Latin America and the Caribbean / Amérique latine et Caraïbes

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    Relationship between smoking and health and education spending in Chile
    (BMJ Publishing Group Ltd / Tab Control, 2017-09) Paraje, Guillermo; Araya, Daniel
    Objective: To estimate the degree to which tobacco consumption is associated with spending on a set of goods and services in Chile, especially health and education, for the total population as well as for specific subgroups.
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    Contenido de azúcares en bebidas no alcohólicas comercializadas en Argentina y Costa Rica
    (Dirección de Investigación para la Salud, 2017-03) Tiscornia, María Victoria; Heredia-Blonval, Katrina; Allemandi, Lorena; Blanco-Metzler, Adriana; Ponce, Miguel
    INTRODUCCIÓN: El consumo de bebidas azucaradas está vinculado con un mayor riesgo de obesidad. OBJETIVOS: Comparar el contenido de azúcares declarado en el etiquetado nutricional de diferentes bebidas no alcohólicas comercializadas en Argentina y Costa Rica. MÉTODOS: Se recogieron datos de azúcares reportados en 13 categorías de bebidas no alcohólicas comercializadas en supermercados en 2012 y 2013. En ambos países se calculó la media de azúcares en una porción estándar de 200 ml. RESULTADOS: Dentro de las bebidas no alcohólicas comercializadas en Argentina (n=287) y Costa Rica (n=495) predominaron las azucaradas (77,6%), de las cuales la mayoría (56%; n=435) mostró contenidos de azúcares por encima del 20% del valor diario recomendado por la Organización Mundial de la Salud. Costa Rica presentó en promedio niveles superiores a los de Argentina. Las categorías con mayor contenido de azúcares en Costa Rica fueron: néctares (24,7 g/200 ml), jugos de fruta (22,5 g/200 ml) y gaseosas regulares (22,5 g/200 ml). En Argentina, gaseosas regulares (20,9 g/200 ml), jugos de fruta (18,5 g/200 ml) y bebidas a base de soja (14,9 g/200 ml). CONCLUSIONES: Este es el primer estudio que analiza y compara el contenido de azúcares de bebidas no alcohólicas en dos países latinoamericanos. El alto contenido observado y la elevada prevalencia de sobrepeso y obesidad en la región evidencian la necesidad de establecer políticas públicas para reducir el consumo de bebidas azucaradas.
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    Analysis of a voluntary initiative to reduce sodium in processed and ultra-processed food products in Argentina : the views of public and private sector representatives
    (Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2017) Castronuovo, Luciana; Allemandi, Lorena; Tiscornia, Victoria; Champagne, Beatriz; Campbell, Norm; Schoj, Veronica
    This study is part of a comprehensive quantitative and qualitative research strategy to monitor sodium reduction policies in Argentina. The qualitative study design aims to contribute to the body of research in the public health sector regarding voluntary initiatives and public-private partnerships (PPPs) towards prevention of non-communicable diseases, and to understand the policy process of PPPs from stakeholders’ perspectives. Objectives include: (1) to identify the role and resources of the different major stakeholders; (2) analyze the main challenges and controversies perceived by stakeholders; and (3) analyze stakeholders’ perspectives concerning mandatory vs. voluntary initiatives. The article discusses the initiative’s challenges and controversies.
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    Effects of licensed characters on children's taste and snack preferences in Guatemala, a low/middle income country
    (Macmillan Publishers, 2014-03) Letona, P.; Chacon, V.; Roberto, C.; Barnoya, J.
    BACKGROUND: Marketing of high-energy, low-nutrient foods is one of the contributing factors to the obesity-promoting environment. Licensed characters are typically used to market these foods to children because they increase brand recognition and sales, and data suggest that they affect the taste and snack preferences of children in high-income countries, but it has not yet been explored in low/middle income countries (LMICs). We sought to examine how licensed characters on food packaging influence children's taste and snack preferences in Guatemala, a LMIC. METHODS: One hundred twenty-one children (mean ± s.d. age, 7.4 ± 1.9 years) from four (two preschool and two elementary) public schools in Guatemala tasted three food types: potato chips, crackers and carrots. Each was presented in two identical packages, except that one had a licensed character and the other did not. Children tasted the foods (six total) in each package and answered whether they tasted the same or one tasted better. Snack preference was also evaluated. RESULTS: Children were significantly (Po0.001) more likely to prefer the taste of the foods inside the package with the licensed character compared with the one with no character (mean ± s.d., 0.24 ± 0.54). Most (66%) chose the food in the package with the character for a snack. Younger children (Po0.001) were more likely to prefer the taste of the food inside the package with the character. CONCLUSIONS: Licensed characters on food packaging influence Guatemalan children's taste and snack preferences. Given that these characters are typically used to promote high-energy, low-nutrient foods, their influence could contribute toward overconsumption of these foods and consequently increased risk of obesity in Guatemalan children. Therefore, public health advocates, in Guatemala and elsewhere, might explore restricting the use of licensed characters on food packaging as a public health strategy.
