Prevalence of risk factors for noncommunicable diseases in an indigenous community in Santiago Atitlán, Guatemala.

OBJECTIVE: To describe the prevalence of noncommunicable disease (NCD) risk factors and assess knowledge of those risk factors in the indigenous community of Santiago Atitlán in Guatemala, a lower-middle income country. METHODS: A population-based, cross-sectional study was conducted using a modified version of the World Health Organization's STEPS protocol. Adults aged 20-65 years were surveyed regarding demographics and NCD risk factors, and the survey was followed by anthropometric and biochemical measurements. RESULTS: Out of 501 screened individuals, 350 respondents were enrolled. The mean age was 36.7 years, and 72.3% were women. Over 90% reported earning less than US$ 65 per month. Almost 80% were stunted. Among women, 37.3% were obese and over three-quarters had central obesity. Over three-quarters of the entire group had dyslipidemia and 18.3% had hypertension, but only 3.0% had diabetes. Overall, 36.0% of participants met criteria for metabolic syndrome. There was no significant association between participants' education and NCD risk factors except for an inverse association with obesity by percent body fat. CONCLUSIONS: Santiago Atitlán is a rural, indigenous Guatemalan community with high rates of poverty and stunting coexisting alongside high rates of obesity, particularly among women. Additionally, high rates of hypertension and dyslipidemia were found, but a low rate of diabetes mellitus. Knowledge of NCDs and their risk factors was low, suggesting that educational interventions may be a high-yield, low-cost approach to combating NCDs in this community.

Prevalence of risk factors for noncommunicable diseases in an indigenous community in Santiago Atitlán, Guatemala / Prevalencia de los factores de riesgo de las enfermedades no transmisibles en una comunidad indígena de Santiago Atitlán, Guatemala

ABSTRACT Objective To describe the prevalence of noncommunicable disease (NCD) risk factors and assess knowledge of those risk factors in the indigenous community of Santiago Atitlán in Guatemala, a lower-middle income country. Methods A population-based, cross-sectional study was conducted using a modified version of the World Health Organization’s STEPS protocol. Adults aged 20–65 years were surveyed regarding demographics and NCD risk factors, and the survey was followed by anthropometric and biochemical measurements. Results Out of 501 screened individuals, 350 respondents were enrolled. The mean age was 36.7 years, and 72.3% were women. Over 90% reported earning less than US$ 65 per month. Almost 80% were stunted. Among women, 37.3% were obese and over three-quarters had central obesity. Over three-quarters of the entire group had dyslipidemia and 18.3% had hypertension, but only 3.0% had diabetes. Overall, 36.0% of participants met criteria for metabolic syndrome. There was no significant association between participants’ education and NCD risk factors except for an inverse association with obesity by percent body fat. Conclusions Santiago Atitlán is a rural, indigenous Guatemalan community with high rates of poverty and stunting coexisting alongside high rates of obesity, particularly among women. Additionally, high rates of hypertension and dyslipidemia were found, but a low rate of diabetes mellitus. Knowledge of NCDs and their risk factors was low, suggesting that educational interventions may be a high-yield, low-cost approach to combating NCDs in this community.

RESUMEN Objetivo Describir la prevalencia de los factores de riesgo de las enfermedades no transmisibles (ENT) y evaluar el conocimiento de esos factores de riesgo en la comunidad indígena de Santiago Atitlán en Guatemala, un país de ingresos medianos bajos. Métodos Se realizó un estudio transversal basado en la población usando una versión modificada del protocolo STEPS de mediciones físicas de la Organización Mundial de la Salud. Se realizó una encuesta a adultos de 20 a 65 años de edad con respecto a algunas características demográficas y los factores de riesgo de las ENT; la encuesta fue seguida de mediciones antropométricas y bioquímicas. Resultados De las 501 personas encuestadas, se registraron 350 para el sondeo. La media de edad fue 36,7 años, y 72,3% eran mujeres. Más de 90% informó tener un ingreso inferior a los US$ 65 mensuales. Casi 80% padecía retraso del crecimiento. Entre las mujeres, 37,3% eran obesas y más de tres cuartas partes tenían obesidad central. Más de tres cuartas partes del grupo tenían dislipidemia y 18,3% tenían hipertensión, pero solo 3,0% tenía diabetes. En términos generales, 36,0% de los participantes satisfacía los criterios de síndrome metabólico. No se observó una asociación significativa entre el nivel de escolaridad de los participantes y los factores de riesgo de las ENT, excepto una asociación inversa con la obesidad por porcentaje de tejidos grasos. Conclusiones Santiago Atitlán es una comunidad indígena rural de Guatemala con tasas elevadas de pobreza y retraso del crecimiento, que coexisten con tasas altas de obesidad, en particular en las mujeres. Además, se encontraron tasas elevadas de hipertensión y dislipidemia, pero una tasa baja de diabetes mellitus. Se observó un conocimiento bajo de las ENT y sus factores de riesgo, lo que indica que las intervenciones educativas pueden ser un enfoque de alto rendimiento y bajo costo para combatir las ENT en esta comunidad.

