Exploring the quality of urban green spaces and their association with health: An epidemiological study on obesity using Street View technology.

OBJECTIVES: Evidence suggests that access to urban green spaces (UGS) may encourage physical exercise and impact nutritional status and health. Nevertheless, the quality of UGS is an understudied area. Novel digital tools allow the analysis of urban environments. This study aims to explore the quality of UGS and its association with obesity in Córdoba, Argentina, using Google Street View (GSV) images. STUDY DESIGN: Population-based cross-sectional study. METHODS: Lifestyle and sociodemographic data were collected in Córdoba, Argentina (n = 1322 adults) during 2020-2022. Anthropometric measurements were obtained. Buffers of 500m were established around dwellings to identify the presence of large-area UGS (≥1ha). The quality of 226 UGS was evaluated across specific dimensions using a multi-dimensional assessment tool adapted for remote monitoring through GSV. Two-level logistic regression models for obesity outcome (yes/no) were fitted using a random intercept to account for spatial variability. Odds ratios (OR) and their 95 % confidence intervals (95 % CI) were estimated as measures of association. RESULTS: Obesity was present in 25.9 % of participants. The UGS quality dimensions that showed an inverse association with obesity were safety (OR = 0.33; 95 % CI 0.32-0.82), potential usage (OR = 0.42; 95 % CI 0.21-0.81), surroundings (OR = 0.54; 95 % CI 0.31-0.93), access (OR = 0.55; 95 % CI 0.31-0.97), aesthetics (OR = 0.55; 95 % CI 0.34-0.87) and amenities (OR = 0.62; 95 % CI 0.42-0.91). Proximity to UGS was not significantly associated with obesity. CONCLUSIONS: Rather than their proximity, the quality of the UGS might play a key role as a determinant of obesity. In urban areas, digital tools such as GSV are useful to explore these topics.

Non-traditional data sources in obesity research: a systematic review of their use in the study of obesogenic environments.

BACKGROUND: The complex nature of obesity increasingly requires a comprehensive approach that includes the role of environmental factors. For understanding contextual determinants, the resources provided by technological advances could become a key factor in obesogenic environment research. This study aims to identify different sources of non-traditional data and their applications, considering the domains of obesogenic environments: physical, sociocultural, political and economic. METHODS: We conducted a systematic search in PubMed, Scopus and LILACS databases by two independent groups of reviewers, from September to December 2021. We included those studies oriented to adult obesity research using non-traditional data sources, published in the last 5 years in English, Spanish or Portuguese. The overall reporting followed the PRISMA guidelines. RESULTS: The initial search yielded 1583 articles, 94 articles were kept for full-text screening, and 53 studies met the eligibility criteria and were included. We extracted information about countries of origin, study design, observation units, obesity-related outcomes, environment variables, and non-traditional data sources used. Our results revealed that most of the studies originated from high-income countries (86.54%) and used geospatial data within a GIS (76.67%), social networks (16.67%), and digital devices (11.66%) as data sources. Geospatial data were the most utilised data source and mainly contributed to the study of the physical domains of obesogenic environments, followed by social networks providing data to the analysis of the sociocultural domain. A gap in the literature exploring the political domain of environments was also evident. CONCLUSION: The disparities between countries are noticeable. Geospatial and social network data sources contributed to studying the physical and sociocultural environments, which could be a valuable complement to those traditionally used in obesity research. We propose the use of information available on the Internet, addressed by artificial intelligence-based tools, to increase the knowledge on political and economic dimensions of the obesogenic environment.

Sociodemographic disparities and contextual factors in obesity: updated evidence from a National Survey of Risk Factors for Chronic Diseases.

