Obesity and hypertension in Latin America: Current perspectives

Clinical Practice Guidelines of the Latin American Federation of Endocrinology for the use of vitamin D in the maintenance of bone health: recommendations for the Latin American context

INTRODUCTION

These guidelines aim to provide evidence-based recommendations for the supplementation of Vitamin D in maintaining bone health. An unmet need persists in Latin American regarding the availability of clinical and real-world data for rationalizing the use of vitamin D supplementation. The objective of these guidelines is to establish clear and practical recommendations for healthcare practitioners from Latin American countries to address Vitamin D insufficiency in clinical practice.

METHODS

The guidelines were developed according to the GRADE-ADOLOPMENT methodology for the adaptation or adoption of CPGs or evidence-based recommendations. A search for high quality CPGs was complemented through a comprehensive review of recent literature, including randomized controlled trials, observational studies, and systematic reviews evaluating the effects of Vitamin D supplementation on bone health. The evidence to decision framework proposed by the GRADE Working Group was implemented by a panel of experts in endocrinology, bone health, and clinical research.

RESULTS

The guidelines recommend Vitamin D supplementation for individuals aged 18 and above, considering various populations, including healthy adults, individuals with osteopenia, osteoporosis patients, and institutionalized older adults. These recommendations offer dosing regimens depending on an individualized treatment plan, and monitoring intervals of serum 25-hydroxyvitamin D levels and adjustments based on individual results.

DISCUSSION

The guidelines highlight the role of Vitamin D in bone health and propose a standardized approach for healthcare practitioners to address Vitamin D insufficiency across Latin America. The panel underscored the necessity for generating local data and stressed the importance of considering regional geography, social dynamics, and cultural specificities when implementing these guidelines.

The synergistic effect of obesity and dyslipidemia on hypertension: results from the STEPS survey

BACKGROUND

Obesity and dyslipidemia are important risk factors for hypertension (HTN). When these two conditions coexist, they may interact in a synergistic manner and increase the risk of developing HTN and its associated complications. The aim of this study was to investigate the synergistic effect of general and central obesity with dyslipidemia on the risk of HTN.

METHOD

Data from 40,387 individuals aged 25 to 64 years were obtained from a repeated cross-sectional study examining risk factors for non-communicable diseases (STEPS) in 2007, 2011 and 2016. Body mass index (BMI) was calculated as a measure of general obesity and waist circumference (WC) as a measure of central obesity. Dyslipidemia was defined as the presence of at least one of the lipid abnormalities. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or current use of antihypertensive medication. To analyze the synergistic effect between obesity and dyslipidemia and HTN, the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were calculated. A weighted logistic regression model was performed to estimate the odds ratios (ORs) for the risk of HTN.

RESULTS

The results showed an association between obesity, dyslipidemia and hypertension. The interaction between obesity and dyslipidemia significantly influences the risk of hypertension. In hypertensive patients, the presence of general obesity increased from 14.55% without dyslipidemia to 64.36% with dyslipidemia, while central obesity increased from 13.27 to 58.88%. This interaction is quantified by RERI and AP values of 0.15 and 0.06 for general obesity and 0.24 and 0.09 for central obesity, respectively. The corresponding SI of 1.11 and 1.16 indicate a synergistic effect. The OR also show that the risk of hypertension is increased in the presence of obesity and dyslipidemia.

CONCLUSION

Obesity and dyslipidemia are risk factors for HTN. In addition, dyslipidemia with central obesity increases the risk of HTN and has a synergistic interaction effect on HTN. Therefore, the coexistence of obesity and lipid abnormalities has many clinical implications and should be appropriately monitored and evaluated in the management of HTN.

The burden of low back pain in adolescents and young adults

BACKGROUND

Low back pain is highly prevalent and the main cause of years lived with disability, but data on the burden and trends of low back pain (LBP) in adolescents and young adults (AYAs) are sparse.

OBJECTIVE

To assess trends in the burden of LBP among AYAs aged 15-39 years at the global, regional and national levels from 1990 to 2019.

METHODS

Data from the Global Burden of Disease (GBD) 2019 were used to analyze incidence, prevalence and Disability-adjusted life year (DALY) due to LBP at global, regional, and national levels. Joinpoint regression analysis calculated the average annual percentage changes (AAPC). Then analyse the association between incidence, prevalence and DALYs and socioeconomic development using the GBD Socio-demographic Index (SDI). Finally, projections were made until 2030 and calculated in Nordpred.

RESULTS

The incidence, prevalence and DALYs rates (95%UI) were 2252.78 (1809.47-2784.79), 5473.43 (4488.62-6528.15) and 627.66 (419.71-866.97) in 2019, respectively. From 1990 to 2019, the incidence, prevalence, and DALYs rates AAPC (95%CI) were -0.49 (-0.56 to -0.42), -0.58 (-0.65 to -0.51) and -0.57 (-0.64 to -0.5), respectively. Incidence, prevalence, and DALYs rates in South Asia, East Asia, High-income North America, Western Europe, and Australasia decreased with SDI. Incidence, prevalence, and DALYs rates in Central Asia, Central Europe, and Eastern Europe decreased and then increased with SDI. At the national level, the incidence, prevalence, and DALYs rates are high in the United States and low in India and China. From the 2020 to 2030, most regions is predicted to decline.

