Are Women's Empowerment and Income Inequality Associated with Excess Weight in Latin American Cities?

While income gradients and gender inequalities in excess weight have been noted elsewhere, data from Latin American cities is lacking. We analyzed gender-specific associations between city-level women's empowerment and income inequality with individual-level overweight/obesity, assessing how these associations vary by individual education or living conditions within cities in Latin America. Data came from national surveys and censuses, and was compiled by the SALURBAL project (Urban Health in Latin America). The sample included 79,422 individuals (58.0% women), living in 538 sub-cities, 187 cities, and 8 countries. We used gender-stratified Poisson multilevel models to estimate the Prevalence Rate Ratios (PRR) for overweight/obesity (body mass index ≥ 25 kg/m2) per a unit change in city-level women's empowerment (proxied by a score that measures gender inequalities in employment and education) and income inequality (proxied by income-based Gini coefficient). We also tested whether individual education or sub-city living conditions modified such associations. Higher city labor women's empowerment (in women) and higher city Gini coefficient (in men) were associated with a lower prevalence of overweight/obesity (PRR = 0.97 (95%CI 0.94, 0.99) and PRR = 0.94 (95%CI 0.90, 0.97), respectively). The associations varied by individual education and sub-city living conditions. For labor women's empowerment, we observed weakened associations towards the null effect in women with lower education and in residents of sub-cities with worse living conditions (men and women). For the Gini coefficient, the association was stronger among men with primary education, and a negative association was observed in women with primary education. Our findings highlight the need for promoting equity-based policies and interventions to tackle the high prevalence of excess weight in Latin American cities.

The Inflammatory Potential of Diet is Associated with Breast Cancer Risk in Urban Argentina: A Multilevel Analysis.

Dietary patterns have been associated with breast cancer (BC) in Argentina. However, little evidence exists relating the inflammatory potential of diet and BC in Latin American countries and how this may relate to rurality.The aim of the present study was to evaluate the association between the Dietary Inflammatory Index (DII®) and BC considering urbanization contexts in Córdoba, Argentina.A frequency-matched case-control study (317 BC cases, 526 controls) was conducted from 2008 through 2016. DII scores were computed based on dietary intake assessed by a validated food frequency questionnaire. Multi-level logistic regression models were fit to evaluate the association between DII and BC, following adjustment for age, body mass index, age at menarche, number of children, smoking habits, socio-economic status and family history of BC as first-level covariates and urbanization level as the contextual variable.Increasing DII score showed significant positive associations with BC risk (ORtertile3vs.tertile1 1.34; 95%CI 1.05, 1.70). The association was stronger in overweight and obese women (ORtertile3vs.tertile1 1.98; 95%CI 1.86, 2.10). The DII effect on BC was higher with increased urbanization.A pro-inflammatory diet, reflected by higher DII scores, was positively associated with BC, especially in overweight women and with increased urbanization.

Urban social environment and low birth weight in 360 Latin American cities.

OBJECTIVE: Using data compiled by the SALURBAL project (Urban Health in Latin America; 'Salud Urbana en América Latina') we quantified variability in low birth weight (LBW) across cities in Latin America, and evaluated the associations of socio-economic characteristics at various levels (maternal, sub-city and city) with the prevalence of LBW. METHODS: The sample included 8 countries, 360 cities, 1321 administrative areas within cities (sub-city units) and birth registers of more than 4.5 million births for the year 2014. We linked maternal education from birth registers to data on socioeconomic characteristics of sub-cities and cities using the closest available national population census in each country. We applied linear and Poisson random-intercept multilevel models for aggregated data. RESULTS: The median prevalence of city LBW by country ranged from a high of 13% in Guatemala to a low of 5% in Peru (median across all cities was 7.8%). Most of the LBW variability across sub-cities was between countries, but there were also significant proportions between cities within a country, and within cities. Low maternal education was associated with higher prevalence of LBW (Prevalence rate ratios (PRR) for less than primary vs. completed secondary or more 1.12 95% CI 1.10, 1.13) in the fully adjusted model. In contrast, higher sub-city education and a better city social environment index were independently associated with higher LBW prevalence after adjustment for maternal education and age, city population size and city gross domestic product (PRR 1.04 95% CI 1.03, 1.04 per SD higher sub-city education and PRR 1.02 95% CI 1.00, 1.04 per SD higher SEI). Larger city size was associated with a higher prevalence of LBW (PRR 1.06; 95% CI 1.01, 1.12). CONCLUSION: Our findings highlight the presence of heterogeneity in the distribution of LBW and the importance of maternal education, local and broader social environments in shaping LBW in urban settings of Latin America. Implementing context-sensitive interventions guided to improve women's education is recommended to tackle LBW in the region.

Nutrition transition profiles and obesity burden in Argentina.

