Latin-american consortium of studies in obesity (LASO): The Latin American Consortium of Studies in Obesity (LASO)

Article (PDF Available)inObesity Reviews 10(3):364 - 370 · April 2009with49 Reads
DOI: 10.1111/j.1467-789X.2009.00591.x
Abstract
Current, high-quality data are needed to evaluate the health impact of the epidemic of obesity in Latin America. The Latin American Consortium of Studies of Obesity (LASO) has been established, with the objectives of (i) Accurately estimating the prevalence of obesity and its distribution by sociodemographic characteristics; (ii) Identifying ethnic, socioeconomic and behavioural determinants of obesity; (iii) Estimating the association between various anthropometric indicators or obesity and major cardiovascular risk factors and (iv) Quantifying the validity of standard definitions of the various indexes of obesity in Latin American population. To achieve these objectives, LASO makes use of individual data from existing studies. To date, the LASO consortium includes data from 11 studies from eight countries (Argentina, Chile, Colombia, Costa Rica, Dominican Republic, Peru, Puerto Rico and Venezuela), including a total of 32 462 subjects. This article describes the overall organization of LASO, the individual studies involved and the overall strategy for data analysis. LASO will foster the development of collaborative obesity research among Latin American investigators. More important, results from LASO will be instrumental to inform health policies aiming to curtail the epidemic of obesity in the region.

Figures

The Latin American Consortium of Studies in Obesity
(LASO)
L. E. Bautista
1
, J. P. Casas
2
, V. M. Herrera
1
, J. J. Miranda
2
, P. Perel
2
, R. Pichardo
3
, A. González
3
,
J. R. Sanchez
4
, C. Ferreccio
5
, X. Aguilera
6
, E. Silva
7
, M. Oróstegui
8
, L. F. Gómez
9
, J. A. Chirinos
10
,
J. Medina-Lezama
11
,C.M.Pérez
12
, E. Suárez
12
,A.P.Ortiz
12
, L. Rosero
13
, N. Schapochnik
14
,Z.Ortiz
15
and D. Ferrante
16
, on behalf of the investigators of the Latin-American Consortium of Studies in
Obesity (LASO)
1
Department of Population Health Sciences, University of
Wisconsin, Madison, WI, USA;
2
Department of Epidemiology
and Population Health, London School of Hygiene and Tropical
Medicine, London, UK;
3
Instituto Dominicano de Cardiología,
Santo Domingo, República Dominicana;
4
Centro Nacional de
Alimentación y Nutrición, Instituto Nacional de Salud, Lima,
Perú;
5
Departamento de Salud Pública, Pontificia Universidad
Católica de Chile, Santiago, Chile;
6
Ministerio de Salud de
Chile, Santiago, Chile;
7
Instituto de Investigación y Estudios de
Enfermedades Cardiovasculares, Facultad de Medicina,
Universidad del Zulia, Maracaibo, Venezuela;
8
Cardiovascular
Diseases Epidemiologic Observatory, Epidemiologic Research
Center, Universidad Industrial de Santander, Bucaramanga,
Colombia;
9
Health Division, Fundación FES Social, Bogotá,
Colombia;
10
Division of Cardiology, University of Pennsylvania
School of Medicine and Philadelphia VA Medical Center,
Philadelphia, PA, USA;
11
Santa Maria Catholic University and
Santa Maria Research Institute, Arequipa, Perú;
12
Department
of Biostatistics and Epidemiology, Graduate School of Public
Health, Medical Sciences Campus, University of Puerto Rico,
San Juan, Puerto Rico;
13
Universidad de Costa Rica, Centro
Centroamericano de Población, San José, Costa Rica;
14
Ministerio de Salud de la Provincia de Tierra del Fuego,
Ushuaia, Argentina;
15
Instituto de Investigaciones
Epidemiológicas Academia Nacional de Medicina, Buenos
Aires, Argentina;
16
Ministerio de Salud y Ambiente, Buenos
Aires, Argentina
Received 8 December 2008; revised 23 February 2009;
