Perspectivas de la investigación científica sobre obesidad

Transcription

1 Perspectivas de la investigación científica sobre obesidad Jaime Miranda, MD, PhD Lima, 25 abril 2017

2 Conflict of interests About me MD, PhD Epidemiology CRONICAS Centre of Excellence in Chronic Diseases Funding Wellcome Trust, NIH, IDRC, WHO, GCC No pharma funding

3 Our values Generosity Innovation Integrity Quality

4 @jjaimemiranda [Disclaimer]

5 Chronic undernutrition

6 Latinoamérica 6

7 Burgeoning cities face catastrophe, says UN Source: The Guardian, June 28,

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9 NCD Global Monitoring Framework

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11 Chronic undernutrition

12 Peru Height Source:

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14 Global BMI If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19 2 million participants Lancet 2016; 387:

15 Peru BMI prevalence Source:

16 NCD Global Monitoring Framework

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20 Transitions Nutritional Epidemiological 20

21 Source: Rev Peru Med Exp Salud Publica 2012;29(3):

22 A high load and a low capacity are each predicted to increase blood pressure Grijalva-Eternod CS, Lawlor DA, Wells JCK (2013) Testing a Capacity-Load Model for Hypertension: Disentangling Early and Late Growth Effects on Childhood Blood Pressure in a Prospective Birth Cohort. PLoS ONE 8(2): e doi: /journal.pone

23 Chronic undernutrition

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26 PERU MIGRANT Study Source: Heart 2011;97:787-96

27 Setting Rural Ayacucho Urban Lima Migrants

28 Prevalence of CVD risk factors Current smoking Low physical activity Obesity Overweight & Obese Hypertension Diabetes IFG & Diabetes Hypercholesterolemia Metabolic Syndrome Age-standardized prevalences (95% CI) Rural Urban Migrant 95% CI 28

29 Aggregation of CVD risk factors None 77 Rural None 41 Migrant None 28 Urban Number of major CVD risk factors (%) 29

30 Obesity incidence

31 Hypertension incidence

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35 CRONICAS Cohort Study

36 Specific Aims 1. Determine the CVD risk factors in three sites at different stages of urbanization 2. Estimate disease progression to hypertension and diabetes from a baseline disease-free status 3. Estimate the prevalence of COPD 4. Characterize the longitudinal rate of decline in lung function

37 Settings

38 Site: Lima, urban Pueblo Joven 38

39 Site: rural Puno, near Bolivian border 39

40 Site: Tumbes, near Ecuadorian border

41 Co-morbidities

42 GBD The Lancet, June 2015 Source: The Lancet DOI: ( /S (15) )

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44 Stupidity vs. altruism? For many social entrepreneurs, happiness comes from the feeling they are making a difference.

45 Target: Prevention of hypertension

46 Design of mhealth SMS

47 Humans = different behaviours

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49 Dose-response

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51 The other side Source: PLoS One 2014;9(12):e

52 What s behind low-adherence? Beliefs of harm about medications and concerns about antihypertensive drugs higher in the low adherence group. Higher scores on ideas of harm were 52% less likely of being high adherents. Higher scores on concerns were 41% less likely of being high adherents. Patients whose ideas of necessity outweighed their concerns more likely to be adherent (PR 2.65; 95% CI ).

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55 Target youngsters

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58 Target: Point of sale purchases

59 No intervention

60 Experiment: Fruit location + price reduction

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63 Urban health

64 Health systems

65 Our values Generosity Innovation Integrity Quality

66 @jjaimemiranda

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