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SSA 04-2 OBESITY THE MOST INFLUENCING AND MODIFIABLE RISK FACTORS IN LATIN AMERICA

Hernandez-Hernandez, Rafael

doi: 10.1097/01.hjh.0000499886.23096.87
SPECIAL SATELLITE SYMPOSIUM 04
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For the last three-decade cardiovascular disease have been the principal causes of death in most Latin American countries. Their importance has been rising, as in developed countries; such as United State, the mortality rate for CV disease declined1 in LA rises as in the other developing countries.

Cardiovascular risk factors epidemiological studies from LA tend to be limited, and with restrictions on the methodology for sampling and interpretation of results; making most of the studies little comparable each other;on the other hand, population characteristics from country to country and inside each country are so different in ethnicity, habits, socio-economic status which make difficult to integrate and compare results as a whole.

Some studies, such as, the CARMELA study, evaluated cardiovascular risk factors in 7 cities of 7 countries of LA, with the same methodology and worldwide standards, in population from 25 to 64 years2, and found significant results. So, CARMELA study found markedly differences in CV risk factors, such as hypertension, where prevalence for Buenos Aires (Argentina), Barquisimeto (Venezuela) and Santiago (Chile) were around 26%, equivalent to US for the same range of age (25–64-y), meanwhile Quito (Ecuador), Bogota (Colombia), Lima (Peru) and Mexico City (Mexico) have a lower level, in average 13%. Average Body Mass Index was higher in men from Mexico City and Buenos Aires; and higher in women from Mexico City, Bogota, Chile and Peru, in both sexes with tendency to increase with age.

The situation for obesity, in multiple reports, showed important variations country to country, as can be seen in the table3, where Mexico, Argentina, Chile, and some cities from Brazil, showed the higher prevalence, not only in obesity but also in overweight, measured as Body Mass Index. So, in average 23.86% of LA population has obesity and 38.02% overweight; making a 61% of LA population with the relation weight/height above the normal limit.

The situation about the abdominal obesity, as presented in the CARMELA study2, (cut values men =>102 cm; women =>88 cm); where the higher prevalence is for Mexico City, especially in women, with, up to 70% at the age of 55–64 y.

On the other hand, prevalence of hypertension, diabetes mellitus and dyslipidaemia is two to three-time more frequent in obese subjects than normal weight population4.

Obesity prevalence tend to increase over the years, as shown recently in an analysis of 19.2 million worldwide participants, from 1975 to 2014, where US and China are the top ranking in obesity subjects, but two of LA countries, Brazil and Mexico following in ranking in fourth and fifth places5.

Body Mass Index and obesity tend to be higher in the less educated population in LA6.

In conclusion, prevalence of obesity in LA is high, representing in average 23.5% in the adults population, when BMI is taking into account; and with tendency to increase over the years. Abdominal obesity is even higher especially for women. Obesity tend to increase with age. Prevalence of other risk factors are several times more frequent when obesity is present. It is urgent to implement global policies and systematically assess their effect, to avoid an epidemic of severe obesity in the region, with consequences to cardiovascular morbidity and mortality.

Universidad Centroccidental Lisandro Alvarado, Venezuela

References:

1. Ford ES, Ajani UA, Croft JB et al. Explaining the decrease in US deaths from coronary disease, 1980-2000. N Engl J Med, 2007;356:2388-2398

2. Schargrodsky H, Hernandez-Hernandez R, et al. CARMELA: assessment of cardiovasuclar risk in seven Latin American cities. Am J Med. 2008;121:58-65

3. M Díaz, in Hipertensión para el clínico, book. R Hernández-Hernandez, M Velasco, MJ Armas, 2008, ISBN 978 980 12 3425-8.

4. Hernández-Hernandez R, Silva H, Velasco M et al. Hypertension in seven Latin American cities: the cardiovascular risk factor multiple evaluation in Latin America (CARMELA) study. J Hypertens 2010;28:24-34

5. Ezzati M et al (NCD Risk Factor Collaboration). Trends in adult body-mass index in 200 countries from 1975 to 2014: pooled analysis of 1698 population-based measurement studies with 19.2 milion participants. Lancet 2016;387:1377-1396

6. Boissonnet C, Schargrodsky H, Pellegrini F. et al. Educational inequalities in obesity, abdominal obesity, and metabolic syndrome in seven Latin American cities: The CARMELA study. Eur J of Cardiovasc Prev & Rehabil. 2011;18:550-556

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