OBJECTIVE: To assess the association of sociodemographic and environmental factors with the obesity occurrence in Argentina from a sex- and age-comparative perspective and a multilevel approach. DESIGN: Cross-sectional study based on secondary data from the National Survey of Chronic Diseases Risk Factors (CDRF) 2018, Argentina. Two-level logistic regression models stratified by sex and age were used. SETTING: The nationwide probabilistic sample of the CDRF survey and twenty-four geographical units. PARTICIPANTS: 16 410 adult people, living in Argentine towns of at least 5000 people, nested into 24 geographical units. Sex and age groups were defined as young (aged 18-44 years), middle-aged (45-64 years) and older (65 years and older) men and women. RESULTS: Single men (all age groups) and divorced/widowed men (aged 45 years or older) had a lower obesity risk compared to married ones. In the middle-aged group, men with higher education showed a lower risk than men with incomplete primary education. In young women, a marked social gradient by educational level was observed. A low-income level coupled with highly urbanised contexts represents an unfavourable scenario for young and middle-aged women. Having a multi-person household was a risk factor for obesity (OR = 1·26, P = 0·038) in middle-aged women. Contextual factors linked to the availability of socially constructed recreational resources and green spaces were associated with obesity among young adults. CONCLUSIONS: Socio-environmental determinants of obesity seem to operate differently according to sex and age in Argentina. This entails the need to address the obesity epidemic considering gender inequalities and the socio-environmental context at each stage of life.

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.

Dietary patterns and risk of urinary tract tumors: a multilevel analysis of individuals in rural and urban contexts.

INTRODUCTION: Bladder cancer is the fourth most frequently diagnosed malignancy in males in Córdoba, Argentina. The evidence regarding an association between urinary tract tumors and dietary factors still remains controversial. Argentina has particular dietary habits, which have already been associated with cancer occurrence. PURPOSES: (a) To estimate the association of typical dietary patterns in Argentina on the occurrence of urinary tract tumors and (b) to assess the urban-rural context of residence and cancer occurrence dependency. METHODS: A case-control study of urinary tract tumors (n = 123, 41/82 cases/controls) was performed in Córdoba Province (Argentina), 2006-2011. A two-level logistic regression model was fitted, taking into account rural-urban residence. An exhaustive probabilistic sensitivity analysis (bias analysis) was performed. RESULTS: Southern Cone pattern, characterized by red meat, starchy vegetables and wine consumptions (OR 1.75 high versus low level of adherence to the pattern), and a medium adherence to a high-sugar drinks pattern, with high loadings for soft drinks (OR 2.55), were associated with increasing risk of urinary tract tumors. High adherence to the latter pattern was inversely associated (OR 0.72). The occurrence of urinary tract tumors was also linked to place of residence (urban-rural), explaining more than 20% of outcome variability and improving the above risk estimations. CONCLUSIONS: A high intake of red meat, starchy vegetables and wine, and a moderate intake of high-sugar drinks seem to be associated with increased risk of urinary tract tumors, with differences related to the context of residence.

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.

An empirically derived "prudent" dietary pattern is associated with lower obesity occurrence: Modeling and mapping from a national nutrition survey.

The characterization of dietary patterns linked to obesity is important to address evidence-based interventions against the obesity epidemic. We hypothesized that both dietary behaviors and environmental characteristics affect the spatial distribution of obesity. This study aimed to analyze the role of dietary patterns in the occurrence of obesity in Colombia, taking into account the hierarchical (geographical) structure of the data. A cross-sectional study based on the Colombian National Nutrition Survey (2015) was carried out. A subsample of 8750 adults who reported dietary intake data (by the 24-hour diet recall method) was extracted. Dietary patterns were identified by principal component factor analysis. Their association with obesity occurrence was assessed by using multilevel Poisson regression models (8750 subjects nested in 33 geographic units). Thematic maps were constructed. The obesity prevalence was 18.0% (95% CI, 16.7-19.4). Four dietary patterns were identified for the study group. An inverse (negative) association was found in people with high adherence (vs. low adherence) to the "prudent pattern" (dairy products, fruits, vegetables) (prevalence ratio, 0.87; 95% CI, 0.78-0.96; P = .01). People with high adherence to the "soft drinks and snacking pattern" (sugary drinks, meat products, snacks) tended to show a direct (positive) association with obesity occurrence (prevalence ratio, 1.12; 95% CI, 0.99-1.27; P = .06). Maps showed higher adherence levels to the prudent pattern in departments with higher socioeconomic conditions and lower obesity prevalence. To conclude, a prudent dietary pattern emerges as a key factor in obesity occurrence in Colombia. Obesity spatial distribution may be conditioned by contextual factors that represent social inequalities in health.

Applying multilevel model to the relationship of dietary patterns and colorectal cancer: an ongoing case-control study in Córdoba, Argentina.

