Epidemia de obesidad: evidencia actual, desafíos y direcciones futuras / Obesity epidemic: current evidence, challenges and future directions

Resumen La epidemia de obesidad es un fenómeno amplia mente estudiado en las últimas décadas, pero aun así incompletamente comprendido, cuyo control se encuen tra lejos del nivel deseable si consideramos las cifras crecientes de prevalencia observadas a nivel mundial. El presente trabajo realiza una revisión narrativa con el propósito de aportar evidencia actualizada sobre la epidemia de la obesidad en el mundo, y en particular en la región latinoamericana y Argentina, identificando además los principales desafíos y direcciones futuras para el abordaje de esta problemática de salud pública. Se describe primeramente la carga actual y tendencias crecientes de la prevalencia de obesidad, general y por grupos poblacionales, y su posible relación con aspec tos genéticos y epigenéticos. Se resumen también las consecuencias socioeconómicas directas e indirectas de esta epidemia, y las estrategias e iniciativas recientes orientadas a la prevención de la obesidad, con especial atención en aquellas reportadas como las más eficientes en el contexto latinoamericano. En función de la revisión realizada, se identifican como desafíos pendientes en esa región, el abordaje integrado de la doble carga de malnutrición así como el creciente sobrepeso infantil; se apuntan también algunos enfoques emergentes, como el sindémico, potencialmente útiles para comprender y abordar esta compleja problemática en el contex to actual. Concluyendo, se destaca la importancia de implementar estrategias renovadas, más eficientes y basadas en evidencia, para controlar la creciente pre valencia de obesidad, lo cual impactaría también en la carga de las enfermedades crónicas relacionadas, y con ello, en la economía y bienestar de las sociedades latinoamericanas.

Abstract The obesity epidemic is a phenomenon that has been widely studied in recent decades but is still incompletely understood, and its control is far from the desirable level in view of the increasing prevalence figures observed worldwide. This paper conducts a narrative review with the aim of providing updated evidence on the global obesity epidemic, and particularly on the situation in Latin America and Argentina, identifying the main chal lenges and future directions for addressing this public health problem. It first describes the current burden and increasing trends in the prevalence of obesity, in the overall population and by population groups, and its pos sible association with genetic and epigenetic aspects. It also summarizes the direct and indirect socioeconomic consequences of this epidemic, as well as recent strate gies and initiatives focused on obesity prevention, with special attention to those reported as the most efficient in the Latin American context. This review identified some pending challenges in the region, the integrated approach to the double burden of malnutrition and the growing childhood overweight; and it points out some emerging approaches, such as the syndemic approach, as potentially useful to understand and address this complex problem in the current context. In conclusion, it highlights the importance of implementing renewed, more efficient and evidence-based strategies to control the growing prevalence of obesity, which would also impact on the burden of related chronic diseases, and thus on the economy and well-being of Latin American societies.

[Obesity epidemic: current evidence, challenges and future directions]. / Epidemia de obesidad: evidencia actual, desafíos y direcciones futuras.

The obesity epidemic is a phenomenon that has been widely studied in recent decades but is still incompletely understood, and its control is far from the desirable level in view of the increasing prevalence figures observed worldwide. This paper conducts a narrative review with the aim of providing updated evidence on the global obesity epidemic, and particularly on the situation in Latin America and Argentina, identifying the main challenges and future directions for addressing this public health problem. It first describes the current burden and increasing trends in the prevalence of obesity, in the overall population and by population groups, and its possible association with genetic and epigenetic aspects. It also summarizes the direct and indirect socioeconomic consequences of this epidemic, as well as recent strategies and initiatives focused on obesity prevention, with special attention to those reported as the most efficient in the Latin American context. This review identified some pending challenges in the region, the integrated approach to the double burden of malnutrition and the growing childhood overweight; and it points out some emerging approaches, such as the syndemic approach, as potentially useful to understand and address this complex problem in the current context. In conclusion, it highlights the importance of implementing renewed, more efficient and evidence-based strategies to control the growing prevalence of obesity, which would also impact on the burden of related chronic diseases, and thus on the economy and well-being of Latin American societies.