CONCLUSION

LBP in AYAs is a major global public problem with a high burden. There are large differences in incidence, prevalence and DALYs across SDIs, regions and countries. there is still a need to focus on LBP in AYAs and tailor interventions to reduce the future burden of this condition.

Inflammatory and Prothrombotic Biomarkers Contribute to the Persistence of Sequelae in Recovered COVID-19 Patients

The presence of long COVID (LC) following SARS-CoV-2 infection is a common condition that affects the quality of life of patients and represents a diagnostic challenge due to the diversity of symptoms that may coexist. We still do not have accurate information regarding the pathophysiological pathways that generate the presence of LC, and so it is important to know the inflammatory and immunothrombotic biomarker profiles and their implications in order to characterize risk subgroups and establish early therapeutic strategies. We performed the determination of inflammatory and immunothrombotic biomarkers in volunteers with previous diagnoses of SARS-CoV-2. The inflammatory biomarkers were analyzed in plasma by flow cytometry, and we analyzed the von Willebrand factor (vWF) in the plasma samples using ELISA. The clinical variables and the presence or absence of long COVID symptoms were then analyzed. IL-6, sCD40L, p-Selectin, PSGL-1, PAI-1, tPA, D-Dimer, TF, and Factor IX levels were elevated in the groups with LC, especially in the subgroup of patients with metabolic syndrome (MetS). VWF levels were found to be increased in patients with sequelae and MetS. Our results confirmed the persistence of an active immunothrombotic state, and so it is important to identify the population at risk in order to provide adequate clinical follow-up.

Allergies, body mass, and hospitalization due to arbovirus infection: A prospective surveillance study in Machala, Ecuador

Dengue, chikungunya, and Zika are arboviruses that cause 390 million infections annually. Risk factors for hospitalization are poorly understood. Communities affected by these diseases have an escalating prevalence of allergies and obesity, which are linked to immune dysfunction. We assessed the association of allergies or body mass with hospitalization for an arbovirus infection. From 2014 to 2017, we recruited participants with a clinical diagnosis of arbovirus infection. Arbovirus infections were laboratory-confirmed and allergies were self-reported. Mid-upper arm circumference (MUAC), weight, and height were measured. We used two logistic regression models to assess the relationships between hospitalization and allergies and between hospitalization and body mass (MUAC for participants <20 years old and body mass index (BMI) for adults ≥20 years old). Models were stratified by age group and adjusted for confounders. For allergies, 41 of 265 were hospitalized. There was no association between allergies and hospitalization. For body mass, 34 of 251 were hospitalized. There was a 43% decrease in hospitalization odds for each additional centimetre MUAC among children (aOR 0.566, 95% CI 0.252-1.019) and a 12% decrease in hospitalization odds for each additional BMI unit among adults (aOR 0.877, 95% CI 0.752-0.998). Our work encourages the exploration of the underlying mechanisms.

Associations of socioeconomic status and obesity with hypertension in tibetan adults in a Chinese plateau area

BACKGROUND

Previous studies have identified that socioeconomic status (SES) and obesity are associated with hypertension. However, their interaction on hypertension risk has not yet been assessed.

METHODS

The study used data from 6,069 Tibetan residents in Chengguan District in Lhasa, the Chinese Tibetan autonomous region's capital, based on a cohort study conducted from May 2018 to September 2019 in five provinces in southwest China. We used logistic regression models to assess the complex relations of SES and obesity with hypertension.

RESULTS

Compared with individuals of high SES, low and moderate SES were positively associated with high risk of hypertension. SES and obesity have significant additive interaction on hypertension (general obesity by BMI: RERI = 1.33, P < 0.001; abdominal obesity by WC: RERI = 0.76, P < 0.001; abdominal obesity by WHtR: RERI = 0.96, P < 0.001). In people from the low and moderate SES segments, obesity was linked to an increased risk of hypertension, but the correlations were stronger in people from the moderate SES category. Compared with people of high SES and non obese, those with moderate SES and obesity had a higher risk of hypertension, and ORs were 4.38 (2.80, 6.84) for general obesity by BMI, 3.38 (2.05, 5.57) for abdominal obesity by WC, and 3.18 (1.57, 6.42) for abdominal obesity by WHtR.

CONCLUSION

There is an independent and additive interaction effect of obesity and SES on the risk of hypertension. People with obesity, especially those of moderate and low SES, should reduce weight and waist circumference, and pay more attention to blood pressure. Moreover, the government, health administration departments, and society should prioritize improving the socioeconomic status of the Tibetan population and addressing risk factors like obesity.