Risk screening for cardiovascular disease and diabetes in Latino migrant farmworkers: a role for the community health worker.

Diabetes and heart disease are two of the leading causes of death for Hispanics living in the United States (American Heart Association [AHA] in Circulation 123:e18-e209. doi: 10.1161/CIR.0b013e3182009701 , 2010). As the Hispanic population continues to grow, the need for low-cost, non-invasive methods to detect at risk populations for such diseases becomes more important. Once at risk individuals are detected, prevention strategies can be implemented. Studies have shown that Latino community health workers (CHWs) are effective educators, patient advocates and health promotion motivators for patients with known heart disease or diabetes. This pilot study examined the accuracy with which Latino CHWs could determine migrant farmworkers at risk for diabetes or cardiovascular disease (CVD) in rural Virginia. This quasi-experimental study supports the hypothesis that Latino CHWs can use non-invasive diabetes and CVD screening tools with similar accuracy as a registered nurse. The screening tools used were the American Diabetes Association's diabetes risk calculator and a non-laboratory screening tool for CVD risk designed by Gaziano et al. (Lancet 371:923-931, 2008). The terms Latino and Hispanic will be used interchangeably.

Trends and heterogeneity of cardiovascular disease and risk factors across Latin American and Caribbean countries.

Aging, globalization and urbanization in Latina America and the Caribbean (LAC) have made cardiovascular disease (CVD) the number one cause of death and disability, while communicable diseases have decreased. This epidemiological transition has been more heterogeneous than in other areas of the world. While countries like Argentina, Chile, Brazil and Colombia have seen a significant decrease in CVD mortality, the rest of the countries have seen an increase, particularly Central American and Caribbean countries. These latter countries have now coexisting high prevalence of communicable and non-communicable diseases, threatening the socioeconomic development. Recent multinational cross sectional studies have provided a better perspective of the prevalence and distribution of cardiovascular risk factors in the region. While there has been a decrease in prevalence of smoking in the region, obesity, diabetes and physical inactivity continue to increase the CVD disease burden in LAC.

Early childhood diarrhea and cardiometabolic risk factors in adulthood: the Institute of Nutrition of Central America and Panama Nutritional Supplementation Longitudinal Study.

BACKGROUND: Nutritional deficits in early life have been associated with a higher prevalence of the metabolic syndrome (MetS) in adulthood. Early childhood diarrhea contributes to undernutrition and may potentially increase the risk for adult noncommunicable diseases. Our objective was to examine associations between early childhood diarrhea burden and later development of MetS. METHODS: We studied individuals who participated in the Institute of Nutrition of Central America and Panama Nutritional Supplementation Longitudinal Study (1969-1977) and were followed up in 2002-2004. We used logistic regression to determine associations of diarrhea burden at ages 0 to 6, 6 to 12, and 12 to 24 months with odds of MetS and elevations in its components as adults. RESULTS: Among 389 adults age 25 to 42 years at follow-up, the prevalence of MetS was 29%. Adjusting for several confounders including adult body mass index (BMI), each absolute 1% increase in diarrhea burden at age 0 to 6 months (but not at other time periods) was associated with increased odds of MetS (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06). This was attributable primarily to associations with elevated blood pressure (OR, 1.03; 95% CI, 1.00-1.06) and waist circumference (OR, 1.03; 95% CI, 1.00-1.06). CONCLUSIONS: Childhood diarrhea burden at 0 to 6 months is associated with MetS in adulthood after controlling for childhood growth parameters and adult BMI.

Early childhood growth failure and the developmental origins of adult disease: do enteric infections and malnutrition increase risk for the metabolic syndrome?

Hypotheses regarding the developmental origins of health and disease postulate that developing fetuses - and potentially young children - undergo adaptive epigenetic changes that have longstanding effects on metabolism and other processes. Ongoing research explores whether these adaptations occur during early life following early childhood malnutrition. In the developing world, there remains a high degree of nutritional stunting, defined as linear growth failure caused by inadequate caloric intake, which may be exacerbated by inflammation from ongoing infections. In areas with poor sanitation, children experience vicious cycles of enteric infections and malnutrition, resulting in poor nutrient absorption as a result of changes in the intestinal mucosa, now termed "environmental enteropathy." Emerging evidence links early childhood diarrhea and/or growth failure with an increased occurrence of risk factors for cardiovascular disease in later life, including dyslipidemia, hypertension, and glucose intolerance. The mechanisms for these associations remain poorly understood and may relate to epigenetic responses to poor nutrition, increased inflammation, or both. Given the increased incidence of cardiovascular disease in developing areas of the world, associations between childhood malnutrition, early-life infections, and the increased occurrence of risk factors for cardiovascular disease underscore further reasons to improve nutrition and infection-related outcomes for young children worldwide.

