Oscar F. Herrán

Prevalence and impact of cardiovascular risk factors in Bucaramanga, Colombia: results from the Countrywide Integrated Noncommunicable Disease Intervention Programme (CINDI/CARMEN) baseline survey

Background Although cardiovascular diseases are the main cause of death in the region, there are few data on the prevalence of cardiovascular risk factors in Latin American. We studied the distribution and impact of cardiovascular risk factors in Bucaramanga, Colombia. Methods We conducted a cross-sectional study in a random sample of 2989 subjects 15–64 years old. Population attributable risks were estimated from Framingham risk scores. Results Smoking prevalence was 16.2% (men 26.3%; women 10.5%). Hypertension prevalence was 9.9% in women and 8.8% in men, but reached 50% in those 60–64 years old. After adjustment for body mass index, men were more likely to be hypertensive, but only if under 40 years old. Obesity was more frequent in women (15.7%) than in men (8.7%), even after age-adjustment. About 46% of the participants were overweight or obese. Women also had higher prevalence of high total cholesterol (19.7 versus 15.7%) and high low-density lipoprotein-cholesterol (23.9 versus 19.5%), but lower prevalence of low high-density lipoprotein (HDL)-cholesterol (22.2 versus 37.6%). Only low-HDL prevalence was significantly different after body mass index and age-adjustment. The prevalence of diabetes was similar in men and women (4%), but age and body mass index-adjusted impaired fasting glucose prevalence was 60% higher in women. Population attributable risks were larger and similar for high total cholesterol, hypertension, and large waist-to-hip ratio (19%). Conclusions Women had higher prevalence of all risk factors with the exception of smoking and low-HDL. Reduction in cholesterol levels, blood pressure and obesity is a priority to control the ongoing epidemic of cardiovascular diseases in this population.

Development and simulated validation of a food-frequency questionnaire for the Colombian population.

OBJECTIVE To develop a food-frequency questionnaire (FFQ) useful for ranking of nutrient intakes. DESIGN Subjects consuming their regular diet completed 7 days of weighed intake registry (7-WIR). Foods for the FFQ were selected by stepwise multiple regression. The FFQ was then completed for each subject using data on individual food consumption from the 7-WIR. The correlation and agreement between the extrapolated FFQ and the 7-WIR data were assessed using Spearmans rank correlation coefficients (rS) and Bland and Altmans limits of agreement (LOA). SETTING Bucaramanga, Colombia. SUBJECTS We studied 97 randomly selected 20-40-year-old subjects. RESULTS Sixty foods were selected for the FFQ. The 7-WIR and the extrapolated FFQ intake estimates correlated well. rS was 0.58 for energy, 0.53 for carbohydrate, 0.50 for total fat, and 0.48 for protein. For micronutrients, rS varied from 0.46 (manganese) to 0.71 (vitamin B12). FFQ average intake estimates were 83%, 80%, 86.2% and 86.4% of 7-WIR estimates for energy, carbohydrate, total fat and protein, respectively. LOA for these nutrients ranged between 45% and 165%. FFQ micronutrient intakes were on average 96% (median) of those from the 7-WIR, and the median lower and upper LOA were 50% and 203%. However, there was no indication that the degree of agreement varied with the level of intake. CONCLUSIONS According to our simulated validation, this FFQ may be useful to rank subjects by nutrient intake. Its validity against standard independent measurements and its applicability to other subsets of the Colombian population should be carefully considered.

Obesity prevalence in Colombian adults is increasing fastest in lower socio-economic status groups and urban residents: results from two nationally representative surveys.

OBJECTIVE Low- and middle-income countries are experiencing rises in the prevalence of adult obesity. Whether these increases disproportionately affect vulnerable subpopulations is unclear because most previous investigations were not nationally representative, were limited to women, or relied on self-reported anthropometric data which are subject to bias. The aim of the present study was to assess changes in the prevalence of obesity from 2005 to 2010 in Colombian adults; overall and by levels of sociodemographic characteristics. DESIGN Two cross-sectional, nationally representative surveys. SETTING Colombia. SUBJECTS Men and women 18-64 years old (n 31 105 in 2005; n 81 115 in 2010). RESULTS The prevalence of obesity (BMI ≥30 kg/m2) was 13·9 % in 2005 and 16·4 % in 2010 (prevalence difference = 2·7 %; 95 % CI 1·9, 3·4 %). In multivariable analyses, obesity was positively associated with female sex, age, wealth, and living in the Pacific or National Territories regions in each year. In 2010, obesity was also associated with living in an urban area. The change in the prevalence of obesity from 2005 to 2010 varied significantly according to wealth; 5·0 % (95 % CI 3·3, 6·7 %) among the poorest and 0·3 % (95 % CI -1·6, 2·2 %) in the wealthiest (P, test for interaction = 0·007), after adjustment. Obesity rates also increased faster in older than younger people (P, test for interaction = 0·01), among people from urban compared with non-urban areas (P, test for interaction = 0·06) and in adults living in the Atlantic region compared with others. CONCLUSIONS Adult obesity prevalence has increased in Colombia and its burden is shifting towards the poor and urban populations.