accepted 24 February 2009
Address for Correspondence: LE Bautista, Department of
Population Health Sciences, University of Wisconsin-Madison,
610 Walnut Street, 703 WARF, Madison, WI 53726-2397, USA.
E-mail: lebautista@wisc.edu; JP Casas, Department of
Epidemiology and Population Health, London School of
Hygiene and Tropical Medicine, Keppel Street, London WC1E
7HT, UK. E-mail: Juan.Pablo-Casas@lshtm.ac.uk
Summary
Current, high-quality data are needed to evaluate the health impact
of the epidemic of obesity in Latin America. The Latin American
Consortium of Studies of Obesity (LASO) has been established,
with the objectives of (i) Accurately estimating the prevalence of
obesity and its distribution by sociodemographic characteristics; (ii)
Identifying ethnic, socioeconomic and behavioural determinants of
obesity; (iii) Estimating the association between various anthropo-
metric indicators or obesity and major cardiovascular risk factors
and (iv) Quantifying the validity of standard definitions of the
various indexes of obesity in Latin American population. To achieve
these objectives, LASO makes use of individual data from existing
studies. To date, the LASO consortium includes data from 11 studies
from eight countries (Argentina, Chile, Colombia, Costa Rica,
Dominican Republic, Peru, Puerto Rico and Venezuela), including a
total of 32 462 subjects. This article describes the overall organiza-
tion of LASO, the individual studies involved and the overall strategy
for data analysis. LASO will foster the development of collaborative
obesity research among Latin American investigators. More impor-
tant, results from LASO will be instrumental to inform health
policies aiming to curtail the epidemic of obesity in the region.
Keywords: Consortium, health surveys, Latin America, obesity, risk
factors.
obesity reviews (2009)
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Introduction
The parallel processes of economic growth, migration and
urbanization in Latin America have shaped the epide-
miological transition by increasing life expectancy and
modifying lifestyles (1–3). In fact, the increase in the con-
sumption of high-energy-density foods and the reduction in
the levels of physical activity have been recognized as the
main factors associated with the accelerated epidemic of
obesity in the region (4,5). This epidemic is a matter of
great concern because obesity constitutes a major modifi-
able risk factor for most of the leading causes of disability
and mortality in Latin American countries, particularly
cardiovascular diseases (CVD), diabetes mellitus, osteoar-
thritis and certain types of cancers (6,7).
Although existing evidence suggests a parallel increment
in total energy and fat consumption, the prevalence of
sedentary behaviours and the prevalence of obesity (8–10),
there are limited reliable data on the magnitude and con-
sequences of the epidemic of obesity in the region. Further-
more, the association of behavioural and environmental
factors with obesity, as well as the relationship between
obesity and other chronic diseases, might be more complex
in Latin America than in more homogeneous populations.
In fact, the current definition of obesity, primarily derived
from White populations from Europe and the United States
(6), might not be optimal to identify individuals at high risk
of CVD or of diabetes mellitus (11,12).
Estimates of the prevalence of obesity have shown a great
variability in Latin American populations, ranging from
9.9% to 35.7% (13). Women and individuals living in
urban areas have been identified as the groups predomi-
nantly affected (14). In addition, obesity has been indepen-
dently associated to low socioeconomic status and poorer
educational level (15,16), and contributes to the accentua-
tion of health inequalities in the region (17). There is also
evidence of a secular trend towards the increase in levels
of obesity among the most economically developed Latin
American countries during the past three decades (14,18);
however, similar data are not available for more disadvan-
taged populations. Moreover, most of the information on
obesity has been obtained from nutritional surveys con-
ducted during the first half of the nineties in adult women,
mostly in urban settings, and little is known about adult
men or the growing elderly population as well as rural
obesity profiles.
In order to compose a comprehensive and updated
picture of the impact of obesity in Latin America, we have
established a multi-country consortium of obesity-related
epidemiological studies conducted in the region. This ini-
tiative constitutes a strategy aimed to efficiently identify
individual and population determinants of obesity, as well
as to assess the role of obesity on the burden of CVD. We
have chosen to focus on CVD for several reasons. First,
CVD is the leading cause of non-traumatic mortality in
Latin America (3,7); second, the projected burden of CVD
will double during the following 20 years in the region
(19,20); and third, there is a well-established association
between obesity and the incidence of major cardiovascular
risk factors and clinical cardiovascular events (21).