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    Child-oriented marketing techniques in snack food packages in Guatemala
    (BioMed Central, 2013) Chacon, Violeta; Letona, Paola; Barnoya, Joaquin
    The study assesses availability of child-oriented snack foods in school kiosks and convenience stores near public schools in Guatemala, and identifies marketing techniques used in packaging. Evidence-based policies restricting the use of promotional characters in unhealthy snack food packages need to be explored as a strategy for control of obesity. Child-oriented marketing was identified as packaging that had promotional characters, premium offers, children′s television/movie tie-ins, sports references, or included the word “child.” 55 stores and street-vendors were assessed. This study is the first to document unhealthy snack foods’ advertising strategies targeted to children in a low income country (LMIC).
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    Projected impact of a sodium consumption reduction initiative in Argentina : an analysis from the CVD policy model - Argentina
    (PLOS, 2013-09) Konfino, Jonatan; Mekonnen, Tekeshe A.; Coxson, Pamela G.; Ferrante, Daniel; Bibbins-Domingo, Kirsten
    Sodium reduction policies targeting processed foods were implemented in 2011 in Argentina. The impact of the Argentinean initiative to reduce sodium consumption should substantially reduce mortality and morbidity from cardiovascular disease. This paper provides evidence-based support to continue implementing strategies to reduce sodium consumption at a population level. The aims of this study are to use Argentina-specific data on sodium excretion and project the impact of Argentina’s sodium reduction policies under two scenarios - the 2-year intervention currently being undertaken or a more persistent 10 year sodium reduction strategy.
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    Avances en la reducción del consumo de sal y sodio en Costa Rica
    (Organización Panamericana de la Salud, Washington, DC, 2012) Blanco-Metzler, Adriana; de los Angeles Montero Campos, María; Núñez-Rivas, Hilda; Gamboa-Cerda, Cecilia; Sánchez, Germana
    En el presente artículo se describen los avances logrados en Costa Rica -así como los desafíos y limitaciones- en la reducción del consumo de sal. El establecimiento del Plan Nacional para la Reducción del Consumo de Sal/sodio en la Población de Costa Rica 2011 - 2021 se complementó con programas y proyectos multisectoriales específicos dirigidos a: 1) conocer la ingesta de sodio y el contenido de sal o sodio en los alimentos de mayor consumo; identificar los conocimientos, actitudes y comportamientos del consumidor respecto a la sal/sodio, su relación con la salud y el etiquetado nutricio-nal; evaluar la relación costo-efectividad de las medidas dirigidas a reducir la prevalencia de hipertensión arterial; 2) implementar estrategias para disminuir el contenido de sal/sodio en los alimentos procesados y los preparados en casa; 3) promover cambios de conducta en la población para reducir el consumo de sal en la alimentación; y 4) monitorear y evaluar las acciones dirigidas a reducir el consumo de sal o sodio en la población. Para alcanzar las metas propuestas se debe lograr una exitosa coordinación interinstitucional con los actores estratégicos, negociar compromisos con la industria alimentaria y los servicios de alimentación, y mejorar la regulación de los nutrientes críticos asociados con las enfermedades crónicas no transmisibles, en los alimentos. Se espera que a partir de los avances logrados durante la ejecución del Plan Nacional, Costa Rica logre alcanzar la meta internacional de reducción del consumo de sal.
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    Systematic review of studies comparing 24-hour and spot urine collections for estimating population salt intake
    (Organización Panamericana de la Salud, Washington, DC, 2012) Chen Ji; Sykes, Lindsay; Paul, Christina; Dary, Omar; Legetic, Branka; Campbell, Norm R.C.; Cappuccio, Francesco P.