OBJECTIVE: The present study aimed to identify nutrition transition (NT) profiles in Argentina (2005-2013) and assess their association with obesity in the adult population. DESIGN: A large cross-sectional study was performed considering data sets of nationally representative surveys. A multiple correspondence analysis coupled with hierarchical clustering was conducted to detect geographical clusters of association among sociodemographic and NT indicators. Multilevel logistic regression models were used to assess the effect of NT profile (proxy variable of contextual order) on obesity occurrence. SETTING: First, we used geographically aggregated data about the adult and child populations in Argentina. Second, we defined the population of adults who participated in the National Survey of Chronic Disease Risk Factors (2013) as the study population.ParticipantsTwenty-four geographical units that make up the territory of Argentina and 32 365 individuals over 18 years old living in towns of at least 5000 people. RESULTS: Three NT profiles were identified: 'Socionutritional lag' (characterized by undernutrition and socio-economically disadvantaged conditions; profile 1); 'Double burden of malnutrition' (undernutrition and overweight in highly urbanized scenarios; profile 2); and 'Incipient socionutritional improvement' (low prevalence of malnutrition and more favourable poverty indicator values; profile 3). Profiles 1 and 2 were significantly associated (OR; 95 % CI) with a higher risk of obesity occurrence in adults (1·17; 1·02, 1·32 and 1·44; 1·26, 1·64, respectively) compared with profile 3. CONCLUSIONS: Argentina is facing different NT processes, where sociodemographic factors play a major role in shaping diverse NT profiles. Most of the identified profiles were linked to obesity burden in adults.

[Adolescents opinions regarding Plato del Bien Comer Maya as nutrition health promotion tool.] / Opiniones de adolescentes sobre el Plato del Bien Comer Maya como herramienta de promoción de la salud.

OBJECTIVE: To know opinions of adolescents from Cholul, Yucatán, about Plato del Bien Comer Maya in order to improve it as health promotion tool. MATERIALS AND METHODS: Qualitative study, formative research. Three focus groups were carried out, participating 28 adolescents: 12-16 years old. Criteria of inclusion: studying middle school; to have native family from the town. Analysis of the data made manually. RESULTS: Comparatively with the national Plato del Bien Comer, the Plato Maya was better identified because have local food products easier to obtain and cheaper. The principal finding was to understand Fruto is a linguistic variation word which represents in Maya context both fruits and vegetables. This might be an important key to improve health promotion activities with that population. CONCLUSIONS: In order to have better results in nutritional interventions, it is necessary to design educational-communicative strategies in accordance with the local culture.

OBJETIVO: Conocer opiniones sobre el Plato del Bien Comer Maya de adolescentes de Cholul, Yucatán, para mejorar la herramienta comunicativa y utilizarla en actividades depromoción de la salud. MATERIAL Y MÉTODOS: Estudio cualitativo, de investigación formativa. Se realizaron tres grupos focales, participaron 28 adolescentes de secundaria: 12-16 años. Criterios de inclusión: pertenecer a alguno de los tres grados de la escuela y tener familias originarias del poblado. El análisis de los datos se realizó manualmente. RESULTADOS: En comparación con el Plato del Bien Comer nacional, el Plato Maya fue mejor identificado por tener elementos locales a los que pueden acceder fácilmente y con costos menores. Se identificó la palabra fruto como una variación lingüística que representa en ese contexto tanto a las frutas como a las verduras. CONCLUSIONES: Para tener mejores resultados en intervenciones nutricionales es necesario diseñar estrategias educativo-comunicativas acordes con la cultura local.

[Trends in mortality from breast cancer in Córdoba, Argentina, 1986-2011: some socio-historical interpretations]. / Tendencias de mortalidad por cáncer de mama en Córdoba, Argentina, 1986­2011: algunas interpretaciones sociohistóricas.

OBJECTIVE: Analyze and interpret trends in mortality from breast cancer in recent decades in the province of Córdoba, Argentina, relative to demographic changes and the sociopolitical context. METHODS: Raw, standardized (direct method), and age-specific mortality from breast cancer was calculated for 1986-2011 in Córdoba. Using RiskDiff® software, variations in the 1986 to 2011 raw rates were analyzed. Joinpoint regression models were adjusted to standardized and specific rates by age group. Secondary data sources (laws, decrees, health programs) were consulted for information on the sociopolitical context of the period. RESULTS: Raw mortality due to breast cancer increased 24.97% from 1986 to 2011, an increase that can be attributed to the increase in the risk of dying (5.22%), to structural changes (19.75%), and to population size (39.66%). Standardized mortality from breast cancer shows a rising trend up to 1996 (annual percentage change [APC] = 1.62%; P <0.05), and then begins to decline (APC = -2.1%; P <0.05), slowing around the year 2001. For socio-historical interpretations, the analysis focused on demographic, epidemiological, and health-related changes, as well as the socioeconomic and political events of the period studied. CONCLUSIONS: The behavior of mortality from breast cancer in this period is associated with contextual factors (demographic, historical, economic, and political). The results of this study will help define actions and policies in breast cancer and women's health care.