The specific objectives of the Latin American Consor-
tium of Studies of Obesity (LASO) are (i) To accurately
estimate the prevalence of obesity and its distribution by
sociodemographic characteristics in Latin American; (ii)
To identify ethnic, socioeconomic and behavioural factors
(nutritional and physical activity patterns) associated to
the prevalence of obesity; (iii) To estimate the association
between various anthropometric indicators of obesity and
classic cardiovascular risk factors and (iv) To quantify the
validity of standard definitions of obesity in this popula-
tion. Along with the accomplishment of these objectives, it
is expected that the consolidation of LASO will foster the
development of collaborative, harmonized studies on the
association between obesity and other relevant chronic dis-
eases in the region. LASO will help understand the obesity
epidemic and develop future studies to evaluate the deter-
minants and the impact of obesity in Latin America.
The aim of this manuscript is to present the protocol for
LASO, describe the use of standardized methodologies for
the pooling of data from individual studies and provide
a general description of participating studies and their
methodologies.
Materials and methodology
Identification and selection of studies
Studies included in LASO are cross-sectional or prospective
population-based cohort studies, based on random samples
of a defined free-living population. All studies have indi-
vidual data on demographic and socioeconomic indicators
and anthropometric indicators of obesity collected through
physical examination. Moreover, they have at least one of
the following (i) Direct measurement of major cardiovas-
cular risk factors; (ii) Determination of levels of physical
activity and (iii) Determination of nutritional patterns.
The search for potential participant studies is based on
computer-assisted literature searches of health-related data-
bases; hand-searching of obesity, cardiology, epidemiology
and other relevant journals; and personal communications
with cardiovascular and obesity researchers from the
region.
Ethical approval, informed consent and
confidentiality of the data
All studies have been approved by their respective local
Institutional Review Board, and all participants provided
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their informed consent. The investigators of the original
studies provide written consent for the use of their data
before transferring and inclusion into the Consortium’s
central database at the University of Wisconsin at Madison.
The data remain the property of the principal investigators
of each participant study and are securely stored in study-
dedicated computers. The central database does not include
codes or data that may directly or indirectly allow the
identification of individuals participating in the original
studies.
Consortium management and coordination
The LASO Steering Committee includes the principal inves-
tigators from all original studies. The tasks of this commit-
tee include (i) Coordinating the recruitment of new studies;
(ii) Developing and prioritizing research questions to be
addressed by the analysis of pooled data; (iii) Identifying
and securing funds for the study; (iv) Producing and dis-
seminating scientific reports of the ongoing research
projects among members of the Consortium and (v) Acting
as a publication committee. Parallel to the Steering Com-
mittee, a statistical centre has been constituted as an exter-
nal academic instance responsible for the creation and
management of the Consortium’s central database, as well
as for data analysis and generation of preliminary reports.
This centre is based at Department of Population Health
Sciences, University of Wisconsin at Madison.
Study variables
Individual data collected in each study are categorized
in five domains (Table 1) (i) Demographics, including age,
gender, race or ethnic group; (ii) Indicators of socioeco-
nomic status, including socioeconomic stratification,
educational attainment, income, occupation and area of
residency; (iii) Anthropometric indicators of total and
regional obesity, measured by physical examination; (iv)
Classic cardiovascular risk factors, including measurements
of blood pressure and the laboratory assessment of glucose
and lipid fractions and (v) Behavioural risk factors, includ-
ing smoking status, alcohol consumption, physical activity
and nutritional intake. Continuous variables such as
anthropometric measures, blood pressure, glucose and lipid
fractions are categorized according to current standard
definitions. Whenever possible, categorical variables are
recoded following standard procedures to maximize com-
parability among studies. Data on study-specific proce-
dures are used to assess heterogeneity among studies.
Data transfer and checking
Password-protected data files are transferred from the indi-
vidual studies to the Consortium’s statistical centre using
electronic mailing. A codebook and a transference form
containing a list of parameters directly estimated from the
original datasets are included as part of the transference
protocol. For security purposes, the datasets and accompa-
nying files are encrypted before transference using key-
words known only to the coordinator of the Consortium
and the principal investigators of each study. Specific
parameters calculated from each study after data transfer
are compared with those obtained by the study investiga-
tors before data transfer. In the case of inconsistencies, the
data are back-transferred to ensure identical results are
obtained with both datasets. The data are then converted to
a standard format and incorporated to the Consortium’s
central database.