Effectiveness of the Combination of Enalapril and Nifedipine for the Treatment of Hypertension versus Empirical Treatment in Primary Care Patients

Hypertension in Mexico has a prevalence of 32% and is the second most widespread cause of consultation in primary care. Only 40% of patients in treatment have a blood pressure (BP) below 140/90 mmHg. This clinical trial aimed to compare the effectiveness of the combination of enalapril and nifedipine versus the empirical treatment for hypertension in patients with uncontrolled BP in a primary care center in Mexico City. Participants were randomized to treatment with enalapril and nifedipine (combination group) or to continue with the empirical treatment. Outcome variables were BP control, therapeutic adherence, and adverse effects at 6 months of follow-up. At the end of the follow-up period, BP control (64% versus 77%) and therapeutic adherence (53% versus 93%) showed an improvement from the baseline values in the group that received the combination treatment. BP control (51% versus 47%) and therapeutic adherence (64% versus 59%) in the group who received the empirical treatment did not show improvement from the baseline to follow-up. Combined treatment was 31% more efficacious than conventional empirical treatment (odds ratio = 3.9), which yielded an incremental clinical utility of 18% with high tolerability extent among patients in primary care in Mexico City. These results contribute to the control of arterial hypertension.

Loss of Health State Utilities Attributable to Obesity

OBJECTIVES

This study aimed to quantify the association between the loss of health state utilities (LHSU) and obesity, considering different obesity categories. This is relevant to interventions economic evaluations and for public policy decision planning.

METHODS

Using data from the Chilean National Health Survey, this study uses linear regression models and counterfactual scenarios to calculate the prevalent burden, population averages, and total sum of LHSU attributable to obesity for the Chilean national level on people older than 15 years, year 2017. Adjustments for socioeconomic status and associated noncommunicable diseases (NCDs) are considered. Calculating the LHSU using these methods enables the approximation of loss of prevalent quality-adjusted life-years (QALYs).

RESULTS

The raw obesity LHSU burden was 9.1% (95% uncertainty interval [UI] 5.1-13). When adjustment is considered, the LHSU attributable to obesity reaches 4.6% (95% UI 0.6-8.5) being responsible for 121 045 prevalent QALYs. Socioeconomic status adjusted analysis of higher body mass index (BMI, in kg/m²) categories of obesity shows a dose-response effect for LHSU, being the BMI ≥ 40 category with the highest population average of attributable LHSU (10.1; 95% UI 5.5-14.5, scale 0 [full health] to 100 [dead]). Burden for BMI ≥ 35 categories showed the biggest change after NCD adjustment.

CONCLUSIONS

Obesity carries a significant burden of QALY loss. Policy decision-making addressing obesity should focus specially on the BMI ≥ 40 group. NCD comorbidity should be considered for policies addressing the BMI ≥ 35 group.

Association of sociodemographic characteristics, mental health, and sleep quality with COVID-19 fear in an elderly Brazilian population

 Aim: This study determined whether COVID-19 fear is correlated with sociodemographic characteristics, general health, mental health, and sleep quality in an elderly Brazilians. Methods: Elderly people aged ≥ 60 years replied to an online survey containing questions about their sociodemographic characteristics; general health; levels of stress, anxiety, and depression; sleep quality; and COVID fear. Results: Data were statistically analyzed using descriptive statistics (α = 5%). In total, 705 elderly people with mean age of 66 ± 5 years, and most (82.7%) respondents were women, graduated and from southeastern Brazil. COVID-19 fear correlated positively and moderately with sleep quality and symptoms of depression, anxiety, and stress (all p < 0.001). It was associated with females. Elderly people from northern and northeastern Brazil and diabetics had increased COVID-19 fear (all p < 0.05). Conclusion: The fear of COVID-19 exists among Brazilian female old people, diabetics, increases anxiety and stress symptoms, and worsen sleep quality in elderly people.

Cardiovascular disease prevention and management in the COVID-19 era and beyond: An international perspective

Despite some indicators of a localized curtailing of cardiovascular disease (CVD) prevalence, CVD remains one of the largest contributors to global morbidity and mortality. While the magnitude and impact of the coronavirus disease 2019 (COVID-19) pandemic have yet to be realized in its entirety, an unquestionable impact on global health and well-being is already clear. At a time when the global state of CVD is perilous, we provide a continental overview of prevalence data and initiatives that have positively influenced CVD outcomes. What is clear is that despite attempts to address the global burden of CVD, there remains a lack of collective thinking and approaches. Moving forward, a coordinated global infrastructure that, if developed with appropriate and relevant key stakeholders, could provide significant and longstanding benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical perspectives must be underpinned by unified approaches that maximize public health.