La epidemia de obesidad es un fenómeno ampliamente estudiado en las últimas décadas, pero aun así incompletamente comprendido, cuyo control se encuentra lejos del nivel deseable si consideramos las cifras crecientes de prevalencia observadas a nivel mundial. El presente trabajo realiza una revisión narrativa con el propósito de aportar evidencia actualizada sobre la epidemia de la obesidad en el mundo, y en particular en la región latinoamericana y Argentina, identificando además los principales desafíos y direcciones futuras para el abordaje de esta problemática de salud pública. Se describe primeramente la carga actual y tendencias crecientes de la prevalencia de obesidad, general y por grupos poblacionales, y su posible relación con aspectos genéticos y epigenéticos. Se resumen también las consecuencias socioeconómicas directas e indirectas de esta epidemia, y las estrategias e iniciativas recientes orientadas a la prevención de la obesidad, con especial atención en aquellas reportadas como las más eficientes en el contexto latinoamericano. En función de la revisión realizada, se identifican como desafíos pendientes en esa región, el abordaje integrado de la doble carga de malnutrición así como el creciente sobrepeso infantil; se apuntan también algunos enfoques emergentes, como el sindémico, potencialmente útiles para comprender y abordar esta compleja problemática en el contexto actual. Concluyendo, se destaca la importancia de implementar estrategias renovadas, más eficientes y basadas en evidencia, para controlar la creciente prevalencia de obesidad, lo cual impactaría también en la carga de las enfermedades crónicas relacionadas, y con ello, en la economía y bienestar de las sociedades latinoamericanas.

The "diet model" and metabolic syndrome components: Results from the Cordoba Health and Dietary Habits Investigation.

OBJECTIVES: Diet, one of the main risk factors for both metabolic syndrome (MetS) and non-communicable diseases (NCDs), is a multidimensional feature whose complexity relies on the individual and contextual characteristics of foods. The aim of this study was to build a "diet model" and estimate its relationship with MetS components in two Argentinian populations. METHODS: This was a population-based cross-sectional study that assessed bio-socio-anthropometrical variables and dietary habits using food frequency questionnaires. Dietary patterns (DPs) were drawn out using exploratory factor analysis (EFA). A structural equation model (SEM) was used to explore and confirm theoretical and empirical relationships between DPs and the diet model. The association between individuals' adherence to DPs and MetS were assessed using a multiple logistic regression analysis. We selected two cities in central Argentina according to socio-eco-environmental characteristics. Participants included 493 men and women (1:1 ratio) from 35 to 65 y of age. RESULTS: We identified four DPs: traditional Argentine (TA; processed meats, meats and eggs, fats, starchy vegetables), prudent (Pr; vegetables, fruits, milk, and yogurt), alcohol and snacks (AS), and sweets (S; candies and sodas). TA and AS DPs were associated with increased waist circumference. The S DP showed a strong effect on hypertension. Moderate adherence to the TA DP was positively associated with dyslipidemia but negatively with hypertension whenever individuals did not adhere to the AS DP. TA was positively correlated to AS and S, but inversely with Pr. CONCLUSION: This diet model integrated those food groups in an associative structure describing per se a synthesis of the Argentine dietary habits and their association with three of the five components of MetS.

Higher dietary glycemic index, intake of high-glycemic index foods, and insulin load are associated with the risk of breast cancer, with differences according to body mass index in women from Córdoba, Argentina.

Dietary patterns based on rich-carbohydrate foods were associated with breast cancer (BC) in Córdoba (Argentina). Nevertheless, the effect of dietary indicators of postprandial blood glucose or insulinemia on this cancer has not been studied. Thus, we hypothesize that higher dietary glycemic and insulinemic indices increase the risk of BC occurrence, with differential effects according to the presence/absence of overweight. A case-control study was conducted for BC (346/596 cases/controls) in Córdoba, Argentina, from 2008 to 2016. Multiple logistic regression models were used to assess the effect of glycemic index (GI), glycemic load, insulin index, and insulin load (IL) and the intake of high-GI foods (HGIF) on BC occurrence, adjusted by specific confounders and stratified by body mass index (BMI, <25 or ≥25 kg/m2). The odds ratio (OR) for BC occurrence comparing the highest versus the lowest tertile of dietary GI was 1.77 (95% confidence interval [CI], 1.19-2.64). Additionally, a positive association between the weekly intake of HGIF and the dietary IL was found (OR, 1.71; 95% CI, 1.14-2.55 and OR, 1.50; 95% CI, 1.03-2.19, respectively). In normal-weight women, dietary GI and IL were associated with cancer occurrence, whereas in overweight women, only weekly intake of HGIF was associated. Our findings suggest that the BC risk related to hyperglycemic and hyperinsulinemic diet changed according to BMI. Furthermore, frequent exposure to HGIF has a relevant role in BC occurrence and its promoting effect is even higher in the presence of overweight.

