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Background: Latin America ranks among the regions with the highest level of intake of sugary beverages in the world. Innovative strategies to reduce the consumption of sugary drinks are necessary.Purpose: Evaluate the effect of a one-off priest-led intervention on the choice and preference of soda beverages.Methods: We conducted a pragmatic cluster-randomized trial in Catholic parishes, paired by number of attendees, in Chimbote, Peru between March and June of 2017. The priest-led intervention, a short message about the importance of protecting one's health, was delivered during the mass. The primary outcome was the proportion of individuals that choose a bottle of soda instead of a bottle of water immediately after the service. Cluster-level estimates were used to compare primary and secondary outcomes between intervention and control groups utilizing nonparametric tests.Results: Six parishes were allocated to control and six to the intervention group. The proportion of soda selection at baseline was ~60% in the intervention and control groups, and ranged from 56.3% to 63.8% in Week 1, and from 62.7% to 68.2% in Week 3. The proportion of mass attendees choosing water over soda was better in the priest-led intervention group: 8.2% higher at Week 1 (95% confidence interval 1.7%-14.6%, p = .03), and 6.2% higher at 3 weeks after baseline (p = .15).Conclusions: This study supports the proof-of-concept that a brief priest-led intervention can decrease sugary drink choice.Clinical Trial Information: ISRCTN, ISRCTN24676734. Registered 25 April 2017, https://www.isrctn.com/ISRCTN24676734. [ABSTRACT FROM AUTHOR]

Aim: To summarize the evidence on diabetes risk scores for Latin American populations. Methods: A systematic review was conducted (CRD42019122306) looking for diagnostic and prognostic models for type 2 diabetes mellitus among randomly selected adults in Latin America. Five databases (LILACS, Scopus, MEDLINE, Embase and Global Health) were searched. type 2 diabetes mellitus was defined using at least one blood biomarker and the reports needed to include information on the development and/or validation of a multivariable regression model. Risk of bias was assessed using the PROBAST guidelines. Results: Of the 1500 reports identified, 11 were studied in detail and five were included in the qualitative analysis. Two reports were from Mexico, two from Peru and one from Brazil. The number of diabetes cases varied from 48 to 207 in the derivations models, and between 29 and 582 in the validation models. The most common predictors were age, waist circumference and family history of diabetes, and only one study used oral glucose tolerance test as the outcome. The discrimination performance across studies was ~ 70% (range: 66–72%) as per the area under the receiving‐operator curve, the highest metric was always the negative predictive value. Sensitivity was always higher than specificity. Conclusion: There is no evidence to support the use of one risk score throughout Latin America. The development, validation and implementation of risk scores should be a research and public health priority in Latin America to improve type 2 diabetes mellitus screening and prevention. What's new?: Risk scores are tools that could support screening, diagnosis and prognosis decisions in clinical medicine and public health.Risk scores for undiagnosed diabetes or to predict diabetes are available worldwide with a few in Latin America. However, the characteristics of risk scores available for Latin America, their performance, pitfalls and other attributes have not been summarized or appraised.A lack of synthesized information makes it difficult to understand the strengths and limitations of the available tools, hampering their implementation in clinical and screening guidelines.We conducted a thorough search for risk scores for type 2 diabetes developed in Latin America, providing the clinical and public health communities with evidence to inform their decisions regarding these risk scores.Local and regional health organizations could recommend one risk score or foster the development of a stronger tool to overcome the limitations signalled herein. [ABSTRACT FROM AUTHOR]

Objective. To synthetize the scientific evidence on the association between serum lipids and premature mortality in Latin America (LA). Methods. Five data bases were searched from inception without language restrictions: Embase, Medline, Global Health, Scopus and LILACS. Population-based studies following random sampling methods were identified. The exposure variable was lipid biomarkers (e.g., total, LDL- or HDL- cholesterol). The outcome was all-cause and cause-specific mortality. The risk of bias was assessed following the Newcastle-Ottawa criteria. Results were summarized qualitatively. Results. The initial search resulted in 264 abstracts, five (N = 27,903) were included for the synthesis. Three papers reported on the same study from Puerto Rico (baseline in 1965), one was from Brazil (1996) and one from Peru (2007). All reports analysed different exposure variables and used different risk estimates (relative risks, hazard ratios or odds ratios). None of the reviewed reports showed strong association between individual lipid biomarkers and all-cause or cardiovascular mortality. Conclusion. The available evidence is outdated, inconsistently reported on several lipid biomarker definitions and used different methods to study the long-term mortality risk. These findings strongly support the need to better ascertain the mortality risk associated with lipid biomarkers in LA. [ABSTRACT FROM AUTHOR]

