Prevalencia, tratamiento y control de la hipertensión arterial en adultos mexicanos: resultados de la Ensanut 2022.

OBJETIVO: Describir la prevalencia de hipertensión arterial (HTA), las características del tratamiento y la proporción de adultos mexicanos que tiene tensión arterial (TA) controlada. Material y métodos. Se midió la TA a 8 647 adultos en la Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022). Se consideró que un participante tenía HTA o TA controlada cuando cumplía los criterios de la American College of Cardiology y la American Heart Association (ACC/AHA) o la Eighth Joint National Committee (JNC-8). RESULTADOS: La prevalencia de HTA en adultos fue 47.8% (según criterio del ACC/AHA). De éstos, 65.5% desconocía su diagnóstico. En adultos con diagnóstico previo de HTA, 33.7% tuvo TA controlada. Según la clasificación JNC-8, 29.4% de los adultos tenía HTA y 43.9% ignoraba su diagnóstico. Conclusión. En la Ensanut 2022 la mitad de los adultos tenía HTA y de ellos, tres de cada cinco no habían sido diagnosticados. El sistema de salud debe mejorar sus mecanismos de detección de HTA porque el subdiagnóstico y el mal control de la TA ocasiona discapacidad, mala calidad de vida y mortalidad prematura.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud.

La creciente epidemia de obesidad ha sido uno de los retos más importantes de salud pública en México durante los últimos años. Con apoyo de la Federación Mundial de Obesidad, en 2021 formamos un grupo de profesionales para identificar y resumir las acciones prioritarias en las que puede enfocarse nuestro país para hacer frente a esta epidemia. Al proceso de desarrollo y discusión de este grupo se sumaron más de 1 000 profesionales de la salud para retomar recomendaciones de documentos y guías de alto nivel previamente publicados. En conmemoración del Día Mundial de la Obesidad, en este 2022 se presenta esta postura como insumo para el desarrollo de acciones en el ámbito profesional y de los diferentes sectores, en la que se incluyen 10 recomendaciones de acción, desde la perspectiva poblacional hasta la atención individualizada, y se enfatiza en la importancia de la participación social, de las intervenciones integrales con visión centrada en la persona y de la sostenibilidad planetaria, además de mejorar la educación y las campañas de difusión, propiciar un ambiente promotor de entornos activos y blindar de conflictos de interés los esfuerzos de prevención y control. La postura hace un llamado para abordar la obesidad de manera seria, con base en la evidencia científica, oportuna e integral, con enfoque de curso de vida, de forma ética y sensible, y sin perpetuar las barreras del estigma de peso en la sociedad.

Screen-Based Sedentary Behaviors and Their Association With Metabolic Syndrome Components Among Adults in Mexico.

INTRODUCTION: Approximately 25% of the adult population worldwide and 49.8% of Mexican adults have metabolic syndrome. Metabolic syndrome is the result of unhealthy dietary and sleeping patterns, sedentary behaviors, and physical inactivity. The objective of our study was to evaluate the association between sedentary behaviors as screen-based sedentary time (SBST) and each component of metabolic syndrome among adults who participated in the Mexico National Survey of Health and Nutrition Mid-way 2016. METHODS: We analyzed sociodemographic, clinical, and physical activity data from 3,166 adults aged 20 years or older. The International Physical Activity Questionnaire was used to evaluate sedentary behavior. SBST was obtained by counting minutes per week spent watching television, playing video games, and interacting with computers and smartphones. We used Poisson regression to estimate the prevalence ratio of time in front of screens as a continuous variable and its association with metabolic syndrome. RESULTS: The mean (SD) hours per day of SBST in men was 3.6 (0.4) and in women was 2.8 (0.2). The prevalence of metabolic syndrome was 59.6%. In men, the risk for metabolic syndrome increased 4% (P < .05) for each hour of SBST. Similarly, for each hour of SBST, the risk of abdominal obesity increased by 4% (P < .01). In women, we observed that the risk of hypertension or high-density lipoprotein cholesterol deficiency increased for each hour of SBST, and the risk of abdominal obesity increased for each hour of SBST in those who were inactive. CONCLUSION: Sedentary behavior based on screen time is associated with metabolic syndrome and its components among Mexicans, depending on hours of sleep. Current public health policies should consider strategies for reducing SBST.

Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS: We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS: From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION: Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING: Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

[Consensus of diagnosis and treatment of obesity in women in reproductive age and climacterium]. / Consenso de diagnóstico y tratamiento de la obesidad en la mujer en edad reproductiva y en el climaterio.

