Quantifying Overlapping Forms of Malnutrition Across Latin America: A Systematic Literature Review and Meta-Analysis of Prevalence Estimates.

Estimating the prevalence of double burden of malnutrition (DBM) is challenging in the Latin American and Caribbean (LAC) region where various DBM typologies (e.g., obesity and stunting) are heterogeneous and estimates are scattered across literature This study aimed to assess the prevalence of DBM typologies in the LAC region. We searched PubMed, Embase, Scopus, and Web of Science to identify studies on the prevalence of DBM published between 1 January, 2000, and 23 January, 2023. Outcomes were the prevalence of the identified DBM typologies at the household, individual, or across life course levels. Random-effect meta-analyses of proportions were used to estimate pooled period prevalence for all outcomes. Heterogeneity was explored using meta-regressions. From 754 records identified, 60 (8%) studies were eligible, with a median of 4379 individuals. Studies reported data from 27 LAC countries collected between 1988 and 2017. Most studies used nationally representative surveys (68%) and scored as low risk of bias (70%). We identified 17 DBM typologies for which 360 estimates were analyzed. The prevalence of the identified DBM typologies ranged between 0% and 24%, with the DBM typology of "adult with overweight and child with anemia" having the highest prevalence (24.3%; 95% CI: 18.8%, 30.2%). The most frequently reported DBM typology was "adult with overweight and child with stunting," with a prevalence of 8.5% (95% CI: 7.7, 9.3). All prevalences carried large heterogeneity (I2>90%), modestly explained by subregions and countries. DBM across the life course could not be estimated owing to insufficient estimates. In conclusion, using available data, our study suggests that the burden of DBM in the LAC region ranges between 0% and 24%. In the most frequent DBM typologies, overweight was a common contributor. Substantial progress can be made in curbing the burden of DBM in the LAC region through strategies addressing excess weight within these population groups. This study was registered at PROSPERO as CRD42023406755.

Prevalencia e incidencia de hipertensión arterial en Perú: revisión sistemática y metaanálisis / Prevalence and incidence of arterial hypertension in Peru: a systematic review and meta-analysis

RESUMEN Objetivo. Determinar la prevalencia e incidencia de hipertensión arterial, y la prevalencia de diagnóstico previo de hipertensión arterial (autorreportado) en población general adulta del Perú. Materiales y métodos. Revisión sistemática y metaanálisis de estudios epidemiológicos disponibles en LILACS, EMBASE, MEDLINE y Global Health. Se incluyeron estudios que siguieron un muestreo aleatorio de la población general adulta. El tamizaje y estudio de los manuscritos fue realizado por dos investigadores de forma independientemente. Se hizo metaanálisis de efectos aleatorios para cuantificar la prevalencia e incidencia global. Los manuscritos fueron evaluados con la escala Newcastle-Ottawa para evaluar el riesgo de sesgo. Resultados. Se tamizaron 903 artículos, y se incluyeron 15 manuscritos para prevalencia, 8 para prevalencia de diagnóstico previo, y 4 para incidencia de hipertensión. El metaanálisis mostró una prevalencia agregada de hipertensión de 22,0% (IC 95%: 20,0% - 25,0%; I 2=99,2%). Esta prevalencia fue menor en estudios nacionales [20,0% (IC 95%: 17,0% - 22,0%; I 2 =99,4%] que en subnacionales [24,0% (IC 95%: 17,0% - 30,0%; I 2 =99,2%]. La prevalencia global de diagnóstico previo de hipertensión fue 51,0% (IC 95%: 43,0% - 59,0%; I 2=99,9%). La incidencia global fue de 4,2 (IC 95%: 2,0 - 6,4; I 2=98,6%) por cada 100 personas-año. Los manuscritos estudiados no presentaron alto riesgo de sesgo. Conclusiones. Nuestros hallazgos muestran que uno de cada cinco peruanos tiene hipertensión, y que aparecen cuatro nuevos casos por 100 personas en un año, además solo la mitad de los pacientes hipertensos tienen el diagnóstico previo de su condición.