Rationale: Forty percent of households worldwide burn biomass fuels for energy, which may be the most important contributor to household air pollution.Objectives: To examine the association between household air pollution exposure and chronic obstructive pulmonary disease (COPD) outcomes in 13 resource-poor settings.Methods: We analyzed data from 12,396 adult participants living in 13 resource-poor, population-based settings. Household air pollution exposure was defined as using biomass materials as the primary fuel source in the home. We used multivariable regressions to assess the relationship between household air pollution exposure and COPD outcomes, evaluated for interactions, and conducted sensitivity analyses to test the robustness of our findings.Measurements and Main Results: Average age was 54.9 years (44.2-59.6 yr across settings), 48.5% were women (38.3-54.5%), prevalence of household air pollution exposure was 38% (0.5-99.6%), and 8.8% (1.7-15.5%) had COPD. Participants with household air pollution exposure were 41% more likely to have COPD (adjusted odds ratio, 1.41; 95% confidence interval, 1.18-1.68) than those without the exposure, and 13.5% (6.4-20.6%) of COPD prevalence may be caused by household air pollution exposure, compared with 12.4% caused by cigarette smoking. The association between household air pollution exposure and COPD was stronger in women (1.70; 1.24-2.32) than in men (1.21; 0.92-1.58).Conclusions: Household air pollution exposure was associated with a higher prevalence of COPD, particularly among women, and it is likely a leading population-attributable risk factor for COPD in resource-poor settings. [ABSTRACT FROM AUTHOR]

Background: Body mass index (BMI) has increased in Latin-America, but the implications for the diabetes burden have not been quantified. We estimated the proportion and absolute number of diabetes cases attributable to high BMI in Bolivia, Ecuador and Peru (Andean Latin-America), with estimation of region-level indicators in Peru.Methods: We estimated the population attributable fraction (PAF) of BMI on diabetes (regardless of type 1 or 2) from 1980 to 2014, including the number of cases attributable to overweight (BMI 25-<30), class I (30-<35), class II (BMI 35-<40) and class III (BMI ≥ 40) obesity. We used age- and sex-specific prevalence estimates of diabetes and BMI categories (NCD-RisC and Peru's DHS survey) combined with relative risks from population-based cohorts in Peru.Findings: Across Andean Latin-America in 2014, there were 1,258,313 diabetes cases attributable to high BMI: 209,855 in Bolivia, 367,440 in Ecuador and 681,018 in Peru. Between 1980 and 2010, the absolute proportion of diabetes cases attributable to class I obesity increased the most (from 12.9% to 27.2%) across the region. The second greatest increase was for class II obesity (from 3.6% to 16.5%). There was heterogeneity in the fraction of diabetes cases attributable to high BMI by region in Peru, as coastal regions had the largest fractions, and so did high-income regions.Interpretation: Over one million diabetes cases are attributable to high BMI in Andean Latin-America. Public health efforts should focus on implementing population-based interventions to reduce high BMI and to develop focused interventions targeted at those at highest risk of diabetes. [ABSTRACT FROM AUTHOR]

Background: Physical activity implies different patterns, but many studies have focused on physical inactivity and sedentary behaviors. This study aimed to estimate the prevalence of different physical activity patterns among adolescents in Latin America and the Caribbean region., Methods: Pooled analysis of the most updated data of the Global School-based Student Health surveys. Age-standardized prevalence of 4 outcomes was estimated using information from the last 7 days: physical inactivity (0 d of at least 60 min/d), insufficient physical activity (&lt;5 d of at least 60 min/d), commuting physical activity (≥5 d of walking or biking to school), and sedentary behavior (≥3 h/d of sitting time)., Results: A total of 132,071 records (33 countries) were analyzed, mean age 14.6 years, 51.2% girls. Pooled age-standardized prevalence of physical inactivity was 22.3%, greater among girls (25.4%) than boys (19.1%); insufficient physical activity was present in 67.7%, greater in girls (73.6%) than boys (61.5%); commuting physical activity was seen in 43.7%, similar between girls (43.3%) and boys (44.1%); and sedentary behavior was present in 43.4%, greater among girls (45.4%) than boys (41.3%)., Conclusions: In Latin America and the Caribbean region, almost two-thirds of adolescents are insufficiently physically active, ≥40% are sedentary, and ≥20% are physically inactive, and these behaviors are more frequent among girls than boys.