Traditional dietary pattern of South America is linked to breast cancer: an ongoing case-control study in Argentina.

INTRODUCTION: Several studies have shown the effect of dietary patterns on breast cancer risk, but none has been conducted in Argentina. The aim of this study was to extract dietary patterns from Food Frequency Questioner, to estimate their effect on breast cancer occurrence while taking into account aggregation factors (family history of breast cancer) and to explore the sensitivity of the estimates to changes in the assumptions. METHODS: A principal component exploratory factor analysis was applied to identify dietary patterns, which were then included as covariates in a multilevel logistic regression. Family history of BC was considered as a clustering variable. A multiple probabilistic sensitivity analysis was also performed. RESULTS: The study included 100 cases and 294 controls. Four dietary patterns were identified. Traditional (fat meats, bakery products, and vegetable oil and mayonnaise) (OR III tertile vs I 3.13, 95% CI 2.58-3.78), Rural (processed meat) (OR III tertile vs I 2.02, 95% CI 1.21-3.37) and Starchy (refined grains) (OR III tertile vs I 1.82, 95 % CI 1.18-2.79) dietary patterns were positively associated with BC risk, whereas the Prudent pattern (fruit and non-starchy vegetables) (OR III tertile vs I 0.56, 95% CI 0.41-0.77) showed a protective effect. For Traditional pattern, the median bias-adjusted ORs (3.52) were higher than the conventional (2.76). CONCLUSIONS: While the Prudent pattern was associated with a reduced risk of BC, Traditional, Rural and Starchy patterns showed a promoting effect. Despite the threats to validity, the nature of associations was not strongly affected.

Social determinants of breast cancer screening: a multilevel analysis of proximal and distal factors related to the practice of mammography.

BACKGROUND: Mammography is crucial for early breast cancer detection. In Latin America, Argentina faces a significant breast cancer burden, with varying mammography rates. The social factors influencing mammography practices remain unclear. This study aimed to identify the proximal and distal social determinants of this practice among Argentinean women using a multilevel approach. METHODS: This nationwide cross-sectional study included 4,924 women aged 50-70 participating in the 2018 National Risk Factor Survey of Argentina. Two-level logistic models were used to estimate measures of association (ORs) between timely mammography practice (within the last 2 years) and selected covariates (sociodemographics, proximal environment, and distal-level variables). The intraclass correlation coefficient (ICC) and proportional change in variance (PCV) were calculated. RESULTS: 62.8% of women underwent timely mammography. Age (OR=0.96; 95%CI 0.94-0.97), health insurance (OR=2.22; 95%CI 1.87-2.63), education (OR=2.1; 95%CI 1.74-2.64), and income (OR=1.56; 95%CI 1.23-1.97) were associated with mammography practice. Women in non-marital (OR=0.61; 95%CI 0.52-0.72) or larger households (OR=0.61; 95%CI 0.51-0.63) were less likely to have timely mammograph; living in a larger city was positively associated (OR=1.28; 95%CI 1.12-1.46). Women in provinces with higher physician density (OR=1.06; 95%CI 1.01-1.11) and lower maternal mortality ratio (OR=0.9; 95%CI 0.87-0.96) had higher chances of timely mammography. The ICC and PCV suggested that the explored healthcare indicators largely explained the macro-contextual effect. CONCLUSIONS: Multilevel factors influenced mammography practices in Argentina. The results highlight disparities linked to sociodemographic characteristics and healthcare resources. IMPACT: Efforts to address social inequalities in breast cancer screening must consider multilevel determinants, including in healthcare settings.

[Public policies and interventions to prevent excess weight in Mexico: analysis from an intersectional perspective]. / Políticas públicas e intervenciones para prevenir el exceso de peso en México: análisis desde una perspectiva interseccional.

The scope of this article is to analyze public policies and interventions (PPI) prevailing in 2022 at the national level for the prevention of excess weight (overweight and obesity) in the adult population of Mexico, from an intersectional perspective. We performed documental analysis of PPI to prevent excess weight in Mexico in adulthood by applying a methodology for policy analysis based on intersectionality (Intersectionality-Based Policy Analysis Framework). A total of nine PPI were analyzed. The extent to which the PPI design considers an intersectional perspective is heterogeneous in the documents analyzed. In the definition of the problem, we identified two main tendencies, namely reductionist and holistic. Both are combined in a variable way in the PPI, revealing internal contradictions in their design. Most PPI consider relatively few cases of social inequality, and as an additive rather than an intersectional consideration. Overall, the PPI consider social inequalities predominantly in the definition of the problem and, to a far lesser extent, in the proposed solutions and in the consultation and negotiation processes. The consideration of the intersectional nature of the problem of excess weight in PPI is important to address the unequal epidemic of excess weight.

