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Objective 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. Methods 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. Findings 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$) in health-care costs annually. Based on the adverse effects of TFA intake reported in prospective cohort studies, 1517 deaths, 5373 acute CHD events, 26394 DALYs and US$ 87 million would be averted annually. Conclusion 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. Objectif Estimer l'impact des politiques argentines de reduction des acides gras trans (AGT) sur les cardiopathies coronariennes (CC), les annees de vie corrigees du facteur incapacite (AVCI) et les couts des soins de sante associes. Methodes Nous sommes partis d'une estimation de l'apport de reference en AGT avant 2004 representant 1,5% de l'apport energetique total. Nous avons concu un modele pour ces politiques, en integrant cet apport en AGT de reference, les huiles et graisses utilisees pour remplacer les AGT artificieis, les effets cliniques de la reduction des AGT artificieis, les couts associes ainsi que les AVCI epargnees du fait des accidents coronariensevites. Pourcalculer le pourcentage de reduction des CC, nous avons calcule les risques de CC sur un echantillon en population, avant et apres la mise en oeuvre de ces politiques. Les effets de ces politiques ont ete modelises de trois manieres, en fonction des changements projetes: (i) au niveau des profils lipidiques plasmatiques; (ii) au niveau des biomarqueurs lipidiques et inflammatoires et (iii) en fonction des resultats des etudes prospectives de cohortes. Nous avons egalement estime la valeur economique actuelle des AVCI et du cout des soins de sante associes correspondant aux cardiopathies coronariennes evitees. Resultats Selon nos estimations, les changements projetes des profils lipidiques devraient permettre d'eviter 301 deces, 1 066 accidents coronariens aigus, 5 237 AVCI et 17 millions de dollars des Etats-Unis d'Amerique ($US) de depenses annuelles en soins de sante. A partir des effets defavorables des apports en AGT indiques dans les etudes prospectives de cohortes, ce sont 1 517 deces, 5 373 accidents coronariens aigus, 26 394 AVCI et 87 millions de $US de depenses qui pourraient etre evites chaque annee. Conclusion Meme dans le scenario le plus prudent, la reduction de l'apport en AGT a un effet considerable sur la sante publique. Ces resultats permettront d'informer les decideurs en Argentine et dans d'autres pays sur les impacts potentiels de ce type de politiques sur le plan economique et en termes de sante publique. Objetivo Estimar el impacto de las politicas argentinas para la reduccion de los acidos grasos de tipo trans (AGT) en las cardiopatias coronarias, los anos de vida ajustados en funcion de la discapacidad (AVAD) y los costes de la atencion sanitaria asociados. Metodos Se estimo que la ingesta base de AGT antes de 2004 era de 1,5% de la ingesta de energia total. Se construyo un modelo de politica que incluia la ingesta base de AGT, los aceites y grasas utilizados para reemplazar los AGT artificiales, el efecto clinico de reducir los AGT artificiales y el coste y los AVAD salvados debido a los casos de cardiopatias coronarias evitadas. Para calcular el porcentaje de reduccion de cardiopatias coronarias, se calcularon los riesgos de cardiopatias coronarias en un modelo basado en la poblacion antes y despues de la implementacion. El efecto de las politicas fue modelado de tres formas, en base a cambios estimados: (i) perfiles de plasma de lipidos; (ii) marcados biologicos inflamatorios de lipidos; y (iii) los resultados de estudios de cohortes prospectivos. Tambien se estimo el valor economico actual de los AVAD y los costes de atencion sanitaria asociados a las cardiopatias coronarias evitadas. Resultados Se estimo que los cambios estimados en el perfil de lipidos evitarian 301 muertes, 1.066 casos graves de cardiopatias coronarias, 5.237 AVAD y 17 millones de dolares estadounidenses (USD) en atencion sanitaria cada ano. Basandose en los efectos adversos del consumo de AGT de los estudios de cohortes prospectivos, se evitarian 1.517 muertes, 5.373 casos graves de cardiopatias coronarias, 26.394 AVAD y 87 millones de USD cada ano. Conclusion Incluso bajo el escenario mas conservador, la reduccion del consumo de AGT tuvo un efecto sustancial en la salud publica. Estos resultados ayudaran a informar a los responsables de la toma de decisiones en Argentina y otros paises sobre el potencial impacto economico y de salud publica de esta politica., Introduction Artificial trans fatty acids (TFAs) are produced during the industrial processing of vegetable oils. The main source of such TFAs is partially hydrogenated vegetable oils. (1) Consumption of TFAs [...]