Validez factorial del cuestionario de expectativas hacia el consumo de alcohol (AEQ-III), en adultos de Bucaramanga, Colombia

Background: Alcohol consumption is associated to expectancies of global positive behavioral changes, improvement in sexual performance and a higher level assertiveness. These issues are evaluated by the Alcohol Expectancy Questionnaire (AEQ-III). Aim: To perform a factorial validation of the Alcohol Expectancy Questionnaire (AEQ-III). Materials and methods: The questionnaire was applied to a representative sample of 601 subjects aged 18 to 60 years (334 males). These subjects also answered a socioeconomic questionnaire. The significant variables of the questionnaire were selected using an exploratory factorial analysis. Based on the selected variables, the verification was performed using multiple models of structural equations. Four factors, namely “decrease in physical tension”, “decrease in psychological tension”, “increase in expressivity and sexuality” and “inhibition and feelings of power”, were identified as significant. Results: The factorial solution explains 59% of the variance. All the factors are conceptually and statistically consistent, with a Cronbach alpha ranging between 0.75 and 0.83. The global internal consistency was of 0.85. Pearson correlation coefficient among factors ranged between 0.45 and 0.74. There was a significant difference among socioeconomic levels for the factors “lack of inhibition and feelings of power” and “decrease of psychological tension”. Goodness of fit statistics and parsimony were high, ranging from 0.80 to 0.93. Conclusions: The expectancy “decrease of physical tension” and “decrease of psychological tension” are a part of individual behavior and could predict problem drinking. The factors “increase of expressiveness and sexuality” and “lack of inhibition and feelings of power”, are more associated to group behaviors (Rev Med Chile 2007; 135: 488-95). (Key words: Alcohol drinking; Alcoholism; Factor analysis, statistical)

Evaluación del impacto de un ensayo comunitario sobre el consumo de frutas y verduras en Colombia

Objective. To evaluate the impact of an alimentary intervention on the frequency of consumption of fruits and vegetables (FV) in the municipality of Giron, Santander, Colombia. Material and Methods. A community intervention was carried out over a ten-month period, where 66 families who use fourteen community homes (HC) received an alimentary intervention based on educational strategies. Seventy-three families in twelve HC served as a control group. The frequency of FV consumption was evaluated by repeated measurements using a food frequency questionnaire. The evaluation was carried out on two levels: the family and the HC. The Bland-Alman method was used to determine the intra- and inter-group impact. A multiple linear regression model enabled the evaluation of the intervention’s effect on consumption frequency, adjusted for economic and demographic variables. Results. The frequency of consumption of fruits increased an average of 1.3 times per week (CI 0.3, 1.8, p=0.040). This was achieved when the probability of having a blender was higher than 75% (R 2 for

Expectativas en el consumo de alcohol en Bucaramanga, Colombia

Eighty nine percent of the population consumes alcohol, without differences by age,gender, body mass index, educational or socioeconomic level. Positive expectancies related todisinhibition and feelings of power with a prevalence ratio (PR) of 1.33 (95% confidenceintervals of 1.06-1.67) and an age of less than 16 years when alcohol consumption started, witha PR of 1.15 (95% confidence intervals of 1.08-1.23), were the only two explanatory variablesfor alcohol consumption.

