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Previous studies have shown the influence of the physical and social environments on the development of obesity and non-communicable diseases (NCD). An obesogenic environment promotes higher dietary energy intakes and sedentary behaviors while limiting opportunities or incentives for active living. This paper presents a dataset with key attributes of the food and physical activity built environment, including green spaces, quality of streets and sidewalks, and different types of food retail outlets in four cities of the Southern Cone of Latin America. A total of 139 representative neighborhoods randomly selected from: Marcos Paz and Bariloche (Argentina), Temuco (Chile) and Canelones-Barros Blancos (Uruguay) were evaluated, where standardized community walks were conducted for direct observation of the built environment. This dataset will contribute valuable data to the evaluation of obesogenic environments in the region, and could be linked to additional ecological information about risk factors for NCDs and socio-economic features from other sources. Understanding environmental influences on cardiovascular risk factors and individual habits may help explain NCD outcomes and plan urban policies., Measurement(s)features of the built environmentTechnology Type(s)ObservationSample Characteristic - Environmentbuilt environmentSample Characteristic - LocationArgentina • Chile • Uruguay Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.14892147

Background and aims in the Southern Cone of Latin America, previous studies have shown that blood hypertension is one of the most significant risk factor for cardiovascular disease, and diet plays a fundamental role. We analyzed the cross-sectional relationship between dietary patterns (DP) and blood pressure values in people involved in the CESCAS I Study. Methods and results the participants (n = 4626) were derived from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). To define DP, a food-frequency questionnaire was applied and principal component analysis was performed. Blood pressure was determined according to standardized guidelines. A multivariate regression model was developed to determine the association between each DP and blood pressure values, according to the quartile (Q) of adherence to DP. Two predominant DP were detected, Prudent (PDP, higher consumption of fruits, vegetables, legumes, whole grains, fish, seafood and nuts) and Western (WDP, higher consumption of red and processed meats, dressings, sweets, snacks and refined grains). A significant inverse association was found between adherence to PDP and systolic and diastolic blood pressure (−1.85 and −1.29 mmHg for Q4 vs Q1, respectively). Adherence to WDP was positively associated with systolic blood pressure (2.09 mmHg for Q4 vs Q1). Conclusion the WDP detected in the studied population is positively associated with higher levels of blood pressure, while greater adherence to healthy DP has a positive impact on blood pressure.

Breastfeeding reduces the risk for morbidity and mortality in children and also provides environmental and financial advantages. Breastfeeding monitoring is critical for public policies.The objectives of this study were to estimate the prevalence of breastfeeding in the population seeking care in the public sector, compare this prevalence to data from 2015, and assess associated outcome measures.Cross-sectional, observational study. A structured questionnaire was used to collect intake and sociodemographic data from infants aged6 months (n = 15 322) and 12-15 months (n = 3243) who sought care from public sector health care providers spontaneously between August and September 2017.The prevalence of exclusive breastfeeding among infants6 months was 53.5% (95% confidence interval [CI]: 52.7-54.3); and at 4 and 6 months, 51.5% (95% CI: 49.7-53.4) and 41.7% (95% CI: 39.8-43.5), respectively. The prevalence of exclusive breastfeeding at 4 and 6 months increased compared to 2015 (p0.001). The prevalence of breastfeeding among infants aged 12-15 months was 77.8% (95% CI: 76.4-79.3). The following variables were independently associated with a lower frequency of exclusive breastfeeding (6 months old) and breastfeeding: older age, lower level of maternal education, delivery via C-section, low birth weight, initial breastfeeding after the first hour, and separation of the mother-child dyad ≥ 4 hours a day.Exclusive breastfeeding at 6 months and continued breastfeeding showed certain improvement, but the rate of breastfed infants is still below desirable levels.Introducción. La lactancia materna (LM) reduce el riesgo de morbimortalidad en niños, además, provee ventajas medioambientales y económicas. El monitoreo de su práctica es indispensable para las políticas públicas.Los objetivos de este trabajo fueron estimar la prevalencia de LM en la población que demanda al sector público, comparar la prevalencia con datos del 2015 y evaluar variables de interés asociadas. Población y métodos. Estudio transversal observacional. Mediante un cuestionario estructurado, se relevó información de ingestión y datos sociodemográficos de lactantes6 meses (n = 15 322) y de entre 12 y 15 meses (n = 3243) que concurrieron en forma espontánea a efectores del sector público entre agosto y septiembre de 2017.La prevalencia de LM exclusiva (LME) en6 meses fue del 53,5 % (intervalo de confianza del 95 % [IC95%]: 52,7-54,3); al cuarto y sexto mes, del 51,5 % (IC95%: 49,7-53,4) y del 41,7 % (IC95%: 39,8-43,5) respectivamente. La prevalencia de LME al cuarto y al sexto mes aumentaron en relación con el 2015 (p0,001). La prevalencia de LM en niños de 12 a 15 meses fue del 77,8 % (IC95%: 76,4-79,3). Las siguientes variables se asociaron en forma independiente con menor frecuencia de LME (en6 meses) y LM: mayor edad del niño, menor nivel educativo materno, parto por cesárea, bajo peso al nacer, puesta al pecho después de la primera hora y separación de la díada madre-hijo/a ≥4 horas diarias.La LME al sexto mes y la LM continuada muestran cierta mejora, pero aún la proporción de lactantes amamantados no logra alcanzar niveles deseables.

Introduction. Health promotion initiatives, even more those promoted by the State, play a fundamental and strategic role in the construction of healthy lifestyles. The objective was to explore from the perspective of a group of young adults from the Autonomous City of Buenos Aires, dimensions and qualitative categories related to health promotion community initiatives with a focus on healthy diet, physical activity, and smoking cessation.A qualitative phenomenological study were conducted, including sixteen in-depth interviews with people under 40 years of age.Were found and explored that interventions through websites, email, social networks, application- Mobile App (App), calls, text messages (SMS), printed material, or brief advice. The most acceptable interventions were: website, social networks, and the App. The potential use of these interventions would be related by the inclusion of audiovisual elements and personalized messages.The findings indicate that interventions that include social networks, App and web would have greater potential among young adults to promote healthy lifestyles.Las iniciativas de promoción de salud, más aún las impulsadas desde el Estado, juegan un papel fundamental y estratégico en torno a la construcción de estilos de vida saludables. El objetivo fue explorar desde la perspectiva de un grupo de adultos jóvenes de la Ciudad Autónoma de Buenos Aires dimensiones y categorías cualitativas relacionadas a iniciativas comunitarias de promoción de la salud con foco en alimentación saludable, actividad física y cesación tabáquica.Se realizó un estudio cualitativo de carácter fenomenológico incluyendo 16 entrevistas en profundidad a personas menores de 40 años.Se identificaron y exploraron intervenciones a través de sitios web, correo electrónico, redes sociales, aplicativo-App móvil (App), llamadas, mensajes de texto-SMS, material impreso o asesoría breve. Las intervenciones de mayor aceptabilidad fueron: sitio web, redes sociales y App. El uso potencial de las intervenciones estaría relacionado con la inclusión de elementos audiovisuales y los mensajes personalizados.Nuestros hallazgos indican que las intervenciones que incluyan redes sociales, App y web tendrían mayor potencial para promover estilos de vida saludables entre los adultos jóvenes.