Modified WCRF/AICR Score and All-Cause, Digestive System, Cardiovascular, Cancer and Other-Cause-Related Mortality: A Competing Risk Analysis of Two Cohort Studies Conducted in Southern Italy.

BACKGROUND: In real life, nutrition goes beyond purely biological domains. Primary prevention is the most efficient approach for reducing the risk of mortality. We aimed to study the association of lifestyle, as measured by a modified World Cancer Research Fund/American Institute for Cancer Research (mWCRF/AICR) scoring system with all-cause, digestive system disease-related (DSD-related), cardiovascular disease-related (CVD-related), cancer-related and other cause-related mortality using data from two population-based cohort studies conducted in Southern Italy. METHODS: A random sample of 5271 subjects aged 18 years or older was enrolled in 2005-2006 and followed up until 2020. Usual food intakes were estimated using a validated dietary questionnaire. Competing risks survival models were applied. RESULTS: High adherence to the mWCRF/AICR score was found to be statistically significant and negatively associated with all-cause mortality (HR 0.56, 95%CI 0.39; 0.82), DSD-related mortality (SHR 0.38, 95%CI 0.15; 0.97) and cancer-related mortality (SHR 0.43, 95%CI 0.19; 0.97) in the male sub-cohort and other-cause mortality (SHR 0.43, 95%CI 0.21; 0.88) only in the female group. CONCLUSIONS: This mWCRF/AICR score can be seen as a simple, easy tool for use in clinical practice to evaluate both qualitative and quantitative aspects of the diet.

Development and validation of a neural network for NAFLD diagnosis.

Non-Alcoholic Fatty Liver Disease (NAFLD) affects about 20-30% of the adult population in developed countries and is an increasingly important cause of hepatocellular carcinoma. Liver ultrasound (US) is widely used as a noninvasive method to diagnose NAFLD. However, the intensive use of US is not cost-effective and increases the burden on the healthcare system. Electronic medical records facilitate large-scale epidemiological studies and, existing NAFLD scores often require clinical and anthropometric parameters that may not be captured in those databases. Our goal was to develop and validate a simple Neural Network (NN)-based web app that could be used to predict NAFLD particularly its absence. The study included 2970 subjects; training and testing of the neural network using a train-test-split approach was done on 2869 of them. From another population consisting of 2301 subjects, a further 100 subjects were randomly extracted to test the web app. A search was made to find the best parameters for the NN and then this NN was exported for incorporation into a local web app. The percentage of accuracy, area under the ROC curve, confusion matrix, Positive (PPV) and Negative Predicted Value (NPV) values, precision, recall and f1-score were verified. After that, Explainability (XAI) was analyzed to understand the diagnostic reasoning of the NN. Finally, in the local web app, the specificity and sensitivity values were checked. The NN achieved a percentage of accuracy during testing of 77.0%, with an area under the ROC curve value of 0.82. Thus, in the web app the NN evidenced to achieve good results, with a specificity of 1.00 and sensitivity of 0.73. The described approach can be used to support NAFLD diagnosis, reducing healthcare costs. The NN-based web app is easy to apply and the required parameters are easily found in healthcare databases.

The effect of the Mediterranean Diet on lifespan: a treatment-effect survival analysis of a population-based prospective cohort study in Southern Italy.

