Prevalence of overweight and obesity in the adult indigenous population in Brazil: A systematic review with meta-analysis

Fourteen-year trends in overweight, general obesity, and abdominal obesity in Amazonian indigenous peoples

BACKGROUND

Available data show that the epidemiological profile of most indigenous Brazilian populations is characterized by the coexistence of long-standing health problems (high prevalence of infectious and parasitic diseases, malnutrition, and deficiency diseases, such as anemia in children and women of reproductive age), associated with new health problems, especially those related to obesity (hypertension, type 2 diabetes mellitus and dyslipidemia). Based on this scenario, this study analyzed the nutritional profile of the adult population of seven indigenous peoples from the Brazilian Amazon in the years 2007 and 2021.

METHODS

A total of 598 adults individuals were analyzed in 2007 (319 women and 279 men) and 924 in 2021 (483 women and 441 men), from seven indigenous peoples located in the state of Pará, who were assisted during health actions carried out in 2007 and in 2021. Body mass index classification used the World Health Organization criteria for adults: low weight, < 18.5 kg/m2; normal weight, ≥ 18.5 and < 25 kg/m2); overweight, ≥ 25 and < 30 kg/m2, and obesity, ≥ 30 kg/m2. A waist circumference (WC) < 90 cm in men and < 80 cm in women was considered normal.

RESULTS

The data revealed heterogeneous anthropometric profiles, with a low prevalence of nutritional changes in the Araweté, Arara and Parakanã peoples, and high proportions of excess weight and abdominal obesity in the Kararaô, Xikrin do Bacajá, Asurini do Xingu and Gavião peoples, similar to or even higher than the national averages.

CONCLUSION

Different stages of nutritional transition were identified in the indigenous peoples analyzed, despite apparently having been subjected to the same environmental pressures that shaped their nutritional profile in recent decades, which may indicate different genetic susceptibilities to nutritional changes. The evidence shown in this study strongly suggests the need to investigate in greater depth the genetic and environmental factors associated with the nutritional profile of Brazilian indigenous peoples, with assessment of diet, physical activity and sociodemographic and socioeconomic variables that enable the development of appropriate prevention and monitoring measures.

A comparative study of the effectiveness of self-management and group management on the amount of weight loss of nurses under low-calorie diet treatment: A simultaneous mixed-methods study

BACKGROUND

Nursing is a profession that is associated with a lot of stress and a risk of being overweight or obese. The purpose of this research was to determine the comparative effectiveness of self-management (self-M) and group management (group-M) on nurses who were following a diet with the aim of proposing a proper planning and a healthy lifestyle for them.

MATERIALS AND METHODS

This study was a simultaneous mixed-methods design (interventional and qualitative). The participants were all overweight or obese nurses working in teaching hospitals at Guilan University of Medical Sciences in 2019 (n = 96). In the qualitative part, data were extracted from semi-structured interviews. For quantitative data analysis, relevant statistical methods such as Kolmogorov-Smirnov test, analysis of variance (ANOVA), and analysis of covariance (ANCOVA) were used. For qualitative data analysis, the conventional content analysis approach was used and Lincoln and Guba's criteria were applied to ensure the accuracy of the data.

RESULTS

In both quantitative and qualitative sections, the results showed that following a diet treatment with group-M is more effective than self-M.

CONCLUSION

The results showed that a healthy lifestyle can be achieved for nurses if they participate in training classes and group programs, which are proven to be effective based on this article and some other studies. Also, since weight gain and obesity, as one of the most important problems of health systems, continue to increase and can impose a heavy economic and social burden on human societies, various general policies should be used and these solutions can range from home to society to prevent and control them.

Global prevalence of cardiovascular risk factors based on the Life's Essential 8 score: an overview of systematic reviews and meta-analysis

Cardiovascular health (CVH) is a critical issue for global health. However, no previous study has determined the prevalence of cardiovascular risk factors based on the American Heart Association's (AHA) Life's Essential 8 (LE8). Therefore, we aimed to estimate the global prevalence of the eight cardiovascular risk factors identified in the LE8. A systematic search of systematic reviews with meta-analysis on cardiovascular risk factors covering data reported between 2000 and 2019 was conducted on PubMed, Epistemonikos, and the Cochrane Library until 1 May 2023. After applying exclusion criteria, 79 studies remained in the final selection for the narrative synthesis in the systematic review, of which 33 of them were used in the meta-analysis which included 2 555 639 participants from 104 countries. The overall pooled prevalence of cardiovascular risk factors was as follows: insufficient physical activity, 26.3% (95% CI 2.3%-63.4%), no adherence to a healthy diet, 34.1% (95% CI 5.8%-71.2%), nicotine exposure, 15.4% (95% CI 10.4%-21.2%), insufficient sleep quality, 38.5% (95% CI 14.0%-66.7%), obesity, 17.3% (95% CI 6.1%-32.6%), dyslipidemia, 34.1% (95% CI 33.8%-34.4%), diabetes, 12.0% (95% CI 7.0%-18.2%), and hypertension, 29.4% (95% CI 23.3%-35.8%). These results warrant prevention strategies aimed at reducing insufficient sleep quality, and no adherence to a healthy diet as leading cardiovascular risk factors worldwide. The high prevalence of hypertension among children and adults is concerning and should also be adequately addressed through global policies.