Statistical analysis
Specific data analysis strategies are used for each specific
study using LASO data. However, some statistical proce-
dures are applied for all analyses. We use multivariate
imputation by chained equations to fill out missing values
within studies in order to minimize selection bias because
of missing data (22). Multiple imputed datasets are gener-
ated and the parameters of interest are averaged across
datasets, using Rubin’s formula (23). In addition, we use
post-stratification by the age and gender distribution of the
Table 1 Variables available in the Latin American Consortium of Studies
in Obesity (LASO)
Domain Variable (description)
Demographic Age (years); gender (male/female)
Ethnicity (Amerindian/Black/White/other)
Socioeconomic Education attainment (highest level or total years)
Income (individual or household)
Occupation (occupational categories)
Area of residency (urban/rural)
Anthropometry* Body weight (kg)/height (m)
Waist circumference (cm)
Hip circumference (cm)
Cardiovascular
and metabolic
risk factors*
Systolic/diastolic blood pressure (mmHg)
Glucose (mmol L
-1
)
Total, HDL and LDL cholesterol (mmol L
-1
)
Triglycerides (mmol L
-1
)
Behavioural
risk factors
Smoking status (never, past or current; cigarettes
per day)
Alcohol consumption (type of beverage, frequency
and quantity)
Physical activity (type of activity, frequency and
duration)
Foods/nutrients’ intake (food frequency
questionnaires)
*Measured by physical examination or laboratory analysis.
HDL, high-density lipoprotein; LDL, low-density lipoprotein.
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whole population in the countries included in the specific
analysis as a way to minimize bias as a result of non-
response and sampling frame under-coverage (24). Post-
strata are constructed using the population totals by
country, gender and age group (20–29, 30–39, 40–49,
50–59, 60–69, 70–79 and 80 years and older). Population
distribution data are obtained from the U.S. Census Bureau
(http://www.census.gov) for Puerto Rico and from the
Centro Latinoamericano y Caribeño de Demografía
CELADE (http://www.cepal.org.ar/Celade) for all other
countries.
Multiple weighted linear and logistic regression are
implemented in order to (i) Compare the distribution of
anthropometric indicators and the prevalence of obesity
and cardiovascular risk factors in groups defined by demo-
graphic and socioeconomic characteristics; (ii) Predict the
prevalence of total and regional obesity in these groups and
(iii) Quantify the independent effect of total and regional
obesity on the distribution of individual cardiovascular risk
factors and coronary heart disease risk. In order to deter-
mine which anthropometric indicator of obesity better
identifies individuals with specific cardiovascular risk
factors or who are at high risk of coronary heart disease,
we estimate and compare the areas under the receiver
operator characteristic (ROC) curves using the method of
placement values (25,26). Finally, optimal cut-points for
the anthropometric indicators of obesity are also deter-
mined on the basis of the ROC analysis by estimating the
values of the indicator that minimize the cost of misclassi-
fying individuals according to the presence of specific car-
diovascular risk factors or the risk of coronary heart
disease (27).
Publication policy
Manuscripts derived from the analysis of aggregated data
undergo an internal peer-review process. Manuscripts cir-
culate among the members of the Steering Committee, who
provide comments and generate a feedback report to the
main authors. The main author addresses and responds to
the comments and prepares a final revised version. LASO’s
Steering Committee approves the final manuscript before
submission. Finally, as part of a strategy of communica-
tion and recruitment, the Consortium has developed a
website (http://www.pophealth.wisc.edu/laso), which con-
tains general information on the participant studies, the
principal investigators and their groups, and links to the all
the publications derived from the analysis of pooled data.
Results
Eleven studies (28–38) from eight countries in Latin
American and the Caribbean (Argentina, Chile, Colombia,
Costa Rica, Dominican Republic, Peru, Puerto Rico and
Venezuela) are currently included in the LASO, including a
total of 32 462 subjects (Table 2). The overall mean age is
45.8 years (standard deviation 18.6 years; range: 15–109
years) and the male proportion is 40.6%, ranging from
31.0% to 50%. Four studies are national health surveys
(29,32–34), but one of them is restricted to urban popula-
tion (33). In addition, one study was conducted at the state
level (38), five exclusively targeted urban populations from
single cities (28,30,31,36,37) and other sampled an urban
and a rural population (35).