Cost and yield of adding electrocardiography to history and physical in screening Division I intercollegiate athletes: a 5-year experience.

BACKGROUND: Electrocardiographic screening of intercollegiate athletes is controversial because the costs and yield are not well defined. Both the American Heart Association (AHA) and the European Society of Cardiology (ESC) have different criteria for screening, partly because the populations being screened are different. OBJECTIVE: The purpose of this study was to determine the cost and yield of a 5-year ECG screening program at a United States Division I college. METHODS: At the University of Virginia, all 1,473 competitive athletes over the course of 5 years were screened with history and physical and with ECGs using ESC guidelines with follow-up testing as dictated by clinical symptoms and ECG findings. RESULTS: History and physical alone uncovered five significant cardiac abnormalities. ECGs were abnormal in 275 (19%), resulting in 359 additional tests. Additional testing confirmed eight significant cardiac abnormalities that were not found by history and physical: 1 bicuspid aortic valve, 4 rapidly conducting accessory pathways, 1 long QT patient, 1 with frequent premature ventricular contractions and low ejection fraction, and 1 with frequent premature ventricular contractions but normal ejection fraction. No cases of hypertrophic cardiomyopathy were found. Total cost of the program was US $894,870. Cost of history and physical screening alone was $343,725 or $68,745 per finding. The marginal cost of adding ECG screening, including resulting tests and procedures. was US$551,145 or US$68,893 per additional finding. CONCLUSION: ECG screening of U.S. college athletes can uncover significant cardiac pathology not discovered by history and physical alone. Although ECG screening also results in many false positives resulting in additional tests, the overall cost per diagnosis of adding ECG screening is similar to that of history and physical screening alone.

Metabolic syndrome and its components are underdiagnosed in cardiology clinics.

BACKGROUND: Although metabolic syndrome (MetS) is an important clinical condition, evidence is scarce on how often doctors successfully diagnose this syndrome. AIMS: To assess the extent of doctors' diagnosis of MetS and its components in cardiology outpatient setting and whether such diagnosis affects the way patients are counselled on lifestyle modification. METHODS: This is a multicentre cross-sectional study on randomly selected clinical notes at ambulatory cardiology clinics in three academic centres in the USA. We abstracted data on cardiovascular risk factors, and examined whether doctors documented a diagnosis of MetS and its components. RESULTS: Of 511 participants who satisfied our inclusion criteria, the MetS was present in 246 participants (48%). The proportions with which a doctor correctly documented diagnoses were: MetS 9.3% (23/246), obesity 60% (119/197), elevated blood pressure 74% (305/412), elevated fasting glucose 17% (49/291), reduced high density lipoprotein cholesterol 10% (18/190) and elevated triglycerides 20% (32/164). This pattern of diagnoses, less frequent with dyslipidaemia and elevated fasting glucose compared with the rest, was persistently observed regardless of sex, age, and presence or absence of MetS. Those diagnosed were more likely to receive a recommendation of weight loss or increase in physical activity than those undiagnosed: 91% (21/23) versus 37% (82/223) for weight loss, and 83% (19/23) versus 26% (58/223) for increase in physical activity (P < 0.001 for both). CONCLUSIONS: Our data indicate that MetS and its components are commonly underdiagnosed in cardiology outpatient setting. Better diagnosis may lead to better counselling on lifestyle changes and improvement in the quality of care.

Risk factors for acute myocardial infarction in Latin America: the INTERHEART Latin American study.

