[Adverse socio-economic conditions associated with the presence of obesity and its metabolic comorbidities in adults in San Luis, Argentina ]. / Bajo nivel de instrucción asociado a la presencia de obesidad y sus comorbilidades metabólicas en adultos de Argentina.

The prevalence of obesity depends on biopsychosocial and environmental factors and represents a risk factor for communicable and non-communicable diseases. Objectives: To determine the association between demographic, socioeconomic and lifestyle characteristics and the presence of obesity and its metabolic comorbidities (MC) in adults in San Luis City, Argentina. Observational population-based cross-sectional study of 306 individuals aged 18-85 years from San Luis, Argentina, selected by multistage random sampling, with an overweight prevalence of 35% and a 0.05 margin of error. Socioeconomic, demographic, and lifestyle variables were assessed, and multiple logistic regression models were fitted with the presence of obesity and MC as outcomes and sociodemographic and lifestyle characteristics as covariates. Obesity was found in 17.3% of participants, diabetes in 3%, high blood pressure (HBP) in 11%, dyslipidemia in 3.3% and coronary ischemic complications (CIC) in 13%. The proportion of residents with at least one of these conditions was 26.8%. Low Educational level (EL) was positively associated with the presence of obesity (OR 3.58; IC95% 1.04-12.24; p=0,04), and its MC (OR 5.25; IC95% 1.05-26.23; p=0.04) with respect to high EL. Similarly, the possibility of presenting CIC was increased in people with medium EL (OR 5.8; IC95% 1.12-30.19; p=0.03). On the other hand, the possibility of presenting diabetes increased by 17% with increasing body mass index (BMI) (OR 1.17; IC95% 1.03-1.34; p=0.01). Finally, women were more likely to present HBP (OR 3.71; IC95% 1.01-13.72; p=0.04) and CIC (OR 3,43; IC95% 1,06-11,10; p=0,03). Conclusion: the increase in age, female sex and medium and low NI are factors and conditions of vulnerability that predispose an increase in the prevalence of MC in adults from San Luis, Argentina.

La prevalencia de obesidad depende de factores biopsicosociales y ambientales, y es un factor de riesgo para enfermedades transmisibles y no transmisibles. Objetivo: Determinar la asociación entre las características demográficas, socioeconómicas y del estilo de vida, y la presencia de obesidad y sus comorbilidades metabólicas (CM) en adultos de la ciudad de San Luis, Argentina. Estudio observacional-poblacional-transversal en 306 individuos entre 18 y 85 años de San Luis, Argentina, seleccionados mediante un muestreo aleatorio multietápico, considerando una prevalencia de sobrepeso del 35% y un error de 0,05. Se indagaron variables socioeconómicas, demográficas, del estilo de vida, y se ajustaron modelos de regresión logística múltiple incluyendo presencia de obesidad y CM como variable de respuesta, y características sociodemográficas y del estilo de vida como covariables. El 17,3% de los participantes presentó obesidad, un 3% diabetes, el 11% hipertensión arterial (HTA), el 3,3% dislipidemia y un 13% complicaciones isquémicas coronarias (CIC). La proporción de habitantes con al menos una de esas patologías fue del 26,8%. Un bajo Nivel de instrucción (NI) se asoció positivamente con la presencia de obesidad (OR 3,58; IC95% 1,04-12,24; p=0,04), y sus CM (OR 5,25; IC95% 1,05-26,23; p=0,04) respecto al NI alto. Asimismo, la posibilidad de presentar CIC se vio aumentada en personas con NI medio (OR 5,8; IC95% 1,12-30,19; p=0,03). Por otro lado, la posibilidad de presentar diabetes aumenta un 17% a medida que aumenta el índice de masa corporal (IMC) (OR 1,17; IC95% 1,03-1,34; p=0,01). Finalmente, las mujeres fueron más propensas a presentar HTA (OR 3,71; IC95% 1,01-13,72; p=0,04) y CIC (OR 3,43; IC95% 1,06-11,10; p=0,03). Conclusión: el aumento en la edad, el sexo femenino y el NI medio y bajo son factores y condiciones de vulnerabilidad que predisponen un aumento en la prevalencia de CM en adultos de San Luis, Argentina.

Non-traditional data sources in obesity research: a systematic review of their use in the study of obesogenic environments.

BACKGROUND: The complex nature of obesity increasingly requires a comprehensive approach that includes the role of environmental factors. For understanding contextual determinants, the resources provided by technological advances could become a key factor in obesogenic environment research. This study aims to identify different sources of non-traditional data and their applications, considering the domains of obesogenic environments: physical, sociocultural, political and economic. METHODS: We conducted a systematic search in PubMed, Scopus and LILACS databases by two independent groups of reviewers, from September to December 2021. We included those studies oriented to adult obesity research using non-traditional data sources, published in the last 5 years in English, Spanish or Portuguese. The overall reporting followed the PRISMA guidelines. RESULTS: The initial search yielded 1583 articles, 94 articles were kept for full-text screening, and 53 studies met the eligibility criteria and were included. We extracted information about countries of origin, study design, observation units, obesity-related outcomes, environment variables, and non-traditional data sources used. Our results revealed that most of the studies originated from high-income countries (86.54%) and used geospatial data within a GIS (76.67%), social networks (16.67%), and digital devices (11.66%) as data sources. Geospatial data were the most utilised data source and mainly contributed to the study of the physical domains of obesogenic environments, followed by social networks providing data to the analysis of the sociocultural domain. A gap in the literature exploring the political domain of environments was also evident. CONCLUSION: The disparities between countries are noticeable. Geospatial and social network data sources contributed to studying the physical and sociocultural environments, which could be a valuable complement to those traditionally used in obesity research. We propose the use of information available on the Internet, addressed by artificial intelligence-based tools, to increase the knowledge on political and economic dimensions of the obesogenic environment.