Although obesity and non-communicable disease (NCD) prevention efforts to-date have focused mainly on individual level factors, the social and physical environments in which people live are now widely recognized as important social determinants of health. Obesogenic environments promote higher dietary energy intakes and sedentary behaviors, thus contributing to the obesity/NCD burden. To develop quality indicators (QIs) for measuring food and physical activity (PA)-built environments in municipalities. A literature review was conducted. Based on the best practices identified from this review, a draft set of candidate QI was retrieved. The initial 67 QIs were then evaluated by a modified Delphi panel of multidisciplinary health professionals (n  = 40) to determine their relevance, validity, and feasibility in 3 rounds of voting and threaded discussion using a modified RAND/University of California, Los Angeles Appropriateness Methodology. Response rate for the panel was 89.4%. All final 42 QIs were rated as highly relevant, valid, and feasible (median rating ≥ 7 on a 1–9 scale), with no significant disagreement. The final QI set addresses for the PA domain: (i) promotion of PA; and (ii) improvements in the environment to strengthen the practice of PA; and for Food environment domain: (i) promotion of healthy eating; (ii) access to healthy foods; and (iii) promotion of responsible advertising. We generated a set of indicators to evaluate the PA and food built environment, which can be adapted for use in Latin American and other low- and middle-income countries. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective. 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. Methods. 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). Results. 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 (p<0.05). 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. Conclusions. 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. [ABSTRACT FROM AUTHOR]

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 <126 mg/dl, respectively. Results: Prevalence of DM varied among cities, between 8.4% in Bariloche and 14.3% in Temuco. Prevalence of IFG varied at different sites, from 3.5% in Barros Blancos to 6.8% in Marcos Paz. Of the total number of people with diabetes, 20% were newly diagnosed at the time of the study. Overall, 79.8% of patients with diabetes were aware of their condition. The treatment and control rate were 58.8% and 46.2%, respectively. Older age, family history of diabetes, lower educational attainment, overweight, obesity, central obesity, low physical activity, hypertension, hypercholesterolemia and hypertriglyceridemia were all significantly associated with an increased risk of diabetes. Conclusions: The prevalence of DM and IFG in the adult population of the SCLA is high and varies among cities. These conditions represent a public health challenge since the rates of awareness, treatment, and control are still low. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Several previous epidemiological studies from developed countries have shown that an unhealthy dietary pattern affects plasma lipid levels and inflammation biomarkers. We assessed the cross-sectional associations between dietary patterns and cardiovascular risk factors among 961 adults from a multi-city cohort in South America. We conducted a principal component analysis to derive dietary patterns. As outcomes, we examined plasma levels of apo A-I, apo B, high-sensitivity C-reactive protein (hs-CRP), LDL-, HDL- and serum total cholesterol and TAG. The crude and adjusted changes in each outcome were estimated for quartiles of dietary patterns using multivariable linear regression models. The prudent pattern (PP) characterised by higher intake of fruits, vegetables, fish, seafood, whole cereal and low-fat dairy products was associated with 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 not significantly 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 total cholesterol. This study provides possible evidence of a prudent diet in South American populations to help reduce the burden of CVD. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM AUTHOR]

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Copyright of Diaeta is the property of Asociacion Argentina de Dietistas & Nutricionistas Dietistas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]