BACKGROUND: Current knowledge of the impact of cardiovascular risk factors in Latin America is limited. METHODS AND RESULTS: As part of the INTERHEART study, 1237 cases of first acute myocardial infarction and 1888 age-, sex-, and center-matched controls were enrolled from Argentina, Brazil, Colombia, Chile, Guatemala, and Mexico. History of smoking, hypertension, diabetes mellitus, diet, physical activity, alcohol consumption, psychosocial factors, anthropometry, and blood pressure were recorded. Nonfasting blood samples were analyzed for apolipoproteins A-1 and B-100. Logistic regression was used to estimate multivariate adjusted odds ratios (ORs) and their 95% confidence intervals (CIs). Persistent psychosocial stress (OR, 2.81; 95% CI, 2.07 to 3.82), history of hypertension (OR, 2.81; 95% CI, 2.39 to 3.31), diabetes mellitus (OR, 2.59; 95% CI, 2.09 to 3.22), current smoking (OR, 2.31; 95% CI, 1.97 to 2.71), increased waist-to-hip ratio (OR for first versus third tertile, 2.49; 95% CI, 1.97 to 3.14), and increased ratio of apolipoprotein B to A-1 (OR for first versus third tertile, 2.31; 95% CI, 1.83 to 2.94) were associated with higher risk of acute myocardial infarction. Daily consumption of fruits or vegetables (OR, 0.63; 95% CI, 0.51 to 0.78) and regular exercise (OR, 0.67; 95% CI, 0.55 to 0.82) reduced the risk of acute myocardial infarction. Abdominal obesity, abnormal lipids, and smoking were associated with high population-attributable risks of 48.5%, 40.8%, and 38.4%, respectively. Collectively, these risk factors accounted for 88% of the population-attributable risk. CONCLUSIONS: Interventions aimed at decreasing behavioral risk factors, lowering blood pressure, and modifying lipids could have a large impact on the risk of acute myocardial infarction among Latin Americans.

Risk factors for acute myocardial infarction in Latin America the INTERHEART Latin American Study

Background—Current knowledge of the impact of cardiovascular risk factors in Latin America is limited. Methods and Results—As part of the INTERHEART study, 1237 cases of first acute myocardial infarction and 1888 age-, sex-, and center-matched controls were enrolled from Argentina, Brazil, Colombia, Chile, Guatemala, and Mexico. History of smoking, hypertension, diabetes mellitus, diet, physical activity, alcohol consumption, psychosocial factors, anthropometry, and blood pressure were recorded. Nonfasting blood samples were analyzed for apolipoproteins A-1 and B-100. Logistic regression was used to estimate multivariate adjusted odds ratios (ORs) and their 95% confidence intervals (CIs). Persistent psychosocial stress (OR, 2.81; 95% CI, 2.07 to 3.82), history of hypertension (OR, 2.81; 95% CI, 2.39 to 3.31), diabetes mellitus (OR, 2.59; 95% CI, 2.09 to 3.22), current smoking (OR, 2.31; 95% CI, 1.97 to 2.71), increased waist-to-hip ratio (OR for first versus third tertile, 2.49; 95% CI, 1.97 to 3.14), and increased ratio of apolipoprotein B to A-1 (OR for first versus third tertile, 2.31; 95% CI, 1.83 to 2.94) were associated with higher risk of acute myocardial infarction. Daily consumption of fruits or vegetables (OR, 0.63; 95% CI, 0.51 to 0.78) and regular exercise (OR, 0.67; 95% CI, 0.55 to 0.82) reduced the risk of acute myocardial infarction. Abdominal obesity, abnormal lipids, and smoking were associated with high population-attributable risks of 48.5%, 40.8%, and 38.4%, respectively. Collectively, these risk factors accounted for 88% of the population-attributable risk. Conclusions—Interventions aimed at decreasing behavioral risk factors, lowering blood pressure, and modifying lipids could have a large impact on the risk of acute myocardial infarction among Latin Americans.

Information and communication technology in cardiovascular disease prevention in developing countries: hype and hope. Report of the International Collaboration on Information Use in Cardiovascular Health Promotion in Developing Countries.

Information can be an important tool in promoting a prevention strategy to address the emerging epidemic of cardiovascular disease in developing countries. Advances in information and communication technology offer new promises for global access to information and for global mobilization to prevent and control cardiovascular disease. This is especially true for health professionals, whose needs in areas such as networking, exchange of expertise and access to relevant advances remain unfulfilled. Information technology can also sensitize the lay public to the magnitude of cardiovascular diseases, creating awareness about risk states, and highlighting preventive strategies. Effective application mandates that the technology be relevant to local needs. Cost, feasibility, and relevance of information need to be considered before wide adoption is advocated. Several initiatives, such as ProCOR, Global Cardiovascular Infobase, Heartfile, and the Virtual Congress of Cardiology, have successfully utilized information technology to promote cardiovascular prevention. The experience of these initiatives suggests that, while information technology holds great potential, there are many potential perils, such as the widening global information gap, inequitable access, and irrelevant information. For now, information technology must be viewed as part of a broader strategy, which includes conventional communication media, to address the unmet information needs for cardiovascular prevention globally. Enlightened policies can exploit the energies of the recent information boom for promoting cardiovascular prevention, taking into account the considered limitations.