[Environmental sociodemographic conditions associated with health-nutrition profiles among elderly people, Córdoba-Argentina]. / Condiciones sociodemográficas ambientales asociadas a perfiles de salud-alimentación entre personas adultas mayores, Córdoba-Argentina.

INTRODUCTION: Demographic trends indicate that population aging is not exclusive to developed countries. Argentina reaches 15.5% of the elderly population. The Covid-19 pandemic has brought to the forefront the public health situation of this population, challenging health systems, with disproportionate impacts on this group, which has suffered more than 80% of the deaths in the country, mainly in those with comorbidities. OBJECTIVE: To analyze the sociodemographic and environmental conditions involved in the process of development of health and nutrition profiles of the elderly people of Córdoba, Argentina 2020. METHODOLOGY: Epidemiological, cross-sectional, population-based study that included 221 elderly people (≥60 years old), through random sampling. Data on sociodemographic and environmental conditions, health and dietary profiles were collected through structured interviews. RESULTS: The average age of the participants was 68 years. Eighty-five percent recognized neighborhood contamination, 38% of them being garbage dumps close to their homes. Eighty-nine percent reported at least one non-communicable disease (NCD) or associated risk factor and 66% were overweight (BMI≥25kg/m2). The presence of obesity (BMI≥30kg/m2) was associated (OR=2.05; CI 1.007-3.922) with the development of NCDs. Only 4% of the population complied with the daily fruit and vegetable consumption recommendation. CONCLUSION: The predominant characteristics of the health and dietary profiles associated with NCDs identified suggest the need to study in depth the social determinants that condition the aging process.

Condiciones sociodemográficas ambientales asociadas a perfiles de salud-alimentación entre personas adultas mayores, Córdoba-Argentina / Environmental sociodemographic conditions associated with health-nutrition profiles among elderly people, Córdoba-Argentina

Introducción: Las tendencias demográficas indican que el envejecimiento poblacional no es exclusivo de los países desarrollados. Argentina alcanza el 15,5% de la población adulta mayor. La pandemia por COVID-19 puso en escena la situación de salud pública de esta población, desafiando los sistemas de salud, con impactos desproporcionados en este grupo que sufrió más del 80% de los decesos ocurridos en el país, principalmente en quienes presentaban comorbilidades. Objetivo: Analizar las condiciones sociodemográficas y ambientales que intervienen en el proceso de desarrollo de perfiles de salud y alimentación de la población adulta mayor de Córdoba, Argentina 2020. Metodología: Estudio epidemiológico de corte transversal, de base poblacional, que incluyó 221 personas adultas mayores (≥60 años) mediante muestreo aleatorizado. A través de entrevista estructurada se indagaron datos sobre condiciones sociodemográficas, ambientales, perfiles de salud y alimentación. Resultados: La edad promedio de los participantes fue de 68 años. Un 85% reconoció contaminación barrial, siendo el 38% basurales cercanos al domicilio. El 89% manifestaron al menos una enfermedad no transmisible (ENT) o factor de riesgo asociado y el 66% presentó exceso de peso (IMC≥25kg/m2). La presencia de obesidad (IMC≥30kg/m2) se asoció (OR: 2,05; IC: 1,007-3,922) con el desarrollo de ENT. Solo el 4% de la población cumplió con la recomendación de consumo diario de frutas y verduras. Conclusión: Las características predominantes de perfiles de salud y alimentación asociadas a ENT identificadas, plantean la necesidad de profundizar sobre los determinantes sociales que condicionan el proceso de envejecimiento. (AU)

Introduction: Demographic trends indicate that population aging is not exclusive to developed countries. Argentina reaches 15.5% of the elderly population. The Covid-19 pandemic has brought to the forefront the public health situation of this population, challenging health systems, with disproportionate impacts on this group, which has suffered more than 80% of the deaths in the country, mainly in those with comorbidities. Objective: To analyze the sociodemographic and environmental conditions involved in the process of development of health and nutrition profiles of the elderly people of Córdoba, Argentina 2020. Methodology: Epidemiological, cross-sectional, population-based study that included 221 elderly people (≥60 years old), through random sampling. Data on sociodemographic and environmental conditions, health and dietary profiles were collected through structured interviews. Results: The average age of the participants was 68 years. Eighty-five percent recognized neighborhood contamination, 38% of them being garbage dumps close to their homes. Eighty-nine percent reported at least one non-communicable disease (NCD) or associated risk factor and 66% were overweight (BMI≥25kg/m2). The presence of obesity (BMI≥30kg/m2) was associated (OR=2.05; CI 1.007–3.922) with the development of NCDs. Only 4% of the population complied with the daily fruit and vegetable consumption recommendation. Conclusion: The predominant characteristics of the health and dietary profiles associated with NCDs identified suggest the need to study in depth the social determinants that condition the aging process. (AU)

The "diet model" and metabolic syndrome components: Results from the Cordoba Health and Dietary Habits Investigation.

OBJECTIVES: Diet, one of the main risk factors for both metabolic syndrome (MetS) and non-communicable diseases (NCDs), is a multidimensional feature whose complexity relies on the individual and contextual characteristics of foods. The aim of this study was to build a "diet model" and estimate its relationship with MetS components in two Argentinian populations. METHODS: This was a population-based cross-sectional study that assessed bio-socio-anthropometrical variables and dietary habits using food frequency questionnaires. Dietary patterns (DPs) were drawn out using exploratory factor analysis (EFA). A structural equation model (SEM) was used to explore and confirm theoretical and empirical relationships between DPs and the diet model. The association between individuals' adherence to DPs and MetS were assessed using a multiple logistic regression analysis. We selected two cities in central Argentina according to socio-eco-environmental characteristics. Participants included 493 men and women (1:1 ratio) from 35 to 65 y of age. RESULTS: We identified four DPs: traditional Argentine (TA; processed meats, meats and eggs, fats, starchy vegetables), prudent (Pr; vegetables, fruits, milk, and yogurt), alcohol and snacks (AS), and sweets (S; candies and sodas). TA and AS DPs were associated with increased waist circumference. The S DP showed a strong effect on hypertension. Moderate adherence to the TA DP was positively associated with dyslipidemia but negatively with hypertension whenever individuals did not adhere to the AS DP. TA was positively correlated to AS and S, but inversely with Pr. CONCLUSION: This diet model integrated those food groups in an associative structure describing per se a synthesis of the Argentine dietary habits and their association with three of the five components of MetS.

