Hugo Amigo

Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study.

BACKGROUND International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries. METHODS Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated. FINDINGS Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations. INTERPRETATION We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems. FUNDING The Lowitja Institute.

Obesidad en el niño en América Latina: situación, criterios de diagnóstico y desafíos

Obesity has emerged as an alarming public health problem, having increased rapidly in both adults and children. Considering 12 countries with reported levels of overweight and obesity, one third have a 20% prevalence of one or both conditions. In 17 countries reporting data on obesity, the mean rate was 4.6%; four countries reported rates over 6%, while three reported less than 2%. The majority of these countries showed increases of 70% in overweight and 60% in obesity during the last decade. Only two countries reported decreasing prevalence rates. Countries may be classified in four groups: (1) low or even downward prevalence of overweight and obesity; (2) underweight reported simultaneously with an increase in obesity; (3) a large territory and population with differences in the prevalence of overweight and obesity between regions and socioeconomic groups; and (4) little underweight and high prevalence of obesity. In conclusion, there is no doubt about the increasing trend in overweight and obesity among Latin American children. However, since there is no consensus as to diagnostic criteria for overweight and obesity, the real prevalence is not known.

Is there a causal relation between obesity and asthma? Evidence from Chile

OBJECTIVE:An association between obesity and asthma symptoms has been reported in the literature, but such a relationship is inconsistent if atopic status or bronchial hyper responsiveness (BHR) is considered. The objective was to assess the association between obesity and asthma symptoms or BHR in adults.METHODS:A study was carried out in 1232 people born between 1974 and 1978 in Chile. The participants completed the European Community Health Survey questionnaire, were skin tested and subject to a BHR challenge to methacholine.MEASUREMENTS:Weight, height and waist circumference were measured and body mass index (BMI) was calculated.RESULTS:There was a positive association between wheeze and breathlessness following exercise and BMI (both with an OR 1.03, 95% CI 1.00–1.06), the associations with wheeze tended to disappear in women who did react at least to one allergen, and persisted in those who did not react to any allergens. BMI was negatively associated with BHR (OR 0.93, 95% CI 0.89–0.97). Waist circumference was not associated with asthma symptoms and it was negatively associated with BHR.CONCLUSION:Although there was an association between BMI and asthma symptoms, there were weaknesses in the evidence because waist circumference, a more direct measure of obesity than BMI, was not associated with asthma symptoms, and BMI and waist circumference were negatively associated with BHR.

Factores de riesgo de enfermedad cardiovascular en adultos jóvenes

Eight hundred and fifty subjects aged 22 to 28 years, living in two cities inValparaiso province, were studied. Weight, height and blood pressure were recorded. A fastingblood sample was obtained from 806 individuals (54% female), to measure plasma lipids,glucose and insulin levels, to estimate their homeostasis model assessment scores (HOMA) and toevaluate the occurrence of metabolic syndrome.

Socioeconomic risk factors for asthma in Chilean young adults.

OBJECTIVES We studied the association between socioeconomic status (SES) and asthma symptoms, severity of asthma, atopy, and bronchial hyperresponsiveness (BHR) to methacholine. METHODS We studied 1232 men and women born between 1974 and 1978 in a semirural area of Chile. We assessed asthma symptoms with a standardized questionnaire, atopy with a skin-prick test to 8 allergens, and BHR to methacholine with the tidal breathing method. SES was derived from several indicators: education, occupation, completion of a welfare form, belongings, housing, number of siblings, and overcrowding. RESULTS Those with fewer belongings had more asthma symptoms. Those who had higher education and those who owned cars had fewer asthma symptoms and BHR. Overcrowding was negatively related to atopy, atopy with asthma symptoms, and BHR. Higher education and noncompletion of a welfare form were risk factors for atopy. CONCLUSION The strength and direction of the association between asthma and SES depended on what definition of asthma was analyzed. Asthma symptoms were more common among poor people. There was some support for the hygiene hypothesis, as overcrowding was associated with less wheezing with atopy, less atopy, and less BHR.

The early origins hypothesis with an emphasis on growth rate in the first year of life and asthma: a prospective study in Chile.

Background: There is uncertainty about the impact of the programming hypothesis in terms of nutritional status at birth, rate of growth in the first year of life, length of gestation, breast feeding, and episodes of illness on asthma. An analysis was therefore carried out to test this hypothesis. Methods: Data were collected on 1232 children born between 1974 and 1978 in a semi-rural area of Chile. Measurements at birth and growth in the first year of life were obtained from a birth registry and clinical notes. Information on asthma was collected using the European Community Respiratory Health Survey questionnaire. Sensitisation to eight allergens and bronchial hyperresponsiveness (BHR) to methacholine were determined. All other information was obtained using a questionnaire. Polytomous logistic analyses were carried out to explore the association of factors at birth and during the first year of life with asthma symptoms, atopy, and BHR. Results: Weight and length gain in the first year were positively associated with wheeze (odds ratio (OR) 1.004, 95% CI 1.001 to 1.007 and OR 1.11, 95% CI 0.98 to 1.25, respectively). A higher body mass index (BMI) at birth was protective in subjects reporting both wheeze and waking with breathlessness (OR 0.54, 95% CI 0.35 to 0.84). Length rate in tertiles divided by length at birth in tertiles was related to asthma symptoms (OR 1.68, 95% CI 1.19 to 2.37). Most other assessments were not associated with asthma. Conclusion: These results show promising but inconclusive evidence that a rapid rate of growth in length, especially in newborn infants of low length, might be involved in the aetiology of asthma.

