Cross-sectional and longitudinal associations of Iron biomarkers and cardiovascular risk factors in pre- and postmenopausal women: leveraging repeated measurements to address natural variability.

BACKGROUND: The association between iron biomarkers and cardiovascular disease risk factors (CVD-RFs) remains unclear. We aimed to (1) evaluate the cross-sectional and longitudinal associations between iron biomarkers (serum ferritin, transferrin saturation (TSAT), transferrin) and CVD-RFs among women, and (2) explore if these associations were modified by menopausal status. METHOD: Cross-sectional and longitudinal analyses including 2542 and 1482 women from CoLaus cohort, respectively. Multiple linear regression and multilevel mixed models were used to analyse the associations between Iron biomarkers and CVD-RFs. Variability of outcomes and iron markers between surveys was accessed using intraclass correlation (ICC). RESULTS: After multivariable adjustment, elevated serum ferritin levels were associated with increased insulin and glucose levels, while higher transferrin levels were linked to elevated glucose, insulin and total cholesterol, and systolic and diastolic blood pressure (p < 0.05). No association was observed between CVD-RFs and TSAT (p > 0.05). Iron biomarkers demonstrated low reliability across reproductive stages but exhibited stronger associations in the perimenopausal group. In longitudinal analysis, we found association only for transferrin with lower glucose levels [ß = - 0.59, 95% CI (- 1.10, - 0.08), p = 0.02] and lower diastolic blood pressure [ß = - 7.81, 95% CI (- 15.9, - 0.56), p = 0.04]. CONCLUSION: In cross-sectional analysis, transferrin was associated with several CVD-RFs, and the associations did not change according to menopausal status. Conversely, in the longitudinal analyses, changes in transferrin were associated only with lower glucose and diastolic blood pressure levels. These differences might stem from the substantial longitudinal variation of iron biomarkers, underscoring the need for multiple iron measurements in longitudinal analyses.

Development, validation, and application of a machine learning model to estimate salt consumption in 54 countries.

Global targets to reduce salt intake have been proposed, but their monitoring is challenged by the lack of population-based data on salt consumption. We developed a machine learning (ML) model to predict salt consumption at the population level based on simple predictors and applied this model to national surveys in 54 countries. We used 21 surveys with spot urine samples for the ML model derivation and validation; we developed a supervised ML regression model based on sex, age, weight, height, and systolic and diastolic blood pressure. We applied the ML model to 54 new surveys to quantify the mean salt consumption in the population. The pooled dataset in which we developed the ML model included 49,776 people. Overall, there were no substantial differences between the observed and ML-predicted mean salt intake (p<0.001). The pooled dataset where we applied the ML model included 166,677 people; the predicted mean salt consumption ranged from 6.8 g/day (95% CI: 6.8-6.8 g/day) in Eritrea to 10.0 g/day (95% CI: 9.9-10.0 g/day) in American Samoa. The countries with the highest predicted mean salt intake were in the Western Pacific. The lowest predicted intake was found in Africa. The country-specific predicted mean salt intake was within reasonable difference from the best available evidence. An ML model based on readily available predictors estimated daily salt consumption with good accuracy. This model could be used to predict mean salt consumption in the general population where urine samples are not available.

Mean blood pressure according to the hypertension care cascade: Analysis of six national health surveys in Peru.

BACKGROUND: While we have good evidence about the hypertension care cascade, we do not know the mean blood pressure (BP) in these groups. We described the mean BP in four groups based on the hypertension care cascade at the national and sub-national levels in Peru. METHODS: Descriptive analysis of six national health surveys. Blood pressure was measured twice and the second record herein analysed. We defined four groups: i) people with self-reported hypertension diagnosis receiving antihypertensive medication; ii) people with self-reported hypertension diagnosis not receiving antihypertensive medication; iii) people unaware they have hypertension with blood pressure ≥140 or 90 mmHg; and iv) otherwise healthy people. FINDINGS: There were 125,066 people; mean age was 49.8 years and there were more women (51.7%). At the national level, in men and women and throughout the study period, we observed that the mean systolic BP (SBP) was the highest in people unaware they have hypertension; the mean SBP was similar between those with and without antihypertension medication, yet slightly higher in the former group. At the sub-national level, even though the mean SBP in the unaware group was usually the highest, there were some regions and years in which the mean SBP was the highest in the untreated and treated groups. INTERPRETATION: These results complement the hypertension care cascade with a clinically relevant parameter: mean BP. The results point where policies may be needed to secure effective interventions to control hypertension in Peru, suggesting that improving early diagnosis and treatment coverage could be priorities. FUNDING: Wellcome Trust (214185/Z/18/Z).