Higher dietary glycemic index, intake of high-glycemic index foods, and insulin load are associated with the risk of breast cancer, with differences according to body mass index in women from Córdoba, Argentina.

Dietary patterns based on rich-carbohydrate foods were associated with breast cancer (BC) in Córdoba (Argentina). Nevertheless, the effect of dietary indicators of postprandial blood glucose or insulinemia on this cancer has not been studied. Thus, we hypothesize that higher dietary glycemic and insulinemic indices increase the risk of BC occurrence, with differential effects according to the presence/absence of overweight. A case-control study was conducted for BC (346/596 cases/controls) in Córdoba, Argentina, from 2008 to 2016. Multiple logistic regression models were used to assess the effect of glycemic index (GI), glycemic load, insulin index, and insulin load (IL) and the intake of high-GI foods (HGIF) on BC occurrence, adjusted by specific confounders and stratified by body mass index (BMI, <25 or ≥25 kg/m2). The odds ratio (OR) for BC occurrence comparing the highest versus the lowest tertile of dietary GI was 1.77 (95% confidence interval [CI], 1.19-2.64). Additionally, a positive association between the weekly intake of HGIF and the dietary IL was found (OR, 1.71; 95% CI, 1.14-2.55 and OR, 1.50; 95% CI, 1.03-2.19, respectively). In normal-weight women, dietary GI and IL were associated with cancer occurrence, whereas in overweight women, only weekly intake of HGIF was associated. Our findings suggest that the BC risk related to hyperglycemic and hyperinsulinemic diet changed according to BMI. Furthermore, frequent exposure to HGIF has a relevant role in BC occurrence and its promoting effect is even higher in the presence of overweight.

[A population-based study on seroprevalence and factors associated with SARS-CoV-2 infection in Córdoba, Argentina]. / Estudio de base poblacional de seroprevalencia y factores asociados a la infección por SARS-CoV-2 en Córdoba, Argentina.

Seroepidemiological studies help identify the indirect distribution of diseases, detecting serological markers of immunity and demonstrating undiagnosed infections in the general population. The objectives were to estimate the seroprevalence of SARS-CoV-2 antibodies in Córdoba, Argentina, from December 2020 to January 2021 and to identify factors associated with the virus' contagiousness. A population-based cross-sectional observational study was performed in 3,225 individuals over two years of age living in Córdoba city, selected by multiple-stage random sampling proportional to distribution by gender, age group, and socioeconomic status in the city's population. Clinical characteristics, anthropometry, and comorbidities were collected by interview. Qualitative serological testing was performed for detection of SARS-CoV-2 nucleocapsid IgG antibodies (ARCHITECT, Abbott). SARS-CoV-2 seroprevalence was estimated for the total population and by age group, sex, socioeconomic status, and presence of target diseases. Prevalence ratios (PR) were estimated using a log-binomial regression model. SARS-CoV-2 seropositivity was 16.68% (95%CI: 15.41-18.01). Age 2 to 18 years, living in neighborhoods with low socioeconomic status, and obesity increased the odds of seropositivity (PR = 1.50; 95%CI: 1.10-2.04, PR = 1.91; 95%CI: 1.34-2.67 and PR = 1.39; 95%CI: 1.04-1.85). The results indicate that the city of Córdoba displays differential attributes that increase the likelihood of a positive SARS-CoV-2 antibody test. This allows targeting epidemiological surveillance strategies to reduce the spread of the virus.

Los estudios seroepidemiológicos permiten conocer la distribución indirecta de las enfermedades, detectando marcadores séricos de inmunidad y demostrando infecciones no diagnosticadas en la población general. El objetivo fue estimar la seroprevalencia de anticuerpos contra el SARS-CoV-2, en Córdoba, Argentina, entre diciembre de 2020 y enero de 2021, e identificar factores asociados a la contagiosidad del virus. Se realizó un estudio observacional transversal, de base poblacional, con 3.225 individuos mayores de 2 años, residentes en Córdoba Capital, que fueron seleccionados mediante un diseño de muestreo aleatorio en múltiples etapas, proporcional a la distribución por género, franja etaria y nivel socioeconómico de la población de Córdoba. Las características clínicas, antropometría y comorbilidades se recogieron mediante entrevistas. Se realizó un test serológico cualitativo para la detección de anticuerpos IgG antinucleocápside para SARS-CoV-2 (ARCHITECT, Abbott). La seroprevalencia del SARS-CoV-2 se estimó en la población y por franja de edad, sexo, nivel socioeconómico y presencia de las patologías estudiadas. Las razones de prevalencia (RP) se estimaron usando un modelo de regresión log-binomial. La seropositividad para SARS-CoV-2 fue de 16,68% (IC95%: 15,41-18,01). Tener entre 2 y 18 años, residir en barrios con nivel socioeconómico bajo y la presencia de obesidad, aumentaron la oportunidad de seropositividad (RP = 1,50; IC95%: 1,10-2,04, RP = 1,91; IC95%: 1,34-2,67 y RP = 1,39; IC95%: 1,04-1,85). Los resultados indican que en Córdoba Capital existen atributos diferenciales que aumentan la posibilidad de ser seropositivo para SARS-CoV-2. Esto permite dirigir estrategias de vigilancia epidemiológica para reducir la propagación del virus.