ABSTRACT Objective . To determine the prevalence and incidence of arterial hypertension, as well as the prevalence of previous diagnosis of arterial hypertension (self-reported) among the adult population of Peru. Materials and methods. Systematic review and meta-analysis of epidemiological studies available in LILACS, EMBASE, MEDLINE and Global Health. Studies were included if they followed a random sampling approach in adult population. Screening and assessment of manuscripts was carried out independently by two researchers. A random-effects meta-analysis was conducted to quantify the overall prevalence and incidence of hypertension. The Newcastle-Ottawa scale was used to assess the risk of bias in the manuscripts. Results. A total of 903 papers were screened, and only 15 were included in the estimation of hypertension prevalence, 8 in the assessment of previous hypertension diagnosis, and 4 for incidence estimations. The pooled prevalence of hypertension was 22.0% (95% CI: 20.0% - 25.0%; I2=99.2%). This estimate was lower in national studies [20.0% (95% CI: 17.0% - 22.0%; I2=99.4%] than in sub-national studies [24.0% (95% CI: 17.0% - 30.0%; I2=99.2%]. The pooled prevalence of previous hypertension diagnosis was 51.0% (95% CI: 43.0% - 59.0%; I2=99.9%). The pooled incidence of hypertension was 4.2 (95% CI: 2.0 - 6.4; I2=98.6%) per 100 person-years. The included studies did not present high risk of bias. Conclusions. Our findings show that one in five Peruvians has hypertension, and that four new cases appear per 100 persons per year; in addition, only half of the subjects with hypertension are previously diagnosed.

CKD and CKDu in northern Peru: a cross-sectional analysis under the DEGREE protocol.

BACKGROUND: This study estimated the prevalence and risk factors for decreased estimated glomerular filtration rate (eGFR) in those without known hypertension, type 2 diabetes mellitus, or heavy proteinuria as a surrogate marker for chronic kidney disease of unknown cause (CKDu) among adults in the North of Peru. METHODS: A cross-sectional study was conducted following the Disadvantaged Populations eGFR Epidemiology (DEGREE) Study protocol. Low eGFR was defined based on a single eGFR ≤60 mL/min/1.7m2 estimated using the CKD-EPI equation. Environmental conditions related to CKDu (i.e., work in agriculture or sugarcane, water source, heat intolerance, and pesticide exposure) were evaluated, in addition to traditional risk factors for CKD (i.e., smoking, heavy drinking, physical activity, hypertension, type 2 diabetes mellitus, urolithiasis, among others). RESULTS: A total of 1514 subjects were included in the study, mean age 45.1 (SD: 16.4), and 55.2% were females. Overall, only 26 cases (1.7%; 95%CI: 1.1-2.5%) had an eGFR < 60 mL/min/1.7m2 compatible with CKD definition; when those with hypertension and type-2 diabetes or heavy proteinuria were excluded, according to the DEGREE protocol, the estimate fell to 0.9% (95%CI: 0.4-1.5%). Low physical activity levels (OR = 1.99; 95%CI: 1.18-3.34), hypertension (OR = 2.07; 1.26-3.41), and urolithiasis (OR = 1.97; 95%CI: 1.18-3.27) were factors associated with low eGFR. CONCLUSIONS: A low population-based prevalence of low eGFR (as a surrogate for CKDu), both in rural and urban settings areas, in the Northern Peru, was found. Low physical activity levels, hypertension and urolithiasis were factors associated with low eGFR. Interventions to prevent CKD cases may be focused on well-known CV risk factors and urolithiasis.

Prevalence and incidence of arterial hypertension in Peru: a systematic review and meta-analysis. / Prevalencia e incidencia de hipertensión arterial en Perú: revisión sistemática y metaanálisis.