There is growing evidence that the food environment can influence diets. The present study aimed to assess the relative availability and prominence of healthy foods (HF) versus unhealthy products (UP) in supermarkets in Buenos Aires, Argentina and to explore differences by retail characteristics and neighborhood income level. We conducted store audits in 32 randomly selected food retails. Food availability (presence/absence, ratio of cumulative linear shelf length for HF vs. UP) and prominence inside the store (location visibility) were measured based on the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) protocol. On average, for every 1 m of shelf length for UP, there was about 25 cm of shelf length for HF (HF/UP ratio: 0.255, SD 0.130). UP were more frequently available in high-prominence store areas (31/32 retails) than HF (9/32 retails). Shelf length ratio differed across commercial chains (p = 0.0268), but not by store size or type. Retails in the lower-income neighborhoods had a lower HF/UP ratio than those in the higher-income neighborhoods (p = 0.0329). Availability of the selected HF was overcome largely by the UP, particularly in high prominence areas, and in neighborhoods with lower income level, which may pose an opportunity for public health interventions.

Background Using data from general adult population, this study aims to describe epidemiology of alcohol consumption patterns and their association with cardiovascular risk. Methods CESCAS I is a population-based study from four mid-sized cities in Argentina, Chile and Uruguay. Associations between diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD) risk and history of CVD and drinking patterns were assessed using crude prevalence odds ratios (ORs) and adjusted OR. Results A total of 37.2% of the studied population never drank and 18.3% reported to be former drinkers. Among current drinkers, moderate drinking was the most frequent pattern (24.2%). For women with light and moderate consumption, the odds of having >20% CVD risk was ~40% lower than that of never drinkers. The odds of having a history of CVD was 50% lower in those with moderate consumption. For men with heavy consumption, the odds of having >20% CVD risk was about twice as high as for never drinkers. Conclusions A harmful association was observed between heavy drinking and having >20% CVD risk for men. However, for women, an apparently protective association was observed between light and moderate drinking and having >20% CVD risk and between moderate drinking and having a history of CVD., Facultad de Ciencias Médicas

OBJECTIVE: We explore the association between occupational physical activity (OPA) and cardiovascular risk factors in four cities of the Southern Cone. METHODS: Robust multivariable linear regression models were used to examine the associations. RESULTS: The working population was constituted by 1868 men and 1672 women. Men performing high levels of OPA showed higher levels of high-density lipoprotein (HDL; mean adj. diff. = 2.24 mg/dL; P = 0.004), lower levels of triglycerides (-24.59 mg/dL; P = 0.006), and total cholesterol (TC)/HDL ratio values (-0.21; P = 0.015) than reference. Women in the highest category of OPA had higher levels of HDL (2.85 mg/dL; P = 0.006), lower TC/HDL (0.27; P = 0.001), and low-density lipoprotein/HDL ratios (-0.18; P = 0.003) than sedentary activities. CONCLUSION: Individuals who performed high levels of OPA did not exhibit a worse cardiovascular risk profile and an improvement on selected biomarkers was observed when compared with those performing sedentary activities. Fil: Poggio, Rosana. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Melendi, Santiago Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Elorriaga, Natalia. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina

The Healthy Municipalities and Communities Strategy (HMCS) was developed by the Pan American Health Organization in 1990. Evaluation and monitoring are fundamental components of health promotion policies. The aim of this study is to explore the indicators used in Latin America and the Caribbean (LAC) countries to assess the performance of HMCS. We searched MEDLINE, EMBASE, LILACS, BVSDE and Google Advanced Search for documents published between January 2000 and April 2016. We included only documents with assessment indicators of the strategy. All articles were independently assessed for eligibility by pairs of reviewers. We classified the indicators with a supporting framework proposed by O’Neill and Simard (Choosing indicators to evaluate Healthy Cities projects: a political task? Health Promot Int 2006, 21, 145–152.). Local level indicators figured far more prominently among countries and were distributed both in projects and specific activities. Regarding the evolution of the HMCS, indicators were reported in the five levels of analysis (local projects and activities, provincial, national and international networks). Empowerment was represented through the presence of active community organizations and different methods of community participation (forums, open hearing and participation maps). Public policies (such as for tobacco cessation) and bylaws adherence and changes in school’s curricula regarding healthy eating were frequently mentioned. However, this review demonstrated that impact indicators related to lifestyle changes or built environment are not clearly defined and there is a lack of indicators to measure progress in achieving change in long-term outcomes in LAC. We highlight the importance of designing validated indicators for measuring the impact of health promotion policies in partnership with each country involved.

Objective: The American Heart Association developed the concept of ‘Ideal Cardiovascular Health’ which is based on the presence of ideal levels across seven health factors. The goal of this study is to assess the prevalence of Ideal Cardiovascular Health in the Southern Cone of Latin America. Study design: We conducted a cross-sectional analysis as part of CESCAS I cohort. Methods: This report included 5458 participants aged between 35 and 75 years who were selected using stratified multistage probability sampling in Argentina, Chile and Uruguay. Interviews included demographic information, the International Physical Activity Questionnaire, and a food frequency questionnaire on dietary habits. Participants were classified as current, former or non-smokers. Weight, height and blood pressure were measured by trained personnel, and fasting cholesterol and glucose plasma levels were measured. Results: Only 0.1% (95% confidence interval [CI]: 0.0–0.2) met the seven criteria that define the Ideal Cardiovascular Health. The least prevalent healthy behaviour was having a healthy diet: 0.5% (95% CI: 0.3–0.7), while the least prevalent health factor was having blood pressure < 120/80 mmHg: 23.6% (95% CI: 22.1–25.0). Conclusions: The prevalence of Ideal Cardiovascular Health is very low in a representative sample of population from the Southern Cone of Latin America, and the levels of healthy lifestyle behaviours are even lower than ideal biochemical parameters. These results highlight the challenge of developing strategies to improve the levels of Ideal Cardiovascular Health at primary prevention levels. Fil: Seron, P.. Universidad de La Frontera; Chile Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Rubinstein, Adolfo Luis. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Calandrelli, Matías Enrique. Sanatorio San Carlos; Argentina Fil: Ponzo, J.. Universidad de la República; Uruguay Fil: Olivera, H.. Municipalidad de Marcos Paz; Argentina Fil: Gutierrez, L.. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Elorriaga, Natalia. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Poggio, Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Lanas, F.. Universidad de La Frontera; Chile

To explore the motivations and expectations of the users of the Program for Healthy Centers in the Autonomous City of Buenos Aires and to evaluate its potential health impact.In-depth interviews were conducted (n = 34) and a self-administered survey was sent to users of the program (n = 605). An epidemiological model was developed to estimate the impact of the program on cardiovascular events (CVE) and disability-adjusted life years (DALYs).The main motivating factors for using the healthy centers were geographic and economic accessibility (free services) and satisfaction with the care received. 14.4% (95% CI, 10.3-18.5%) of hypertensive users and 24.8% (95% CI, 17.6-32.0%) of diabetic users reported having learned of their altered values in the healthy center. More than half of the respondents reported some improvement in their knowledge about the benefits of physical activity and healthy eating; this was more frequent among those who were younger, of lower educational level, users of the public health system, users of a healthy center in the South zone and those who had a cardiometabolic risk factor (p0.05). It was estimated that the healthy centers would prevent 12.5 cardiovascular and cerebrovascular events per year in the assisted population (4.75 events/100 000) and 47.75 DALYs due to these causes.The healthy centers are a favorable space for the implementation of health promotion and prevention actions, contributing to the detection of and facilitating the monitoring of risk factors, with a potential to prevent cardiovascular events and its consequences.Explorar as motivações e expectativas dos usuários do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires e avaliar seu impacto potencial na saúde.Foram realizadas entrevistas em profundidade (n = 34) e uma pesquisa auto-administrada (n = 605) a usuários do programa. Um modelo epidemiológico foi desenvolvido para estimar o impacto do programa em eventos cardiovasculares e anos de vida ajustados por incapacidade (DALY).Os principais fatores motivadores para o uso do estações saudáveis foram a acessibilidade geográfica, econômica (serviços gratuitos) e a satisfação com o atendimento recebido. 14,4% (intervalo de confiança de 95% [IC95%] 10,3-18,5%) de usuários hipertensos e 24,8% (IC95% 17,6-32,0%) dos diabéticos relataram ter aprendido sobre seus valores alterados na estação saudável. Mais da metade dos entrevistados relataram alguma melhora no conhecimento sobre os benefícios da atividade física e da alimentação saudável, com maior freqüência entre os mais jovens, de menor escolaridade, usuários do sistema público de saúde, usuários de estações saudáveis na zona sul e aqueles que apresentaram algum fator de risco cardiometabólico (p0,05). Estimou-se que, devido à existência de estações saudáveis, 12,5 eventos cardiovasculares e cerebrovasculares por ano seriam evitados na população atendida (4,75 eventos/100 000) e 47,75 DALY por essas causas.As estações saudáveis são um espaço propício para a implementação de ações de promoção e prevenção da saúde, contribuindo para a detecção e facilitação do monitoramento dos fatores de risco, com potencial para prevenir os eventos cardiovasculares e suas consequências.