Os estudos soroepidemiológicos permitem conhecer a distribuição indireta das doenças, detectando marcadores séricos de imunidade e demonstrando infecções não diagnosticadas na população geral. O objetivo foi estimar a soroprevalência de anticorpos contra o SARS-CoV-2, em Córdoba, Argentina, entre dezembro de 2020 e janeiro de 2021, e identificar fatores associados à contagiosidade do vírus. Um estudo observacional transversal foi realizado, de base populacional, com 3.225 indivíduos maiores de 2 anos, residentes em Córdoba Capital, que foram selecionados por meio de um delineamento de amostragem aleatória em múltiplos estágios, proporcional à distribuição de gênero, a faixa etária e o nível socioeconômico da população de Córdoba. As características clínicas, antropometria e comorbidades foram coletadas por meio de entrevistas. Um teste sorológico qualitativo foi realizado para a detecção de anticorpos IgG anti-nucleocapsídeo para SARS-CoV-2 (ARCHITECT, Abbott). A soroprevalência do SARS-CoV-2 foi estimada na população e por faixa etária, sexo, nível socioeconômico e presença das patologias estudadas. Razões de prevalência (RP) foram estimadas usando um modelo de regressão log-binomial. A soropositividade para SARS-CoV-2 foi de 16,68% (IC95%: 15,41-18,01). Ter entre 2 e 18 años, residir em bairros com nível socioeconômico baixo e a presença de obesidade aumentaram a chance de soropositividade (RP = 1,50; IC95%: 1,10-2,04, RP = 1,91; IC95%: 1,34-2,67 e RP = 1,39; IC95%: 1,04-1,85). Os resultados indicam que em Córdoba Capital existem atributos diferenciais que aumentam a possibilidade de ser soropositivo para SARS-CoV-2. Isso permite direcionar estratégias de vigilância epidemiológica para reduzir a propagação do vírus.

Estudio de base poblacional de seroprevalencia y factores asociados a la infección por SARS-CoV-2 en Córdoba, Argentina / A population-based study on seroprevalence and factors associated with SARS-CoV-2 infection in Córdoba, Argentina / Estudo populacional de soroprevalência e fatores associados à infecção por SARS-CoV-2 em Córdoba, Argentina

Los estudios seroepidemiológicos permiten conocer la distribución indirecta de las enfermedades, detectando marcadores séricos de inmunidad y demostrando infecciones no diagnosticadas en la población general. El objetivo fue estimar la seroprevalencia de anticuerpos contra el SARS-CoV-2, en Córdoba, Argentina, entre diciembre de 2020 y enero de 2021, e identificar factores asociados a la contagiosidad del virus. Se realizó un estudio observacional transversal, de base poblacional, con 3.225 individuos mayores de 2 años, residentes en Córdoba Capital, que fueron seleccionados mediante un diseño de muestreo aleatorio en múltiples etapas, proporcional a la distribución por género, franja etaria y nivel socioeconómico de la población de Córdoba. Las características clínicas, antropometría y comorbilidades se recogieron mediante entrevistas. Se realizó un test serológico cualitativo para la detección de anticuerpos IgG antinucleocápside para SARS-CoV-2 (ARCHITECT, Abbott). La seroprevalencia del SARS-CoV-2 se estimó en la población y por franja de edad, sexo, nivel socioeconómico y presencia de las patologías estudiadas. Las razones de prevalencia (RP) se estimaron usando un modelo de regresión log-binomial. La seropositividad para SARS-CoV-2 fue de 16,68% (IC95%: 15,41-18,01). Tener entre 2 y 18 años, residir en barrios con nivel socioeconómico bajo y la presencia de obesidad, aumentaron la oportunidad de seropositividad (RP = 1,50; IC95%: 1,10-2,04, RP = 1,91; IC95%: 1,34-2,67 y RP = 1,39; IC95%: 1,04-1,85). Los resultados indican que en Córdoba Capital existen atributos diferenciales que aumentan la posibilidad de ser seropositivo para SARS-CoV-2. Esto permite dirigir estrategias de vigilancia epidemiológica para reducir la propagación del virus.

Seroepidemiological studies help identify the indirect distribution of diseases, detecting serological markers of immunity and demonstrating undiagnosed infections in the general population. The objectives were to estimate the seroprevalence of SARS-CoV-2 antibodies in Córdoba, Argentina, from December 2020 to January 2021 and to identify factors associated with the virus' contagiousness. A population-based cross-sectional observational study was performed in 3,225 individuals over two years of age living in Córdoba city, selected by multiple-stage random sampling proportional to distribution by gender, age group, and socioeconomic status in the city's population. Clinical characteristics, anthropometry, and comorbidities were collected by interview. Qualitative serological testing was performed for detection of SARS-CoV-2 nucleocapsid IgG antibodies (ARCHITECT, Abbott). SARS-CoV-2 seroprevalence was estimated for the total population and by age group, sex, socioeconomic status, and presence of target diseases. Prevalence ratios (PR) were estimated using a log-binomial regression model. SARS-CoV-2 seropositivity was 16.68% (95%CI: 15.41-18.01). Age 2 to 18 years, living in neighborhoods with low socioeconomic status, and obesity increased the odds of seropositivity (PR = 1.50; 95%CI: 1.10-2.04, PR = 1.91; 95%CI: 1.34-2.67 and PR = 1.39; 95%CI: 1.04-1.85). The results indicate that the city of Córdoba displays differential attributes that increase the likelihood of a positive SARS-CoV-2 antibody test. This allows targeting epidemiological surveillance strategies to reduce the spread of the virus.