OBJECTIVE: . To determine the prevalence and incidence of arterial hypertension, as well as the prevalence of previous diagnosis of arterial hypertension (self-reported) among the adult population of Peru. MATERIALS AND METHODS.: Systematic review and meta-analysis of epidemiological studies available in LILACS, EMBASE, MEDLINE and Global Health. Studies were included if they followed a random sampling approach in adult population. Screening and assessment of manuscripts was carried out independently by two researchers. A random-effects meta-analysis was conducted to quantify the overall prevalence and incidence of hypertension. The Newcastle-Ottawa scale was used to assess the risk of bias in the manuscripts. RESULTS.: A total of 903 papers were screened, and only 15 were included in the estimation of hypertension prevalence, 8 in the assessment of previous hypertension diagnosis, and 4 for incidence estimations. The pooled prevalence of hypertension was 22.0% (95% CI: 20.0% - 25.0%; I2=99.2%). This estimate was lower in national studies [20.0% (95% CI: 17.0% - 22.0%; I2=99.4%] than in sub-national studies [24.0% (95% CI: 17.0% - 30.0%; I2=99.2%]. The pooled prevalence of previous hypertension diagnosis was 51.0% (95% CI: 43.0% - 59.0%; I2=99.9%). The pooled incidence of hypertension was 4.2 (95% CI: 2.0 - 6.4; I2=98.6%) per 100 person-years. The included studies did not present high risk of bias. CONCLUSIONS.: Our findings show that one in five Peruvians has hypertension, and that four new cases appear per 100 persons per year; in addition, only half of the subjects with hypertension are previously diagnosed.

OBJETIVO.: Determinar la prevalencia e incidencia de hipertensión arterial, y la prevalencia de diagnóstico previo de hipertensión arterial (autorreportado) en población general adulta del Perú. MATERIALES Y MÉTODOS.: Revisión sistemática y metaanálisis de estudios epidemiológicos disponibles en LILACS, EMBASE, MEDLINE y Global Health. Se incluyeron estudios que siguieron un muestreo aleatorio de la población general adulta. El tamizaje y estudio de los manuscritos fue realizado por dos investigadores de forma independientemente. Se hizo metaanálisis de efectos aleatorios para cuantificar la prevalencia e incidencia global. Los manuscritos fueron evaluados con la escala Newcastle-Ottawa para evaluar el riesgo de sesgo. RESULTADOS.: Se tamizaron 903 artículos, y se incluyeron 15 manuscritos para prevalencia, 8 para prevalencia de diagnóstico previo, y 4 para incidencia de hipertensión. El metaanálisis mostró una prevalencia agregada de hipertensión de 22,0% (IC 95%: 20,0% - 25,0%; I 2=99,2%). Esta prevalencia fue menor en estudios nacionales [20,0% (IC 95%: 17,0% - 22,0%; I 2 =99,4%] que en subnacionales [24,0% (IC 95%: 17,0% - 30,0%; I 2 =99,2%]. La prevalencia global de diagnóstico previo de hipertensión fue 51,0% (IC 95%: 43,0% - 59,0%; I 2=99,9%). La incidencia global fue de 4,2 (IC 95%: 2,0 - 6,4; I 2=98,6%) por cada 100 personas-año. Los manuscritos estudiados no presentaron alto riesgo de sesgo. CONCLUSIONES.: Nuestros hallazgos muestran que uno de cada cinco peruanos tiene hipertensión, y que aparecen cuatro nuevos casos por 100 personas en un año, además solo la mitad de los pacientes hipertensos tienen el diagnóstico previo de su condición.

Blood pressure and 10-year all-cause mortality: Findings from the PERU MIGRANT Study.

Background: The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines. Methods: Data analysis of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Results: A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%-18.4%) to 31.3% (95% CI 28.4%-34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty-three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4-4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2.1-fold and 5.1-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage-1 and stage-2 hypertension. Conclusions: Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.

Tear biomarkers and corneal sensitivity as an indicator of neuropathy in type 2 diabetes.

