resource-constrained settings. The identification of these individuals can be potentially addressed using risk scores and neuropathy assessment tools. This study aimed to assess the diagnostic accuracy of the FINDRISC, a blood-free risk score, three neuropathy assessment tools (EZSCAN, pupillometer, and biothesiometer), alone and in combination. A population-based study was conducted enrolling a sex-stratified random sample of participants from Tumbes, a semiurban area in the north of Peru. Undiagnosed T2DM was the outcome, defined using WHO OGTT thresholds. Diagnostic accuracy of the FINDRISC and neuropathy tools was evaluated using the area under the ROC curve (aROC) and respective 95% confidence intervals (95%CI). Data from 1609 participants were analysed, mean age 48.2 (SD: 10.6) years, 810 (50.3%) females. A total of 176 (10.9%) individuals had T2DM, and only 71 (4.7%) had undiagnosed T2DM. The diagnostic accuracy of the FINDRISC was aROC = 0.69 (95% CI: 0.64–0.74), with a sensitivity of 69% and specificity of 67%. Among devices, the EZSCAN (aROC = 0.59; 95%CI: 0.53–0.66; sensitivity of 59% and specificity of 54%) and biothesiometer in the third metatarsal head (aROC = 0.60; 95%CI: 0.53–0.67; sensitivity of 31% and specificity of 85%) performed best. A combination of the FINDRISC and the biothesiometer had the best diagnostic accuracy, with a similar aROC of FINDRISC alone (AROC = 0.69; 95%CI: 0.68–0.78), with a sensitivity of 79% and a specificity of 59%. Our results confirm that combination of the FINDRISC and biothesiometer can improve diagnostic accuracy of the FINDRISC and biothesiometer alone, increasing sensitivity without affecting specificity or the area under the ROC curve

Mean blood pressure according to the hypertension care cascade: Analysis of six national health surveys in Peru

Background: While we have good evidence about the hypertension care cascade, we do not know the mean blood pressure (BP) in these groups. We described the mean BP in four groups based on the hypertension care cascade at the national and sub-national levels in Peru. Methods: Descriptive analysis of six national health surveys. Blood pressure was measured twice and the second record herein analysed. We defined four groups: i) people with self-reported hypertension diagnosis receiving antihypertensive medication; ii) people with self-reported hypertension diagnosis not receiving antihypertensive medication; iii) people unaware they have hypertension with blood pressure ≥140 or 90 mmHg; and iv) otherwise healthy people. Findings: There were 125,066 people; mean age was 49.8 years and there were more women (51.7%). At the national level, in men and women and throughout the study period, we observed that the mean systolic BP (SBP) was the highest in people unaware they have hypertension; the mean SBP was similar between those with and without antihypertension medication, yet slightly higher in the former group. At the sub-national level, even though the mean SBP in the unaware group was usually the highest, there were some regions and years in which the mean SBP was the highest in the untreated and treated groups. Interpretation: These results complement the hypertension care cascade with a clinically relevant parameter: mean BP. The results point where policies may be needed to secure effective interventions to control hypertension in Peru, suggesting that improving early diagnosis and treatment coverage could be priorities. Funding: Wellcome Trust (214185/Z/18/Z)

Who is getting screened for diabetes according to body mass index and waist circumference categories in Peru? a pooled analysis of national surveys between 2015 and 2019

BACKGROUND: At the population level we would expect that people with obesity undergo diabetes screening tests more often than people with overweight and much more often than people with normal weight. We described the trends of diabetes screening according to body mass index (BMI) and waist circumference (WC) in Peru. METHODS: Pooled analysis of health national surveys (2015-2019); men and women aged 35-70 years. We used relative frequencies to study: among those who have had a glucose test in the last year, how many there were in each BMI and WC category. We fitted a Poisson model to study whether people with high BMI or WC were more likely to have had a glucose test. RESULTS: People with overweight (PR = 1.34; 95% CI: 1.29-1.38), obesity (PR = 1.57; 95% CI: 1.51-1.63) and central obesity (PR = 1.63; 95% CI: 1.35-1.96) were more likely to have had a glucose test. At the sub-national level, there was one (of twenty-five) region in which men with obesity were more often screened for diabetes than men with overweight and much more than men with normal weight. There were seven regions in which women with obesity were the most often screened for diabetes. CONCLUSIONS: Consistent with a risk-based prevention approach, people with obesity would be screened for diabetes more often than those with overweight and those with normal weight. This ideal profile was only observed in few regions. Diabetes screening strategies should be strengthened and homogenised, so that they reach those at high risk of diabetes