BACKGROUND: The development of obesity is complex and multifactorial, with genetic, biological, environmental and lifestyle of each individual etiology. The different changes in metabolism of women, amongst other factors, lead to disorganization in the distribution of lipids, which gathered in large quantities within the viscera, increases cardiovascular mortality and it is a major determinant factor of the metabolic syndrome. OBJECTIVE: To homologate and to apply concepts of evidence-based clinical practice in diagnosis and treatment of obesity in women in reproductive age and climacterium. METHOD: The experts' consensus was done by specialized physicians properly endocrinologists, gynecologists, surgeons, psychologists, nutrition specialists, physical activity and public health, according to their expertise and clinical judgment. The recommendations were based in diagnostic criteria aside from the level of evidence of previously established treatment guidelines, controlled clinical trials and standardized guides for women in reproductive age and climacterium with obesity. RESULTS: The establishment of a nutritional intervention amongst other aspects of lifestyle is the first-line in the treatment of obesity. Current pharmacological treatments offer modest results in efficiency and security in weight reduction so these must go along with real changes in lifestyle in order to obtain better results in the short and long term. CONCLUSION: The high prevalence of overweight and obesity in our country, especially in women in reproductive age, compels us to pose and work in prevention strategies as well as diverse therapeutic plans favoring safe weight loss and results in the long term.

[Hypertension: prevalence, early diagnosis, control and trends in Mexican adults]. / Hipertensión arterial: prevalencia, diagnóstico oportuno, control y tendencias en adultos mexicanos.

OBJECTIVE: The present study aims to describe the prevalence, distribution and trends of hypertension (HT) in Mexican adults ≥20 years, and to describe the prevalence of early diagnosis and treatment of HT. MATERIALS AND METHODS: A total of 10 898 adults were considered. The measurement of blood pressure was performed following the procedures recommended by the American Heart Association. An adult was considered, hypertensive when he met the diagnostic criteria of JNC-7. RESULTS: The prevalence of HT was 31.5%, of which 47.3% were unaware of their condition. Pharmacological treatment was not associated with a higher percentage of subjects under control. CONCLUSION: Prevalences from 2000, 2006 and 2012 suggest that there is a stabilization. A health problem of this magnitude requires better diagnosis, care and training of the medical sector so that appropriate treatments are prescribed and HT control can be enhanced.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

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Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

Hipertensión arterial: prevalencia, diagnóstico oportuno, control y tendencias en adultos mexicanos / Hypertension: prevalence, early diagnosis, control and trends in Mexican adults

Objetivo. Describir la prevalencia, distribución y tendencias de la hipertensión arterial (HTA) en los adultos mexicanos de 20 años o más, así como conocer la prevalencia de diagnóstico oportuno y control de HTA. Material y métodos. Se consideró un total de 10 898 adultos. La medición de la tensión arterial se realizó mediante el uso del esfigmomanómetro de mercurio siguiendo los procedimientos recomendados por la American Heart Association. Se consideró que un adulto era hipertenso cuando cumplía con los criterios diagnósticos del JNC-7. Resultados. La prevalencia de HTA fue de 31.5%, del cual 47.3% desconocía que padecía esta enfermedad. Recibir tratamiento farmacológico no estuvo asociado con un mayor porcentaje de población bajo control. Conclusión. La tendencia entre los años 2000, 2006 y 2012 sugiere una estabilización. Un problema de salud con esta magnitud requiere mejor diagnóstico, atención y capacitación del sector médico para que éste prescriba tratamientos adecuados y mejore el control de la HTA.

Objective. The present study aims to describe the prevalence, distribution and trends of hypertension (HT) in Mexican adults ≥20 years, and to describe the prevalence of early diagnosis and treatment of HT. Materials and methods. A total of 10 898 adults were considered. The measurement of blood pressure was performed following the procedures recommended by the American Heart Association. An adult was considered, hypertensive when he met the diagnostic criteria of JNC-7. Results. The prevalence of HT was 31.5%, of which 47.3% were unaware of their condition. Pharmacological treatment was not associated with a higher percentage of subjects under control. Conclusion. Prevalences from 2000, 2006 and 2012 suggest that there is a stabilization. A health problem of this magnitude requires better diagnosis, care and training of the medical sector so that appropriate treatments are prescribed and HT control can be enhanced.