Progresión del deterioro cognitivo y su relación con factores de riesgo modificables en una cohorte de adultos / Progression of cognitive impairment and its relation to modifiable risk factors in a cohort of adults

Resumen Un estudio de corte transversal realizado entre 2012-2014 en adultos autónomos de Bogotá, mostró una prevalencia de 23% de demencia, encontrándose asociada con baja escolaridad, edad avanzada e hipertensión arterial. La relación de estos factores de riesgo con la progresión del dete rioro cognitivo no ha sido estudiada en nuestra población. Objetivo: evaluar la asociación entre factores de riesgo cardiometabólicos o sociales con la progresión a deterioro cognitivo leve (DCL) o demencia, en adultos autónomos de Bogotá. Material y métodos: una cohorte de sujetos normales y con DCL, del estudio de 2012-2014, se revaluó aplicándose el protocolo neuropsiquiátrico y neuropsicológico del estudio anterior. Se realizaron análisis de correspondencia múltiple y de regresión logística. Resultados: se revaluaron 215 adultos autónomos, 118 sujetos habían sido diagnosticados con cognición normal y 97 con DCL en el primer estudio; 73% fueron mujeres con edad promedio de 71(DE:7.3) años y escolaridad de 8.2 (DE: 5.4) años. Progresaron a demencia 6% de los sujetos en un tiempo de 4(DE:1) años. Un 75% de sujetos normales permaneció sin cambio y 22% progresó a DCL; mientras que 65% de sujetos con DCL no tuvo cambios y un 25% se normalizó. Progresar de normal a DCL se asoció con baja escolaridad OR=2.43 (IC95% 1.004-5.91; p=0.049) y de DCL a demencia con IMC<25 OR=6.3 (IC95% 1.26-31; p=0.025). Conclusión: tener baja escolaridad (<5 años) se asoció en los sujetos normales con un mayor riesgo de progresión a DCL, mientras que tener un IMC <25 aumentó el riesgo de progresión a demencia en los sujetos con DCL. No identificamos factores protectores en los sujetos que se nor malizaron. (Acta Med Colomb 2019; 44: 66-74).

Abstract A cross-sectional study carried out between 2012-2014 in autonomous adults of Bogotá showed a 23% prevalence of dementia, being associated with low schooling, advanced age and arterial hy pertension. The relationship between these risk factors and the progression of cognitive deterioration has not been studied in our population. Objective: to evaluate the association between cardio-metabolic or social risk factors with the progression to mild cognitive impairment (MCI) or dementia, in autonomous adults of Bogotá. Material and methods: a cohort of normal subjects with MCI, from the 2012-2014 study was re-evaluated applying the neuropsychiatric and neuropsychological protocol of the previous study. Multiple correspondence and logistic regression analyzes were performed. Results: 215 autonomous adults were re-evaluated; 118 subjects had been diagnosed with normal cognition and 97 with MCI in the first study; 73% were women with an average age of 71 (SD: 7.3) years and schooling of 8.2 (SD: 5.4) years. 6% of the subjects progressed to dementia in a time of 4 (SD: 1) years. 75% of normal subjects remained unchanged and 22% progressed to MCI while 65% of subjects with MCI did not change and 25% normalized. Progressing from normal to MCI was associated with low schooling OR = 2.43 (95% CI 1.004-5.91; p = 0.049) and from MCI to dementia with BMI≤25 OR = 6.3 (IC95% 1.26-31; p = 0.025). Conclusion: having low schooling (≤5 years) was associated in normal subjects with a higher risk of progression to MCI, while having a BMI ≤25 increased the risk of progression to dementia in subjects with MCI. Protective factors in subjects who normalized were not identified. (Acta Med Colomb 2019; 44: 66-74).