BACKGROUND: The Mediterranean diet (MedDiet) is associated with good health. We aimed to estimate the effect of levels of adherence to the MedDiet on lifespan by performing treatment effects survival analysis. METHODS: A sample of 5250 subjects aged ≥18 years were randomly selected from the electoral list of Castellana Grotte and Putignano (Apulian Region, Italy). Cohorts were enrolled in 2005-06 and followed-up until December 2018. The adherence to the MedDiet was measured by the relative Mediterranean score (rMED) and categorized as high, medium and low. Time-to-death (all-causes) as estimated by average treatment effect on the treated (ATET), potential outcome mean (POM) and relative efficiency of exposure were the outcomes. RESULTS: A total of 4896 subjects were included. The median follow-up time was 12.82 (inter quartile range (IQR) 12.22-13.05), 12.91 (IQR 12.21-13.27) and 12.84 (IQR 12.19-13.03) years for high, medium and low rMED subjects respectively. By December 2018, 453 (9.25%) had died. There was a strong effect of medium and low rMED {ATET, -5.10 [95% confidence interval (CI) -9.39, -0.80] and -8.91 (95%CI -13.37, -4.45), respectively}. High rMED has an important effect on mean age at death [POM 90.16 (95% CI 86.06, 94.25)]. The relative effect size for medium and low rMED subjects was a lower lifespan of 5.62% (95% CI 1.01, 10.3) and 9.90% (95% CI 5.30, 5.30), respectively. CONCLUSIONS: We observed an important benefit in additional years of survival from adherence to MedDiet in this southern Italian cohort. Further investigation corroborating our findings in other population groups in other geographic regions will be an important contribution to promoting health and longevity.

Physical Activity and Low Glycemic Index Mediterranean Diet: Main and Modification Effects on NAFLD Score. Results from a Randomized Clinical Trial.

BACKGROUND: Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common chronic liver disease worldwide, and lifestyle modification is the current standard treatment. The aim of the study was to estimate the effect of two different physical activity (PA) programs, a Low Glycemic Index Mediterranean Diet (LGIMD), and their combined effect on the NAFLD score as measured by FibroScan®. METHODS: Moderate or severe NAFLD subjects (n = 144) were randomly assigned to six intervention arms during three months. Interventions arms were a control diet, LGIMD, aerobic activity program (PA1), combined activity program (PA2), and LGIMD plus PA1 or LGIMD plus PA2. The data were compared at baseline, at 45 days, and at 90 days. Analysis of variance was performed under the intention-to-treat principle. RESULTS: There was a statistically significant reduction in the NAFLD score after 45 days of treatment in every working arm except for Arm 1 (control diet). After 90 days, the best results were shown by the intervention arms in which LGIMD was associated with PA: LGIMD plus PA1 (-61.56 95% CI -89.61, -33.50) and LGIMD plus PA2 (-38.15 95% CI -64.53, -11.77). CONCLUSION: All treatments were effective to reduce NAFLD scores, but LGIMD plus PA1 was the most efficient.

Obesidad central, sarcopenia y conductas sedentarias en el riesgo cardiovascular por score Framingham y área total de placa carotídea / Central Obesity, Sarcopenia, and Sedentary Behaviors Related to Cardiovascular Risk by Framingham Score and Total Carotid Plaque Area

Resumen Antecedentes: las enfermedades cardiovasculares son la principal causa de morbimortalidad mundial. La obesidad, sarcopenia, actividad física insuficiente y las conductas sedentarias impactan de manera sinérgica en el riesgo cardiovascular. Objetivo: evaluar el riesgo cardiovascular en relación con la actividad física, las conductas sedentarias y la composición corporal. Materiales y métodos: estudio observacional transversal de 95 personas adultas de ambos sexos. Se determinó el riesgo cardiovascular mediante el score de Framingham y el score de Framingham corregido por área total de placa aterosclerótica; la composición corporal, por antropometría, bioimpedancia y dinamometría como indicador indirecto; y la actividad física y las conductas sedentarias, por cuestionario validado. Se condujeron análisis descriptivos, de correlación y asociación con un 95 % de confianza. Resultados: el 95 % de las mujeres y el 98 % de los varones presentaron riesgo cardiovascular elevado; el 51,5 %, obesidad; el 95,5%, obesidad central; y el 47,3 %, fuerza muscular disminuida. Se observaron asociaciones positivas significativas entre riesgo cardiovascular y circunferencia de cintura (rho=0,26; p=0,024). No hubo asociación significativa entre la fuerza muscular y el riesgo cardiovascular (rho=-0,21; p=0,065). La conducta sedentaria tuvo un efecto promotor del riesgo cardiovascular (OR=3,9; p=0,033). Conclusiones: la obesidad central y permanecer más de 6/h día en posición sedente son factores asociados al riesgo cardiovascular.