Os estudos soroepidemiológicos permitem conhecer a distribuição indireta das doenças, detectando marcadores séricos de imunidade e demonstrando infecções não diagnosticadas na população geral. O objetivo foi estimar a soroprevalência de anticorpos contra o SARS-CoV-2, em Córdoba, Argentina, entre dezembro de 2020 e janeiro de 2021, e identificar fatores associados à contagiosidade do vírus. Um estudo observacional transversal foi realizado, de base populacional, com 3.225 indivíduos maiores de 2 anos, residentes em Córdoba Capital, que foram selecionados por meio de um delineamento de amostragem aleatória em múltiplos estágios, proporcional à distribuição de gênero, a faixa etária e o nível socioeconômico da população de Córdoba. As características clínicas, antropometria e comorbidades foram coletadas por meio de entrevistas. Um teste sorológico qualitativo foi realizado para a detecção de anticorpos IgG anti-nucleocapsídeo para SARS-CoV-2 (ARCHITECT, Abbott). A soroprevalência do SARS-CoV-2 foi estimada na população e por faixa etária, sexo, nível socioeconômico e presença das patologias estudadas. Razões de prevalência (RP) foram estimadas usando um modelo de regressão log-binomial. A soropositividade para SARS-CoV-2 foi de 16,68% (IC95%: 15,41-18,01). Ter entre 2 e 18 años, residir em bairros com nível socioeconômico baixo e a presença de obesidade aumentaram a chance de soropositividade (RP = 1,50; IC95%: 1,10-2,04, RP = 1,91; IC95%: 1,34-2,67 e RP = 1,39; IC95%: 1,04-1,85). Os resultados indicam que em Córdoba Capital existem atributos diferenciais que aumentam a possibilidade de ser soropositivo para SARS-CoV-2. Isso permite direcionar estratégias de vigilância epidemiológica para reduzir a propagação do vírus.

The Inflammatory Potential of Diet is Associated with Breast Cancer Risk in Urban Argentina: A Multilevel Analysis.

Dietary patterns have been associated with breast cancer (BC) in Argentina. However, little evidence exists relating the inflammatory potential of diet and BC in Latin American countries and how this may relate to rurality.The aim of the present study was to evaluate the association between the Dietary Inflammatory Index (DII®) and BC considering urbanization contexts in Córdoba, Argentina.A frequency-matched case-control study (317 BC cases, 526 controls) was conducted from 2008 through 2016. DII scores were computed based on dietary intake assessed by a validated food frequency questionnaire. Multi-level logistic regression models were fit to evaluate the association between DII and BC, following adjustment for age, body mass index, age at menarche, number of children, smoking habits, socio-economic status and family history of BC as first-level covariates and urbanization level as the contextual variable.Increasing DII score showed significant positive associations with BC risk (ORtertile3vs.tertile1 1.34; 95%CI 1.05, 1.70). The association was stronger in overweight and obese women (ORtertile3vs.tertile1 1.98; 95%CI 1.86, 2.10). The DII effect on BC was higher with increased urbanization.A pro-inflammatory diet, reflected by higher DII scores, was positively associated with BC, especially in overweight women and with increased urbanization.

Diet Quality, Obesity and Breast Cancer Risk: An Epidemiologic Study in Córdoba, Argentina.

Breast cancer (BC) is a multifactorial disease. Environmental factors, specifically, obesity and diet quality, have been linked with an increased risk of BC in women. This research was aimed at assessing the association of diet quality with BC risk, considering nutritional status, in Córdoba province (Argentina). A case-control study was conducted during the period 2008-2016 (346 cases/566 controls). A diet quality score was calculated for each woman based on fifteen dietary components related to low-grade inflammation. Dietary information was obtained through a validated questionnaire. A score (0, 0.5, or 1) was assigned to each variable depending on compliance with dietary recommendations. The higher the score, the higher the degree of adherence to a poor quality diet, which carries a potential inflammatory effect. A multiple logistic regression analysis was used to assess the association between BC occurrence and diet quality, adjusting by body mass index. The mean score of women was 6.86 (1.83). Of total women studied, 20% were obese. A 39% increase in BC risk was observed for each unit of increase in the score in this group (Odds Ratio: 1.39; 95% Confidence Interval: 1086-1796). Obese women with poorer quality diet have a greater risk of BC occurrence in Córdoba (Argentina).

Association of the glycaemic index and glycaemic load with colorectal cancer in the population of Córdoba (Argentina): results of a case-control study using a multilevel modelling approach.

The glycaemic index (GI) and glycaemic load (GL) are involved in the aetiology of different diseases, and they could be related to the development of colorectal cancer (CRC). The aim of this study was to evaluate the association between the quality and quantity indicators of carbohydrates consumed by the population of Córdoba (Argentina) and the odds of developing CRC in 2008-2016 period. A case-control study was conducted with 492 participants (161/331 cases/controls), interviewed through a validated FFQ. Multilevel logistic regression models were used to assess the effect of GI, GL and the quantity or weekly intake of high-GI foods on CRC occurrence, following adjustment for individual/first-level covariates, and using level of urbanisation as the contextual variable. The models were stratified by sex. Participants in the highest v. lowest tertile of dietary GL and weekly intake of high-GI foods had increased odds of CRC presence in the entire sample (OR 1·64, 95 % CI 1·16, 2·34 and OR 1·11, 95 % CI 1·09, 1·14, respectively) and in women (OR 1·98, 95 % CI 1·24, 3·18 and OR 1·41, 95 % CI 1·09, 1·83, respectively). In men, the second tertile of GL and weekly intake of high-GI foods were associated with CRC (OR 1·44, 95 % CI 1·04, 1·99 and OR 1·48, 95 % CI 1·32, 1·65, respectively). Also, GI was associated with CRC in women (highest v. lowest tertile OR 2·12, 95 % CI 1·38, 3·27). In addition to the quantity and quality of carbohydrates intake, it is important to consider the frequency of consumption of high-GI foods in CRC prevention.