Associations between self-reported physical activity and screen time with cardiometabolic risk factors in adolescents: Findings from the 1993 Pelotas (Brazil) Birth Cohort Study.

The overall aim of this study was to examine the association of physical activity (PA) and screen time (ST) on indicators of cardio-metabolic risk during adolescence, by examining the combined association of PA and ST at ages 11, 15 and 18 on cardio-metabolic risk factors at 18 years. Data from the 1993 Pelotas (Brazil) Birth Cohort Study (N = 3613) were analysed in 2017. Self-reported PA and ST data were collected at 11, 15 and 18 years. Cardio-metabolic risk factors (fat mass index, waist circumference, triglycerides, blood glucose, non-HDL cholesterol and resting diastolic blood pressure) were examined at age 18. Multivariate linear regression was used to examine the associations between four mutually exclusive PA/ST groups: 1) active (≥1 h/day PA) and low ST (<5 h/day ST); 2) active (≥1 h/day PA) and high ST (≥5 h/day ST); 3) inactive (<1 h/day PA) and low ST (<5 h/day ST); 4) inactive (<1 h/day PA) and high ST (≥5 h/day ST) at each age, and outcomes at age 18. There were no significant associations between PA/ST at ages 11 and 15 with outcomes at 18 years. In the cross-sectional analyses, adolescents in the most active group had significantly better levels of all the outcomes, regardless of ST. Inactive participants with high ST had the highest levels of glucose and non-HDL-C. For diastolic blood pressure, values were higher among inactive participants. Overall, higher levels of physical activity appeared to be more important than low levels of ST for cardio-metabolic health in adolescents.

Obesity and cardio-metabolic risk factors in Ecuadorian university students. First report, 2014-2015.

OBJECTIVE: Overweight and obesity are risk factors for developing cardiovascular disease. The objective of this study was to determine the prevalence of obesity and risk factors associated with metabolic syndrome and cardiovascular disease in university students. METHODS: 883 students from the Faculty of Medical Sciences of the Central University of Ecuador were included, who were surveyed with demographic data, smoking habits and physical activity. Body mass index, abdominal circumference and blood pressure were determined. Blood chemistry and lipid profile were performed. Central tendency and dispersion measures, average comparisons (Student's T) and Pearson's correlation were calculated to study quantitative variables and χ2 distributed statistic for the comparison of qualitative variables. RESULTS: The prevalence of overweight and obesity was 25.5%. The body mass index was similar in both sexes (23.15 women / 23.57 men), waist circumference was higher in women. Men had higher than normal levels in blood pressure and elevated triglycerides while women had high cholesterol. CONCLUSIONS: One of four students presents some degree of overweight or obesity and an important percentage of altered levels of plasma lipids and blood pressure. Blood glucose levels were found in normal ranges.

Prevalence of abdominal obesity and its association with cardio metabolic risk factors among older adults in Ecuador.

AIMS: To describe the prevalence of abdominal obesity and its association with cardio metabolic risk factors among older adults in Ecuador. MATERIALS AND METHODS: The present study used data from the National Survey of Health, Wellbeing, and Aging survey to examine the prevalence of abdominal obesity according to certain demographic, behavioral, and health characteristics of the participants. Logistic regression models adjusted for potential confounders were used to evaluate the association of abdominal obesity with cardio metabolic risk factors. RESULTS: Of 2053 participants aged 60 years and older, the prevalence of abdominal obesity was 65.9% (95% CI; 62.2%, 69.4%) in women and 16.3% (95% CI; 13.8%, 19.2%) in men. Notably, a higher prevalence of abdominal obesity was seen among residents in the urban areas of the country, those who reported their race as black or mulatto, individuals with sedentary lifestyle and obesity, and older adults with greater number of comorbidities. Moreover, after adjustment for potential confounders, women with abdominal obesity were 2.0, 2.8, and 1.6 times more likely to have diabetes, the metabolic syndrome, and hypertriglyceridemia as compared with those without, respectively. Likewise, men with abdominal obesity had 51% and 22% higher rates of hypertension and diabetes than their non-obese counterparts, respectively. CONCLUSIONS: the prevalence of abdominal obesity is high among older adults in Ecuador. Moreover, abdominal obesity is significantly associated with cardio metabolic risk factors. Therefore, further research is needed to evaluate sociodemographic and nutritional determinants of this emerging public health burden among older Ecuadorians.