PURPOSES: Scientific literature has consistently shown the effects of certain diets on health but regional variations of dietary habits, and their relationship colorectal cancer (CRC) has been poorly studied in Argentina. Our aims were to identify dietary patterns and estimate their effect on CRC occurrence and to quantify the association between family history of CRC and CRC occurrence by applying multilevel models to estimate and interpret measures of variation. METHODS: Principal components factor analysis was performed to identify dietary patterns that were then used in a multilevel logistic regression applied to an ongoing case-control data about dietary exposure and CRC occurrence taking into account familiar clustering. RESULTS: Three dietary patterns were identified: "Southern Cone pattern" (red meat, wine, and starchy vegetables), "High-sugar drinks pattern", and "Prudent pattern". The study considered 41 cases and 95 controls. There was a significant promoting effects on CRC of "Southern Cone" (OR 1.5, 95%CI 1.0-2.2) and "High-sugar drinks" (OR 3.8, 95%CI 2.0-7.1) patterns, whereas "Prudent pattern" (OR 0.3, 95%CI 0.2-0.4) showed a significant protective effect at third tertile level. BMI, use of NSAIDs, and to have medical insurance showed significant effects. Variance of the random effect of family history of CRC was highly significant. CONCLUSIONS: This novel approach for Argentina showed that Southern Cone and High-sugar drinks patterns were associated with a higher risk of CRC, whereas the Prudent pattern showed a protective effect. There was a significant clustering effect of family history of CRC.

The impact of the COVID-19 pandemic on mortality: life expectancy reduction and geographical disparities in Argentina.

OBJECTIVE: To assess the impact of the COVID-19 pandemic on mortality in Argentina, considering temporal trends in life expectancy at birth and premature mortality rate during 2010-2020. METHODS: Based on demographic projections, this ecological time-series study compares a "normal" versus a "COVID-19" mortality scenario for 2020 over a set of 11 Argentine provinces. Annual life expectancy at birth and age-standardized rates of premature mortality were estimated from 2010 to 2020. Joinpoint regression and multilevel models were used. RESULTS: A potential reduction in life expectancy at birth (a gap between scenarios >1 year) was observed. A significant (negative) point of inflection in temporal trends was identified for the country and most of the provinces, under the COVID-19 mortality scenario. However, our findings reveal disparities between provinces in the estimated life expectancy reduction toward 2020 (values range from -0.63 to -1.85 year in females and up to -2.55 years in males). While men showed more accentuated declines in life expectancy at birth in 2020 (a national gap between scenarios of -1.47 year in men vs. -1.35 year in women), women experienced more unfavorable temporal trends of premature mortality. In the absence of COVID-19, an improvement in both indicators was estimated toward 2020 in both sexes, while a return to levels reported in the past was observed under the COVID-19 scenario. CONCLUSION: The COVID-19 pandemic might seriously affect the trends of mortality and exacerbate health disadvantages in Argentina. A temporal and contextual perspective of health inequities merits special attention in the COVID-19 research.

Bladder cancer mortality trends and patterns in Córdoba, Argentina (1986-2006).

BACKGROUND: Bladder cancer is common worldwide and the fourth most commonly diagnosed malignancy in men in Argentina. OBJECTIVE: To describe bladder cancer mortality trends in Córdoba (1986-2006), considering the effect of age, period, and cohort, and to estimate the effect of arsenic exposure on bladder cancer, and its interaction with sex, while controlling by smoking habits and space and time variation of the rates. METHODS: A joinpoint regression was performed to compute the estimated annual percentage changes (EAPC) of the age-standardized mortality rates (ASMR) in an adult population from Córdoba, Argentina. A Poisson model was fitted to estimate the effect of age, period, and cohort. The influence of gender, tobacco smoking (using lung cancer ASMR as surrogate), and arsenic in drinking water was examined using a hierarchical model. RESULTS: A favorable trend (1986-2006) in bladder cancer ASMR in both sexes was found: EAPC of -2.54 in men and -1.69 in women. There was a decreasing trend in relative risk (RR) for cohorts born in 1931 or after. The multilevel model showed an increasing risk for each increase in lung cancer ASMR unit (RR = 1.001) and a biological interaction between sex and arsenic exposure. RR was higher among men exposed to increasing As-exposure categories (RR male low exposure 3.14, RR male intermediate exposure 4.03, RR male high exposure 4.71 versus female low exposure). A non-random space-time distribution of the rates was observed. CONCLUSIONS: There has been a decreasing trend in ASMR for bladder cancer in Córdoba. This study confirms that bladder cancer is associated with age, gender, smoking habit, and exposure to arsenic. Moreover, an effect measure modification between exposure to arsenic and sex was found.