Increased inflammatory potential of diet is associated with increased odds of prostate cancer in Argentinian men.

PURPOSE: Various aspects of diet, including specific food items and nutrients, have been shown to modulate inflammation and have been implicated in the etiology of prostate cancer (PrCA). No study examining the role of diet-associated inflammation in PrCA has been conducted in Latin America. METHOD: We examined the association between the Dietary Inflammatory Index (DII®) and PrCA in a population-based case-control study in Córdoba, Argentina. A total of 153 incident cases of PrCA and 309 controls frequency matched on sex, age (± 5 years), and place of residence were recruited from 2008 to 2015. The DII was developed to determine the inflammatory potential of individuals' diets and was computed from a validated food frequency questionnaire using nutrient data from diet only. Multi-level logistic regression models were fit to evaluate the association between DII scores and PrCA, adjusting for age, body mass index, energy intake, and occupational exposure as first-level covariates and family history of prostate cancer as the second-level variable. Odds ratios were estimated in all subject and stratified by BMI (< 30 vs. ≥ 30 kg/m2). RESULTS: Men in the most pro-inflammatory group (tertile 3) had 50% higher odds of having PrCA compared to men in the most anti-inflammatory group (tertile 1) (ORtertile3 vs. tertile1 1.50; 95% CI 1.24-1.80). The odds of prostate cancer were higher in obese men (n = 109, ORtertile3 vs. tertile1 1.81; 95% CI 1.45-2.27), while no association was found among non-obese men (n = 375, ORtertile3 vs. tertile1 0.93; 95% CI 0.25-3.51). CONCLUSIONS: A pro-inflammatory diet, reflected by higher DII scores, was positively associated with PrCA occurrence. Based on these results and those from other studies, steps should be taken to promote a diet rich in anti-inflammatory foods, in order to reduce risk of PrCA and other chronic diseases. Future studies should explore this association in a prospective setting.

Do Exposure to Arsenic, Occupation and Diet Have Synergistic Effects on Prostate Cancer Risk?

Background: Diverse environmental exposures, as well as dietary and lifestyle factors, are associated with prostate cancer (PC) etiology; however little is known about joint interactive influences. The aim of this study was to analyse effects of diet combined with arsenic in drinking water and agricultural occupation on PC risk. Methods: A case-control study was conducted in Córdoba, Argentina (period 2008-2015) including 147 cases of PC and 300 controls. All subjects were interviewed about food consumption, socio-demographic and lifestyle characteristics. A sample of drinking water was taken to determine arsenic concentrations. Adherence scores to the Traditional Dietary Pattern were estimated, based on a principal component factor analysis. A two-level logistic regression model was fitted in order to assess effects of the Traditional Pattern, occupation and arsenic exposure on the occurrence of PC (outcome). Family history of PC was considered as a clustering variable. Results: PC risk was greatest in subjects with high adherence to the Traditional Pattern (OR 2.18; 95%IC 1.097­4.344). Subjects exposed to arsenic in drinking water above 0.01mg/l who simultaneously performed agricultural activities showed a markedly elevated PC risk (OR 5.07; 95%IC 2.074-12.404). Variance of the random effect of family history of PC was significant. conclusion: Diet, arsenic and occupation in agriculture exert significant effects on PC risk. Further efforts are necessary to analyse risk factors integrally, in order to achieve a better understanding of the complex causal network for PC in this multiple-exposure population.

Proinflammatory Dietary Intake is Associated with Increased Risk of Colorectal Cancer: Results of a Case-Control Study in Argentina Using a Multilevel Modeling Approach.

Little evidence regarding the inflammatory potential of diet and its effect on colorectal cancer exists in Latin American countries. The aim of the present study was to evaluate the association between the Dietary Inflammatory Index (DII®) and colorectal cancer (CRC) risk in Córdoba, Argentina. A frequency-matched case-control study (N = 446, including 144 (32.3%) CRC cases and 302 (67.7%) controls was conducted in Córdoba (Argentina) from 2008 through 2015. DII® scores were computed based on dietary intake assessed by a validated food frequency questionnaire (FFQ). Multilevel logistic regression models were fit to evaluate the association between DII scores and CRC, following adjustment for age, body mass index, sex, energy intake, smoking habits, socio-economic status, physical activity, and use of nonsteroidal anti-inflammatory drugs as first-level covariates and level of urbanization as the contextual variable. Odds of colorectal cancer increased linearly with increasing DII scores (ORcontinuous 1.34; 95%CI 1.07 to 1.69 and ORtertile3 vs. tertile1 1.21; 95%CI 1.01 to 1.44). The association was stronger among men than women (ORcontinuous 1.29; 95%CI 1.21 to 1.37 vs. ORcontinuous 1.05; 95%CI 0.83 to 1.33, respectively). A proinflammatory diet, reflected by higher DII scores, was positively associated with colorectal cancer occurrence, mainly in men.

Burden of cancer mortality and differences attributable to demographic aging and risk factors in Argentina, 1986-2011.

The world faces an aging population that implies a large number of people affected with chronic diseases. Argentina has reached an advanced stage of demographic transition and presents a comparatively high rate of cancer mortality within Latin America. The objectives of this study were to examine cancer mortality trends in the province of Córdoba, Argentina, between 1986 and 2011, and to analyze the differences attributable to risk variations and demographic changes. Longitudinal series of age-standardized mortality rates for overall, breast and prostate cancers were modeled by Joinpoint regression to estimate the annual percent change. The Bashir & Estève method was used to split crude mortality rate variation into three components: mortality risk, population age structure and population size. A decreasing cancer age-standardized mortality rates trend was observed (1986-2011 annual percent change: -1.4, 95%CI: -1.6, -1.2 in men; -0.8, 95%CI: -1.0, -0.6 in women), with a significant shift in 1996. There were positive crude mortality rate net changes for overall female cancer, breast and prostate cancers, which were primarily attributable to demographic changes. Inversely, overall male cancer crude mortality rate showed a 9.15% decrease, mostly due to mortality risk. Despite favorable age-standardized mortality rates trends, the influence of population aging reinforces the challenge to control cancer in populations with an increasingly aged demographic structure.