Actividad física, condición física y factores de riesgo cardio-metabólicos en adultos jóvenes de 18 a 29 años / Physical activity, physical condition and cardio-metabolic risk factors in young adults aged 18 to 29

Introducción. La actividad física y condición física son determinantes de los factores de riesgo cardiometabólicos, pudiendo influenciar en la incidencia de enfermedades crónicas no transmisibles. Objetivos. Analizar la asociación entre nivel de actividad física, condición física y factores de riesgo cardio-metabólicos en adultos jóvenes. Diseño. Estudio observacional, analítico y transversal. Lugar. Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú. Participantes. Estudiantes de pregrado de las escuelas académico profesionales. Intervenciones. La muestra fue no probabilística, seleccionada por conveniencia, estuvo conformada por 149 hombres y mujeres que consintieron voluntariamente su participación. Se excluyó aquellos con patología cardiaca, metabólica o discapacidad física que impidiera realizar las evaluaciones. Principales medidas de resultados. Nivel de actividad física (NAF), condición física, factores de riesgo cardio-metabólicos. Resultados. El 48,9% de participantes presentó NAF alta; 53,7% tenía uno o dos factores de riesgo alterados: HDL-colesterol bajo (43%), hipertensión (8,7%), hiperglicemia (4%), hipertrigliceridemia (2,7%). El 40,9% de mujeres y 35,6% de varones lograron resultados óptimos en la evaluación de resistencia cardio-respiratoria. El 49% de varones y 34,9% de mujeres alcanzaron resultados óptimos en la evaluación de fuerza abdominal. El 94,6% y 53,7% de participantes tuvieron resultados regulares o deficientes en las evaluaciones de fuerza de miembros inferiores y superiores, respectivamente. Conclusiones. El nivel de actividad física alto estuvo asociado al sexo masculino, presión arterial alta, hipertrigliceridemia, sobrepeso/obesidad, y resultados óptimos de resistencia cardio-respiratoria y fuerza abdominal, en los sujetos estudiados.

Introduction: Physical activity and physical condition are determinants of cardio-metabolic risk factors, and may influence the incidence of chronic non-communicable diseases. Objectives: To analyze the association between physical activity level, physical condition and cardio-metabolic risk factors in young adults. Design: Observational, analytical and transversal study. Setting: Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru. Participants: Graduate students from professional academic schools. Interventions: The sample was non-probabilistic, selected by convenience, it was formed by 149 men and women who voluntarily consented to participate. Those with cardiac, metabolic or physical disability which prevented the evaluation were excluded. Main outcome measures: Physical activity level (PAL), physical condition, cardio-metabolic risk factors. Results: 48.2% of the participants had high PAL. 53.7% had one or two altered cardio-metabolic risk factors: low HDL-cholesterol (43%), hypertension (8,7%), hyperglycemia (4%),hypertriglyceridemia (2.7%). 40.9% of women and 35.6% of men achieved optimal results in the evaluation of cardio-respiratory resistance. 49% of males and 34.9% of females obtained optimal results in abdominal strength assessment. 94.6% and 53.7% of participants achieved regular or deficient results in strength assessments of lower and upper limbs, respectively. Conclusions: In the subjects studied, high physical activity level was associated with the male sex, arterial hypertension, hypertriglyceridemia, overweight / obesity, and optimal results of cardio-respiratory resistance and abdominal muscle strength tests.