Data on demographic and socioeconomic characteristics,
smoking, medical history and current treatment of hyper-
tension and diabetes were collected by trained interviewers
using similar questionnaires (available to the members of
the statistical centre) in all studies. Standing height and
weight were measured in all surveys with the participants
wearing light clothing and no shoes. Waist circumference
was measured at the umbilical level in five studies
(28,31,32,36,38), at the midpoint between the lowest rib
and the iliac crest in four studies (29,30,34,35), at the high
Table 2 Characteristics of the studies from the Latin American Consortium of Studies in Obesity (LASO)
Study Location Year Target Sample Age Male
Encuesta de Factores de Riesgo (28) Argentina, Ushuaia/Rio Grande 2003–2004 City 1135 18–65 48%
Encuesta Nacional de Salud (29) Chile 2003 National 3619 16–97 45%
CARMEN (30) Colombia, Bogotá 2001 City 2962 15–69 43%
CARMEN (31) Colombia, Bucaramanga 2001 City 2994 15–66 36%
CRELES (32) Costa Rica 2004–2006 National 2826 60–109 46%
EFRICARD (33) Dominican Republic 1998 National (urban) 6184 18–75 34%
ENINBSC-ECNT (34) Peru 2005 National 4209 20–95 50%
PERU MIGRANT (35) Peru, Lima/Ayacucho 2007–2008 Urban/rural 990 29–92 47%
PREVENCION (36) Peru, Arequipa 2004–2006 City 1878 20–80 46%
Metabolic syndrome in San Juan (37) Puerto Rico 2005–2007 City 865 21–79 35%
The Zulia CHD Factor Study (38) Venezuela, Zulia 1999–2001 State 4800 20–97 31%
CHD, coronary heart disease.
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point of the iliac crest in one study (37), and was not
measured in one study (33). Hip circumference was mea-
sured at the maximum extension of the buttocks. Blood
pressure measurements were conducted at least twice in all
but one study (34), following standard recommendations
(39). Blood samples were obtained in all studies, after 8h
of fast, blood glucose, total cholesterol and high-density
lipoprotein cholesterol were measured enzymatically by
automated methods. Low-density lipoprotein (LDL) cho-
lesterol was directly measured in two studies (36,38)
and was calculated using the Friedewald equation (40)
otherwise.
For effects of statistical analyses, hypertension is defined
as a systolic blood pressure 140 mmHg, or as a diastolic
blood pressure 90 mm Hg, or as current anti-
hypertensive treatment, and participants are considered
diabetics if their fasting glucose is 7.0 mmol L
-1
(126 mg dL
-1
) or if they report current pharmacological
treatment for diabetes (either insulin or oral agents).
High total cholesterol is defined as a total cholesterol
6.15 mmol L
-1
(240 mg dL
-1
). High LDL cholesterol
and low high-density lipoprotein cholesterol are deemed
present if the corresponding cholesterol levels are 4.10
(160 mg dL
-1
) and <1.03 mmol L
-1
(<40 mg dL
-1
), respec-
tively. Hypertriglyceridemia is defined as a level of triglyc-
erides 2.25 mmol L
-1
(200 mg dL
-1
). Also, participants
are classified as current smokers if they report to have
smoked at least 100 cigarettes in their lives and have
smoked during the previous 1–6 months in two studies
(30,35) or if they were smoking at least one cigarette per
day at the moment of the evaluation in the remaining
studies. Overall, obesity is defined as body mass index
30 kg m
-2
and abdominal obesity as a waist circumfer-
ence 88 cm in women and 102 cm in men, following
the recommendations of the World Health Organiza-
tion (6).
Finally, as a strategy to summarize the cardiovascular
risk, the expected 10-year risk of coronary heart disease is
estimated in men and women 30–74 years old by using the
Framingham equation (41). Considering that the equation
may overestimate the absolute risk of coronary heart
disease (CHD) in Latin Americans (42), we use the
population-specific mean values for the risk factors in order
to minimize such effect. Participants with an estimated
10-year risk of CHD 20% are considered at ‘high risk’,
because current standards of care recommend aggressive
risk reduction and selective use of proven drug therapies in
these individuals (43,44).