[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.

Cancer mortality in Córdoba, Argentina, 1986-2006: an age-period-cohort analysis.

AIMS AND BACKGROUND: Cancer is the second main cause of death in Argentina, surpassed only by cardiovascular disease. However, analytical approaches isolating some of the known effects, such as age at death, period of death and birth cohort, have never been performed in cancer mortality studies in Argentina. The aim of this study was to analyze cancer mortality trends in a representative region of the country, the Córdoba province (1986-2006). METHODS AND STUDY DESIGN: Overall age-standardized (world population) mortality rates for cancer (all sites) were computed by a direct method. Joinpoint regression was fitted to the age-standardized mortality rates for both sexes to provide estimated and 95% confidence intervals of the annual percentage changes. The effects of age (15 age groups), period of death (1986-90, 1991-95, 1996-00 or 2001-06), and birth cohort (18 overlapping 10-year birth cohorts) covariates on mortality rates were estimated using a sequentially fitted Poisson regression model. RESULTS: During the study period, 102,737 people died of cancer in Córdoba, with the age-standardized mortality rates decreasing from 139.3 to 118.7/100,000 person-years. Although this reduction was more noticeable in men, the joinpoint regression model showed a significant change of the age-standardized mortality rates after 1996 in both sexes. Age-period-cohort analysis suggested that the cancer mortality trends may be linked with a strong age effect and a moderate or mild period and cohort effect, related to sex and place of residence. CONCLUSIONS: Based on the observed cohort effect, it may be argued that there has been a lower exposure level to some risk factors, such as diet and other environmental factors, in Cordoba over the last decades.

Effectiveness of two physical activity programs on non-alcoholic fatty liver disease. a randomized controlled clinical trial.

Introduction: To estimate the effectiveness of two physical activity programs on NAFLD. Methods: Participants come from a survey conducted in southern Italy. Subjects with moderate or severe NAFLD were invited to participate. After giving informed consent, they completed a questionnaire, underwent ultrasonography and anthropometric measurements. Then they were randomized an Aerobic or a Combined Exercise program and followed up for six months. The first group followed a program of moderate aerobic activity lasting 30 minutes, 5 days per week. The second group did aerobic training with the addition of muscle training involving the large muscle groups, stimulating them to make more intense efforts, for a duration of 60 minutes, at least, 3 days a week. Compliance with the programs was measured. A mixed linear model was applied to the data. Results: Compliance with Aerobic Exercise was homogeneous and increased over time. Combined Program compliance was equal to 100%. There was no significant difference in the NAFLD mean score by treatment at baseline and after six months. However, there was a significant reduction in the NAFLD mean score for treatments after six months. The NAFLD measured score was reduced by 22% in the Aerobic treatment group when confronted with the other program. In the Combined program, after 6 months, results showed to be less effective than the Aerobic Exercise in reducing the NAFLD score. Conclusion: An aerobic exercise program is a realistic intervention which could be included as a part of primary prevention of several chronic diseases.

Introducción: Estimar la eficiencia de dos programas de actividad física sobre la NAFLD Métodos: Sujetos con NAFLD moderada o severa que habían participado a un estudio de pobación en el sur de Italia fueron invitados a participar. Fue completado un cuestionario, se tomaron medidas antropométricas y se realizó una ecografia hepática. Cada participante proveyó el consenso informato. Los participantes fueron aleatorizados a un programa aerobico (actividad aerobica moderada per 30 minutos, 5 veces a la semana) o un programa mixto (aerobico más entrenamiento de la fuerza de los grandes grupos musculares, 60 minutos, tres veces a la semana). Fue medida la adherencia a los programas y se aplicó un modelo linear mixto a los datos. Resultados: El programa aerobico tuvo muy buena adherencia y esta aumentó con el tiempo mientras el programa mixto tuvo 100% de adherencia. No hubo diferencias estadísticamente significativas en el score de NAFLD al enrolamiento, mientras hubo diferencias estadísticamente significativas en el score medio de NAFLD después de 6 meses pero el score en el grupo del programa aerobico tuvo una reducción del 22% más intensa que el programa mixto. Este último programa por lo tanto se ha mostrado menos efectivo que el programa aerobico. Conclusión: Un programa de actividad física aerobica es un tratamiento realístico que podría ser efectuado no solo para la NAFLD sino también como prevención primaria de otras enfermedades crónicas.