Relationship between blood pressure and BMI in young adult population: a national-level assessment in Bangladesh

Young adulthood is a crucial period for major physiological transitions. Environmental changes associated with these transitions can influence health behaviour and health (e.g. poor diet, high body weight and elevated blood pressure (EBP)). Excess body weight can lead to EBP; however, little is known about this relationship among young adults in developing countries. Focusing on Bangladesh, this study assessed the association between BMI and blood pressure (BP) metrics (systolic BP (SBP), diastolic BP (DBP) and BP class (optimal, normal/high normal and elevated)). Sex-specific analyses of these relationships were performed to assess any difference across sexes. Furthermore, associations of overweight/obesity with BP metrics were investigated. Young adults aged 18-24 years (n 2181) were included from nationally representative cross-sectional Bangladesh Demographic and Health Survey 2017-2018. Multivariable linear and multinomial logistic regression models examined the relationships between BMI, overweight/obesity and BP metrics. Findings reveal that higher BMI was associated with higher SBP (0·83; 95 % CI 0·67, 0·99), DBP (0·66; 95 % CI 0·54, 0·74) and higher odds of having EBP (adjusted OR 1·24; 95 % CI 1·17, 1·31). These relationships were stronger among males than females. Moreover, overweight/obese individuals had higher SBP, DBP and higher odds of having EBP than individuals with normal BMI. Strategies to reduce body weight and to improve healthy lifestyle, and awareness and monitoring of BP may help to address these serious health problems, particularly at an early age.

Central Adiposity Indicators Maintain a Stronger Association With the Risk of Hypertension: A Prospective Cohort Study in Southwest China

Objectives: Studies have linked obesity to an increased risk of hypertension, but the optimal adiposity indicators to predict hypertension remains controversial. We comprehensively explored the correlation between body mass index, waist circumference (WC), waist-to-height ratio (WHtR), long-term weight and WC change, and hypertension in an adult population in Southwest China. Methods: We studied 9,280 participants from 48 townships of 12 districts with a follow-up of 10 years in the Guizhou Population Health Cohort Study. We used Pearson's correlation coefficients combined with Dunn and Clark's z test and Zou's confidence interval test, receiver operating characteristic (ROC) analyses, and multivariate Cox proportional hazards regressions adjusting for demographic characteristics, lifestyle habits, disease history, and lipid information of participants. Results: Baseline central adiposity indicators (WC and WHtR) had closer associations with hypertension than BMI, and long-term WC change was more predictive of hypertension compared with weight change in the studied population. Conclusion: Central adiposity indicators maintain a stronger association with the risk of hypertension, hinting at the importance of WC management in the precaution of hypertension.

Concordance between Different Criteria for Metabolic Syndrome in Peruvian Adults Undergoing Bariatric Surgery

Background: Metabolic Syndrome (MetS) is a clinical entity that has been linked to several non-communicable diseases. There are various consensuses to determine its presence, such as the IDF, ALAD, Harmonized, AHA/NHLBI, NCEP-ATP III or AACE criteria. However, there is currently no standardization to properly identify it. Objective: To assess the diagnostic concordance between different criteria for MetS in Peruvian adults undergoing bariatric surgery. Methods: We conducted a secondary analysis of the institutional database of a bariatric clinic located in Lima, Peru. We obtained data from adults between 18–59 years who underwent bariatric surgery (Roux-en-Y Gastric Bypass or Sleeve Gastrectomy). According to the Kappa coefficient, a heatplot was designed to analyze the concordance of the criteria. Results: An almost perfect concordance was found between all criteria except AACE. The highest kappa coefficient (κ = 0.980) was recorded between the IDF and ALAD criteria using all the sample. Similar results were obtained when we stratified by sex. Conclusions: This study shows that, excluding the AACE, different criteria for metabolic syndrome could be used in Latino adults undergoing bariatric surgery with similar results. Given the postoperative implications, we believe that IDF and ALAD would be the best options in our population.

Interaction effect between overweight/obesity and alcohol consumption on hypertension risk in China: a longitudinal study

OBJECTIVE

To explore the interaction effect between overweight/obesity and alcohol consumption on hypertension risk.

DESIGN

A longitudinal study of the independent and combined effects of hypertension risk factors.

SETTING

Twelve provinces in China, including Beijing Liaoning, Heilongjiang, Shanghai, Jiangsu, Shandong, Henan, Hubei, Hunan, Guangxi, Guizhou and Chongqing.

PARTICIPANTS

Longitudinal data of China Health and Nutrition Survey, collected between 2011 and 2015, were used in this study. A total of 13 121 residents from 12 provinces were included and completed physical examinations and questionnaires at baseline.

OUTCOME

First incidence of hypertension.

RESULTS

Over a mean follow-up of 4 years, 690 incident hypertension cases were reported. After adjusting for age, gender, education level, marital status, physical activity, diabetes and smoking, high body mass index (BMI) and light drinking (OR=5.07, 95% CI 3.06 to 8.41), high waist circumference (WC) and light drinking (OR=4.81, 95% CI 2.92 to 7.91), high waist hip ratio and light drinking (OR=2.85, 95% CI 1.84 to 4.42) were the highest risk of all participants in the three combinations. Multiplicative interaction measures were statistically significant in overweight/obesity and drinking/light drinking/heavy drinking categories in men (p<0.05). Additive interactions were observed between high BMI and drinking in men (relative excess risk due to interaction=1.75, 95% CI 0.85 to 2.65, attributable proportion due to interaction=0.56, 95% CI 0.36 to 0.76, synergy index=6.43, 95% CI 1.02 to 28.84).