La ingesta de altos niveles de sal y grasas trans está fuertemente relacionada con la ocurrencia de enfermedades cardiovasculares. OBJETIVOS: Describir los conocimientos, comportamientos y prácticas socioculturales de diferentes grupos de población, con relación al consumo de sal y grasas trans en Argentina. MÉTODOS: Se efectuó un estudio cualitativo con diseño exploratoriodescriptivo. Participaron varones y mujeres mayores de 18 años. Se realizaron entrevistas en profundidad y grupos focales en tres zonas geográficas diferentes del país. RESULTADOS: Los participantes desconocen que el sodio es un componente de la sal. Se observó una tendencia a considerar que el consumo en exceso de sal es perjudicial para la salud principalmente en adultos mayores, mujeres embarazadas y en personas con enfermedades cardiovasculares. A su vez, se evidenció un total desconocimiento acerca de las grasas trans, en qué alimentos se encuentran y su impacto sobre la salud. CONCLUSIONES: Las percepciones acerca del consumo personal de sal hacen referencia a un consumo moderado. La reducción del consumo de sal ocurre predominantemente ante eventos de salud de familiares, no como conducta preventiva personal. Existe un escaso conocimiento acerca de las grasas trans

Food composition data are essential for the assessment of nutrient intake and the development of food policies. The aim of this study was to conduct a systematic review of available published data not previously included in the national food composition table in Argentina (ARGENFOODS), in order to supplement the existing information. An electronic literature search was conducted of literature published from January 1997 to December 2012. An annotated search for non-indexed ‘gray literature’ was also completed. Quality of data was assessed in terms of sampling and analytical criteria. A total of 2474 potentially eligible references were identified, out of which 138 articles and reports met inclusion criteria. These studies provided information about energy value, macronutrients, micronutrients, and/or other components, such as phytochemicals, for 82 individual food items and multi-ingredient foods. Cereals, legumes and their derivatives, milk and dairy products, meat, fish and fish derivatives were the most frequently reported food groups. Non-representative sampling and poor description of the analytical quality control used were the most frequent issues found in evaluation of data quality. These results will contribute to the continuous and systematic updating of food composition databases, which are of paramount importance for public health. Collaboration among data generators, compilers, and users is essential.