    OBJECTIVE: To examine the usefulness of urine sodium (Na) excretion in spot or timed urine samples to estimate population dietary Na intake relative to the gold standard of 24-hour (h) urinary Na. METHODS: An electronic literature search was conducted of MEDLINE (from 1950) and EMBASE (from 1980) as well as the Cochrane Library using the terms "sodium," "salt," and "urine." Full publications of studies that examined 30 or more healthy human subjects with both urinary Na excretion in 24-h urine and one alternative method (spot, overnight, timed) were examined. RESULTS: The review included 1 380 130 participants in 20 studies. The main statistical method for comparing 24-h urine collections with alternative methods was the use of a correlation coefficient. Spot, timed, and overnight urine samples were subject to greater intra-individual and interindividual variability than 24-h urine collections. There was a wide range of correlation coefficients between 24-h urine Na and other methods. Some values were high, suggesting usefulness (up to r = 0.94), while some were low (down to r = 0.17), suggesting a lack of usefulness. The best alternative to collecting 24-h urine (overnight, timed, or spot) was not clear, nor was the biological basis for the variability between 24-h and alternative methods. CONCLUSIONS: There is great interest in replacing 24-h urine Na with easier methods to assess dietary Na. However, whether alternative methods are reliable remains uncertain. More research, including the use of an appropriate study design and statistical testing, is required to determine the usefulness of alternative methods.
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    Progress toward sodium reduction in the United States
    (Organización Panamericana de la Salud, Washington, DC, 2012) Levings, Jessica; Cogswell, Mary; Curtis, Christine J.; Gunn, Janelle; Neiman, Andrea; Angell, Sonia Y.
    The average adult in the United States of America consumes well above the recommended daily limit of sodium. Average sodium intake is about 3 463 mg/day, as compared to the 2010 dietary guidelines for Americans recommendation of < 2 300 mg/day. A further reduction to 1 500 mg/day is advised for people 51 years or older; African Americans; and people with high blood pressure, diabetes, or chronic kidney disease. In the United States of America, the problem of excess sodium intake is related to the food supply. Most sodium consumed comes from packaged, processed, and restaurant foods and therefore is in the product at the time of purchase. This paper describes sodium reduction policies and programs in the United States at the federal, state, and local levels; efforts to monitor the health impact of sodium reduction; ways to assess consumer knowledge, attitudes, and behavior; and how these activities depend on and inform global efforts to reduce sodium intake. Reducing excess sodium intake is a public health opportunity that can save lives and health care dollars in the United States and globally. Future efforts, including sharing successes achieved and barriers identified in the United States and globally, may quicken and enhance progress.
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    Reducing salt intake to prevent hypertension and cardiovascular disease
    (Organización Panamericana de la Salud, Washington, DC, 2012) He, Feng J.; Campbell, Norm R.C.; MacGregor, Graham A.
    The Pan American Health Organization–WHO Regional Expert Group on Cardiovascular Disease Prevention through Dietary Salt Reduction produced a policy statement out lining the recommendations for a population-based approach to reduce dietary salt intake in the Americas (2010). While government legislation of salt reduction lags in developing countries, public health campaigns play an important role in educating and encouraging people to consume less salt. Stroke mortality rates, the key outcome of increased blood pressure, are very high in Latin America and the Caribbean, with annual rates up to 77.5 deaths per 100,000 women in St. Lucia.
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    Iniciativas desenvolvidas no Brasil para a redução do teor de sódio em alimentos processados
    (Organización Panamericana de la Salud, Washington, DC, 2012) Nilson, Eduardo Augusto Fernandes; Jaime, Patrícia Constante; de Oliveira Resende, Denise
    A construção de estratégias para a redução do teor de sódio em alimentos processados faz parte de um conjunto de iniciativas para diminuir o consumo desse nutriente no Brasil - dos atuais 12 g de sal por pessoa ao dia para menos de 5 g por pessoa por dia (2 000 mg de sódio) até 2020. Nesse processo, uma ação central é a pactuação, entre o governo e a indústria de alimentos, de metas de redução voluntária, gradual e sustentável dos teores máximos de sódio nos alimentos industrializados. Este artigo apresenta a experiência brasileira na construção e implementação de estratégias para a redução dos limites máximos de sódio nos alimentos processados e os atores sociais envolvidos.
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    Need for coordinated programs to improve global health by optimizing salt and iodine intake
    (Organización Panamericana de la Salud, Washington, DC, 2012) Campbell, Norm R.C.; Dary, Omar; Cappuccio, Francesco P.; Neufeld, Lynnette M.; Harding, Kim B.; Zimmermann, Michael B.