Burden of cancer mortality and differences attributable to demographic aging and risk factors in Argentina, 1986-2011 / Carga de mortalidad por cáncer y diferencias atribuibles al envejecimiento poblacional y factores de riesgo en Argentina, 1986-2011 / Carga de mortalidade por câncer e diferenças atribuíveis ao envelhecimento populacional e fatores de risco na Argentina, 1986-2011

Abstract: The world faces an aging population that implies a large number of people affected with chronic diseases. Argentina has reached an advanced stage of demographic transition and presents a comparatively high rate of cancer mortality within Latin America. The objectives of this study were to examine cancer mortality trends in the province of Córdoba, Argentina, between 1986 and 2011, and to analyze the differences attributable to risk variations and demographic changes. Longitudinal series of age-standardized mortality rates for overall, breast and prostate cancers were modeled by Joinpoint regression to estimate the annual percent change. The Bashir & Estève method was used to split crude mortality rate variation into three components: mortality risk, population age structure and population size. A decreasing cancer age-standardized mortality rates trend was observed (1986-2011 annual percent change: -1.4, 95%CI: -1.6, -1.2 in men; -0.8, 95%CI: -1.0, -0.6 in women), with a significant shift in 1996. There were positive crude mortality rate net changes for overall female cancer, breast and prostate cancers, which were primarily attributable to demographic changes. Inversely, overall male cancer crude mortality rate showed a 9.15% decrease, mostly due to mortality risk. Despite favorable age-standardized mortality rates trends, the influence of population aging reinforces the challenge to control cancer in populations with an increasingly aged demographic structure.

Resumen: El mundo enfrenta el fenómeno del envejecimiento poblacional, con grandes contingentes de individuos afectados por enfermedades crónicas. Entre los países de América Latina, Argentina ya alcanzó un nivel avanzado en la transición demográfica y presenta una tasa relativamente alta de mortalidad por cáncer. El estudio tuvo como objetivos: examinar las tendencias en la mortalidad por cáncer en la provincia de Córdoba, Argentina, entre 1986 y 2011, y analizar las diferencias atribuibles a variaciones de riesgo y cambios demográficos. Para estimar la variación porcentual anual, se elaboraron modelos de series longitudinales de la tasa de mortalidad estandarizada por edad para todos los cánceres y, específicamente, para mama y próstata utilizando regresión Joinpoint. Se utilizó el método de Bashir & Estève para dividir la variación de la tasa bruta de mortalidad en tres componentes: riesgo de mortalidad, estructura etaria poblacional y tamaño de la población. Se observó una tendencia decreciente en la tasa de mortalidad estandarizada por edad por cáncer (variación porcentual annual 1986-2011: -1,4; IC95%: -1,6; -1,2 en hombres; -0,8; IC95%: -1,0; -0,6 en mujeres), con un cambio significativo en 1996. Las tasas brutas de mortalidad aumentaron para todos los cánceres en mujeres, y de mama y próstata, lo cual fue atribuible principalmente a cambios demográficos. Inversamente, la tasa bruta de mortalidad para todos los cánceres en hombres mostró una caída de 9,15%, influenciada básicamente por el riesgo de mortalidad. A pesar de las tendencias favorables en la tasa de mortalidad estandarizada por edad, la influencia del envejecimiento poblacional refuerza el desafío del control de cáncer en poblaciones con una estructura etaria cada vez más envejecida.

Resumo: O mundo enfrenta o fenômeno do envelhecimento populacional, com grandes contingentes de indivíduos afetados por doenças crônicas. Entre os países da América Latina, a Argentina já atingiu um patamar avançado na transição demográfica e apresenta uma taxa relativamente alta de mortalidade por câncer. O estudo teve como objetivos, examinar as tendências na mortalidade por câncer na província de Córdoba, Argentina, entre 1986 e 2011, e analisar as diferenças atribuíveis a variações de risco e mudanças demográficas. Para estimar a variação percentual anual, a regressão Joinpoint foi utilizada para elaborar modelos de séries longitudinais da taxa de mortalidade padronizada por idade para todos os cânceres e especificamente para mama e próstata. Foi utilizado o método de Bashir & Estève para dividir a variação da taxa bruta de mortalidade em três componentes: risco de mortalidade, estrutura etária populacional e tamanho da população. Observou-se uma tendência decrescente na taxa de mortalidade padronizada por idade por câncer (variação percentual annual 1986-2011: -1,4; IC95%: -1,6; -1,2 em homens; -0.8, IC95%: -1,0; -0.6 em mulheres), com um deslocamento significativo em 1996. As taxas brutas de mortalidade aumentaram para todos os cânceres em mulheres, e de mama e próstata, atribuíveis principalmente a mudanças demográficas. Inversamente, a taxa bruta de mortalidade para todos os cânceres em homens mostrou uma queda de 9,15%, influenciada basicamente pelo risco de mortalidade. Apesar de tendências favoráveis na taxa de mortalidade padronizada por idade, a influência do envelhecimento populacional reforça o desafio do controle de câncer em populações com estrutura etária cada vez mais envelhecida.

Traditional Dietary Pattern Increases Risk of Prostate Cancer in Argentina: Results of a Multilevel Modeling and Bias Analysis from a Case-Control Study.