CONCLUSIONS

Measures of body weight and size, particularly BMI and WC, appear to interact synergistically with alcohol consumption to increase the risk of hypertension in the Chinese population. Given that approximately 245 million people in China have hypertension, and that hypertension is a major cause of cardiovascular disease worldwide, our results may have implications for chronic disease prevention.

Challenges and perspectives of the double burden of malnutrition in Latin America

Nutrition is a key factor in the development of non-communicable chronic diseases (NCCDs), especially cardiovascular diseases (CVD) and their risk factors. The "double burden of malnutrition" (DBM) is the coexistence of undernutrition and overnutrition in the same population across the life-course. In Latin America, the transition from a predominantly underweight to an overweight and obese population has increased more rapidly than in other regions in the world. Undernutrition and the micronutrient deficiencies particularly iron, zinc, and vitamins A and D, present high heterogeneity in Latin American countries, and are currently considered important public health problems. In this region, NCCDs account for 50% of the disability-adjusted life-years, led by CVD. The most prevalent cardiovascular risk factors are overweight, obesity, hypertension, dyslipidemia and type 2 diabetes mellitus. Because of the cost of treatment and the potential years of life lost due to premature death, CVD is known to affect the poorest segments of the population, affecting communities, and governments. More than 80% of CVD deaths occur in low- and middle-income countries. The persistence of damage in some cells due to undernutrition may explain certain findings regarding the increase in NCCD. These aspects together with epigenetic changes have highlighted the importance of a lifelong approach to nutritional policy development. Reducing DBM requires major societal interventions in public health and nutrition to achieve holistic change that can be sustained over the long term and spread throughout the global food system. The implementation of effective state policies of double impact actions should influence both sides of the burden and be considered an urgent priority, considering country-specific inequalities and socio-demographic differences in the Latin American region, using diverse and multidisciplinary strategies.

Metabolically healthy versus unhealthy obese phenotypes in relation to hypertension incidence; a prospective cohort study

Background

Although obesity increases the risk of hypertension, the effect of obesity based on metabolic status on the incidence of hypertension is not known. This study aimed to determine the association between obesity phenotypes including metabolically unhealthy obesity (MUO) and metabolically healthy obesity (MHO) and the risk of hypertension incidence.

Methods

We conducted a prospective cohort study on 6747 adults aged 35–65 from Ravansar non-communicable diseases (RaNCD) study. Obesity was defined as body mass index above 30 kg/m² and metabolically unhealthy was considered at least two metabolic disorders based on the International Diabetes Federation criteria. Obesity phenotypes were categorized into four groups including MUO, MHO, metabolically unhealthy non obesity (MUNO), and metabolically healthy non obesity (MHNO). Cox proportional hazards regression models were applied to analyze associations with hypertension incidence.

Results

The MHO (HR: 1.37; 95% CI: 1.03–1.86) and MUO phenotypes (HR: 2.44; 95% CI: 1.81–3.29) were associated with higher hypertension risk compared to MHNO. In addition, MUNO phenotype was significantly associated with risk of hypertension incidence (HR: 1.65; 95% CI: 1.29–2.14).

Conclusions

Both metabolically healthy and unhealthy obesity increased the risk of hypertension incidence. However, the increase in metabolically unhealthy phenotype was higher.

PRospective Observational Registry Evaluating the Safety and Effectivenessof Orsiro Stent in Chilean Patients - ROSES Registry

BACKGROUND

There is little information on the performance of the new generation of stents with bioabsorbable polymers in the Latin American population. This registry aimed to further validate the safety and efficacy of the Orsiro bioresorbable-polymer sirolimus-eluting stent (BPSES) in unselected patients undergoing percutaneous coronary intervention (PCI) in Chilean centers.

METHODS

We prospectively enrolled patients undergoing PCI with BPSES in 6 Chilean centers. The primary endpoint was defined as the composite of cardiac death, target vessel-related myocardial infarction (MI), and clinically driven target lesion revascularization at 1-year follow-up.

RESULTS

From April 2017 to February 2019, 520 patients were enrolled in the registry, more frequently male (74.6%), with a mean age of 62.7 ± 10.8 years and a high prevalence of diabetes (40.2%). The clinical presentation was stable angina in 41.1% (n = 214), acute MI in 52.5% (n = 167 [32.1%] ST-elevation MI and n = 106 [20.4%] non-ST-elevation MI), and unstable angina in 6.3% (n = 33). Of 610 treated lesions, 425 (69.7%) were American College of Cardiology/American Heart Association type B or C lesions. Device and procedural success were achieved in 99.4% and 98.7% of the patients, respectively. The primary endpoint of the study occurred in 4%, primarily driven by cardiac death.

CONCLUSIONS

The results of the ROSES multicenter registry indicated good clinical outcomes of BPSES Orsiro in all-comers Latin Americann patients undergoing PCI, despite the high-risk patients and treated lesions.