Conclusion
The LASO constitutes a multinational initiative to effi-
ciently assess the public health problem of obesity, its socio-
demographic and behavioural determinants, and its impact
on the risk of CVD in the region. The strategy of combining
data captured at individual level from population-based
studies will allow not only to increase precision in estimat-
ing the prevalence of obesity, but also to capture the het-
erogeneity of the effect of this condition on the health of the
Latin American population. Finally, the Consortium, which
currently includes data from 11 studies involving approxi-
mately 33 000 participants, will serve as framework for the
interchange of observational data, discussion and interpre-
tation of regional epidemiological evidence, and ultimately
the formulation of high-quality, standardized, collaborative
proposals on obesity and other prevalent chronic diseases.
Conflict of Interest Statement
None.
Acknowledgements
The authors want to express their thanks to Dr Paula
Margozzini (Pontificia Universidad Católica de Chile,
Chile), Claudia González (Ministerio de Salud, Chile), Dr
Luis A. Santa María (Instituto Nacional de Salud, Perú), Dr
Manuel Guzmán and Dr Lillian Haddock (University of
Puerto Rico, School of Medicine, Puerto Rico), and Profes-
sors José Villasmil and Mairelis Nuváez (Universidad del
Zulia).
The ‘Prueba de Validación de la Encuesta Nacional de
Factores de Riesgo’ was funded by the Ministerio de Salud
de la República Argentina and the Gobierno de la Provincia
de Tierra del Fuego, Antártida e Islas del Atlántico Sur,
Argentina. The ‘Encuesta Nacional de Factores de Riesgo’
was funded by the Ministerio de Salud de la República
Argentina. The ‘Encuesta Nacional de Salud 2003’ was
funded by the Ministerio de Salud, Chile. The ‘Estudio
CARMEN Santa Fe’ was funded by the Secretaría Distrital
de Salud de Bogotá, Colombia. CARMEN-Bucaramanga
was funded by the Secretaría de Salud Municipal de
Bucaramanga and the Secretaría Departamental de Salud
de Santander, Colombia. The ‘Costa Rica: Estudio de Lon-
gevidad y Envejecimeinto Saludable (CRELES)’ was funded
by The Wellcome Trust Foundation, grant number 072406.
The ‘Estudio de Factores de Riesgo Cardiovascular en la
República Dominicana (EFRICARD)’ was funded by the
Sociedad Dominicana de Cardiología, Brystol Myers
Squibb, Warners Lambert (Pfizer), Novartis, Merck
Sharp Dohme and Magnachen International. The ‘Encuesta
Nacional de Indicadores Nutricionales, Bioquímicos,
Socioeconómicos y Culturales Relacionados con las Enfer-
medades Crónico Degenerativas (ENINBSC-ECNT)’ was
funded by the Instituto Nacional de Salud, Lima, Perú.
JJM and the ‘PERU MIGRANT study’ were supported
by a Wellcome Trust Research Training Fellowship
(GR074833MA). The study ‘Prevalencia de Enfermedades
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Cardiovasculares y Factores de Riesgo Coronario en
Arequipa (PREVENCION)’ was partially supported by the
Instituto de Investigación Santa Maria. The study of the
‘Prevalence of Metabolic Syndrome and its Individual
Components in the adult population of the San Juan
Metropolitan Area in Puerto Rico’ was funded by an unre-
stricted grant from Merck Sharp & Dohme Corporation
with additional support from the National Institutes of
Health/National Center for Research Resources (NCRR/
NIH) grant awards G12RR03051 and P20RR011126. The
Zulia Coronary Heart Disease Risk Factor Study was
funded by the Fondo Nacional de Ciencia, Tecnología e
Innovación (FONACIT) and the Fundación Venezolana de
Hipertensión Arterial (FUNDAHIPERTENSION).