El objetivo de este artículo es analizar las políticas públicas e intervenciones (PPI) a nivel nacional vigentes a 2022 para la prevención del exceso de peso (sobrepeso y obesidad) en población adulta de México, desde una perspectiva interseccional. Se realizó un análisis documental de las estrategias para prevenir el exceso de peso en México en la adultez. Los documentos fueron analizados aplicando una metodología para el análisis de políticas basado en la interseccionalidad. Un total de 9 PPI fueron analizadas. En el diseño de las mismas operan alcances variables para visibilizar una perspectiva interseccional. En la definición del problema identificamos dos tendencias principales: una tendencia reduccionista y una tendencia holística. Ambas se combinan de manera variable en las PPI, evidenciando contradicciones internas en su diseño. La mayoría de las PPI señalan pocos ejes de desigualdad social, y como aditivos más que interseccionales. Las PPI consideran las desigualdades sociales mayormente en la definición del problema y, en mucho menor medida, en las soluciones y en los procesos de consulta y negociación. La consideración de la naturaleza interseccional de la problemática del exceso de peso en las PPI es importante para abordar la epidémica desigualdad del exceso de peso.

Urban social determinants of non-communicable diseases risk factors in Argentina.

We examined associations of individual-, neighborhood- and city-level education -as proxies of SES at different levels-, with diabetes, hypertension, obesity, smoking and binge drinking (non-communicable disease risk factors -NCD/RF) among Argentinian adults. We estimated mixed models based on 21,415 individuals from the 2013 National Survey of Risk Factors, living in 2,698 neighborhoods and 33 cities. Gradients by individual-level education differed by gender and NCD/RF, and some were modified by city education. In addition, we identified contextual effects of neighborhood and city education on some NCD/RF. Urban efforts to tackle NCD/RF in Argentina should be context- and gender-sensitive, and mainly focused on socially disadvantaged groups.

Intraurban socioeconomic inequalities in life expectancy: a population-based cross-sectional analysis in the city of Córdoba, Argentina (2015-2018).

OBJECTIVES: To evaluate variability in life expectancy at birth in small areas, describe the spatial pattern of life expectancy, and examine associations between small-area socioeconomic characteristics and life expectancy in a mid-sized city of a middle-income country. DESIGN: Cross-sectional, using data from death registries (2015-2018) and socioeconomic characteristics data from the 2010 national population census. PARTICIPANTS/SETTING: 40 898 death records in 99 small areas of the city of Córdoba, Argentina. We summarised variability in life expectancy at birth by using the difference between the 90th and 10th percentile of the distribution of life expectancy across small areas (P90-P10 gap) and evaluated associations with small-area socioeconomic characteristics by calculating a Slope Index of Inequality in linear regression. PRIMARY OUTCOME: Life expectancy at birth. RESULTS: The median life expectancy at birth was 80.3 years in women (P90-P10 gap=3.2 years) and 75.1 years in men (P90-P10 gap=4.6 years). We found higher life expectancies in the core and northwest parts of the city, especially among women. We found positive associations between life expectancy and better small-area socioeconomic characteristics, especially among men. Mean differences in life expectancy between the highest versus the lowest decile of area characteristics in men (women) were 3.03 (2.58), 3.52 (2.56) and 2.97 (2.31) years for % adults with high school education or above, % persons aged 15-17 attending school, and % households with water inside the dwelling, respectively. Lower values of % overcrowded households and unemployment rate were associated with longer life expectancy: mean differences comparing the lowest versus the highest decile were 3.03 and 2.73 in men and 2.57 and 2.34 years in women, respectively. CONCLUSION: Life expectancy is substantially heterogeneous and patterned by socioeconomic characteristics in a mid-sized city of a middle-income country, suggesting that small-area inequities in life expectancy are not limited to large cities or high-income countries.

[Comparison of a community-based nutritional intervention and a conventional nutritional intervention in Mayan communities in Mexico]. / Comparación de una intervención nutricional basada en la comunidad y una intervención nutricional convencional en localidades mayas de México.

Poor nutritional conditions persist in many Mayan communities in Yucatán, Mexico, even though various programs have been implemented. The study aimed to compare the effects of a community-based nutritional intervention with an intercultural focus versus a conventional nutritional intervention on body mass index (BMI) and diet in women in Mayan communities in Yucatán. The sample included adult women with BMI ≥ 25kg/m2 from neighboring rural Mayan villages. Both interventions lasted three months with 11 sessions and followed the prevailing guidelines. The community-based intervention used an intercultural tool called Good Mayan Food [Plato del Bien Comer Maya], besides strategies designed according to information obtained from a prior qualitative study phase using interviews. The group that received the community-based intervention (n = 7), compared to the conventional intervention group (n = 9), showed larger decreases in BMI (-0.58 ± 0.70 kg/m2 and +0.27 ± 0.64kg/m2; p = 0.042), waist circumference (-2.15 ± 2.60 cm and -0.50 ± 0.75 cm; p = 0.042), and consumption of fats (-53.23 ± 21.92 grams and -7.34 ± 25.77 grams; p = 0.004), as well as higher increases in weekly consumption of some local foods such as nance fruit (p = 0.012), tamarind (p = 0.001), and chili peppers (p = 0.004). The community-based intervention was the only one to show a significant decrease in daily calorie intake (baseline: 2,067 ± 91 kcal/day, at three months: 1,474 ± 31 kcal/day; p = 0.018), and both groups showed decreases in the consumption of ultra-processed foods, but without significant differences between the two groups. The community-based intervention group showed better results than the conventional intervention group.