AIMS: Explore potential of 31 tear biomarkers involved in screening for diabetic peripheral neuropathy (DPN). Assess the utility of aesthesiometry for measuring corneal damage in DPN and determine optimal cutoff point for detecting DPN. METHODS: Screening test pilot study recruited 90 participants from a tertiary hospital in Lima, Peru. Participants were grouped by diabetes and neuropathy status. Tears collected on Schirmer strips, and proteins measured by both ELISA and multiplex-bead assay. Corneal sensitivity was measured by aesthesiometry, and DPN by vibration perception threshold testing. RESULTS: There were 89 participants included in the analysis. The mean age was 55.7 ± 1.46, and 58.4% were female. MMP-9 and TGF-alpha concentrations were higher in participants with DPN versus diabetes alone, though not significant. Aesthesiometry was decreased in individuals with DPN when compared to participants with diabetes alone (p < 0.01) and normal controls (p < 0.01). Optimal cutoff point for aesthesiometry was found to be 5.8 cm, with 79% sensitivity and 75% specificity. CONCLUSIONS: Tears are an insufficient standalone tool for detecting DPN based on the biomarkers analyzed. Aesthesiometry is a simple, inexpensive, and accurate method to assess corneal damage associated with moderate-severe DPN, and its integration into screening practices has potential to improve detection of DPN in poor-resource settings.

Skinfold thickness and the incidence of type 2 diabetes mellitus and hypertension: an analysis of the PERU MIGRANT study.

OBJECTIVE: To determine the association between excess body fat, assessed by skinfold thickness, and the incidence of type 2 diabetes mellitus (T2DM) and hypertension (HT). DESIGN: Data from the ongoing PERU MIGRANT Study were analysed. The outcomes were T2DM and HT, and the exposure was skinfold thickness measured in bicipital, tricipital, subscapular and suprailiac areas. The Durnin-Womersley formula and SIRI equation were used for body fat percentage estimation. Risk ratios and population attributable fractions (PAF) were calculated using Poisson regression. SETTING: Rural (Ayacucho) and urban shantytown district (San Juan de Miraflores, Lima) in Peru. PARTICIPANTS: Adults (n 988) aged ≥30 years (rural, rural-to-urban migrants, urban) completed the baseline study. A total of 785 and 690 were included in T2DM and HT incidence analysis, respectively. RESULTS: At baseline, age mean was 48·0 (sd 12·0) years and 47 % were males. For T2DM, in 7·6 (sd 1·3) years, sixty-one new cases were identified, overall incidence of 1·0 (95 % CI 0·8, 1·3) per 100 person-years. Bicipital and subscapular skinfolds were associated with 2·8-fold and 6·4-fold risk of developing T2DM. On the other hand, in 6·5 (sd 2·5) years, overall incidence of HT was 2·6 (95 % CI 2·2, 3·1) per 100 person-years. Subscapular and overall fat obesity were associated with 2·4- and 2·9-fold risk for developing HT. The PAF for subscapular skinfold was 73·6 and 39·2 % for T2DM and HT, respectively. CONCLUSIONS: We found a strong association between subscapular skinfold thickness and developing T2DM and HT. Skinfold assessment can be a laboratory-free strategy to identify high-risk HT and T2DM cases.

Regression from prediabetes to normal glucose levels is more frequent than progression towards diabetes: The CRONICAS Cohort Study.

AIMS: This study aimed to (1) estimate the prevalence of prediabetes according to different definitions, (2) evaluate regression to normal glucose levels and progression towards T2DM, and (3) determine factors associated with regression and progression across four diverse geographical settings in a Latin American country. METHODS: The CRONICAS Cohort Study was conducted in four different areas in Peru. Enrollment started in September 2010 and follow-up was conducted in 2013. Prediabetes, T2DM and normal glucose levels were determined according to definitions from the World Health Organization (WHO), American Diabetes Association (ADA), and National Institute for Health and Care Excellence (NICE). The main outcomes were regression to normal glucose levels and incidence of T2DM. Prevalence estimates and 95% confidence intervals (95% CI) were calculated. Crude and adjusted models using Poisson regression were performed and relative risk ratios (RRR) and 95% CI were calculated. RESULTS: At baseline, the prevalence of prediabetes varied markedly by definition used: 6.5%(95% CI 5.6-7.6%), 53.6% (95% CI 51.6-55.6%), and 24.6% (95% CI 22.8-26.4%) according to WHO, ADA and NICE criteria, respectively. After 2.2  years of follow-up, in those with prediabetes, the cumulative incidence of regression to euglycemia ranged between 31.4% and 68.9%, whereas the incidence of T2DM varied from 5.5% to 28.8%. Factors associated with regression to normal glucose levels and progression to diabetes were age, body mass index, and insulin resistance. CONCLUSIONS: Regression from pre-diabetes back to euglycemia was much more common than progression to diabetes.