Epidemiology of chronic kidney disease in older indigenous peoples of Brazil: findings from a cross-sectional survey

BACKGROUND

Chronic kidney disease (CKD) is a prevalent disease worldwide, with increasing incidence particularly in low- and middle-income countries. Indigenous communities have poorer CKD outcomes due to limited access to healthcare. They are also experiencing a shift toward a sedentary lifestyle and urbanization-related dietary changes, increasing the risk of CKD-related risk factors.

AIM

To determine the prevalence of CKD in older Brazilian indigenous and identify the main associated risk factors.

METHODS

This cross-sectional study analyzed demographic and clinical data of 229 older indigenous individuals aged 60 years and above in 2022-2023. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 or a urinary albumin-creatinine ratio > 30 mg/g. Data were presented categorically and analyzed using the Chi-square test or Fisher's exact test.

RESULTS

The prevalence of CKD in the population was 26.6%, with higher prevalence in women and increasing with age. The prevalence of hypertension and diabetes was 67.7% and 24.0%, respectively, and these comorbidities were associated with CKD: hypertension (OR = 5.12; 95% CI 2.2-11.9) and diabetes (OR = 5.5; 95% CI 3.7-8.2). No association was found between the prevalence of CKD and obesity, dyslipidemia, cardiovascular disease, or smoking.

DISCUSSION

The study found a higher prevalence of CKD among older indigenous populations in Brazil compared to non-indigenous populations, which is exacerbated by risk factors, such as aging, hypertension, diabetes, and lifestyle changes, emphasizing the importance of early detection and intervention in these communities.

CONCLUSION

Older persons' indigenous individuals have a high prevalence of CKD, which is correlated with factors, such as sex, age, diabetes mellitus, and hypertension.

Pharmacological Management of Obesity: A Century of Expert Opinions in Cecil Textbook of Medicine

BACKGROUND

Innovations in drug therapy for obesity have had a limited impact on the body mass index, prevalence of medical complications, quality of life, and work potential of a substantial majority of affected persons.

STUDY QUESTION

What are the milestones of the changes in the expert approach to the pharmacological management of obesity in the past century?

STUDY DESIGN

To determine the changes in the experts' approach to the management of obesity, as presented in a widely used textbook in the United States.

DATA SOURCES

The primary sources were chapters describing the management of obesity in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. Secondary sources were publications retrieved from Medline that clarified technical issues related to the development, regulatory approval, and use of the drugs mentioned in the Cecil Textbook of Medicine.

RESULTS

Pharmacological interventions aimed at increasing caloric expenditures through thermogenesis were recommended from 1927 through 1943. Thyroid extracts were prescribed even in the absence of demonstrated hypothyroidism or decreased basal metabolic rate throughout this period. Dinitrophenol was mentioned in 1937, but was banned soon thereafter. Appetite suppression with amphetamine was considered useful from 1943 through 1988, after which the drug was replaced with other centrally acting molecules, such as fenfluramine in 1988, sibutramine in 2000, and rimonabant in 2008, which were in turn withdrawn because of major adverse effects. In the past decade, obesity has been treated with the appetite suppressants phentermine-topiramate, bupropion-naltrexone, lorcaserin, and liraglutide, and with orlistat, a drug promoting fat malabsorption. The change in weight produced by these drugs is generally modest and transient.

CONCLUSIONS

The pharmacological management of obesity has remained frustratingly inefficient. The reasons for the relative lack of success may reside in the ever-growing access to dense, palatable, and relatively inexpensive food, coupled with the decrease in energy expenditure created by a sedentary lifestyle.

Common BMI and diabetes-related genetic variants: A pilot study among indigenous people in the Brazilian Amazon

This study was carried out to investigate the frequency of genetic variants related to body mass index (BMI) and type 2 diabetes (T2D) and evaluating the potential impact of risk alleles on susceptibility to these disorders in six indigenous peoples from Brazilian Amazon region. The majority of Fst values for pairwise population comparisons among the indigenous groups are low or moderate. The indigenous people show high values of differentiation with Africans, Europeans and Southeast Asians and moderate values with East Asian and American populations, as expected. The allelic frequencies among indigenous indicate that the majority of associations observed with T2D in continental populations can be replicated in native Amazonians. The genetic risk scores calculated for T2D in indigenous are high and similar to those calculated for Americans and East Asians, while the estimates obtained for obesity are low, probably due to the low frequencies of the risk allele of the FTO gene found in our samples. ADRB3-rs4994 and ABCC8-rs1799854 genes showed a significant association with BMI and waist circumference, and the KCNJ11-rs5219 gene with hyperglycemia. These results emphasize the importance of knowing the genetic variability underlying complex genetic diseases in indigenous peoples and the search for particular or rare variants.