    High dietary salt is a major cause of increased blood pressure, the leading risk for death worldwide. The World Health Organization (WHO) has recommended that salt intake be less than 5 g/day, a goal that only a small proportion of people achieve. Iodine deficiency can cause cognitive and motor impairment and, if severe, hypothyroidism with serious mental and growth retardation. More than 2 billion people worldwide are at risk of iodine deficiency. Preventing iodine deficiency by using salt fortified with iodine is a major global public health success. Programs to reduce dietary salt are technically compatible with programs to prevent iodine deficiency through salt fortification. However, for populations to fully benefit from optimum intake of salt and iodine, the programs must be integrated. This review summarizes the scientific basis for salt reduction and iodine fortification programs, the compatibility of the programs, and the steps that need to be taken by the WHO, national governments, and nongovernmental organizations to ensure that populations fully benefit from optimal intake of salt and iodine. Specifically, expert groups must be convened to help countries implement integrated programs and context-specific case studies of successfully integrated programs; lessons learned need to be compiled and disseminated. Integrated surveillance programs will be more efficient and will enhance current efforts to optimize intake of iodine and salt. For populations to fully benefit, governments need to place a high priority on integrating these two important public health programs.
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    Relación costo-utilidad de la disminución del consumo de sal y su efecto en la incidencia de enfermedades cardiovasculares en Argentina
    (Organización Panamericana de la Salud, Washington, DC, 2012) Daniel Ferrante; Jonatan Konfino; Raúl Mejía; Pamela Coxson; Andrew Moran; Lee Goldman; Eliseo J. Pérez-Stable
    OBJETIVO: Estimar la relación costo-utilidad de una intervención dirigida a reducir el consumo de sal en la dieta de personas mayores de 35 años en Argentina. MÉTODOS: La intervención consistió en reducir entre 5% y 25% el contenido de sal en los alimentos. Se utilizó el modelo de simulación del impacto de las políticas sobre la enfermedad coronaria para predecir la evolución de la incidencia, la prevalencia, la mortalidad y los costos en la población de la enfermedad coronaria y cerebrovascular en personas de 35 a 84 años. Se modeló el efecto y los costos de una disminución de 3 g de sal en la dieta, mediante su reducción en alimentos procesados y en la añadida por los consumidores, por un período de 10 años. Se estimó el cambio en la ocurrencia de eventos en este período y la ganancia en años de vida ajustados por la calidad (AVAC) en un escenario de efecto alto y otro de efecto bajo. RESULTADOS: La intervención generó un ahorro neto de US$ 3 765 millones y una ganancia de 656 657 AVAC en el escenario de efecto alto y de US$ 2 080 millones y 401 659 AVAC en el escenario de efecto bajo. Se obtendrían reducciones en la incidencia de enfermedad coronaria (24,1%), infarto agudo de miocardio (21,6%) y accidente cerebrovascular (20,5%), y en la mortalidad por enfermedad coronaria (19,9%) y por todas las causas (6,4%). Se observaron beneficios para todos los grupos de edad y sexo. CONCLUSIONES: La implementación de esta estrategia de reducción del consumo de sal produciría un efecto sanitario muy positivo, tanto en AVAC ganados como en recursos económicos ahorrados.
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    Consumer attitudes, knowledge, and behavior related to salt consumption in sentinel countries of the Americas
    (Organización Panamericana de la Salud, Washington, DC, 2012) Moreira Claro, Rafael; Linders, Hubert; Zancheta Ricardo, Camila; Legetic, Branka; Campbell, Norm R.C.
    OBJECTIVE: To describe individual attitudes, knowledge, and behavior regarding salt intake, its dietary sources, and current food-labeling practices related to salt and sodium in five sentinel countries of the Americas. METHODS: A convenience sample of 1 992 adults (≥ 18 years old) from Argentina, Canada, Chile, Costa Rica, and Ecuador (approximately 400 from each country) was obtained between September 2010 and February 2011. Data collection was conducted in shopping malls or major commercial areas using a questionnaire containing 33 questions. Descriptive estimates are presented for the total sample and stratified by country and sociodemographic characteristics of the studied population. RESULTS: Almost 90% of participants associated excess intake of salt with the occurrence of adverse health conditions, more than 60% indicated they were trying to reduce their current intake of salt, and more than 30% believed reducing dietary salt to be of high importance. Only 26% of participants claimed to know the existence of a recommended maximum value of salt or sodium intake and 47% of them stated they knew the content of salt in food items. More than 80% of participants said that they would like food labeling to indicate high, medium, and low levels of salt or sodium and would like to see a clear warning label on packages of foods high in salt. CONCLUSIONS: Additional effort is required to increase consumers' knowledge about the existence of a maximum limit for intake and to improve their capacity to accurately monitor and reduce their personal salt consumption.