To estimate the impact of Argentine policies to reduce trans fatty acids (TFA) on coronary heart disease (CHD), disability-adjusted life years (DALYs) and associated health-care costs.We estimated the baseline intake of TFA before 2004 to be 1.5% of total energy intake. We built a policy model including baseline intake of TFA, the oils and fats used to replace artificial TFAs, the clinical effect of reducing artificial TFAs and the costs and DALYs saved due to averted CHD events. To calculate the percentage of reduction of CHD, we calculated CHD risks on a population-based sample before and after implementation. The effect of the policies was modelled in three ways, based on projected changes: (i) in plasma lipid profiles; (ii) in lipid and inflammatory biomarkers; and (iii) the results of prospective cohort studies. We also estimated the present economic value of DALYs and associated health-care costs of coronary heart disease averted.We estimated that projected changes in lipid profile would avert 301 deaths, 1066 acute CHD events, 5237 DALYs and 17 million United States dollars (US$) in health-care costs annually. Based on the adverse effects of TFA intake reported in prospective cohort studies, 1517 deaths, 5373 acute CHD events, 26 394 DALYs and US$ 87 million would be averted annually.Even under the most conservative scenario, reduction of TFA intake had a substantial effect on public health. These findings will help inform decision-makers in Argentina and other countries on the potential public health and economic impact of this policy.Estimer l'impact des politiques argentines de réduction des acides gras trans (AGT) sur les cardiopathies coronariennes (CC), les années de vie corrigées du facteur incapacité (AVCI) et les coûts des soins de santé associés.Nous sommes partis d'une estimation de l'apport de référence en AGT avant 2004 représentant 1,5% de l'apport énergétique total. Nous avons conçu un modèle pour ces politiques, en intégrant cet apport en AGT de référence, les huiles et graisses utilisées pour remplacer les AGT artificiels, les effets cliniques de la réduction des AGT artificiels, les coûts associés ainsi que les AVCI épargnées du fait des accidents coronariens évités. Pour calculer le pourcentage de réduction des CC, nous avons calculé les risques de CC sur un échantillon en population, avant et après la mise en œuvre de ces politiques. Les effets de ces politiques ont été modélisés de trois manières, en fonction des changements projetés: (i) au niveau des profils lipidiques plasmatiques; (ii) au niveau des biomarqueurs lipidiques et inflammatoires et (iii) en fonction des résultats des études prospectives de cohortes. Nous avons également estimé la valeur économique actuelle des AVCI et du coût des soins de santé associés correspondant aux cardiopathies coronariennes évitées.Selon nos estimations, les changements projetés des profils lipidiques devraient permettre d'éviter 301 décès, 1 066 accidents coronariens aigus, 5 237 AVCI et 17 millions de dollars des États-Unis d'Amérique ($US) de dépenses annuelles en soins de santé. À partir des effets défavorables des apports en AGT indiqués dans les études prospectives de cohortes, ce sont 1 517 décès, 5 373 accidents coronariens aigus, 26 394 AVCI et 87 millions de $US de dépenses qui pourraient être évités chaque année.Même dans le scénario le plus prudent, la réduction de l'apport en AGT a un effet considérable sur la santé publique. Ces résultats permettront d'informer les décideurs en Argentine et dans d'autres pays sur les impacts potentiels de ce type de politiques sur le plan économique et en termes de santé publique.Estimar el impacto de las políticas argentinas para la reducción de los ácidos grasos de tipo trans (AGT) en las cardiopatías coronarias, los años de vida ajustados en función de la discapacidad (AVAD) y los costes de la atención sanitaria asociados.Se estimó que la ingesta base de AGT antes de 2004 era de 1,5% de la ingesta de energía total. Se construyó un modelo de política que incluía la ingesta base de AGT, los aceites y grasas utilizados para reemplazar los AGT artificiales, el efecto clínico de reducir los AGT artificiales y el coste y los AVAD salvados debido a los casos de cardiopatías coronarias evitadas. Para calcular el porcentaje de reducción de cardiopatías coronarias, se calcularon los riesgos de cardiopatías coronarias en un modelo basado en la población antes y después de la implementación. El efecto de las políticas fue modelado de tres formas, en base a cambios estimados: (i) perfiles de plasma de lípidos; (ii) marcados biológicos inflamatorios de lípidos; y (iii) los resultados de estudios de cohortes prospectivos. También se estimó el valor económico actual de los AVAD y los costes de atención sanitaria asociados a las cardiopatías coronarias evitadas.Se estimó que los cambios estimados en el perfil de lípidos evitarían 301 muertes, 1.066 casos graves de cardiopatías coronarias, 5.237 AVAD y 17 millones de dólares estadounidenses (USD) en atención sanitaria cada año. Basándose en los efectos adversos del consumo de AGT de los estudios de cohortes prospectivos, se evitarían 1.517 muertes, 5.373 casos graves de cardiopatías coronarias, 26.394 AVAD y 87 millones de USD cada año.Incluso bajo el escenario más conservador, la reducción del consumo de AGT tuvo un efecto sustancial en la salud pública. Estos resultados ayudarán a informar a los responsables de la toma de decisiones en Argentina y otros países sobre el potencial impacto económico y de salud pública de esta política.تقدير أثر السياسات الأرجنتينية للحد من الأحماض الدهنية المتحولة (TFA) على مرض القلبي الوعائي (CHD)، وسنوات العمر المصححة باحتساب مدد العجز (DALYs)، ونفقات الرعاية الصحية المرتبطة بها.تشير تقديراتنا إلى أن نسبة المدخول الأساسي من الأحماض الدهنية المتحولة قبل عام 2004 كانت تبلغ 1.5% من إجمالي مدخول الطاقة. لذلك، قمنا بوضع نموذج لسياسة تتضمن المدخول الأساسي من الأحماض الدهنية المتحولة والزيوت والدهون المستخدمة لتحل محل تلك الأحماض الدهنية المتحولة، والأثر الإكلينيكي لتقليل الأحماض الدهنية المتحولة والتكاليف وسنوات العمر المصححة باحتساب مدد العجز التي يتم توفيرها بسبب تحاشي وقائع الإصابة بالأمراض القلبية الوعائية. ولكي يتم حساب النسبة المئوية لتقليل الإصابة بالأمراض القلبية الوعائية، فقد احتسبنا مخاطر تلك الأمراض على عينة تستند إلى شريحة سكانية قبل تنفيذ السياسة وبعدها. وتم وضع نماذج لأثر السياسات باتباع ثلاث طرق استناداً إلى التغييرات المتوقعة: (1) في أنماط دهون البلازما، و(2) في الدهون والمحددات الحيوية الالتهابية (Inflammatory biomarkers، و(3) نتائج الدراسات الأترابية الاستباقية (Prospective cohort studies). كما وضعنا تقديرًا للقيمة الاقتصادية الحالية لسنوات العمر المصححة باحتساب مدد العجز وما يرتبط بها من تكاليف للرعاية الصحية لمرض القلب الوعائي الذي تم تحاشي الإصابة به.تشير تقديراتنا إلى أن التغييرات المتوقعة في نمط الدهون سيؤدي إلى تحاشي 301 حالة وفاة، و1066 واقعة إصابة بحالات حادة من الأمراض القلبية الوعائية، وإنقاذ 5237 سنة عمر مصححة باحتساب مدد العجز، و17 مليون دولار أمريكي سنويًا من نفقات الرعاية الصحية. وبناءً على الآثار الجانبية لمدخول الأحماض الدهنية المتحولة التي وردت تقارير بشأنها في الدراسات الأترابية الاستباقية، فسيتم تجنب 1517 حالة وفاة، و5373 واقعة إصابة بحالات حادة من الأمراض القلبية الوعائية، وإنقاذ 26,394 سنة عمر مصححة باحتساب مدد العجز، و87 مليون دولار أمريكي سنويًا.حتى في ظل السيناريوهات الأكثر تحفظًا، فقد كان للحد من مدخول الأحماض الدهنية المتحولة أثر كبير على الصحة العامة. ومن شأن هذه النتائج أن تفيد في تقديم المعلومات الكافية لصناع القرار بالأرجنتين وغيرها من البلدان بشأن الأثر المحتمل على الصحة العامة والآثار الاقتصادية لهذه السياسية.旨在评估阿根廷境内关于减少使用反式脂肪酸 (TFA) 的政策对冠心病 (CHD)、残疾调整生命年 (DALY) 和相关医疗保健成本产生的影响。.我们估计出 2004 年之前对反式脂肪酸 (TFA) 的基准摄入量为总能量摄入的 1.5%。 我们构建了政策模型，包括对反式脂肪酸 (TFA) 的基准摄入量、用于代替人工反式脂肪酸 (TFA) 的油脂、减少使用人工反式脂肪酸 (TFA) 的临床效果，以及因预防冠心病 (CHD) 事件而节约的成本和残疾调整生命年 (DALY)。 为了计算冠心病 (CHD) 减少的百分比，我们在实施前后基于研究人群计算了冠心病 (CHD) 风险。 根据预测的变化，以三种方式模拟政策的影响： (i) 血浆中的血脂；(ii) 脂质和炎性标记物；以及 (iii) 前瞻性群组研究的结果。 我们还估计了残疾调整生命年 (DALY) 在当下的经济价值，以及预防冠心病的相关医疗保健成本。.我们估计，血脂变化预计每年将会避免 301 人死亡、1066 例急性冠心病 (CHD) 事件和 5237 个残疾调整生命年 (DALY)，并可节约 1700 万美元 (US$) 的医疗保健成本。 基于前瞻性群组研究中所报告的摄入反式脂肪酸 (TFA) 后产生的不良影响，每年可防止 1517 人死亡、5373 例急性冠心病 (CHD) 事件和 26 394 个残疾调整生命年 (DALY)，并可节约 8700 万美元 (US$)。.即使是在最为保守的情况中，减少摄入反式脂肪酸 (TFA) 也可对公众健康产生重大影响。 这些调查结果将有助于让阿根廷和其他国家的决策制定者了解潜在的公众健康问题和这项政策的经济影响。.Оценить воздействие применяемых в Аргентине политик по уменьшению количества трансжирных кислот в пище (ТЖК) на развитие ишемической болезни сердца (ИБС), на количество лет жизни, утраченных в результате болезни, и на сопутствующие расходы на здравоохранение.По нашим оценкам, до 2004 года 1,5% общего количества пищевых калорий приходилось на ТЖК, и эту величину мы приняли за базовый уровень. Мы разработали модель политики, включающую базовый уровень потребления ТЖК, жиры и масла, которыми планировалось заменить искусственные ТЖК, клинический эффект от снижения уровня ТЖК, а также уровень экономии и количество спасенных лет жизни в результате предотвращения случаев ИБС. Для расчета процентной доли снижения ИБС были рассчитаны риски возникновения ИБС для популяционной выборки до и после реализации вышеуказанной политики. Эффект от применения политик моделировался тремя путями в зависимости от предполагаемых изменений: (i) по профилям липидов в плазме, (ii) по липидам и биомаркерам воспалительного процесса и (iii) по результатам проспективных когортных исследований. Мы также оценили текущее экономическое значение спасенных лет жизни и уменьшения сопутствующих расходов на лечение в случае предотвращения ишемической болезни сердца.По предварительным оценкам, предполагаемые изменения в профиле липидов позволят предотвратить 301 смерть, 1066 острых случаев ИБС, спасти 5237 лет жизни и сэкономить 17 млн долл. США на ежегодных расходах на здравоохранение. Если исходить из неблагоприятных последствий употребления пищевых ТЖК, о которых сообщалось в проспективных когортных исследованиях, то ежегодно можно будет предотвратить 1517 смертей, 5373 острых случая ИБС, спасти 26 394 года жизни и сэкономить 87 млн долл. США на медицинских расходах.Даже при самом неблагоприятном сценарии уменьшение употребления ТЖК в значительной мере повлияет на здоровье населения. Эти результаты помогут информировать ответственных лиц в Аргентине и других странах о потенциальном воздействии такой политики на здоровье населения и национальную экономику.