Las malas condiciones nutricionales en muchas localidades mayas de Yucatán, México, persisten, a pesar de que se han implementado diversos programas. El objetivo fue comparar los efectos de una intervención nutricional basada en la comunidad con enfoque intercultural (INBC) y una intervención nutricional convencional (INC), sobre el índice de masa corporal (IMC) y la dieta en mujeres de localidades mayas de Yucatán. Fueron incluidas mujeres adultas con IMC ≥ 25kg/m2 de dos pequeñas localidades rurales mayas vecinas. Ambas intervenciones fueron de tres meses y con 11 sesiones, siguiendo la normatividad vigente; en la INBC fue utilizada la herramienta intercultural, denominada Plato del Bien Comer Maya, además se incluyeron en la INBC estrategias diseñadas con base en información obtenida en una fase previa de estudio cualitativo con entrevistas. El grupo con la INBC (n = 7), en comparación con el grupo con la INC (n = 9), tuvo una mayor disminución de IMC (-0,58 ± 0,70 kg/m2 y +0,27 ± 0,64 kg/m2; p = 0,042), de la circunferencia de cintura (-2,15 ± 2,60 cm y -0,50 ± 0,75 cm; p = 0,042) y del consumo de grasas (-53,23 ± 21,92 gramos y -7,34 ± 25,77 gramos; p = 0,004), así como mayor incremento en las frecuencias semanales de consumo de algunos alimentos locales como nance (p = 0,012), tamarindo (p = 0,001) y chile (p = 0,004), la INBC fue la única que presentó una disminución significativa en el consumo diario de calorías (basal: 2.067 ± 91 kcal/día, a los tres meses: 1.474 ± 31 kcal/día; p = 0,018), hubo en ambos grupos disminuciones en el consumo de alimentos ultraprocesados, pero sin diferencias comparando los grupos; el grupo con la INBC obtuvo mejores resultados que el grupo con la INC.

As más condições nutricionais em muitas localidades maias de Yucatán (México) persistem apesar da implementação de diversos programas. O objetivo era comparar os impactos de uma intervenção nutricional baseada na comunidade com enfoque intercultural (INBC) e uma intervenção nutricional convencional (INC), sobre o índice de massa corporal (IMC) e a dieta de mulheres de localidades maias de Yucatán. Foram incluídas mulheres adultas com IMC ≥ 25kg/m2 de duas pequenas localidades rurais maias vizinhas. Ambas as intervenções duraram três meses e contaram com 11 sessões, conforme as normas vigentes; na INBC, foi utilizada a ferramenta intercultural denominada Prato de Comer Bem Maia [Plato del Bien Comer Maya], além de estratégias adicionais idealizadas com base em dados obtidos em uma fase prévia de estudo qualitativo com entrevistas. Em comparação com o grupo com a INC (n = 9), o grupo com a INBC (n = 7) teve maior diminuição de IMC (-0,58 ± 0,70 kg/m2 e +0,27 ± 0,64 kg/m2; p = 0,042), da circunferência abdominal (-2,15 ± 2,60 cm y -0,50 ± 0,75 cm; p = 0,042) e do consumo de gorduras (-53,23 ± 21,92 gramas y -7,34 ± 25,77 gramas; p = 0,004), bem como um aumento maior das frequências semanais de consumo de alguns alimentos locais como o murici (p = 0,012), o tamarindo (p = 0,001) e pimenta (p = 0,004). A INBC foi a única a apresentar uma diminuição significativa do consumo diário de calorias (inicial: 2.067 ± 91 kcal/dia, após três meses: 1.474 ± 31 kcal/dia; p = 0.018). Houve em ambos os grupos redução equivalente do consumo de alimentos ultraprocessados; o grupo com a INBC obteve melhores resultados que o grupo com a INC.

The urban built environment and adult BMI, obesity, and diabetes in Latin American cities.

Latin America is the world's most urbanized region and its heterogeneous urban development may impact chronic diseases. Here, we evaluated the association of built environment characteristics at the sub-city -intersection density, greenness, and population density- and city-level -fragmentation and isolation- with body mass index (BMI), obesity, and type 2 diabetes (T2D). Data from 93,280 (BMI and obesity) and 122,211 individuals (T2D) was analysed across 10 countries. Living in areas with higher intersection density was positively associated with BMI and obesity, whereas living in more fragmented and greener areas were negatively associated. T2D was positively associated with intersection density, but negatively associated with greenness and population density. The rapid urban expansion experienced by Latin America provides unique insights and vastly expand opportunities for population-wide urban interventions aimed at reducing obesity and T2D burden.