The contribution of specific non-communicable diseases to the achievement of the Sustainable Development Goal 3.4 in Peru

Background Non-communicable diseases (NCDs) have received political attention and commitment, yet surveillance is needed to measure progress and set priorities. Building on global estimates suggesting that Peru is not on target to meet the Sustainable Development Goal 3.4, we estimated the contribution of various NCDs to the change in unconditional probability of dying from NCDs in 25 regions in Peru. Methods Using national death registries and census data, we estimated the unconditional probability of dying between ages 30 and 69 from any and from each of the following NCDs: cardiovascular, cancer, diabetes, chronic respiratory diseases and chronic kidney disease. We estimated the contribution of each NCD to the change in the unconditional probability of dying from any of these NCDs between 2006 and 2016. Results The overall unconditional probability of dying improved for men (21.4%) and women (23.3%). Cancer accounted for 10.9% in men and 13.7% in women of the overall reduction; cardiovascular diseases also contributed substantially: 11.3% in men) and 9.8% in women. Consistently in men and women and across regions, diabetes moved in the opposite direction of the overall reduction in the unconditional probability of dying from any selected NCD. Diabetes contributed a rise in the unconditional probability of 3.6% in men and 2.1% in women. Conclusions Although the unconditional probability of dying from any selected NCD has decreased, diabetes would prevent Peru from meeting international targets. Policies are needed to prevent diabetes and to strengthen healthcare to avoid diabetes-related complications and delay mortality

The Andean Latin-American burden of diabetes attributable to high body mass index: a comparative risk assessment

Background:Body mass index (BMI)has increased in Latin-America, but the implications for the diabetesburden havenot been quantified. We estimated the proportion and absolute number of diabetescasesattributable to high BMI in Bolivia, Ecuador and Peru(Andean Latin-America), with estimation of region-level indicators in Peru.Methods: Weestimated the population attributable fraction (PAF) of BMI ondiabetes(regardless of type 1 or 2)from 1980 to 2014, including the number of cases attributable to overweight (BMI 25-<30), class I (30-<35),class II (BMI 35-<40) and class III(BMI ≥40)obesity.We used age-and sex-specific prevalence estimates of diabetes and BMI categories(NCD-RisC and Peru’s DHS survey)combined with relative risks from population-based cohortsin Peru. Findings: Across Andean Latin-Americain 2014, there were 1,258,313diabetes cases attributable to high BMI: 209,855 in Bolivia, 367,440in Ecuadorand681,018in Peru. Between 1980-2010, the absolute proportion of diabetes cases attributable toclass I obesity increased the most (from 12.9% to 27.2%) across the region. The second greatest increase was for class II obesity (from 3.6% to 16.5%). There was heterogeneity in the fraction of diabetes cases attributable to high BMI by region in Peru, ascoastal regions hadthelargestfractions,andso did high-income regions. Interpretation: Over one milliondiabetes cases are attributable to high BMI in Andean Latin-America. Public health efforts should focus on implementing population-based interventions to reduce high BMI and to developfocused interventions targeted at those at highest risk of diabetes

Global inequalities in the double burden of malnutrition and associations with globalisation: a multilevel analysis of Demographic and Health Surveys from 55 low-income and middle-income countries, 1992-2018