Background Cardiovascular disease is a major cause of death, and its mortality is increasing in Latin America. However, population-based data on cardiovascular disease risk factors are sparse in these countries. Methods A total of 7524 men and women, aged 35 to 74years old, were recruited between February 2010 and December 2011 from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay) in the Southern Cone of Latin America. Cardiovascular risk factors were measured using standard methods by trained and certified observers. Results Approximately 85.5% of adults ate less than five servings of fruit or vegetables per day, 35.2% engaged in low physical activity, and 29.7% currently smoked cigarettes. The prevalences of obesity, central obesity, hypertension, chronic kidney disease, dyslipidemia, diabetes, and metabolic syndrome were 35.7%, 52.9%, 40.8%, 2.0%, 58.4%, 12.4%, and 37.4%, respectively. The proportion of individuals with ≥3 cardiovascular risk factors, including low intake of fruit and vegetables, low physical activity, current cigarette smoking, obesity or central obesity, hypertension, chronic kidney disease, dyslipidemia, and diabetes, was 68.3%, and the proportion of individuals with ≥3 cardiometabolic risk factors, including obesity or central obesity, hypertension, chronic kidney disease, dyslipidemia, and diabetes, was 22.9%. Conclusions Cardiovascular disease risk factors are highly prevalent in the general population in the Southern Cone of Latin America. These data suggest that national efforts on the prevention, treatment, and control of cardiovascular risk factors should be a public health priority in the Southern Cone of Latin America.

The maximum content of sodium in selected processed foods (PF) in Argentina was limited by a law enacted in 2013. Data about intake of these and other foods are necessary for policy planning, implementation, evaluation, and monitoring. We examined data from the CESCAS I population-based cohort study to assess the main dietary sources among PF and frequency of discretionary salt use by sex, age, and education attainment, before full implementation of the regulations in 2015. We used a validated 34-item FFQ (Food Frequency Questionnaire) to assess PF intake and discretional salt use. Among 2127 adults in two Argentinean cities, aged 35–76 years, mean salt intake from selected PFs was 4.7 g/day, higher among male and low education subgroups. Categories of foods with regulated maximum limits provided near half of the sodium intake from PFs. Use of salt (always/often) at the table and during cooking was reported by 9% and 73% of the population, respectively, with higher proportions among young people. Reducing salt consumption to the target of 5 g/day may require adjustments to the current regulation (reducing targets, including other food categories), as well as reinforcing strategies such as education campaigns, labeling, and voluntary agreement with bakeries.

Several previous epidemiological studies from developed countries have shown that an unhealthy dietary pattern affects plasma lipid levels andinflammation biomarkers. We assessed the cross-sectional associations between dietary patterns and cardiovascular risk factors among 961adults from a multi-city cohort in South America. We conducted a principal component analysis to derive dietary patterns. As outcomes, weexamined plasma levels of apo A-I, apo B, high-sensitivity C-reactive protein (hs-CRP), LDL-, HDL- and serum total cholesterol and TAG. Thecrude and adjusted changes in each outcome were estimated for quartiles of dietary patterns using multivariable linear regression models. Theprudent pattern (PP) characterised by higher intake of fruits, vegetables, fish, seafood, whole cereal and low-fat dairy products was associatedwith reduced plasma concentrations of apo B (−8·5mg/l), total cholesterol (−18·8 mg/dl) and LDL-cholesterol (−16·5mg/dl) and hs-CRP(−1·6mg/l) in men. In women also reduced plasma concentrations of apo B (−6·6mg/l), total (−12·0mg/dl) and LDL (−9·3mg/dl). The ?Westernlike?pattern characterised by higher intake of eggs, pastry and cakes, pizza, snacks, refined grains, red meat, vegetable oils and poultry was notsignificantly associated with any of the selected serum lipid or inflammatory biomarkers. The explained variances were 10·3 and 7·4%,respectively. The PP was associated with better lipid profile, mainly lower atherogenic particles (apo B) and LDL-cholesterol and serum totalcholesterol. This study provides possible evidence of a prudent diet in South American populations to help reduce the burden of CVD. Fil: Poggio, Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Elorriaga, Natalia. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Rubinstein, Adolfo Luis. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Danaei, Goodarz. Harvard University. Harvard School of Public Health; Estados Unidos

Introduction: There are no published data in relation to this topic at population level from the Southern Cone of Latin America. Hence, we assessed the hypothesis that higher levels of occupational PA will be associated with lower plasma levels of lipoproteins, apolipoproteins, C reactive protein, blood pressure and lower body mass index (BMI) compared to those of the subjects who performed sedentary activities at work Methods: The CESCAS I study is a population-based prospective cohort study with a 4-stage stratified sampling of a general population from four mid-sized cities in Argentina, Chile and Uruguay. PA was assessed using the International Physical Activity Questionnaire long form. We expressed the total PA score per week as total metabolic equivalent per minutes per week. To test univariate associations between tertiles (T) of occupational PA and continuous variables we used simple linear regression models and chi-square test for categorical variables. The changes in crude and adjusted means of systolic and diastolic blood pressure, BMI, lipoproteins, C reactive protein and apolipoproteins AI and B were tested using multivariate linear regression models Results: The working population consisted in 1,868 men and 1,672 women. In men, T3 compared to T1 (reference category) showed lower prevalence of university education (12.4% vs. 26.9 %; p 0.001 (90 and 235 of 1,868, respectively)), obesity or overweight (76.0% vs. 82.9 %; p 0.001 (553 and 724 of 1,868, respectively)) and higher prevalence of active transportation (60.2 vs. 51.9%; p 0.002 (453 and 439 of 1,868, respectively)). In multivariate analysis, T2 vs. T1 showed a reduction of BMI (mean adjusted difference -1.0; p 0.001), systolic blood pressure (-2.5 mmHg; p 0.027), glycemia (-3.9 mg/dL; p 0.024), triglycerides (-32.0 mg/dL; p 0.003) and higher mean values of high density lipoprotein (HDL) (2.5 mg/dL; p 0.002) and apolipoprotein AI (13.7 mg/dL; p 0.002). When compared, T3 vs. T1 only showed lower mean values of BMI and triglycerides and higher values of HDL but with a lower magnitude. In women, T3 compared to T1 showed lower prevalence of university education (20.4 vs. 29.5%; p 0.001), lower sleep hours (7.4 vs. 7.7; p 0.007) and higher prevalence of major depressive episode (16.9 vs. 11.5; p 0.003). In multivariate analysis, T3 compared to T1 showed higher levels of HDL (mean adjusted difference 2.0 mg/dL; p 0.025) Conclusions: Moderate or high physical activity at work was not associated with an increased cardiovascular risk profile. On the contrary, the results showed that this population would have a lower cardiovascular risk, especially in those who perform moderate intensity activities compared to those performing sedentary activities. The lack of associations in woman could be related to a better baseline risk profile and the higher prevalence of active transportation in all categories of occupational PA compared to men

Aims To determine the prevalence, treatment and control of diabetes mellitus (DM) and impaired fasting glucose (IFG) as well as associated factors in the adult population of four cities of the Southern Cone of Latin America (SCLA). Methods This is a cross-sectional population-based study that included 7407 adults between 35 and 74 years old in four cities of the SCLA: Temuco (Chile), Marcos Paz and Bariloche (Argentina), and Pando-Barros Blancos (Uruguay). DM was defined as fasting plasma glucose ≥126 mg/dL or self-reported history of diabetes. Awareness, treatment, and control of DM were defined as subjects self-reporting a DM previous diagnosis, the use of a prescription medication or nonpharmacological intervention for DM, and fasting plasma glucose

The purpose of this study was to conduct a systematic review on the association of food patterns (FPs) and endothelial biomarkers. An electronic literature search from 1990 to 2012 was conducted and reference lists and experts were consulted. Studies without dietary intervention and without language restrictions were considered. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were employed. Methodological quality was assessed by Strengthening the Reporting of Observational Studies in Epidemiology guidelines. A total of 546 references were identified, of which 8 were finally included. Several FPs were identified. Healthy FPs (abundant in fruits and vegetables) had a beneficial impact on endothelial function as estimated by circulating levels of biomarkers such as C-reactive protein, soluble intercellular adhesion molecule 1, soluble vascular adhesion molecule 1, and E-selectin molecules. Westernized patterns (higher intakes of processed meats, sweets, fried foods, and refined grains) were positively associated with inflammation molecules and atherogenic promoters. The study of FPs in relation to endothelial function contributes to the development of dietary recommendations for improved cardiovascular health and therefore a better lifestyle.