Addressing the impact of urban exposure on the incidence of type 2 diabetes mellitus: The PERU MIGRANT Study.

The aim of this study was to estimate the incidence of T2DM in three population groups: rural, rural-to-urban migrants and urban dwellers. Data from the PERU MIGRANT Study was analysed. The baseline assessment was conducted in 2007-2008 using a single-stage random sample and further follow-up was undertaken in 2015-16. T2DM was defined based on fasting glucose and self-reported diagnosis. Poisson regression models and robust variance to account for cluster effects were used for reporting risk ratios (RR) and 95%CI. At baseline, T2DM prevalence was 8% in urban, 3.6% in rural-to-urban migrants and 1.5% in rural dwellers. After 7.7 (SD: 1.1) years, 6,076 person-years of follow-up, 61 new cases were identified. The incidence rates in the urban, migrant and rural groups were 1.6, 0.9 and 0.5 per 100 person-years, respectively. Relative to rural dwellers, a 4.3-fold higher risk (95%CI: 1.6-11.9) for developing T2DM was found in urban dwellers and 2.7-fold higher (95%CI: 1.1-6.8) in migrants with ≥30 years of urban exposure. Migration and urban exposure were found as significant risk factors for developing T2DM. Within-country migration is a sociodemographic phenomenon occurring worldwide; thus, it is necessary to disentangle the effect of urban exposure on non-healthy habits and T2DM development.

EZSCAN for undiagnosed type 2 diabetes mellitus: A systematic review and meta-analysis.

OBJECTIVES: The EZSCAN is a non-invasive device that, by evaluating sweat gland function, may detect subjects with type 2 diabetes mellitus (T2DM). The aim of the study was to conduct a systematic review and meta-analysis including studies assessing the performance of the EZSCAN for detecting cases of undiagnosed T2DM. METHODOLOGY/PRINCIPAL FINDINGS: We searched for observational studies including diagnostic accuracy and performance results assessing EZSCAN for detecting cases of undiagnosed T2DM. OVID (Medline, Embase, Global Health), CINAHL and SCOPUS databases, plus secondary resources, were searched until March 29, 2017. The following keywords were utilized for the systematic searching: type 2 diabetes mellitus, hyperglycemia, EZSCAN, SUDOSCAN, and sudomotor function. Two investigators extracted the information for meta-analysis and assessed the quality of the data using the Revised Version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklist. Pooled estimates were obtained by fitting the logistic-normal random-effects model without covariates but random intercepts and using the Freeman-Tukey Arcsine Transformation to stabilize variances. Heterogeneity was also assessed using the I2 measure. Four studies (n = 7,720) were included, three of them used oral glucose tolerance test as the gold standard. Using Hierarchical Summary Receiver Operating Characteristic model, summary sensitivity was 72.0% (95%CI: 60.0%- 83.0%), whereas specificity was 56.0% (95%CI: 38.0%- 74.0%). Studies were very heterogeneous (I2 for sensitivity: 79.2% and for specificity: 99.1%) regarding the inclusion criteria and bias was present mainly due to participants selection. CONCLUSIONS: The sensitivity of EZSCAN for detecting cases of undiagnosed T2DM seems to be acceptable, but evidence of high heterogeneity and participant selection bias was detected in most of the studies included. More studies are needed to evaluate the performance of the EZSCAN for undiagnosed T2DM screening, especially at the population level.

[Medical students at risk: prevalence and incidence of tuberculin skin test conversion]. / Estudiantes de medicina en riesgo: prevalencia e incidencia de conversión de PPD.