Validity and reproducibility of two semi-quantitative alcohol frequency questionnaires for the Colombian population

OBJECTIVE To determine the relative validity and reproducibility of two alcohol intake frequency questionnaires (AFQ-A; AFQ-B), designed to classify subjects according to their alcohol intake level, in Bucaramanga, Colombia. METHOD One hundred and nine randomly selected subjects, aged between 20 and 60 years, completed three 30-day semi-quantitative alcohol intake records (30-DR). The AFQs were applied three months after the last 30-DR. AFQ-A contained 53 items; AFQ-B contained five items, with the alcoholic drinks for AFQ-B selected by Max_r. The correlation and agreement between alcohol intake assessed with the AFQs and the 30-DR were obtained using Pearsons correlation coefficient (r), Lins concordance correlation coefficient (rhoC), Spearmans rank correlation coefficient (rS), Bland and Altmans limits of agreement (LOA) and Cohens weighted kappa statistic (Kw). RESULTS The reproducibility of the 30-DR was poor; rS ranged from 0.33 to 0.41. The reproducibility of the AFQs was higher, with rS between 0.50 and 0.73. The agreement (Kw) of the 30-DR and the AFQs was 0.40. The lower and upper LOA were between -56.4% and -11.0%. The AFQs and 30-DR were well correlated. Assessment of relative validity between the two methods yielded r values for alcohol between 0.52 and 0.60, which reduced to 0.20-0.29 after energy adjustment. CONCLUSIONS These AFQs may be useful to rank subjects according to their alcohol intake. The AFQ-B is easy and quick to apply, and is also highly cost-effective.

Seguridad alimentaria: un método alterno frente a uno clásico

Objetivos Evaluar durante 2007-2008 el desempeno la Escala de Percepcion de Seguridad Alimentaria (EPSA) frente a la inseguridad alimentaria (IA) determinada con base en la energia usualmente consumida. Metodos Participaron 211 hogares. El responsable de la preparacion de los alimentos contesto la EPSA, otro integrante del hogar contesto dos veces un recordatorio del consumo de veinticuatro horas (R24H). El referente fue la IA por el R24H y la prueba la EPSA. Resultados La IA por el R24H fue del 48,8 %, con la EPSA de 19,4 %. La sensibilidad de la EPSA fue de 16,5 %, la especificidad de 77,8 %. El acuerdo segun la Kappa fue de -0,06 (IC; -0,20 a -0,03). Conclusiones Bajo el supuesto de equivalencia de metodos, la EPSA subestima la inseguridad alimentaria en el hogar. Los resultados de la EPSA comparados con los del R24H no son coherentes.

Desigualdad y nutrición: Encuesta de la Situación Nutricional en Colombia, 2010

Objectives: to calculate inequality indices based on seven variables relating to monetary poverty in children aged between 5 and 17 years and postpartum women of interest to the public nutrition authorities in Colombia. Methods: an ecological study was carried out based on 2011 data for monetary poverty and ENSIN obtained in the 2010 survey used to calculate rates based on inequality of ranges, disparity, disproportionality, regression models, and the concept of entropy. The study focused on children aged between 5 and 17 years old and postpartum women up to 48 hours after having given birth. Results: the prevalence of monetary poverty was 41.5% (95% CI 35.7 to 47.4). 82.4% of anemia and 68.2% of B12 deficiency could be avoided if there were no poverty. Inequality was found for all the variables except excess television. The Gini index for underweight was 0.20 and for anemia 0.38. Poverty accounts for 78% of house hold food insecurity. Conclusions: inequalities in nutrition can be considered to be dynamic and match structural inequalities. It was evident that there is inequality in all variables except excess to watching television or playing video games. Public policy for poor women stresses gender inequality. The distribution of malnutrition in Colombia is not homogeneous and this shows the existence of unjust inequalities affecting the most vulnerable.

Consumo dietario y estado de nutrición en población colombiana

The objective of this study was to establish the relationship between nutritional status and dietary intake in a Colombian population. An analytical study with measurements of dietary intake of energy (calories), nutritional status, socioeconomic conditions, environmental conditions and food insecurity was carried out in 1,488 subjects. Dietary intake was calculated based on two recall of the past 24 hours and nutritional status was assessed with anthropometry. Food intake was expressed as: a) participation (%) intra-household, b) consumption per 1000 kcal usual, c) adequacy between required consumed and d) individual food insecurity. Using multinomial logistic models with nutritional status as dependent variable, we calculated adjusted prevalence ratios with 95%. For every fi ve percentage points increase in the participation in energy consumption, the risk of defi cit increased by 1.16 times (CI 95 %: 1.03 to 1.30). The risk of defi cit increases by living in urban areas 4.10 (CI 95 %: 1.29 to 13.02), increasing age (per 5 years) 1.32 (CI 95 %: 1.27 to 1.37) and not getting food aid 1.73 (CI 95 %: 1.10 to 2.74). The loss of discriminating power of dietary intake, explaining the nutritional status and the emergence of other variables such as food support calls for reformulation of individual and populationbased care of nutritional status.