ObjectiveThe purpose of the present study was to determine whether elevated dietary Na intake could be associated with CVD mortality.DesignWe performed a systematic review and meta-analysis of prospective studies representing the general population. The adjusted relative risks and their 95 % confidence intervals were pooled by the inverse variance method using random-effects models. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed.SettingsMEDLINE (since 1973), Embase (since 1975), the Cochrane Library (since 1976), ISI Web of Science, Google Scholar (until September 2013) and secondary referencing were searched for inclusion in the study.SubjectEleven prospective studies with 229 785 participants and average follow-up period of 13·37 years (range 5·5–19 years).ResultsHigher Na intake was significantly associated with higher CVD mortality (relative risk=1·12; 95 % CI 1·06, 1·19). In the sensitivity analysis, the exclusion of studies with important relative weights did not significantly affect the results (relative risk=1·08; 95 % CI 1·01, 1·15). The meta-regression analysis showed that for every increase of 10 mmol/d in Na intake, CVD mortality increased significantly by 1 % (P=0·016). Age, hypertensive status and length of follow-up were also associated with increased CVD mortality.ConclusionsHigher Na intake was associated with higher CVD mortality in the general population; this result suggests a reduction in Na intake to prevent CVD mortality from any cause.

ObjectiveTo assess the reproducibility and validity among adults in the Southern Cone of Latin America (Argentina, Chile and Uruguay) of a self-administered FFQ to be used in the CESCAS I Study, an ongoing observational prospective cohort study to detect and follow up CVD and their risk factors, as well as in other epidemiological studies.DesignRelative validity of the FFQ was evaluated by comparing nutrient and selected food group intakes with those from three 24 h recalls (24HR) administered over 6 months. The FFQ was administered at baseline (FFQ1) and again after 3 months (FFQ2).SettingPrimary-care centres in Argentina, Chile and Uruguay.SubjectsAdults (n 147) aged 21–74 years.ResultsReproducibility (FFQ1 v. FFQ2): the intra-class correlation coefficients for nutrients ranged from 0·52 (potassium) to 0·74 (fat). Validity (FFQ1 v. the average of three 24HR): the Pearson correlations for energy-adjusted nutrients ranged from 0·39 (thiamin and cholesterol) to 0·59 (carbohydrate). Joint classification: overall, 66 % of participants in the lowest 24HR quintile were in the lowest one or two FFQ1 quintiles, and 62 % of those in the highest 24HR quintile were in the highest one or two FFQ1 quintiles. On average, only 4 % were misclassified into extreme quintiles.ConclusionsThe FFQ version for the Southern Cone seems to present moderate to acceptable relative validity and reliability for its use in the CESCAS I Study to measure dietary exposure.

We examined whether dietary patterns (DPS) are associated with endothelial dysfunction (ED) markers in an Argentinian population.The sample in this cross-sectional study was derived from 1,983 subjects from two mid-sized cities in Argentina who were involved in the CESCAS I Study. To define DP, a food-frequency questionnaire was applied. In a subsample randomly selected from the primary cohort, serum concentrations of C-reactive protein (hs-CRP), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble E selectin (sSELE) were determined. Correlations and multiple linear regression models were used to assess the relation between each quartile of DP adherence score and ED markers (Q1 lowest adherence; Q4 highest adherence).Three DPs were identified: Traditional (TDP), Prudent (PDP), and Convenience and processed (CDP). TDP was characterized by higher intake of refined grains, red meat, whole fat dairy products, vegetable oils, and "mate", a traditional South American infused drink; PDP was characterized by higher intake of vegetables, fruit, low-fat dairy products, whole grains, and legumes; and CDP consisted mainly of processed meat, snacks, pizza, and "empanadas", a stuffed bread served baked or fried. Lower scores (Q2, Q3) in TDP were inversely associated with concentrations of sSELE (P0.0001 and P0.05, respectively). In PDP, higher scores were inversely associated with hs-CRP, whereas lower scores showed a positive relation with sSELE (P0.05). Contrariwise, higher scores in CDP were directly associated with sSELE concentrations (P0.05).Adherence for each DP identified is differentially related to ED markers in the studied population.

Background: Obesogenic environments promote sedentary behavior and high dietary energy intake. The objective of the study was to identify barriers and facilitators to the implementation and impact evaluation of projects oriented to promote physical activity and healthy diet at community level. We analyzed experiences of the projects implemented within the Healthy Municipalities and Communities Program (HMCP) in Argentina. Methods: A mixed methods approach included (1) in-depth semi-structured interviews, with 44 stakeholders, and (2) electronic survey completed by 206 individuals from 96 municipalities across the country. Results: The most important barriers included the lack of: adequate funding (43%), skilled personnel (42%), equipment and material resources (31%), technical support for data management and analysis (20%), training on project designs (12%), political support from local authorities (17%) and acceptance of the proposed intervention by the local community (9%). Facilitators included motivated local leaders, inter-sectorial participation and seizing local resources. Project evaluation was mostly based on process rather than outcome indicators. Conclusions: This study contributes to a better understanding of the difficulties in the implementation of community-based intervention projects. Findings may guide stakeholders on how to facilitate local initiatives. There is a need to improve project evaluation strategies by incorporating process, outcome and context specific indicators.

The promotion of healthy feeding for the child and family is essential to support the growth and the prevention and treatment of chronic no communicable diseases. Factors influencing food choices are varied. In childhood, although not exclusively, the mother essentially transmits food education. The objective was: to describe the reasons that consider a group of women-mothers of Buenos Aires when selecting food. A structured, self-administered food choice questionnaire with 39 motives was used and a principal component analysis was carried out to synthesize them into groups. Were detected 10 groups of motives. The main factors that women-mothers have considered in the choice of food were: nutritional value, followed by sensory attractiveness and price. Knowing these elections can be useful to facilitate the development of healthy eating habits and / or implementation of interventions to improve them.La promoción de una alimentación saludable para el niño y su familia resulta fundamental para acompañar el crecimiento, prevención y tratamiento de enfermedades crónicas no transmisibles. Los factores que influyen en la selección de los alimentos son variados. Aunque no en forma exclusiva, la educación alimentaria es transmitida fundamentalmente por la madre. El objetivo fue: describir los motivos que tienen en cuenta las madres en nuestro medio al seleccionar los alimentos. Se utilizó un cuestionario de elección de alimentos con 39 motivos y se realizó un análisis de componentes principales para sintetizar los mismos en grupos. Se detectaron 10 grupos de motivos. Los principales factores que tuvieron en cuenta las madres en la elección de los alimentos fueron: el valor nutritivo, seguido por el atractivo sensorial y el precio. Conocer estas elecciones puede ser de utilidad para facilitar el desarrollo de hábitos alimentarios saludables y/o la implementación de intervenciones para mejorarlos.