Objective: To estimate the pooled prevalence of multimorbidity (≥2 non-communicable diseases in the same individual) among adults of the general population of Latin American and the Caribbean (LAC)., Design: Systematic review and meta-analysis., Data Sources: MEDLINE, Embase, Global Health, Scopus and LILACS up to 1 July 2020., Eligibility Criteria for Selecting Studies: The outcome was the prevalence of multimorbidity. Reports were selected whether they enrolled adult individuals (age ≥18 years) from the general population., Data Extraction and Synthesis: Reviewers extracted relevant data and assessed risk of bias independently. A random-effects meta-analysis was conducted to report pooled prevalence estimates of multimorbidity; pooled estimates by pre-specified subgroups (eg, national studies) were also pursued., Results: From 5830 results, we selected 28 reports, mostly from Brazil and 16 were based on a nationally representative sample. From the 28 selected reports, 26 were further included in the meta-analysis revealing a pooled multimorbidity prevalence of 43% (95% CI: 35% to 51%; I 2 : 99.9%). When only reports with a nationally representative sample were combined, the pooled prevalence was 37% (95% CI: 27% to 47%; I 2 : 99.9%). When the ascertainment of multimorbidity was based on self-reports alone, the pooled prevalence was 40% (95% CI: 31% to 48%; I 2 : 99.9%); this raised to 52% (95% CI: 33% to 70%; I 2 : 99.9%) for reports including self-reported and objective diagnosis., Conclusions: Our results complement and advance those from global efforts by incorporating much more reports from LAC. We revealed a larger presence of multimorbidity in LAC than previously reported., Prospero Registration Number: CRD42020196177., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

We aimed to study time trends and levels of mean total cholesterol and lipid fractions, and dyslipidaemias prevalence in Latin America and the Caribbean (LAC). Systematic-review and meta-analysis of population-based studies in which lipid (total cholesterol [TC; 86 studies; 168,553 people], HDL-Cholesterol [HDL-C; 84 studies; 121,282 people], LDL-Cholesterol [LDL-C; 61 studies; 86,854 people], and triglycerides [TG; 84 studies; 121,009 people]) levels and prevalences were laboratory-based. We used Scopus, LILACS, Embase, Medline and Global Health; studies were from 1964 to 2016. Pooled means and prevalences were estimated for lipid biomarkers from ≥2005. The pooled means (mg/dl) were 193 for TC, 120 for LDL-C, 47 for HDL-C, and 139 for TG; no strong trends. The pooled prevalence estimates were 21% for high TC, 20% for high LDL-C, 48% for low HDL-C, and 21% for high TG; no strong trends. These results may help strengthen programs for dyslipidaemias prevention/management in LAC., Competing Interests: RC, CB, CA, LA, DS, NP, AB No competing interests declared, (© 2020, Carrillo-Larco et al.)

Sodium/salt consumption is a risk factor for cardiovascular diseases. Although global targets to reduce salt intake have been established, current levels and trends of sodium consumption in Latin America and the Caribbean (LAC) are unknown. We conducted a systematic review and meta-analysis of population-based studies in which sodium consumption was analyzed based on urine samples (24 hour samples or otherwise). The search was conducted in Medline, Embase, Global Health, Scopus and LILACS. From 2350 results, 53 were studied in detail, of which 15 reports were included, providing evidence for 18 studies. Most studies were from Brazil (7/18) and six collected 24 hour urine samples. In the random effects meta-analysis, 12 studies (29,875 people) were analyzed since 2010. The pooled mean 24 hour estimated sodium consumption was 4.13 g/day (10.49 g/day of salt). When only national surveys were analyzed, the pooled mean was 3.43 g/day (8.71 g/day of salt); when only community studies were analyzed the pooled mean was 4.39 g/day (11.15 g/day of salt). Studies had low risk of bias. The estimated 24 hour sodium consumption is more than twice the World Health Organization recommendations since 2010. Regional organizations and governments should strengthen policies and interventions to measure and reduce sodium consumption in LAC.

Context: Observational studies investigating household air pollution (HAP) exposure to biomass fuel smoke as a risk factor for pulmonary tuberculosis have reported inconsistent results., Objective: To evaluate the association between HAP exposure and the prevalence of self-reported previous pulmonary tuberculosis., Design: We analyzed pooled data including 12,592 individuals from five population-based studies conducted in Latin America, East Africa, and Southeast Asia from 2010 to 2015. We used multivariable logistic regression to model the association between HAP exposure and self-reported previous pulmonary tuberculosis adjusted for age, sex, tobacco smoking, body mass index, secondary education, site and country of residence., Results: Mean age was 54.6 years (range of mean age across settings 43.8-59.6 years) and 48.6% were women (range of % women 38.3-54.5%). The proportion of participants reporting HAP exposure was 38.8% (range in % HAP exposure 0.48-99.4%). Prevalence of previous pulmonary tuberculosis was 2.7% (range of prevalence 0.6-6.9%). While participants with previous pulmonary tuberculosis had a lower pre-bronchodilator FEV 1 (mean - 0.7 SDs, 95% CI - 0.92 to - 0.57), FVC (- 0.52 SDs, 95% CI - 0.69 to - 0.33) and FEV 1 /FVC (- 0.59 SDs, 95% CI - 0.76 to - 0.43) as compared to those who did not, we did not find an association between HAP exposure and previous pulmonary tuberculosis (adjusted odds ratio = 0.86; 95% CI 0.56-1.32)., Conclusions: There was no association between HAP exposure and self-reported previous pulmonary tuberculosis in five population-based studies conducted worldwide.