There is increasing evidence that dietary habits play a role in prostate cancer (PC) occurrence. Argentinean cancer risk studies require additional attention because of the singular dietary pattern of this population. A case-control study (147 PC cases, 300 controls) was conducted in Córdoba (Argentina) throughout 2008-2013. A principal component factor analysis was performed to identify dietary patterns. A mixed logistic regression model was applied, taking into account family history of cancer. Possible bias was evaluated by probabilistic bias analysis. Four dietary patterns were identified: Traditional (fatty red meats, offal, processed meat, starchy vegetables, added sugars and sweets, candies, fats, and vegetable oils), Prudent (nonstarchy vegetables, whole grains), Carbohydrate (sodas/juices and bakery products), and Cheese (cheeses). High adherence to the Traditional (OR 2.82, 95%CI: 1.569-5.099) and Carbohydrate Patterns (OR 2.14, 95%CI: 1.470-3.128) showed a promoting effect for PC, whereas the Prudent and Cheese Patterns were independent factors. PC occurrence was also associated with family history of PC. Bias adjusted ORs indicate that the validity of the present study is acceptable. High adherence to characteristic Argentinean dietary patterns was associated with increased PC risk. Our results incorporate original contributions to knowledge about scenarios in South American dietary patterns and PC occurrence.

[Trends in mortality from breast cancer in Córdoba, Argentina, 1986-2011: some socio-historical interpretations]. / Tendencias de mortalidad por cáncer de mama en Córdoba, Argentina, 1986­2011: algunas interpretaciones sociohistóricas.

OBJECTIVE: Analyze and interpret trends in mortality from breast cancer in recent decades in the province of Córdoba, Argentina, relative to demographic changes and the sociopolitical context. METHODS: Raw, standardized (direct method), and age-specific mortality from breast cancer was calculated for 1986-2011 in Córdoba. Using RiskDiff® software, variations in the 1986 to 2011 raw rates were analyzed. Joinpoint regression models were adjusted to standardized and specific rates by age group. Secondary data sources (laws, decrees, health programs) were consulted for information on the sociopolitical context of the period. RESULTS: Raw mortality due to breast cancer increased 24.97% from 1986 to 2011, an increase that can be attributed to the increase in the risk of dying (5.22%), to structural changes (19.75%), and to population size (39.66%). Standardized mortality from breast cancer shows a rising trend up to 1996 (annual percentage change [APC] = 1.62%; P <0.05), and then begins to decline (APC = -2.1%; P <0.05), slowing around the year 2001. For socio-historical interpretations, the analysis focused on demographic, epidemiological, and health-related changes, as well as the socioeconomic and political events of the period studied. CONCLUSIONS: The behavior of mortality from breast cancer in this period is associated with contextual factors (demographic, historical, economic, and political). The results of this study will help define actions and policies in breast cancer and women's health care.

Tendencias de mortalidad por cáncer de mama en Córdoba, Argentina, 1986-2011: algunas interpretaciones sociohistóricas / Trends in mortality from breast cancer in Córdoba, Argentina, 1986-2011: some socio-historical interpretations

OBJETIVO: Analizar e interpretar las tendencias de mortalidad por cáncer de mama (CM) en las últimas décadas en la provincia de Córdoba, Argentina, en función de los cambios demográficos y características del contexto sociopolítico. MÉTODOS: Se calcularon tasas de mortalidad por CM crudas, estandarizadas (método directo) y específicas por edad, para Córdoba, en el período 1986-2011. Mediante la aplicación RiskDiff®, se analizó la variación observada en las tasas crudas entre 1986 y 2011. Se ajustaron modelos de regresión Joinpoint® a las tasas estandarizadas y específicas por grupos etarios. Se consultaron fuentes de datos secundarias (leyes, decretos, programas de salud) para obtener información sobre el contexto sociopolítico del período estudiado. RESULTADOS: La tasa cruda de mortalidad por CM aumentó 24,97% entre 1986 y 2011, siendo esto atribuible a un aumento del riesgo de morir (5,22%), a cambios en la estructura (19,75%) y al tamaño poblacional (39,66%). La tasa estandarizada de mortalidad por CM presentó tendencia creciente hasta 1996 (porcentaje de cambio anual [PCA] = 1,62%; P < 0,05), y luego comienza a descender (PCA = -2,1%; P < 0,05), advirtiéndose una desaceleración alrededor del año 2001. Para las interpretaciones sociohistóricas, se consideraron como ejes de análisis las transiciones demográfica, epidemiológica y sanitaria, así como hechos socioeconómicos y políticos del período estudiado. CONCLUSIONES: El comportamiento de la mortalidad por CM en este período se asocia a factores de índole contextual (demográficos, históricos, económicos, políticos). Los resultados de este trabajo contribuyen a definir acciones y políticas en torno la problemática del CM y en materia del cuidado de salud de las mujeres.

OBJECTIVE: Analyze and interpret trends in mortality from breast cancer in recent decades in the province of Córdoba, Argentina, relative to demographic changes and the sociopolitical context. METHODS: Raw, standardized (direct method), and age-specific mortality from breast cancer was calculated for 1986-2011 in Córdoba. Using RiskDiff® software, variations in the 1986 to 2011 raw rates were analyzed. Joinpoint regression models were adjusted to standardized and specific rates by age group. Secondary data sources (laws, decrees, health programs) were consulted for information on the sociopolitical context of the period. RESULTS: Raw mortality due to breast cancer increased 24.97% from 1986 to 2011, an increase that can be attributed to the increase in the risk of dying (5.22%), to structural changes (19.75%), and to population size (39.66%). Standardized mortality from breast cancer shows a rising trend up to 1996 (annual percentage change [APC] = 1.62%; P <0.05), and then begins to decline (APC = -2.1%; P <0.05), slowing around the year 2001. For socio-historical interpretations, the analysis focused on demographic, epidemiological, and health-related changes, as well as the socioeconomic and political events of the period studied. CONCLUSIONS: The behavior of mortality from breast cancer in this period is associated with contextual factors (demographic, historical, economic, and political). The results of this study will help define actions and policies in breast cancer and women's health care.