Socio-Environmental Patterns Associated with Cancer Mortality: A Study Based on a Quality of Life Approach

Background: With 18.6% of total deaths due to malignant tumors in 2016, cancer is the second leading death cause in Argentina. While there is a broad consensus on common risk factors at the individual cancer level, those operating at a contextual level have been poorly studied in developing countries. The objective of our study was to identify socio-environmental patterns in Argentina (2010), emphasizing quality of life, and to explore their associations with the spatial distribution of cancer mortality in the country. Methods: The study was conducted in 525 geographical divisions nested into 24 provinces. Sex-specific crude and age-standardized mortality rates (ASMR) for cancer (2009-2011 period) were calculated. Empirically derived socio-environmental patterns were identified through principal-component factor analysis on a selected set of variables: an urban scale and 29 indicators of a quality of life index in Argentina for 2010. Two-level Poisson regression models were used to estimate associations between the ASMR and the continuous factor scores for socio-environmental patterns as covariates. A random intercept was included to account for spatial variability in the ASMR distribution using Stata software. Results: Four socio-environmental patterns were identified, termed "Contexts with urban-related resources or cultural capital", "Socioeconomically prosperous contexts", "Environments with anthropic exposures" and "Plains region" (cumulative explained variance=57%). High mortality rates were found in counties characterized by socioeconomically prosperous contexts (RR=1.025 in women; 1.088 in men) and plain landscapes (RR=1.057 and 1.117, respectively). Counties featuring urban or cultural resources demonstrated increased mortality in women (RR=1.015, 95%CI=1.005-1.025), whereas rising rates associated with environments having anthropic exposures (RR=1.008, 95%CI=1.001-1.016) were observed only for men. Conclusion: This study identified four characteristic socio-environmental patterns in Argentina which incorporate features of quality of life, accounting to some extent for the differential burden of cancer mortality in this country.

[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.

The impact of the COVID-19 pandemic on mortality: life expectancy reduction and geographical disparities in Argentina / O impacto da pandemia de COVID-19 na mortalidade: redução da expectativa de vida e disparidades geográficas na Argentina

ABSTRACT: Objective: To assess the impact of the COVID-19 pandemic on mortality in Argentina, considering temporal trends in life expectancy at birth and premature mortality rate during 2010-2020. Methods: Based on demographic projections, this ecological time-series study compares a "normal" versus a "COVID-19" mortality scenario for 2020 over a set of 11 Argentine provinces. Annual life expectancy at birth and age-standardized rates of premature mortality were estimated from 2010 to 2020. Joinpoint regression and multilevel models were used. Results: A potential reduction in life expectancy at birth (a gap between scenarios >1 year) was observed. A significant (negative) point of inflection in temporal trends was identified for the country and most of the provinces, under the COVID-19 mortality scenario. However, our findings reveal disparities between provinces in the estimated life expectancy reduction toward 2020 (values range from -0.63 to -1.85 year in females and up to -2.55 years in males). While men showed more accentuated declines in life expectancy at birth in 2020 (a national gap between scenarios of -1.47 year in men vs. -1.35 year in women), women experienced more unfavorable temporal trends of premature mortality. In the absence of COVID-19, an improvement in both indicators was estimated toward 2020 in both sexes, while a return to levels reported in the past was observed under the COVID-19 scenario. Conclusion: The COVID-19 pandemic might seriously affect the trends of mortality and exacerbate health disadvantages in Argentina. A temporal and contextual perspective of health inequities merits special attention in the COVID-19 research.