Abstract Background: Cardiovascular diseases are the principal cause of morbidity and mortality worldwide. Obesity, sarco-penia, insufficient physical activity, and sedentary behaviors synergistically impact cardiovascular risk. Objective: Evaluate cardiovascular risk in relation to physical activity, sedentary behaviors, and body composition. Materials and Methods: Cross-sectional observational study in 95 total males and females. Cardiovascular risk was determined using the Framingham score, which corrects for total area of atherosclerotic plaque. Risk was also determined using body composition, anthropometry, bioimpedance and dynamometry as indirect indicators, physical activity, sedentary behaviors, and a validated questionnaire. Descriptive, correlation and association analyses were conducted with 95% confidence. Results: 95% of women and 98% of men presented with an elevated cardiovascular risk; 51.5% with obesity, 95.5% central obesity, and 47.3% with diminished muscular strength. Significant positive associations were observed between cardiovascular risk and waist circumference (rho=0.26; p=0.024). There was no significant association between muscle strength and cardiovascular risk (rho=-0.21, p=0.065). Sedentary behavior increased cardiovascular risk (OR=3.9; p=0.033). Conclusions: Central obesity and staying more than six hours per day in a sitting position are factors associated with cardiovascular risk.

Remnant cholesterol as a risk factor for cardiovascular, cancer or other causes mortality: A competing risks analysis.

BACKGROUND AND AIMS: Cardiovascular diseases (CVDis) are leading causes of morbidity and mortality. Even after the introduction of pharmacological therapy to lower Cholesterol, there is still a residual risk that may be ascribed to remnant cholesterol (RC). We aimed, by analyzing two prospective cohort studies, to estimate the effect of RC on risk and hazard of cardiovascular deaths (CVDs), while accounting for competing risks such as cancer (CDs) and other-causes deaths (OCDs). METHODS AND RESULTS: Cohorts were enrolled in 1992 and 2005. Personal data history was recorded. A fasting venous blood sample was obtained, and RC was calculated at baseline. Cause of Death was coded by using ICD-10th version. Follow-up ended on December 31, 2017. Flexible parametric competing-risks models were applied, with age at death as time-axis. In total, 5729 subjects were enrolled. There were 861 (15.1%) deaths: 234 CVDs (27.2%), 245 CDs (28.5%), 271 OCDs (31.5%) and 111 unknown causes of death (12.8%). RC exposure was a strong risk factor only for CVDs (Risk 2.54, 95% Confidence Interval 1.21; 5.34; Trend 1.26 (1.00; 1.58) for ≥1.29 mmol/L). CONCLUSIONS: RC is a strong independent risk factor for cardiovascular mortality. Competing risk analysis is demonstrably a useful tool to disentangle associations among different competing events with a common risk factor.

[Modifications of the superoxide anion level in breast milk by the intake of flavonoids and carotenoids]. / Modificaciones en el nivel de anión superóxido en leche materna, según la ingesta de flavonoides y carotenoides.

OBJECTIVE: To associate the intake of flavonoids and carotenoids with the breast milk level of superoxide anion, as an oxidative stress marker. MATERIALS AND METHODS: 100 women from Cordoba (Argentina), who breastfed within the first postpartum 6 months, were studied during the 2013-2015 period, by evaluating their sanitary data, food intake and anion level in milk with multiple logistic regression. RESULTS: The intake of flavonoids, provitamin A carotenoids and non-provitamin carotenoids was 72 (61) mg/d, 1813 (1 657) µg/d y 5427 (3 664) µg/d, respectively. The anion was associated with the intake of flavanols (OR=1.081; CI95 1.001-1.167) y flavanones (OR=1.025; CI95 1.001-1.048). This effect was not seen with other flavonoids and carotenoids. CONCLUSIONS: Intake of flavanols and flavanones increases milk oxidation risk, which is relevant to develop diet recommendations.