INTRODUCTION: One third of the world population is affected by latent tuberculosis, with 9.4 million new cases; medical students have 2 to 50 times the probability of acquiring the infection. OBJECTIVES: Establish the baseline prevalence of positive tuberculin skin test (TST) at the beginning of medical studies and determine the incidence and variables associated with TST conversion in medical students. MATERIALS AND METHODS: Secondary analysis of a historical cohort (2007-2010) of medical students in a private Peruvian university. The TST conversion was evaluated. A binomial regression analysis was applied for each associated variable. RESULTS: 707 medical students were included, of whom 219 (31%) were male. The basal prevalence of reactive TST was 14.4%. Significant associations were found with the year of university entry of 2007-08 (p = 0.007) and a history of tuberculosis (p = 0.02). With a total of 822 person-years, the incidence of conversion was 2.92 cases per 100 person-years (CI95%: 1.96-4.36). The TST conversion was associated with the year of university entry (RR = 2,55; IC95%: 1,06-6,30) and a body mass index > 25 kg/m² (RR = 0,16; IC95%: 0,01-0,97). No association was detected with gender, tobacco or alcohol use. CONCLUSIONS: There is evidence of a high basal prevalence of latent tuberculosis infection in medical students. The incidence rate is within expected values and high in comparison with the general population. People with BMI > 25 kg/m² have protection against a latent infection. In medical students, more attention should be paid to biosecurity.

Estudiantes de medicina en riesgo: prevalencia e incidencia de conversión de PPD / Medical students at risk: prevalence and incidence of tuberculin skin test conversion

Introduction: One third of the world population is affected by latent tuberculosis, with 9.4 million new cases; medical students have 2 to 50 times the probability of acquiring the infection. Objectives: Establish the baseline prevalence of positive tuberculin skin test (TST) at the beginning of medical studies and determine the incidence and variables associated with TST conversion in medical students. Materials and Methods: Secondary analysis of a historical cohort (2007-2010) of medical students in a private Peruvian university. The TST conversion was evaluated. A binomial regression analysis was applied for each associated variable. Results: 707 medical students were included, of whom 219 (31%) were male. The basal prevalence of reactive TST was 14.4%. Significant associations were found with the year of university entry of 2007-08 (p = 0.007) and a history of tuberculosis (p = 0.02). With a total of 822 person-years, the incidence of conversion was 2.92 cases per 100 person-years (CI95%: 1.96-4.36). The TST conversion was associated with the year of university entry (RR = 2,55; IC95%: 1,06-6,30) and a body mass index > 25 kg/m² (RR = 0,16; IC95%: 0,01-0,97). No association was detected with gender, tobacco or alcohol use. Conclusions: There is evidence of a high basal prevalence of latent tuberculosis infection in medical students. The incidence rate is within expected values and high in comparison with the general population. People with BMI > 25 kg/m² have protection against a latent infection. In medical students, more attention should be paid to biosecurity.

Introducción: Un tercio de la población mundial presenta una infección tuberculosa latente, con 9,4 millones de casos nuevos reportados en el 2009; los estudiantes de medicina tienen de 2 a 50 veces más probabilidad de adquirir la infección. Objetivos: Establecer la prevalencia de PPD positivo basal al inicio de la carrera médica y determinar la incidencia y los factores asociados a la conversión de PPD en alumnos de medicina. Materiales y Métodos: Análisis secundario de datos de una cohorte histórica (2007-2010) involucrando alumnos de medicina de una universidad privada en Perú. Se evaluó la conversión de PPD. Se aplicó un análisis de regresión binomial para cada variable de interés. Resultados: 707 estudiantes fueron seguidos, de ellos 219 (31%) fueron hombres. La prevalencia basal de PPD positivo fue 14,4%. Se encontró asociación significativa con el año de ingreso 2007-08 (p = 0,007) y antecedente de tuberculosis anterior (p = 0,02). Con un total de 822 personas-año, la incidencia de conversión fue de 2,92 por 100 personas-año (IC95%: 1,96-4,36). En el modelo bivariado, el año de ingreso a la carrera y el IMC > 25 kg/m² estuvieron asociados con conversión de PPD. Sin embargo, en el modelo multivariado, sólo el año de ingreso mostró asociación estadísticamente significativa (RR = 2,53; IC95%: 1,11-5,76). Conclusiones: Existe una prevalencia basal elevada de infección latente en alumnos de medicina. La tasa de incidencia está dentro de los valores esperados y previamente reportados. Se recomienda prestar más atención a las medidas de bioseguridad y prevención en estudiantes de medicina.