A’uwẽ (Xavante) views of food security in a context of monetarization of an indigenous economy in Central Brazil

Following boom-and-bust economic cycles provoked by Brazilian governmental attempts to integrate Indigenous peoples into national society, it is approximately since the beginning of the 2000s that Brazilian Indigenous peoples came to be viewed officially as “poor” and victims of “hunger.” Consequently, the national indigenist agency and other State entities started to conceive and implement diverse initiatives that ultimately injected money and resources into Indigenous communities. In 2019 we undertook an ethnographic study in three A’uwẽ (Xavante) communities in the Pimentel Barbosa Indigenous Reserve, Central Brazil, with the objective of analyzing how people understand and pursue food security. We propose that in the studied communities the complex network of A’uwẽ food reciprocity is a fundamental strategy for mitigating hunger and acute lack of food. We show that among the A’uwẽ, the hybrid economy that developed since the 1970s has proved resilient to dramatic transformations and uncertainty in the availability and characteristics of external government inputs.

A Critical Review on New Approaches for Chronic Disease Prevention in Brazil and Canada: From Wholistic Dietary Guidelines to Physical Activity Security

In light of new evidence on the prevention of chronic diseases and the elevated rates of overweight and obesity in Brazil and Canada, this critical review aims to interpret and synthesize current aspects regarding dietary and physical activity initiatives in both countries and make future recommendations. The pioneering work presented in the last Brazilian dietary guidelines has been called a model that can be applied globally, given its conceptualization of healthy eating that translates easily to practical guidance. The new Canadian Food Guide has incorporated similar aspects, also putting the country as a leader in dietary guidance. With these new recommendations, citizens in both Brazil and Canada have access to impactful evidence-informed nutritional guidelines. Both documents propose eating patterns that focus not only on health benefits, such as chronic disease prevention, but also incorporate well-being concerning cultural, economic, sociodemographic, biological, and ecological dimensions. A similar approach is required for physical activity to allow individuals to have attainable health and life goals and thereby fully enjoy their lives, regardless of geographical location, health status, and socioeconomic condition, a concept recently described as physical activity security. The wholistic dietary guidelines from both countries represent a change in paradigm in public health. Likewise, national evidence-based policies are warranted to reduce disparities in physical activity, allowing healthier and more active lifestyles for everyone.

The "Double Burden of Malnutrition" in the Amazon: dietary change and drastic increases in obesity and anemia over 40 years among the Awajún

Undernutrition and overnutrition are interconnected. Yet few studies have examined the "double burden of malnutrition" (DBM) over time in indigenous communities. We investigated changes in the food systems and nutritional health of Awajún communities in the Peruvian Amazon in the 1970s and in 2013. Methods included ethnography, 24 hr food recalls, and biological measures. In 2013, the number of traditional foods consumed decreased to 10% of levels in the 1970s and the number of market foods consumed increased 40-fold. Rates of anemia and obesity were also substantially higher in 2013 compared to the 1970s (23% vs 6% for anemia and 30% vs. 0% for obesity) indicating a DBM has emerged. Examining the predictors of hemoglobin levels and body mass indices in the 2013 sample reveals that this DBM is differentially impacting women and that risk for obesity among the Awajún is associated with multiple proxies of market integration beyond just the consumption of market foods. These findings highlight the complex pathways by which rapid lifestyle changes are creating gendered health inequalities within indigenous communities over time.

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

PURPOSE OF REVIEW

Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes.

RECENT FINDINGS

The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.

Exploring Iranian obese women's perceptions of barriers to and facilitators of self-management of obesity: A qualitative study

BACKGROUND

Despite the clinical importance of self-management for obesity, poor compliance or noncompliance with the treatment regimen is a prevalent and persistent problem concerning people with obesity.

AIMS

The aim of this study was to explore Iranian obese women's perceptions regarding the barriers to and facilitators of self-management of obesity.

MATERIALS AND METHODS

In this qualitative study, the participants were selected through purposeful sampling and the data were collected using semistructured interviews and focus groups between July 2017 and September 2018. Nineteen participants between the age range of 28-50 years and mean age of 38.56 years were interviewed. A focus group with seven participants was conducted to reach data saturation. All the interviews and the focus group were transcribed verbatim and the data were analyzed using constant comparative method.

RESULTS

The perceived barriers to obese women's self-management for obesity were identified and classified into four main categories: (I) restrictions, (II) the pressures of being in the group, (III (temptation, (IV) resonators. In addition, seven main categories emerged as facilitators of obese women's self-management for obesity: (I) achieving self-awareness, (II) positive consequences for weight loss success, (III) positive outcomes of exercise and physical activity, (IV) peers experience, (V) correct and logical program, (VI) autonomy and empowerment, and (VII) having supporting umbrella.

CONCLUSION

This qualitative research provided a range of facilitators and barriers to self-management of obesity perceived by an obese woman to improve our understanding of the complex nature of self-management of obesity. Healthcare providers may consider this issue while designing and implementing appropriate interventions to upgrades woman's ability for self-management of obesity.