OBJETIVO: Asociar la ingesta de flavonoides y carotenoides con el nivel en leche materna del anión superóxido, como marcador de estrés oxidativo. MATERIAL Y MÉTODOS: Durante el periodo 2013-2015 se estudió a 100 mujeres lactantes de Córdoba (Argentina), dentro los primeros seis meses posparto; se evaluaron sus datos sanitarios, ingesta alimentaria y nivel lácteo del anión con regresión logística múltiple. RESULTADOS: La ingesta de flavonoides, carotenoides provitamínicos y carotenoides no provitaminas fue de 72 (61) mg/día, 1 813 (1657) µg/día y 5 427 (3664) µg/día, respectivamente. El anión se asoció con la ingesta de flavanoles (RM=1.081; IC95 1.001-1.167) y flavanonas (RM=1.025; IC95 1.001-1.048). No se observó este efecto con otros flavonoides ni con los carotenoides. CONCLUSIONES: La ingesta de flavanoles y flavanonas aumenta el riesgo de oxidación láctea, lo cual es relevante para realizar recomendaciones dietéticas.

Modificaciones en el nivel de anión superóxido en leche materna, según la ingesta de flavonoides y carotenoides / Modifications of the superoxide anion level in breast milk by the intake of flavonoids and carotenoids

Resumen: Objetivo: Asociar la ingesta de flavonoides y carotenoides con el nivel en leche materna del anión superóxido, como marcador de estrés oxidativo. Material y métodos: Durante el periodo 2013-2015 se estudió a 100 mujeres lactantes de Córdoba (Argentina), dentro los primeros seis meses posparto; se evaluaron sus datos sanitarios, ingesta alimentaria y nivel lácteo del anión con regresión logística múltiple. Resultados: La ingesta de flavonoides, carotenoides provitamínicos y carotenoides no provitaminas fue de 72 (61) mg/día, 1 813 (1657) µg/día y 5 427 (3664) µg/día, respectivamente. El anión se asoció con la ingesta de flavanoles (RM=1.081; IC95 1.001-1.167) y flavanonas (RM=1.025; IC95 1.001-1.048). No se observó este efecto con otros flavonoides ni con los carotenoides. Conclusiones: La ingesta de flavanoles y flavanonas aumenta el riesgo de oxidación láctea, lo cual es relevante para realizar recomendaciones dietéticas.

Abstract: Objective: To associate the intake of flavonoids and carotenoids with the breast milk level of superoxide anion, as an oxidative stress marker. Materials and methods: 100 women from Cordoba (Argentina), who breastfed within the first postpartum 6 months, were studied during the 2013-2015 period, by evaluating their sanitary data, food intake and anion level in milk with multiple logistic regression. Results: The intake of flavonoids, provitamin A carotenoids and non-provitamin carotenoids was 72 (61) mg/d, 1813 (1 657) µg/d y 5427 (3 664) µg/d, respectively. The anion was associated with the intake of flavanols (OR=1.081; CI95 1.001-1.167) y flavanones (OR=1.025; CI95 1.001-1.048). This effect was not seen with other flavonoids and carotenoids. Conclusions: Intake of flavanols and flavanones increases milk oxidation risk, which is relevant to develop diet recommendations.

Nutritional profile and obesity: results from a random-sample population-based study in Córdoba, Argentina.

INTRODUCTION: Obesity is a chronic, heterogeneous, multifactorial disease, which has sharply increased in prevalence in both developed and developing countries. This study aimed to estimate the prevalence of obesity and to identify socio-demographic risk factors associated with it, with special emphasis on diet. METHODS: Nutritional status, demographic characteristics, lifestyle habits, and food consumption patterns derived from a Food Frequency Questionnaire were investigated. Exhaustive exploratory analyses were performed in order to describe dietary patterns, and logistic regression models were used for odds ratio estimation. RESULTS: The study included 4328 subjects, over 18 years old and resident in Cordoba city. The prevalence of overweight and obesity was 34 and 17 %, respectively, with 60 % in men and 45 % in women of BMI ≥ 25. Obesity risk factors were high intake of sodium, refined grains, starchy vegetables, and snacks. A lower risk of overweight and obesity was associated with an adequate, moderate intake of meats, eggs, alcoholic beverages, sugar and sweets, milk, yogurt, and pulses. CONCLUSIONS: A high intake of snacks, refined grains, starchy vegetables and sodium and low intake of yogurt, milk, pulses, and whole grains seem to be associated with the emergence and high prevalence of obesity in Cordoba, Argentina.