Background: Yerba mate tea, made from tree leaves of Ilex paraguariensis, is a widely consumed beverage in South America. Animal studies have reported improvement in serum lipids parameters and reduction in cholesterol content and size of aortic lesions with consumption of ilex paraguariensis extracts, that contain potentially bioactive saponin, phenolic compounds and methilxanthines. Few studies have been conducted in humans, mostly pilot studies. Evidence on the association between mate tea consumption and lipid profile, Apolipoprotein (Apo) AI, Apo B and C-reactive protein (CRP) in humans are sparse. We assessed these associations among adults from Argentina, Chile and Uruguay. Methods: CESCAS I (Center of Excellence in Cardiovascular Health of South America Study I) study is an observational population-based prospective cohort study of 7,600 participants from general population of four cities in the three countries. We conducted a cross-sectional analysis in a randomly selected subsample of 988 subjects aged 35 to 74 years. Participants with previous cardiovascular events or receiving lipid-lowering agents were excluded. Mate consumption and other dietary habits were assessed using a previously validated 126-item food frequency questionnaire. Multivariable linear regression models were used to examine the associations between Apo AI, B, CRP, and other lipids by tertiles (T) of mate tea consumption. The models adjusted for age, smoking status, body mass index, physical activity, alcohol intake, ‘prudent’ or ‘Western’ diet-pattern scores (identified by principal component analysis), added sugar to the mate, and presence of diabetes. Results: The sample included 418 men and 570 women. The proportion of mate drinkers (at least once a month during last year) were 40% in Temuco (Chile), 84% in Canelones (Uruguay), 89% in Marcos Paz and 91% in Bariloche (Argentina). Median mate intake across tertiles was 0, 590 and 1875ml/day in men and 0, 625 and 1875ml/day in women, respectively. Higher mate consumption (T3 vs. T1) was independently associated with higher levels of Apo AI in both men (5.1mg/L, 95% CI, 0.1 to 10.1) and women (6.7mg/L, 95% CI, 1.5 to 11.9). In men higher mate consumption was also associated with lower levels of triglycerides (-49mg/dL, 95% CI, -11 to -86) and in women with slightly lower Apo B/AI ratio (-0.05, 95% CI, -0.001 to -0.06). Differences in total cholesterol, HDL cholesterol, LDL cholesterol, Apo B, and CRP were not statistically significant. Conclusions: Among generally healthy adults, higher consumption of mate during the past 12 months was associated with higher levels of APO-A1 in both men and women, and with lower triglycerides levels in men.

In Argentina, cardiovascular disease (CVD) accounts for 30% of deaths and more than 600 000 disability-adjusted life years. However, no reviews describing local studies on interventions to address CVD risk factors have been identified. The purpose of this study is to characterize those population-based interventions and public policies implemented in Argentina to reduce the burden of cardiovascular disease with an adequate evaluation of their impact on population health. We conducted a systematic review of studies that assessed interventions in health promotion and/or primary prevention conducted in adult populations of Argentina, addressing specific CVD factors, from 1999 to 2016. We searched major bibliographic databases, grey literature, ministries and secretariats of health, and academic national libraries. Key informants, non-governmental organizations, universities, hospitals and experts were also contacted. We applied specific inclusion criteria. We assessed the methodological quality of the studies and reported the effectiveness and impact of population interventions and policies, as well as process evaluations' characteristics. After removing duplicates we identified 1686 references from databases. After reviewing title and abstracts 18 studies were selected, five of them corresponded to evaluations of public policies-all addressing tobacco smoking. We presented a structured review of each experience. Most of the studies were deemed to entail moderate or high risk of bias. We summarized the findings and characteristics of these studies, including implementation strategies, process and impact evaluation. This is the first systematic review of interventions focused on primary prevention and health promotion to counter CVD and diabetes in Argentina.

Pneumococcal meningitis and bacteremia pose a significant disease burden in Latin America and the Caribbean (LAC).To perform a systematic review of studies of pediatric pneumococcal meningitis and non-pneumonia, non-meningitis pneumococcal bacteremia in LAC, we conducted an exhaustive search from 2000 to 2010 in electronic databases and grey literature. Pairs of independently selected reviewers assessed the quality and extracted the studies' data. A STROBE-based checklist was used to assess the risk of bias in observational studies. Meta-analyses were performed.Of 1218 retrieved studies, 39 were included. In children5 years, the pooled 95% confidence interval (CI) percentage of pneumococcal etiology out of cases studied with cerebrospinal fluid/blood cultures was 6.0% (95% CI: 3.3-9.5) for meningitis and 8.0% (95% CI: 5.3-12.4) for bacteremia. The incidences per 100,000 children were 4.7 (95% CI: 3.2-6.1) and 3.9 (95% CI: 2.0-5.9) for pneumococcal meningitis and non-pneumonia, non-meningitis bacteremia, respectively. The mortality was 8.3 (95% CI: 0.0-21.0) and 0.5 (95% CI: 0.3.0-0.6)/100,000 for meningitis and sepsis, respectively. The case fatality ratio was 33.2% (95% CI: 21.3-46.2) for meningitis and 29.0% (95% CI: 21.9-36.8) for sepsis. The pooled serotype distribution from SIREVA surveillance data showed that 14, 5, 6B (for meningitis) and 14, 6B, 19F (for bacteremia) were the most frequent serotypes, all included in licensed vaccines.Pneumococcal meningitis and bacteremia are important causes of morbidity and mortality in LAC children5 years of age. This systematic review provided evidence about the burden of pneumococcal disease and the serotype distribution to assess the impact the pneumococcal vaccines and to assist decision makers in the region.

Objectives: to identify Diet Patterns (DP) in the adult population of Argentina, and explore associations with gender, age and educational level. Methods: We defined DP among 3,010 adults between 35 to 74 years old, participating in CESCAS I, a population-based cohort study carried out in two cities in Argentina, Marcos Paz and Bariloche. Data on food intake was obtained from a validated self-administered food frequency questionnaire. Principal component Analysis (PCA) was used to identify DP. A summary score for each pattern was then derived and used in multiple regression analysis to examine the relationship between DP and socio-demographic variables. Results: 3 major eating patterns were identified. They explained 25% of the total variance. Factor 1 (Traditional diet pattern) was characterized by a high intake of refined grains, red meat, whole- fat dairy products, vegetable oils and other fat spreads, and “mate”, a traditional South American drink. Factor 2 (Healthy diet pattern), was characterized by a high intake of vegetables, fruit, low-fat dairy products, whole grains, and legumes. Factor 3 (Processed-food diet pattern) consisted mainly of processed meat, snacks, pizza, and “empanadas”, a stuffed bread baked or fried. After adjusting for energy intake, we found that DP were associated with age, gender, and educational level. Traditional DP score was lower at high educational level (p 0.001), Healthy DP score was higher among women (p 0.000), and high educational level (p 0.001) while men scored significantly higher in the Processed-food DP (p 0.002). Conclusions: Local DP has been identified in our population. This study will provide useful information to set priority targets for nutrition interventions, and promote healthy policies based on local food habits.