[Profiles of epidemiological-nutritional transition and burden of morbimortality from COVID-19 in Argentina: an ecological study]. / Perfiles de transición epidemiológica-nutricional y carga de morbi-mortalidad por COVID-19 en Argentina: un estudio ecológico.

The study aimed to identify epidemiological-nutritional profiles in Argentina and to compare the burden of morbimortality from COVID-19. A multigroup ecological study was conducted with 24 geographic units in Argentina. We estimated the percent change from 2005 to 2018 in indicators of the epidemiological-nutritional transition and sociodemographic indicators according to geographic unit. We performed principal components analysis and hierarchical cluster analysis to identify geographic groupings to define profiles in the epidemiological-nutritional transition. By group, we calculated summary measures of COVID-19 cumulative incidence (CI), mortality, and case fatality (epidemiological week 50), establishing comparisons via Student's t test. Three profiles were identified: (1) reemergence of infectious diseases, (2) persistence of cardiovascular diseases despite social, health, and lifestyle improvements, and (3) consolidation of the triad obesity-sedentarism-cardiometabolic diseases. Mean COVID-19 cumulative incidence and mortality were higher in provinces with profile 1 compared to profile 2 (CI: p = 0.0159; mortality: p = 0.0187) and profile 3 (CI: p = 0.0205). Case-fatality was higher in profile 3, which includes provinces with more unfavorable socioeconomic conditions, showing significant differences from profile 2 (p=0.0307). In conclusion, there are distinct epidemiological-nutritional profiles in Argentina which tend to differ in terms of their COVID-19 epidemiological situation. Strategies to fight COVID-19 should consider the underlying epidemiological, nutritional, and sociodemographic characteristics.

El objetivo de este trabajo fue identificar perfiles epidemiológico-nutricionales en Argentina, y comparar su carga de morbi-mortalidad por COVID-19. Se condujo un estudio ecológico multigrupal (24 unidades geográficas de Argentina). Se estimó el porcentaje de cambio 2005-2018 de indicadores de transición epidemiológica-nutricional, y sociodemográficos por unidad geográfica. Se condujo un análisis de componentes principales y análisis de clúster jerárquico para identificar agrupamientos geográficos que definan perfiles de transición epidemiológica-nutricional. Por grupo, se calcularon medidas resumen de incidencia acumulada (IA), mortalidad y tasa de letalidad por COVID-19 (semana epidemiológica 50), estableciendo comparaciones mediante prueba t de Student. Se identificaron tres perfiles denominados: (1) reemergencia de enfermedades infecciosas, (2) persistencia de enfermedades cardiovasculares con mejoras sociosanitarias y en estilos de vida, y (3) consolidación de la tríada obesidad-sedentarismo-enfermedades cardiometabólicas. La IA y mortalidad por COVID-19 promedio fue mayor en provincias con perfil 1, en comparación con el perfil 2 (IA: p = 0,0159; mortalidad: p = 0,0187) y el perfil 3 (IA: p = 0,0205). La letalidad resultó mayor en el perfil 3, que aglomera provincias con situación socioeconómica más desfavorable, estimándose diferencias significativas respecto al perfil 2 (p = 0,0307). En conclusión, existen distintos perfiles epidemiológico-nutricionales en Argentina, que tienden a diferenciarse en su situación epidemiológica de COVID-19. Las estrategias contra COVID-19 deberían considerar las características epidemiológico-nutricionales y sociodemográficas de base.

O objetivo deste trabalho era identificar perfis epidemiológico-nutricionais na Argentina, e comparar a sua carga de morbimortalidade por COVID-19. Foi desenvolvido um estudo ecológico multigrupal (24 unidades geográficas da Argentina). Foi avaliado o percentual de mudança 2005-2018 de indicadores de transição epidemiológica-nutricional, e sociodemográficos, por unidade geográfica. Foi feita uma análise de componentes principais e de cluster hierárquico para identificar agrupamentos geográficos, definindo perfis de transição epidemiológica-nutricional. Por grupo, foram calculadas medidas de resumo de incidência acumulada (IA), mortalidade e taxa de letalidade por COVID-19 (semana epidemiológica 50), estabelecendo comparações mediante teste t de Student. Foram identificados três perfis: (1) reemergência de doenças infecciosas, (2) persistência de doenças cardiovasculares com melhorias sociossanitárias e nos estilos de vida, e (3) consolidação da tríade obesidade-sedentarismo-doenças cardiometabólicas. A IA e a mortalidade média por COVID-19 foi maior nas províncias com perfil 1, comparado com o perfil 2 (IA: p = 0,0159; mortalidade: p = 0,0187) e o perfil 3 (IA: p = 0,0205). A letalidade resultou maior no perfil 3, que abrange províncias com situação socioeconômica mais desfavorável, sendo encontradas diferenças significativas com relação ao perfil 2 (p = 0,0307). Em conclusão, existem distintos perfis epidemiológico-nutricionais na Argentina, que tendem a diferenciar-se na sua situação epidemiológica de COVID-19. As estratégias contra a COVID-19 deveriam considerar as características epidemiológico-nutricionais e sociodemográficas de base.