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    • "In Chile, the National Health Survey 2003 (ENS) provided prevalence data for those between the17 and 24 years of age, which indicated that males were 14% overweight, 10% obese and 0.3% morbidly obese, and females were 19.6%, 7.1%, and 1.1%, respectively. Despite the great number of recent studies on obesity and associated conditions in the Latin American popula- tion [5,171819202122232425262728, fewer studies explore its relation with other health-risk behaviors, including smoking, alcohol and other drug use [1,5]. Specifically, university population studies show a higher prevalence of legal and illegal drug use than in other popu- lations [29], with implications for public health problems, as well as the relationship between drug use and academic performance. "
    [Show abstract] [Hide abstract] ABSTRACT: Obesity is a public health problem of alarming proportions, including among the university population in Latin America. The purpose of this study was to determine the relation between the self-reported body mass index and the associated drug use and health-risk behaviors. We performed a cross-sectional, descriptive study of 3,311 Chilean university students (17-24 years). The variables weight, height, frequency of physical activity, diet quality index, and drug use were evaluated by way of a self-report questionnaire. 16.7% of students were overweight and 2.1% were obese. Higher rates of overweight and obesity were observed in the men compared to women. There was a significant but moderate association between self-perceived obesity and being men and higher age, and just low with greater use of analgesics and tranquilizers with or without a prescription. The punctual prevalence rates of self-reported obesity, in this sample, are consistent with other Latin American studies. The risk behaviors associated with perceived obesity in terms of gender, particularly the different pattern of drug use, highlight the importance of considering gender when designing strategies to promote health in a university setting.
    Full-text · Article · Jan 2014
    • "These discrepancies in types of foods purchased and consumed in major urban areas and the Northern states of Mexico may partially account for the interactive effects noted between higher levels of education and increased obesity risks for rural residents and men. The increase in sedentary lifestyles across Mexico in conjunction with changing dietary patterns [41] [42] raises serious public health concerns that require programs and policies targeted at the appropriate subgroups experiencing increasing and continued high rates of obesity. Third, an interesting association was noted in the multilevel logistic regression models in that an independent negative association was noted between the level of marginality in a respondent's municipio and their risk of being obese. "
    [Show abstract] [Hide abstract] ABSTRACT: This paper assesses individual and social environment determinants of obesity in the adult Mexican population based on socioeconomic position, rural residence, and areal deprivation. Using a nationally representative health and nutrition survey, this analysis considers individual and structural determinants of obesity from a socioeconomic position and health disparities conceptual framework using multilevel logistic regression models. We find that more than thirty percent of Mexican adults were obese in 2006 and that the odds of being obese were strongly associated with an individual's socioeconomic position, gender, place of residence, and the level of marginalization (areal deprivation) in the place of residence. Surprisingly, areas of the country where areal deprivation was highest had lower risks of individual obesity outcomes. We suggest that programs oriented towards addressing the health benefits of traditional food systems over high-energy dense refined foods and sugary beverages be promoted as part of a public health program aimed at curbing the rising obesity prevalence in Mexico.
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    • "The characteristics and stages of development in the transition differ among the various countries. However, one point stands out, namely the marked increase in the prevalence of obesity in the various population sub-groups in nearly all Latin America and a decline in undernutrition in most countries.24–26 "
    [Show abstract] [Hide abstract] ABSTRACT: This article analyses the epidemiological research developments in Latin America and the Caribbean (LAC). It integrates the series commissioned by the International Epidemiological Association to all WHO Regions to identify global opportunities to promote the development of epidemiology. Health situations of the regions were analysed based on published data on selected mortality, morbidity and risk factors. Epidemiological publication output by country was estimated by Medline bibliometrics. Internet and literature searches and data provided by key informants were used to describe perspectives on epidemiological training, research and funding. Despite important advances in recent decades, LAC remains the world's most unequal region. In 2010, 10% of the LAC's people still lived in conditions of multidimensional poverty, with huge variation among countries. The region has experienced fast and complex epidemiological changes in past decades, combining increasing rates of non-communicable diseases and injuries, and keeping uncontrolled many existing endemic and emerging diseases. Overall, epidemiological publications per year increased from 160 articles between 1961 and 1970 to 2492 between 2001 and 2010. The increase in papers per million inhabitants in the past three decades varied from 57% in Panama to 1339% in Paraguay. Universities are the main epidemiological training providers. There are at least 34 universities and other institutions in the region that offer postgraduate programmes at the master's and doctoral levels in epidemiology or public health. Most LAC countries rely largely on external funding and donors to initiate and sustain long-term research efforts. Despite the limited resources, the critical mass of LAC researchers has produced significant scientific contributions. FUTURE NEEDS: The health research panorama of the region shows enormous regional discrepancies, but great prospects. Improving research and human resources capacity in the region will require establishing research partnerships within and outside the region, between rich and poor countries, promoting collaborations between LAC research institutions and universities to boost postgraduate programmes and aligning research investments and outputs with the current burden of disease.
    Full-text · Article · Mar 2012
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