Growth in indigenous and nonindigenous Chilean schoolchildren from 3 poverty strata

OBJECTIVES This study sought to determine whether the short stature of Mapuche children, an indigenous group in Chile, reflects poverty or genetic heritage and whether the international reference population, derived from studies of US children of mostly European origin, is appropriate for assessing growth failure in indigenous peoples of the Americas. METHODS The study assessed 768 schoolchildren of Mapuche and non-Mapuche ancestry, aged 6 to 9 years, living under conditions of extreme, medium, and low poverty. RESULTS Growth retardation was strongly related to poverty in both ethnic groups. Within poverty levels, there were no significant differences in stature between ethnic groups, and in low-poverty areas in Santiago, the capital city, mean stature was only slightly less than in the reference population. CONCLUSIONS Poverty, not ancestry, explains the short stature of Mapuche children, and use of the international reference to assess growth in this population is appropriate.

Factores determinantes del exceso de peso en escolares: Un estudio multinivel

BACKGROUND Rates of obesity reach high levels in Chile, with geographic, social and school variations. AIM To identify factors at two levels associated with excessive weight in school children: child-family characteristics and school-neighborhood. MATERIAL AND METHODS Using a cross-sectional and multi-step design, seven counties with the highest prevalence of obesity were identified, and schools were randomly chosen from within the 1st, 3 and 5 quintiles of the school strata (same level of obesity prevalence). Within each school, twelve 2nd grade children were randomly chosen (n =42 schools and 504 students). Nutritional status, food intake, eating habits and physical activity were measured. Socio demographic, economic characteristics and nutritional status of the parents were assessed. Home size and facilities for children physical activities were assessed, as well as school infrastructure and management. RESULTS Most of the explained variance (97%) in the Body Mass Index (BMI) was due to individual-level factors: sedentary children behaviour (JS coefficient 1.6, standard error (SE) 0.052), maternal obesity (ss 0.94; SE 0.25), paternal obesity (ss 0.83; SE 0.28) and hours watching television (ss 0.789, SE 0.297). The same risk factors were predictive of obesity: child sedentary behaviours odds ratio (OR): 3-98, 95%) confidence interval (CI): 2.44-6.48, maternal obesity (OR 1.91, CI 1.21-3-02) and being woman (OR 1.75, CI 1.01-2.76). CONCLUSIONS BMI and obesity are associated with children behaviour or biological and cultural conditions of their families and not with school characteristics.

Socioeconomic status and age at menarche in indigenous and non-indigenous Chilean adolescents

The objective was to analyze the relationship between socioeconomic status and age at menarche among indigenous and non-indigenous girls in the Araucanía Region of Chile, controlling for nutritional status and mothers age at menarche. A total of 8,624 randomly selected girls from 168 schools were screened, resulting in the selection of 207 indigenous and 200 non-indigenous girls who had recently experienced menarche. Age at menarche was 149.6 ± 10.7 months in the indigenous group and 146.6 ± 10.8 months in the non-indigenous group. Among the non-indigenous, the analysis showed no significant association between age at menarche and socioeconomic status. In the indigenous group, age at menarche among girls with low socioeconomic status was 5.4 months later than among those with higher socioeconomic status. There were no differences in nutritional status according to socioeconomic level. Obesity was associated with earlier menarche. Menarche occurred earlier than in previous generations. An inverse relationship between socioeconomic status and age at menarche was seen in the indigenous group only; low socioeconomic status was associated with delayed menarche, regardless of nutritional status or mothers age at menarche.

Nutritional status, especially body mass index, from birth to adulthood and lung function in young adulthood.

Objective: The study assessed the impact of body mass index (BMI) at birth, infancy, and adulthood, and waist circumference on lung function. Methods: Using a longitudinal design 1221 Chilean young adults were studied. A standardized respiratory questionnaire was used. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), height, weight and waist circumference were measured. Data at birth and at 1 year were obtained from clinical notes. Results: Males with a BMI ≥ 30 and women with a BMI < 20 had a lower FEV1 (−230 mL, 95% CI −363 to −98; −106 mL, 95% CI −211 to −0.18, respectively). In both sexes those with a BMI 20–25 had the highest FEV1 and FVC. In males there was a negative association between waist circumference and FEV1 and FVC while in women the middle tertile had the highest FEV1 and FVC. There was an association between birthweight and BMI at birth, and FEV1 in men, when unadjusted for other measurements. Conclusions: BMI and waist circumference in adulthood make a greater impact on lung function in adulthood than anthropometric measurements at birth and infancy. Proxy measures of fatness in adulthood reduce lung function, but the pattern between fatness and lung function by sex may be different.