The Latin American Dialysis and Renal Transplantation Registry: report 2019

Background

Chronic kidney disease (CKD) in Latin America (LA) continues to represent a challenge due to the burden of disease it causes and the difficulty in accessing treatment. LA has a total population of 652 million people living in 20 countries that occupy an area of 19.2 million km². The Latin American Dialysis and Renal Transplantation Registry (LADRTR), founded in 1991, has collected data and reports on patients receiving kidney replacement therapy (KRT) since 1993. This article summarizes the registry data for 2019.

Methods

Participating countries complete an annual survey collecting aggregated data on incident and prevalent patients on KRT in all modalities. The different treatment modalities considered were hemodialysis (HD), peritoneal dialysis (PD) and living functioning kidney graft (LFG). National gross domestic product per capita (GDP, expressed in US dollars) and life expectancy at birth (LEB) corresponding to the year 2019 were collected from the World Bank Data Bank. Prevalence and incidence were compared with previous years and were also correlated with GDP and LEB.

Results

On 31 December 2019 a total of 432 610 patients were in KRT in LA, corresponding to an overall unadjusted prevalence of 866 per million population (pmp). Regarding treatment modality, 66.7% of the prevalent patients were treated with HD and 9.3% with PD while 24% of the patients had an LFG. A total of 85 224 patients started KRT in LA, representing a total unadjusted incidence rate of 168 pmp. Diabetic nephropathy as a cause of CKD continues to be a relevant percentage (36%) and five countries reported CKD of nontraditional causes. The kidney transplant rate in the region was 22 pmp, varying from 1 to >60 pmp. The total prevalence of KRT correlated positively with GDP per capita (r² = 0.6, P < 0.01) and LEB (r² = 0.23, P < 0.05). The overall incidence rate also significantly correlated with GDP (r² = 0.307, P < 0.05). The overall unadjusted mortality rate was 13%.

Conclusion

Accessibility to KRT is still limited in LA. It is necessary to continue the efforts made by each country and the Latin American Society of Nephrology and Hypertension to guarantee equal access to treatment.

Preventing heart failure: a position paper of the Heart Failure Association in collaboration with the European Association of Preventive Cardiology

The heart failure epidemic is growing and its prevention, in order to reduce associated hospital readmission rates and its clinical and economic burden, is a key issue in modern cardiovascular medicine. The present consensus document aims to provide practical evidence-based information to support the implementation of effective preventive measures. After reviewing the most common risk factors, an overview of the population attributable risks in different continents is presented, to identify potentially effective opportunities for prevention and to inform preventive strategies. Finally, potential interventions that have been proposed and have been shown to be effective in preventing HF are listed.

School Feeding Programs: What Happens Globally?

School feeding programs (SFPs) are an important effort to address food insecurity, improve nutritional education, and ultimately improve health outcomes. The objective of this research was to describe the nutritional, cultural, food safety, and agro-family participation of SFPs in different countries and observe the SFP in low-middle and high-income countries to establish disparities. The study followed documentary research of SFP official online resources complemented by a literature review. The programs were assessed in four criteria: (1) nutritional aspects, (2) cultural aspects, (3) food safety, and (4) agro-family participation. Out of 192 countries registered, 117 countries (60.93%) have an SFP, and only 8 (4.16%) do not have SFPs. A total of 67 countries (34.89%) did not have an official online resource and did not respond to follow-up emails. Out of the 117 countries with SFP, all of them had a detailed description of their nutritional aspects, cultural aspects (11.96%), food safety (16.23%), and agro-family participation (23.93%). Europe and Central Asia were the continents with the most comprehensive SFP. While most countries incorporate nutritional aspects and healthy food, cultural, food safety, and agro-family participation must be incorporated in their SPF to optimize children and adolescent development. Moreover, the study identified disparities across countries where the SFPs were identified in low-middle countries compared to middle- and high-income countries.

A comprehensive review on phytochemicals for fatty liver: are they potential adjuvants?

Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome and, as such, is associated with obesity. With the current and growing epidemic of obesity, NAFLD is already considered the most common liver disease in the world. Currently, there is no official treatment for the disease besides weight loss. Although there are a few synthetic drugs currently being studied, there is also an abundance of herbal products that could also be used for treatment. With the World Health Organization (WHO) traditional medicine strategy (2014-2023) in mind, this review aims to analyze the mechanisms of action of some of these herbal products, as well as evaluate toxicity and herb-drug interactions available in literature.

Preventing heart failure: a position paper of the Heart Failure Association in collaboration with the European Association of Preventive Cardiology

The heart failure epidemic is growing and its prevention, in order to reduce associated hospital readmission rates and its clinical and economic burden, is a key issue in modern cardiovascular medicine. The present position paper aims to provide practical evidence-based information to support the implementation of effective preventive measures. After reviewing the most common risk factors, an overview of the population attributable risks in different continents is presented, to identify potentially effective opportunities for prevention and to inform preventive strategies. Finally, potential interventions that have been proposed and have been shown to be effective in preventing heart failure are listed.

Fibrosis assessment in patients with nonalcoholic fatty liver disease: Adherence to proposed algorithms and barriers to complying with them

INTRODUCTION AND AIMS

Fibrosis staging in patients with nonalcoholic fatty liver disease (NAFLD) is carried out through the application of stepwise algorithms but there is little real-world data on their use. Our aim was to calculate the number of patients with NAFLD and indeterminate or high risk for fibrosis, assessed through noninvasive scores, that consequently underwent further staging evaluation.