Objectives: The objective is to describe hypertension (HTN) prevalence, awareness, treatment and control in urban and rural communities in Latin America to inform public and policy-makers., Methods: Cross-sectional analysis from urban (n = 111) and rural (n = 93) communities including 33 276 participants from six Latin American countries (Argentina, Brazil, Chile, Colombia, Peru and Uruguay) were included. HTN was defined as self-reported HTN on blood pressure (BP) medication or average BP over 140/90 mmHg, awareness as self-reported HTN, and controlled as those with BP under 140/90 mmHg., Results: Mean age was 52 years, 60% were Female and 32% belonged to rural communities. HTN prevalence was 44.0%, with the lowest rates in Peru (17.7%) and the highest rates in Brazil (52.5%). 58.9% were aware of HTN diagnosis and 53.3% were receiving treatment. Prevalence of HTN were higher in urban (44.8%) than rural (42.1%) communities in all countries. Most participants who were aware of HTN were receiving medical treatment (90.5%), but only 37.6% of patients receiving medical treatment had their BP controlled (<140/<90 mmHg), with the rates being higher in urban (39.6%) than in rural (32.4%) communities. The rate of use of two or more drugs was low [36.4%, lowest in Argentina (29.6%) and highest in Brazil (44.6%)]. Statin use was low (12.3%), especially in rural areas (7.0%). Most modifiable risk factors were higher in people with HTN than people without HTN., Conclusion: HTN prevalence is high but BP control is low in Latin America, with marked differences between countries and between urban and rural settings. There is an urgent need for systematic approaches for better detection, treatment optimization and risk factor modification among those with HTN in Latin America.

Type 2 diabetes mellitus (T2DM) is associated with a high mortality risk, although the magnitude of this association remains unknown in Latin America (LA). We aimed to assess the strength of the association between T2DM and all-cause and cause-specific mortality in population-based cohort studies in LA. Systematic review and meta-analysis: inclusion criteria were (1) men and women 18 years old and above with T2DM; (2) study outcomes all-cause and/or cause-specific mortality; and (3) using people without T2DM as comparison group. Five databases (Scopus, Medline, Embase, Global Health, and LILACS) were searched. Risk of bias was evaluated with the ROBINS-I criteria. Initially, there were 979 identified studies, of which 17 were selected for qualitative synthesis; 14 were included in the meta-analysis (N = 416 821). Self-reported T2DM showed a pooled relative risk (RR) of 2.49 for all-causes mortality (I-squared [I 2 ] = 85.7%, p < 0.001; 95% confidence interval [CI], 1.96-3.15). T2DM based on a composite definition was associated with a 2.26-fold higher all-cause mortality (I 2  = 93.9%, p < 0.001; 95% CI, 1.36-3.74). The pooled risk estimates were similar between men and women, although higher at younger ages. The pooled RR for cardiovascular mortality was 2.76 (I 2  = 59.2%; p < 0.061; 95% CI, 1.99-3.82) and for renal mortality 15.85 (I 2  = 0.00%; p < 0.645; 95% CI, 9.82-25.57). Using available population-based cohort studies, this work has identified and estimated the strength of the association between T2DM and mortality in LA. The higher mortality risk compared with high-income countries deserves close attention from health policies makers and clinicians to improve diabetes care and control hence preventing complications and delaying death., (© 2019 John Wiley & Sons, Ltd.)

The relationship of body mass index (BMI) with lung function and COPD has been previously described in several high-income settings. However, few studies have examined this relationship in resource-limited settings where being underweight is more common. We evaluated the association between BMI and lung function outcomes across 14 diverse low- and middle-income countries. We included data from 12,396 participants aged 35-95 years and used multivariable regressions to assess the relationship between BMI with either COPD and lung function while adjusting for known risk factors. An inflection point was observed at a BMI of 19.8 kg/m 2 . Participants with BMI < 19.8 kg/m 2 had a 2.28 greater odds (95% CI 1.83-2.86) of having COPD and had a 0.21 (0.13-0.30) lower FEV 1 and 0.34 (0.27-0.41) lower FEV 1 /FVC z -score compared to those with BMI ≥ 19.8 kg/m 2 . The association with lung function remained even after excluding participants with COPD. Individuals with lower BMI were more likely to have COPD and had lower lung function compared to those in higher BMI. The association with lung function remained positive even after excluding participants with COPD, suggesting that being underweight may also play a role in having worse lung function.