What Do We Know about Inequalities in NAFLD Distribution and Outcomes? A Scoping Review.

With prevalence high and rising given the close relationship with obesity and diabetes mellitus, non-alcoholic fatty liver disease (NAFLD) is progressively becoming the most common chronic liver condition worldwide. However, little is known about the health inequalities in NAFLD distribution and outcomes. This review aims to analyze health inequalities in NAFLD distribution globally and to assess the health disparities in NAFLD-related outcomes. We conducted a scoping review of global health inequalities in NAFLD distribution and outcomes according to gender/sex, ethnicity/race, and socioeconomic position from PubMed's inception to May 2021. Ultimately, 20 articles were included in the review, most (75%) of them carried out in the United States. Males were found to have a higher NAFLD prevalence (three articles), while available evidence suggests that women have an overall higher burden of advanced liver disease and complications (four articles), whereas they are less likely to be liver-transplanted once cirrhosis develops (one article). In the US, the Hispanic population had the highest NAFLD prevalence and poorer outcomes (seven articles), whereas Whites had fewer complications than other ethnicities (two articles). Patients with low socioeconomic status had higher NAFLD prevalence (four articles) and a higher likelihood of progression and complications (five articles). In conclusion, globally there is a lack of studies analyzing NAFLD prevalence and outcomes according to various axes of inequality through joint intersectional appraisals, and most studies included in our review were based on the US population. Available evidence suggests that NAFLD distribution and outcomes show large inequalities by social group. Further research on this issue is warranted.

[Emotions, concerns and reflections regarding the COVID-19 pandemic in Argentina]. / Emociones, preocupaciones y reflexiones frente a la pandemia del COVID-19 en Argentina.

The scope of this work is to explore the feelings and expectations that COVID-19 has generated in Argentina during the first stage of the pandemic. A survey of the World Health Organization adapted to the local context was applied. Open-ended questions were included to study people's feelings about COVID-19, and content analysis was subsequently conducted. In terms of results, it is revealed that the population surveyed feels uncertainty, fear and anguish, albeit a feeling of responsibility and care in the face of COVID-19 also emerges. Moreover, positive feelings regarding society stand out as an achievement of social interdependence. The results obtained show that the impact on mental health differs in accordance with gender, educational level, and perceived comfort in the home. The study concludes that the emotional and bonding dimensions of people are central to confronting the COVID-19 pandemic in Argentina. It is recommended that these dimensions, as well as their subjective and differential social impact among the different population groups, should be considered in the planning of policies to address the COVID-19 pandemic.

El objetivo de este trabajo es explorar los sentimientos y expectativas que genera el COVID-19 en Argentina durante la primera etapa de la pandemia. Se aplicó una encuesta de la Organización Mundial de la Salud adaptada al contexto local. Se incluyeron preguntas abiertas para indagar sentimientos de las personas frente al COVID-19, y se realizó un análisis de contenido. Como resultados se advierte que la población encuestada siente incertidumbre, miedo y angustia, pero también emerge un sentimiento de responsabilidad y cuidado frente al COVID-19. Así mismo se destacan sentimientos positivos para la sociedad como una valoración de la interdependencia social. Los resultados arribados señalan que el impacto en la salud mental es desigual según el género, el nivel educativo alcanzado y el confort percibido en el hogar. El estudio permite concluir que las dimensiones emocionales y vinculares de las personas resultan aspectos centrales ante la pandemia del COVID-19 en Argentina. Es recomendable que estas dimensiones, así como y su impacto subjetivo y social diferencial entre los diversos grupos poblacionales, sean consideradas en la planificación de políticas para afrontar el COVID-19.

Políticas públicas e intervenciones para prevenir el exceso de peso en México: análisis desde una perspectiva interseccional / Public policies and interventions to prevent excess weight in Mexico: analysis from an intersectional perspective

Resumen El objetivo de este artículo es analizar las políticas públicas e intervenciones (PPI) a nivel nacional vigentes a 2022 para la prevención del exceso de peso (sobrepeso y obesidad) en población adulta de México, desde una perspectiva interseccional. Se realizó un análisis documental de las estrategias para prevenir el exceso de peso en México en la adultez. Los documentos fueron analizados aplicando una metodología para el análisis de políticas basado en la interseccionalidad. Un total de 9 PPI fueron analizadas. En el diseño de las mismas operan alcances variables para visibilizar una perspectiva interseccional. En la definición del problema identificamos dos tendencias principales: una tendencia reduccionista y una tendencia holística. Ambas se combinan de manera variable en las PPI, evidenciando contradicciones internas en su diseño. La mayoría de las PPI señalan pocos ejes de desigualdad social, y como aditivos más que interseccionales. Las PPI consideran las desigualdades sociales mayormente en la definición del problema y, en mucho menor medida, en las soluciones y en los procesos de consulta y negociación. La consideración de la naturaleza interseccional de la problemática del exceso de peso en las PPI es importante para abordar la epidémica desigualdad del exceso de peso.