RESUMO: Objetivo: Avaliar o impacto da pandemia de COVID-19 sobre a mortalidade na Argentina, considerando as tendências temporais da expectativa de vida ao nascer e a taxa de mortalidade prematura 2010-2020. Métodos: Com base em projeções demográficas, este estudo ecológico de séries temporais compara um cenário de mortalidade "normal" versus "COVID-19" para 2020 em 11 províncias argentinas. Foram calculadas a expectativa de vida ao nascer anual e taxas de mortalidade prematura padronizadas por idade (2010-2020). Utilizaram-se modelos de regressão joinpoint e multiníveis. Resultados: Observou-se redução da expectativa de vida ao nascer (lacuna entre cenários >1 ano). Foi identificado um ponto de inflexão significativo (negativo) nas tendências temporais para o país e a maioria das províncias no cenário COVID-19. Nossos resultados revelam disparidades entre as províncias na redução da expectativa de vida 2020 (valores de -0,63 a -1,85 ano nas mulheres e até -2,55 nos homens). Enquanto os homens mostraram declínios mais acentuados na expectativa de vida ao nascer em 2020 (lacuna nacional entre os cenários de -1,47 vs. -1,35 ano nas mulheres), as mulheres experimentaram tendências temporais mais desfavoráveis de mortalidade prematura. Na ausência do COVID-19, estimou-se melhoria de ambos os indicadores até 2020 em ambos os sexos, enquanto se observou retorno aos níveis reportados no passado no cenário COVID-19. Conclusão: A pandemia de COVID-19 pode afetar seriamente as tendências de mortalidade e agravar as desvantagens para a saúde na Argentina. Uma perspectiva temporal e contextual das iniquidades em saúde merece atenção especial na pesquisa em COVID-19.

Burden of cancer mortality and differences attributable to demographic aging and risk factors in Argentina, 1986-2011.

The world faces an aging population that implies a large number of people affected with chronic diseases. Argentina has reached an advanced stage of demographic transition and presents a comparatively high rate of cancer mortality within Latin America. The objectives of this study were to examine cancer mortality trends in the province of Córdoba, Argentina, between 1986 and 2011, and to analyze the differences attributable to risk variations and demographic changes. Longitudinal series of age-standardized mortality rates for overall, breast and prostate cancers were modeled by Joinpoint regression to estimate the annual percent change. The Bashir & Estève method was used to split crude mortality rate variation into three components: mortality risk, population age structure and population size. A decreasing cancer age-standardized mortality rates trend was observed (1986-2011 annual percent change: -1.4, 95%CI: -1.6, -1.2 in men; -0.8, 95%CI: -1.0, -0.6 in women), with a significant shift in 1996. There were positive crude mortality rate net changes for overall female cancer, breast and prostate cancers, which were primarily attributable to demographic changes. Inversely, overall male cancer crude mortality rate showed a 9.15% decrease, mostly due to mortality risk. Despite favorable age-standardized mortality rates trends, the influence of population aging reinforces the challenge to control cancer in populations with an increasingly aged demographic structure.

Perfiles de transición epidemiológica-nutricional y carga de morbi-mortalidad por COVID-19 en Argentina: un estudio ecológico / Profiles of epidemiological-nutritional transition and burden of morbimortality from COVID-19 in Argentina: an ecological study / Perfis de transição epidemiológica-nutricional e carga de morbimortalidade por COVID-19 na Argentina: um estudo ecológico

Resumen: 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.

Abstract: 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.

Resumo: 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.

Identification of dietary patterns in urban population of Argentina: study on diet-obesity relation in population-based prevalence study.