MATERIALS AND METHODS

A cross-sectional multicenter cohort study was conducted on patients with NAFLD evaluated by hepatologists within the time frame of June 1 and July 31, 2018. The FIB-4 and NAFLD fibrosis scores were calculated in all the patients, and if at least one of the scores suggested indeterminate or high risk for fibrosis, we believed the patient should have undergone additional fibrosis staging assessment.

RESULTS

The study included 238 patients. The median time interval from NAFLD diagnosis and inclusion in the analysis was 12.2 months (IQR 3.0-36.5). A total of 128 (54%) patients had at least one noninvasive score that suggested indeterminate or high risk for fibrosis but studies to confirm the fibrosis grade (elastography, biopsy, etc.) were performed on only 72 (56%). The main barriers encountered by the physicians for applying the staging algorithms were related to health insurance coverage and imaging study costs.

CONCLUSIONS

A high percentage of patients with NAFLD were at indeterminate or high risk for fibrosis, according to noninvasive scores, but additional studies were carried out on only half of them, showing low adherence to current recommendations.

Multidimensional analysis of health in Mexico: implementation of fuzzy sets

BACKGROUND

The national health and nutrition survey allows to know the state of health of the Mexican population, it provides data for the analysis of different factors and / or indicators of health, diseases and nutritional conditions, such as chronic degenerative diseases and depressive symptoms, which, in turn, if both occur simultaneously, they will have a negative impact on health. This article studies the four factors involved in the overall health of the population in Mexico: excess weight, diabetes, high blood pressure, and depressive symptoms, which are used to conduct a multidimensional characterization and analysis.

METHODS

Two methodological resources are applied, a descriptive statistical characterization and the construction of a multidimensional health index with the use of fuzzy sets, through the National Health and Nutrition Survey (ENSANUT 2018-19 - for its acronym in Spanish) in Mexico.

RESULTS

The results reveal a growing percentage of individuals who experience detriments to their health, that is, the factors being studied have had a negative impact and tend to follow international projections. The construction of a multidimensional index enables the interaction between the factors being studied, thus allowing for an adequate modeling for the identification of health in Mexico.

CONCLUSION

This study aims to elucidate the current state of health throughout the population in Mexico by using the most current data provided by the autonomous public body of statistics and geography to build a multidimensional panorama using four elementary public health indicators (diabetes, obesity, high blood pressure, and depressive symptoms).

Fibrosis assessment in patients with nonalcoholic fatty liver disease: Adherence to proposed algorithms and barriers to complying with them

INTRODUCTION AND AIMS

Fibrosis staging in patients with nonalcoholic fatty liver disease (NAFLD) is carried out through the application of stepwise algorithms but there is little real-world data on their use. Our aim was to calculate the number of patients with NAFLD and indeterminate or high risk for fibrosis, assessed through noninvasive scores, that consequently underwent further staging evaluation.

MATERIALS AND METHODS

A cross-sectional multicenter cohort study was conducted on patients with NAFLD evaluated by hepatologists within the time frame of June 1 and July 31, 2018. The FIB-4 and NAFLD fibrosis scores were calculated in all the patients, and if at least one of the scores suggested indeterminate or high risk for fibrosis, we believed the patient should have undergone additional fibrosis staging assessment.

RESULTS

The study included 238 patients. The median time interval from NAFLD diagnosis and inclusion in the analysis was 12.2months (IQR 3.0-36.5). A total of 128 (54%) patients had at least one noninvasive score that suggested indeterminate or high risk for fibrosis but studies to confirm the fibrosis grade (elastography, biopsy, etc.) were performed on only 72 (56%). The main barriers encountered by the physicians for applying the staging algorithms were related to health insurance coverage and imaging study costs.

CONCLUSIONS

A high percentage of patients with NAFLD were at indeterminate or high risk for fibrosis, according to noninvasive scores, but additional studies were carried out on only half of them, showing low adherence to current recommendations.

Demographic/anthropometric factors and physiological performance-related parameters associated with the six-minute walk test in bariatric surgery candidates, from Valdivia, Chile

ABSTRACT The six-minute walk test (6MWT) is widely used to measure functional capacity in special populations. However, the factors associated with its performance in candidates for bariatric surgery are unclear. Therefore, this study aimed to investigate the influence of anthropometric and physiological factors in the 6MWT performance in bariatric surgery candidates. This cross-sectional study included 107 candidates for bariatric surgery. Anthropometric factors considered: gender, weight, height, body mass index (BMI), waist-to-hip, and waist-to-height ratios. Along with distance covered during 6MWT, physiological factors such as ratings of perceived exertion (RPE) and heart rate reserve percentage used (%HRR) were recorded. Among the 107 patients (mean age: 39.6 years), 83 volunteers were accepted to perform the 6MWT. No gender differences were observed in terms of distance covered, %HRR, and RPE during the 6MWT. Moreover, BMI and %HRR explained 21% of the 6MWT distance covered. Furthermore, participants with BMI ≤41.5 kg/m2 walked ~50 meters more than their peers above this level (p=0.05). Interestingly, heart rate increase during the 6MWT was lower than described for healthy populations. BMI and %HRR partially explain the variability of the 6MWT performance in bariatric surgery candidates.