BACKGROUND: Low-income and middle-income countries (LMICs) face a double burden of malnutrition (DBM), whereby overnutrition and undernutrition coexist within the same individual, household, or population. This analysis investigates global inequalities in household-level DBM, expressed as a stunted child with an overweight mother, and its association with economic, social, and political globalisation across country income and household wealth. METHODS: We pooled anthropometric and demographic data for 1 132 069 children (aged <5 years) and their mothers (aged 15-49 years) from 189 Demographic and Health Surveys in 55 LMICs between 1992 and 2018. These data were combined with country-level data on economic, social, and political globalisation from the Konjunkturforschungsstelle Globalisation Index and gross national income (GNI) from the World Bank. Multivariate associations between DBM and household wealth, GNI, and globalisation and their interactions were tested using multilevel logistic regression models with country and year fixed-effects and robust standard errors clustered by country. FINDINGS: The probability of DBM was higher among richer households in poorer LMICs and poorer households in richer LMICs. Economic globalisation was associated with higher odds of DBM among the poorest households (odds ratio 1·49, 95% CI 1·20-1·86) compared with the richest households. These associations attenuated as GNI increased. Social globalisation was associated with higher odds of DBM (1·39, 95% CI 1·16-1·65), independently of household wealth or country income. No associations were identified between political globalisation and DBM. INTERPRETATION: Increases in economic and social globalisation were associated with higher DBM, although the impacts of economic globalisation were mostly realised by the world's poorest. The economic patterning of DBM observed in this study calls for subpopulation-specific double-duty actions, which should further aim to mitigate the potential negative and unequal impacts of globalisation. FUNDING: UK Biotechnology and Biological Sciences Research Council. TRANSLATIONS: For the Spanish and Portuguese translations of the abstract see Supplementary Materials section

Fruits and vegetables consumption and depressive symptoms: A population-based study in Peru.

OBJECTIVES: Among different factors, diet patterns seem to be related to depression. The aim of this study was to evaluate the association between the consumption of fruits and/or vegetables and depressive symptoms. METHODOLOGY/PRINCIPAL FINDINGS: A secondary data analysis was conducted using information from a population-based survey from 25 regions from Peru. The outcome was the presence of depressive symptoms according to the Patient Health Questionnaire (cutoff ≥15 to define major depressive syndrome); whereas the exposure was the self-reported consumption of fruits and/or vegetables (in tertiles and using WHO recommendation ≥5 servings/day). The association of interest was evaluated using Poisson regression models controlling for the complex-sample survey design and potential confounders. Data from 25,901 participants were analyzed, mean age 44.2 (SD: 17.7) and 13,944 (54.0%) women. Only 910 (3.8%; 95%CI: 3.5%-4.2%) individuals reported consuming ≥5 servings of fruits and/or vegetables/day; whereas 819 (2.8%; 95%CI: 2.5%-3.1%) had depressive symptoms. Those in the lowest tertile of fruits and/or vegetables consumption had greater prevalence of depressive symptoms (PR = 1.88; 95%CI: 1.39-2.55) than those in the highest tertile. This association was stronger with fruits (PR = 1.92; 95%CI: 1.46-2.53) than vegetables (PR = 1.42; 95%CI: 1.05-1.93) alone. CONCLUSIONS: An inverse relationship between consumption of fruits and/or vegetables and depressive symptoms is reported. Less than 5% of subjects reported consuming the amount of fruits and vegetables recommended by the WHO. There is a need to implement strategies to promote better diet patterns with potential impact on mental health

Evaluation of cognitive impairment in elderly population with hypertension from a low-resource setting: Agreement and bias between screening tools.

INTRODUCTION: The evaluation of cognitive impairment in adulthood merits attention in societies in transition and especially in people with chronic diseases. Screening tools available for clinical practice and epidemiological studies have been designed in high-income but not in resource-constrained settings. The aim of this study was to assess the agreement and bias of three common tools used for screening of cognitive impairment in people with hypertension: the modified Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Leganés Cognitive Test (LCT). METHODS: A cross-sectional study enrolling participants with hypertension from a semi-urban area in Peru was performed. The three screening tools for cognitive impairment were applied on three consecutive days. The prevalence of cognitive impairment was calculated for each test. Pearson's correlation coefficients, Bland-Altman plots, and Kappa statistics were used to assess agreement and bias between screening tools. RESULTS: We evaluated 139 participants, mean age 76.5 years (SD ± 6.9), 56.1% females. Cognitive impairment was found in 28.1% of individuals using LCT, 63.3% using MMSE, and 100% using MoCA. Correlation coefficients ranged from 0.501 between LCT and MoCA, to 0.698 between MMSE and MoCA. Bland-Altman plots confirmed bias between screening tests. The agreement between MMSE and LCT was 60.4%, between MMSE and MoCA was 63.3%, and between MoCA and LCT was 28.1%. CONCLUSIONS: Three of the most commonly used screening tests to evaluate cognitive impairment showed major discrepancies in a resource-constrained setting, signaling towards a sorely need to develop and validate appropriate tools