BACKGROUND/OBJECTIVES: In Argentina, obesity prevalence rose from 14.6% in 2005 to 20.8% in 2013. Although the number of studies on noncommunicable diseases and dietary patterns as a unique dietary exposure measure has increased, information on this topic remains scarce in developing countries. This is the first population-based study investigating the association between diet and obesity using a dietary pattern approach in Argentina. We aimed (a) to identify current dietary patterns of the population of Córdoba city, (b) to investigate its association with obesity prevalence, and (c) to identify and describe dietary patterns from the subgroup of people with obesity. SUBJECTS/METHODS: The Córdoba Obesity and Diet Study (CODIES) was conducted in Córdoba city by using a random sample of n = 4,327 subjects between 2005 and 2012. Empirically derived dietary patterns were identified through principal component factor analysis. A multiple logistic regression analysis was used to investigate the association of dietary patterns with obesity. RESULTS: Four dietary patterns were identified, called "Starchy-Sugar", "Prudent", "Western", and "Sugary drinks". High scores for the "Western" pattern (with strongest factor loading on meats/eggs, processed meats, and alcohol) showed a positive association with obesity (OR: 1.33, 95% CI: 1.06-1.67, for third versus first tertile of factor score). "Meats/Cheeses" and "Snacks/Alcohol" patterns emerged in people with obesity. CONCLUSIONS: The findings suggest that high adherence to the "Western" pattern promoted obesity in this urban population. In addition, people with obesity showed characteristic dietary patterns that differ from those identified in the overall population.

[Cancer and its association with dietary patterns in Córdoba (Argentina)]. / Cáncer y su asociación con patrones alimentarios en Córdoba (Argentina).

INTRODUCTION: Feeding habits play a prominent role in carcinogenesis. The dietary patterns approach applied to the study of chronic diseases is of increasing interest in nutritional epidemiology. Nevertheless, it has been seldom used in Latin America. OBJECTIVE: To identify dietary patterns in adult population in Córdoba (Argentina) and to estimate their effects on the risk of colon-rectal (CRC), urothelial (UC), breast (BC) and prostate (PC) cancers. METHODS: Four case control studies were conducted, 2006-2012 for CRC, PC, BC and UC. To identify the dietary patterns, a Principal Components Factor Analysis was conducted. A multilevel logistic regression was adjusted for the risk analyses. RESULTS: Characteristic dietary patterns in the whole population, and in women and men independently, were identified. In the whole population South Cone and Sweet Beverages patterns behaved as promoters for CRC and UC while the Prudent Pattern had a protective effect. Female South Cone, Rural and Starchy patterns were associated to a higher BC risk. Prudent Pattern lowered BC risk. In men, South Cone, Sweet Beverages and Typical Measured patterns promoted PC. CONCLUSION: It is necessary to promote a regular intake of vegetables, fruits and diary products (although a moderate intake for men), and to reduce red meat (especially fat meat), processed meat, starchy vegetables, wine and sweet beverages intakes, to prevent the occurrence of cancer. In men, it is recommended a moderate intake of egg. In women, it is advised a moderate intake of refined grains, bakery products, oils and mayonnaise intake.

Introducción: La alimentación es un importante factor vinculado a la ocurrencia del cáncer. Su abordaje en términos de patrones alimentarios es de creciente interés en epidemiología nutricional, no obstante ha sido pocas veces empleado en Latinoamérica. Objetivos: Identificar patrones alimentarios en la población adulta de Córdoba (Argentina) y estimar sus efectos sobre el riesgo de ocurrencia de cáncer colorrectal (CCR), cáncer de mama (CM), cáncer de próstata (CP) y urotelial (CU). Métodos: Se condujeron estudios caso-control, 2006-2012, correspondientes a CCR, CM, CP y CU. Empleando un análisis factorial de componentes principales se identificaron patrones alimentarios. Se estimaron ORs mediante regresión logística multinivel. Resultados: Se identificaron patrones característicos en la población general, y en hombres y mujeres independientemente. En población total, los patrones Cono Sur y Bebidas Azucaradas evidenciaron un efecto promotor para CCR y CU, y el Patrón Prudente mostró efecto protector. En mujeres, el CM se asoció de manera directa con los patrones Cono Sur Femenino, Rural y Amiláceo, e inversa con el Patrón Prudente. En hombres, los Patrones Cono Sur Masculino, Bebidas Azucaradas y Típico Mesurado mostraron un efecto promotor para CP. Conclusión: Resulta necesario promover una ingesta habitual de vegetales, frutas y lácteos (éstos últimos de manera moderada en hombres), y disminuir el consumo de carnes rojas (fundamentalmente grasas), carnes procesadas, vegetales amiláceos, vino y bebidas azucaradas, a fin de prevenir la ocurrencia de cáncer. En hombres se sugiere moderar la ingesta de huevos, y en mujeres la de granos refinados, productos de pastelería, aceites y mayonesa.