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.

Overweight and obesity: a review of their relationship to metabolic syndrome, cardiovascular disease, and cancer in South America.

Socioeconomic and demographic transformations are occurring very rapidly in some areas of the world, especially in South America, and are accompanied by changes in lifestyle, dietary patterns, and the epidemiological profile of prevalent diseases. This review examines whether obesity and overweight are related to metabolic syndrome, cardiovascular disease, and cancer in South America. Research carried out in more than 6,000 cases and controls was evaluated, along with most of the available publications related to South America. In South America, obesity and risk factors for cardiovascular disease are related mainly to aging, ethnicity effects, and preventable risky lifestyle conditions. Most of the studies that found an association between cancer and obesity are from the Southern Cone, the geographic area most affected by this pathology. Overall, the prevalence of metabolic syndrome was highest in Chile, followed in decreasing order by Colombia, Peru, Argentina, and Ecuador, with differences noted between urban and rural areas or between urban and periurban areas. Obesity and cancer may be preventable, at least in part, by healthy behavior; hence, exercise, weight control, and healthy dietary habits are important to reduce the risk of these major chronic diseases.

Cancer incidence pattern in Cordoba, Argentina.

Cancer is the second cause of death in Argentina; nevertheless the distribution of the cancer incidence rates throughout the country is unknown. This study was conducted to describe cancer incidence patterns in Córdoba Province. Incidence data were supplied by the Government Córdoba Cancer Registry. Demographic information (age, sex, and place of residence) and diagnosis, certified by a pathologist, about all incident cases from June 2003 to May 2005 by type and 5-year age groups were obtained. Comparison of the incidence rate of cancer in various counties was performed by using standardized incidence rates (SIR) per 100,000 inhabitants using the world standard population. Estimated SIRs were used to build up incidence maps. Two indicators were created: sex ratio and site-specific ratio. Mixed Poisson models were fitted. Taken as a whole for all counties, SIR was 121.42 and 141.57 for men and women, respectively. The most common sites in men were prostate (13.62), lung (10.12), colon (7.53), and bladder (7.03); in women were breast (22.51) and colon (3.31). The highest and lowest rates were in urban and rural areas, respectively. Cancer registry has a pivotal role in cancer control. Such information is the primary resource of information not only for epidemiological research on cancer determinants but also for planning and evaluating health services for the policies of prevention, diagnosis and treatment of the disease.

Overweight and obesity: Prevalence and their association with some social characteristics in a random sample population-based study in Córdoba city, Argentina.

BACKGROUND: Obesity has become a threat to public health, as the epidemic is not confined to developed countries but is affecting many developing countries. Because obesity is known to vary according to socio-cultural factors, including socio-economic position and social roles, a multi-stage random sample population-based study was conducted in Córdoba, Argentina, from January 2005 to December 2006, to explore the effect of selected social factors on the prevalence of obesity. METHODS: Information was obtained about demographic, anthropometric, lifestyle, dietary and physical activity characteristics. Logistic regression (LR) and proportional odds models (POM) were used in data analysis. RESULTS: The prevalence of overweight and obesity was 52 and 17%, respectively. LR models revealed that overweight was positively associated with gender (men), decreasing socio-economic status (SES), married and divorced status and negatively with increasing levels of physical activity whereas obesity was positively associated with decreasing SES levels, married status and negatively associated with physical activity levels. POM revealed strong associations between variables and the outcomes and an effect modification among women aged 30 years or older with a low SES. CONCLUSIONS: Our data indicate a high prevalence of overweight and obesity in this population; several social factors and lifestyle characteristics are associated with both overweight and obesity. However, a prospective cohort study would be needed to investigate causality.