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    Conocimientos, percepciones y comportamientos relacionados con el consumo de sal, la salud y el etiquetado nutricional en Argentina, Costa Rica y Ecuador
    (Organización Panamericana de la Salud, Washington, DC, 2012) Sánchez, Germana; Peña, Lorena; Varea, Soledad; Mogrovejo, Patricia; Goetschel, María Lorena
    OBJETIVO: Identificar los conocimientos, percepciones y comportamientos relacionados con el consumo de la sal y el sodio alimentarios y su relación con la salud y el etiquetado nutricional de los alimentos, en tres países de la Región. MÉTODOS: Estudio cualitativo-exploratorio basado en entrevistas semiestructuradas, según las categorías del modelo de creencias en salud. Se realizaron 34 entrevistas y 6 grupos focales con líderes comunales (71 informantes en total) en áreas rurales y urbanas de Argentina, Costa Rica y Ecuador. RESULTADOS: El consumo de sal varía en las áreas rurales y urbanas de los tres países. Para la mayoría de los entrevistados, los alimentos no se podrían consumir sin sal y solo las personas que consumen una cantidad excesiva de sal tendrían riesgos para la salud. Se desconoce que los alimentos procesados contienen sal y sodio. Aunque no medían la cantidad de sal agregada a las comidas, los participantes consideraban que consumían poca sal y no percibían su salud en riesgo. La mayoría de los informantes no revisaba la información nutricional y los que lo hacían manifestaron no comprenderla. CONCLUSIONES: Existe un conocimiento popular en relación con la sal, no así con el término "sodio". Se consume más sal y sodio de lo informado y no hay perspectivas de reducción. Aunque se sabe que el consumo excesivo de sal representa un riesgo para la salud, no se perciben en riesgo. El reemplazo de la palabra sodio por sal facilitaría la elección de los alimentos.
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    Iniciativas para reducir la sal alimentaria en la Región de las Américas
    (Organización Panamericana de la Salud, Washington, DC, 2012) Campbell, Norm R.C.; Correa-Rotter, Ricardo; Legowski, Barbara; Legetic, Branka
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    Efforts to reduce dietary salt in the Americas
    (Organización Panamericana de la Salud, Washington, DC, 2012) Campbell, Norm R.C.; Correa-Rotter, Ricardo; Legowski, Barbara; Legetic, Branka
    Programs that lower dietary salt intake are estimated to be among the most effective at decreasing the rates of death and disability and among the most cost-effective in improving population health. This is an introduction to the special issue of the Pan American Journal of Public Health which outlines some of the efforts and best practices so far, while reflecting on challenges and research needs. Aspects of national activities in Argentina, Barbados, Brazil, Canada, Chile, Mexico, and the United States of America are outlined, and some regional projects and resources developed by the expert group are featured.
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    Reducción de la ingesta de sodio en las Américas : un imperativo de salud pública
    (Organización Panamericana de la Salud, Washington, DC, 2012) Barquera, Simón; Appel, Lawrence J.
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    Reduction of sodium intake in the Americas : a public health imperative
    (Organización Panamericana de la Salud, Washington, DC, 2012) Barquera, Simón; Appel, Lawrence J.
    The nine papers included in this special issue are of direct relevance to public health efforts designed to reduce sodium intake in the Americas. This two-page article is an introduction to the papers which provide an in-depth exploration of behavior related to health, salt consumption, and nutrition labeling preference in Argentina, Costa Rica, and Ecuador. Four articles are “Special reports” documenting the need for program coordination to optimize salt and iodine intake for improvements in global health.
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    Radiografía del tabaquismo en Argentina : muerte, enfermedad y costos atribuibles al tabaco para el año 2013
    (Instituto de Efectividad Clínica y Sanitaria (IEC), Buenos Aires, AR, 2013-05) Pichon-Riviere, Andres; Alcaraz, Andrea; Bardach, Ariel; Augustovski, Federico; Caporale, Joaquin; Caccavo, Francisco