Effect of Income Level and Perception of Susceptibility and Severity of COVID-19 on Stay-at-Home Preventive Behavior in a Group of Older Adults in Mexico City

Early information on public health behaviors adopted to prevent the spread of coronavirus (COVID-19) may be useful in controlling the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission. The objective of this study was to assess the role of income level (IL) and the perception of older adults, regarding COVID-19 susceptibility and severity, on adopting stay-at-home preventive behavior during the first week of the outbreak in Mexico. Participants in this cross-sectional study were urban community dwellers, aged ≥ 65 years from Mexico City. A total of 380 interviews were conducted over the phone. The mean respondent age was 72.9 years, and 76.1% were women. Over half (54.2%) of the participants perceived their susceptibility to COVID-19 as very low or low. Similarly, 33.4% perceived COVID-19 severity as being very low or low, and 57.6% had decided to stay at home: this behavior was associated with IL (β = 1.05, p < 0.001), and its total effect was partially mediated (15.1%) by perceived severity. Educational attainment was also associated with staying at home (β = 0.10, p = 0.018) and its total effect was partially mediated (15.0%) by perceived susceptibility. Interventions aimed at low income and less educated older adults should be developed to improve preventive behaviors in this vulnerable group during the COVID-19 pandemic.

Reaching blood pressure guideline targets with the CNIC polypill in patients with a previous cardiovascular event in Mexico: a post hoc analysis of the SORS study

Aim: To determine the effectiveness of Centro Nacional de Investigaciones Cardiovasculares (CNIC)-polypill (acetylsalicylic acid 100 mg, ramipril 5/10 mg, simvastatin 40 mg) in achieving blood pressure (BP) goals. Patients & methods: A multicenter, observational, one cohort, prospective study. BP targets were analyzed in patients with cardiovascular disease after 12-months treatment with the CNIC polypill. Results: A total of 572 patients (59.4 ± 13.9 years, 57.3% men) were analyzed. At baseline, BP was 147.1 ± 18.1/88.3 ± 10.6 mmHg, 97.1% of patients were taken renin-angiotensin system inhibitors, 5.4% calcium antagonists, 1.9% diuretics and 13.1% β-blockers. The proportion of patients who achieved BP targets increased from 20.1 to 55.4% (p < 0.001). Conclusion: In routine practice, switching from usual care to the CNIC-polypill in patients with cardiovascular disease could facilitate achieving BP goals.

Analysis of Dose-response Relationship between BMI and Hypertension in Northeastern China Using Restricted Cubic Spline Functions

High body mass index (BMI) was significantly associated with hypertension. The purpose of this study is to investigate the association between BMI and hypertension in people in northeast China. Our study was a cross-sectional study conducted from June to August 2012. According to multistage, stratified cluster sampling, a total of 21435 inhabitants aged between 18 and 79 years in Jilin Province were selected randomly. The prevalence of hypertension was 35.66% overall. After adjusting for potential confounders, the multivariable-adjusted odds ratios for the BMI- hypertension association for overweight and obesity were 2.503 (95% confidence interval = 1.912-2.204) and 4.259 (95% confidence interval = 3.883-4.671). The results of multivariable restricted cubic spline regression analysis showed that there was a non-linear relationship between the continuous change of BMI and hypertension (P < 0.001) after adjusting the confounding factors of different genders and age groups, which indicated that there was an adjusted dose-response association between continuous BMI and hypertension.

Inhibition of the Angiotensin I Converting Enzyme (ACE) and proteolysis of non-fat probiotic yogurt

Abstract Yogurt is an important source of many biologically active peptides with specific health benefits. The majority of the bioactive peptides produced during yogurt manufacture are related to angiotensin converting enzyme inhibitory (ACE-I) peptides. The present study evaluated the proteolysis and angiotensin converting enzyme (ACE) inhibitory activities of non-fat probiotic yogurt supplemented with sodium caseinate (0 to 4%), and Mentha piperita (peppermint) extract (0 to 0.4%) during 20 days of storage. Good correlation (R = 0.90) was found between the growth of Lactobacillus casei LFTI® L26 and ACE inhibition in all samples during the initial stages of storage, as compared to the control yogurt, with a significant (p < 0.05) decrease after storage. The results showed that the addition of sodium caseinate and peppermint extract had a significant (p < 0.05) effect on proteolysis and the viability of L. casei LFTI® L26, enhancing the ACE activity. The IC50 values of the sample containing 0.4% of peppermint and of the sample containing 4% of sodium caseinate were 0.12 and 0.02 mg/mL respectively. The results showed that the use of 4% of sodium caseinate and 0.4% of peppermint extract could provide higher probiotic viability (1.3×107cfu/g) on the 20th day of storage.