Objectives: Industrial trans fatty acids (TFA) increase CHD risk, but use remains high in developing nations. From 2004-2014, Argentina initiated policies to reduce industrial TFA: voluntary agreements with industry in 2004, mandatory labeling in 2006, and elimination by Food Code by 2014. We aimed to evaluate the policy’s impact on CHD, DALYs and costs. Methods: A review of diet trials, local studies, and consultations with experts was performed to estimate baseline TFA intake in 2004 and types of replacements used by industry from 2004-2014. We built an epidemiological simulation model calculating 3 scenarios to estimate effects of isocaloric replacement of TFA with alternative fats/oils, based on (1) changes in the total:HDL-C ratio (Δ TC/HDL) and (2) changes in other risk biomarkers, and the predicted effects of these biomarker changes on CHD; and (3) observed associations of TFA which CHD events in prospective studies, which may better account for pleiotrophic effects. We used Framingham risk equations to estimate first CHD events with vs. without the policy according to individual age-sex-risk factor distributions (including ΔTC/HDL), utilizing an Argentine population-based sample of 4,000 adults weighted to the full population. Results: After 2014, this policy would prevent each year from 1.3% (based on Δ TC/HDL only; to 7.4% (based on pleiotrophic effects) of all CHD events in Argentina (Table). Accounting for intervention costs and averted events, the policy is actually cost-saving. Conclusions: This is the first model evaluating the impact of an actual policy for eliminating TFA in a developing country. Given the 165,000 annual CHD events in Argentina, at an annual incidence rate of almost 1% in adults, near elimination of industrial TFA might avert under the most conservative assumptions, 1.3% of CHD and saved $36 million. In other low-resource settings, where TFA intake is higher, these effects could be larger. Our findings inform policy makers in Argentina and other developing countries on the huge impact of this policy

Background: In the last decades, the nutrition transition in Latin America turned to diets with higher total caloric intake and lower consumption of vegetables, cereals and fruits. An unhealthy dietary pattern affects plasma levels of apolipoprotein (Apo) AI, Apo B and C-reactive protein (CRP) which are independently associated with the incidence of coronary heart disease and stroke). There is no data regarding these biomarkers in relation to dietary patterns from the Southern Cone of Latin America. Therefore the objective of this study is to analyze these biomarkers in relation to our traditional dietary patterns. Methods: CESCAS I study is an observational prospective cohort study with a multistage probabilistic sample of 7,600 participants from general population of 4 sites in Argentina, Chile and Uruguay. We conducted a cross-sectional analysis in a randomly selected subsample of 988 subjects. Subjects with previous cardiovascular event or under lipid lowering agents were excluded. Diet was assessed using a previously validated 126-item food frequency questionnaire. We used a factor analysis to derive the major dietary patterns by gender. Linear regression model were used to examine the independent associations among Apo AI, B, CRP, other lipids by tertiles of dietary pattern scores. Results: The population sample included 418 men and 570 women. Higher scores of “Prudent pattern”, characterized by intake of fruits, vegetables, low fat dairy products, fish, seafood and whole cereal was independently and significantly associated in men with the reduction of Apo B (β -4,4), low density lipoprotein (LDL) (β -7,2), Apo B/A ratio (β -0,03) and a non-significant reduction of CRP (β -0,6). In women, we observed a significant reduction in Apo B (β -1,3), LDL (β -2,1), total cholesterol (TC) /high density lipoprotein (HDL) ratio (β -0,1) and a non-significant reduction of triglycerides (β -4 mg/dl). The “Western like pattern” (WLP) was characterized by meat, processed foods, pizza, empanadas, sweets and desserts, refined grains, vegetables oils and other fats. Higher scores of WLP showed in men a non-significant increment of Apo B (β 0,7), TC/HDL ratio (β 0,1), CRP (β 0,1), LDL (β 3), triglycerides (β 1,3) and a non-significant reduction of Apo AI (β -1,7) and HDL (β -0,7). In women, we observed a significant increment of TC/HDL ratio (β 0,2) and triglycerides (β 12). We also found a non-significant increment of Apo B and LDL and to reduce HDL and CRP. Conclusion: Our findings confirm that diet has an important role on health. Prudent diet pattern was associated with a healthier lipid profile especially in men. The WLP showed a trend to adversely affect the lipids profile and CRP.

Background: Obesity is a major determinant of cardiovascular disease in South America. However, population-based data are limited. Methods: A total of 7,524 women and men, aged 35 to 74 years old, were randomly selected from 4 cities in the Southern Cone of Latin America between February 2010 and December 2011. Obesity clinical measurements and cardiovascular risk factors were measured using standard methodology. Results: The prevalence of obesity and central obesity were 35.7% and 52.9%, respectively. The prevalence of obesity and central obesity were higher in women, and even higher in women with lower education compared with women with higher education. In men and women obesity was associated with a higher prevalence of diabetes, odds ratio (OR) 2.38 (95% Confidence Interval [CI]: 1.86 to 3.05) and 3.01 (95%CI 2.42 to 3.74) respectively, hypertension (OR 2.79 (95%CI 2.32 to 3.36) and 2.40 (95%CI 2.05 to 2.80) respectively, dyslipidemia (OR 1.83 (95%CI 1.50 to 2.24) and 1.69 (95%CI 1.45 to 1.98), respectively, low physical activity (OR 1.38(95%CI 1.14 to 1.68) and 1.38 (95%CI 1.18 to 1.62) respectively and a lower prevalence of smoking (OR, 0.65 (95%CI 0.53 to 0.80) and 0.58(95%CI 0.48 to 0.70) respectively. Conclusions: Obesity and central obesity are highly prevalent in the general population in the Southern Cone of Latin America and are strongly associated with cardiovascular risk factor prevalence. These data suggest that efforts toward prevention, treatment, and control of obesity should be a public health priority in the Southern Cone of Latin America. Fil: Lanas, Fernando. Universidad de La Frontera; Chile Fil: Bazzano, Lydia. University of Tulane; Estados Unidos Fil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina. Centro de Excelencia en Salud Cardiovascular para el Cono Sur ; Argentina Fil: Calandrelli, Matias. Sanatorio San Carlos; Argentina Fil: Chen, Chung-Shiuan. University of Tulane; Estados Unidos Fil: Elorriaga, Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina. Centro de Excelencia en Salud Cardiovascular para el Cono Sur ; Argentina Fil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; Argentina. Centro de Excelencia en Salud Cardiovascular para el Cono Sur ; Argentina Fil: Manfredi, Maria Jose. Universidad de la República; Uruguay Fil: Seron, Pamela. Universidad de La Frontera; Chile Fil: Mores, Nora. Municipalidad de Marcos Paz; Argentina Fil: Poggio, Rosana. Instituto de Efectividad Clínica y Sanitaria; Argentina. Centro de Excelencia en Salud Cardiovascular para el Cono Sur ; Argentina Fil: Ponzo, Jacqueline. Universidad de la República; Uruguay Fil: Olivera, Hector. Municipalidad de Marcos Paz; Argentina Fil: He, Jiang. University of Tulane; Estados Unidos Fil: Irazola, Vilma. Universidad de La Frontera; Chile

Effectively tackling the growing noncommunicable disease (NCD) burden in low- and middle-income countries (LMIC) is a major challenge. To address research needs in this setting for NCDs, in 2009, National Heart, Lung, and Blood Institute (NHLBI) and UnitedHealth Group (UHG) engaged in a public-private partnership that supported a network of 11 LMIC-based research centers and created the NHLBI-UnitedHealth Global Health Centers of Excellence (COE) Program. The Program’s overall goal was to contribute to reducing the cardiovascular and lung disease burdens by catalyzing in-country research institutions to develop a global network of biomedical research centers. Key elements of the Program included team science and collaborative approaches, developing research and training platforms for future investigators, and creating a data commons. This Program embraced a strategic approach for tackling NCDs in LMICs and will provide capacity for locally driven research efforts that can identify and address priority health issues in specific countries’ settings.HighlightsA public-private partnership created the Program.Forming the Program captured all the elements of team science.The Program used best practices of collaborative science.Research training for future investigators was a high priority.