Abstract The scope of this article is to analyze public policies and interventions (PPI) prevailing in 2022 at the national level for the prevention of excess weight (overweight and obesity) in the adult population of Mexico, from an intersectional perspective. We performed documental analysis of PPI to prevent excess weight in Mexico in adulthood by applying a methodology for policy analysis based on intersectionality (Intersectionality-Based Policy Analysis Framework). A total of nine PPI were analyzed. The extent to which the PPI design considers an intersectional perspective is heterogeneous in the documents analyzed. In the definition of the problem, we identified two main tendencies, namely reductionist and holistic. Both are combined in a variable way in the PPI, revealing internal contradictions in their design. Most PPI consider relatively few cases of social inequality, and as an additive rather than an intersectional consideration. Overall, the PPI consider social inequalities predominantly in the definition of the problem and, to a far lesser extent, in the proposed solutions and in the consultation and negotiation processes. The consideration of the intersectional nature of the problem of excess weight in PPI is important to address the unequal epidemic of excess weight.

Determinantes sociales y de género del exceso de peso en la adultez en contextos de pobreza urbana en Córdoba, Argentina, 2019 / Social and gender determinants of excess weight in the adulthood in contexts of urban poverty in Córdoba, Argentina, 2019

INTRODUCCIÓN: La clase social y el género se vinculan con la malnutrición por exceso. Sin embargo, existe aún escasa evidencia al respecto en contextos de pobreza urbana de Córdoba. El objetivo de este trabajo fue analizar los determinantes sociales individuales de la ocurrencia de sobrepeso, obesidad y obesidad abdominal en la población adulta por género en contextos de pobreza de la ciudad de Córdoba en 2019. MÉTODOS: Se realizó un estudio epidemiológico observacional de corte transversal, con una muestra aleatoria (n=380) de personas adultas usuarias de un hospital público. Se efectuaron mediciones antropométricas y una entrevista sobre características sociodemográficas, socioeconómicas, de género y de salud. Se estimaron modelos de regresión logística múltiple estratificados por género. RESULTADOS: Las mujeres solteras, separadas o viudas tenían menor probabilidad de sobrepeso (OR 0,40; IC 95%: 0,18-0,87) y las mujeres desocupadas (OR 0,27; IC 95%: 0,08-0,87 ) de obesidad abdominal. Los varones de nivel socioeconómico medio o bajo presentaban menor probabilidad de sobrepeso (OR 0,21; IC 95%: 0,05-0,76), y los que dedicaban mayor tiempo al trabajo no remunerado tenían menor probabilidad de presentar obesidad (OR 0,43; IC 95%: 0,20-0,89). DISCUSIÓN: La malnutrición por exceso en contextos de pobreza de Córdoba está relacionada con determinantes sociales y de género, y es diferente en varones y mujeres.

[Inequities in health: socio-demographic and spatial analysis of breast cancer in women from Córdoba, Argentina]. / Inequidades en salud: análisis sociodemográfico y espacial del cáncer de mama en mujeres de Córdoba, Argentina.

OBJECTIVE: To identify sociodemographic determinants associated with the spatial distribution of the breast cancer incidence in the province of Córdoba, Argentina, in order to reveal underlying social inequities. METHOD: An ecological study was developed in Córdoba (26 counties as geographical units of analysis). The spatial autocorrelation of the crude and standardised incidence rates of breast cancer, and the sociodemographic indicators of urbanization, fertility and population ageing were estimated using Moran's index. These variables were entered into a Geographic Information System for mapping. Poisson multilevel regression models were adjusted, establishing the breast cancer incidence rates as the response variable, and by selecting sociodemographic indicators as covariables and the percentage of households with unmet basic needs as adjustment variables. RESULTS: In Córdoba, Argentina, a non-random pattern in the spatial distribution of breast cancer incidence rates and in certain sociodemographic indicators was found. The mean increase in annual urban population was inversely associated with breast cancer, whereas the proportion of households with unmet basic needs was directly associated with this cancer. CONCLUSIONS: Our results define social inequity scenarios that partially explain the geographical differentials in the breast cancer burden in Córdoba, Argentina. Women residing in socioeconomically disadvantaged households and in less urbanized areas merit special attention in future studies and in breast cancer public health activities.