RESUMO

The characterization of dietary patterns linked to obesity is important to address evidence-based interventions against the obesity epidemic. We hypothesized that both dietary behaviors and environmental characteristics affect the spatial distribution of obesity. This study aimed to analyze the role of dietary patterns in the occurrence of obesity in Colombia, taking into account the hierarchical (geographical) structure of the data. A cross-sectional study based on the Colombian National Nutrition Survey (2015) was carried out. A subsample of 8750 adults who reported dietary intake data (by the 24-hour diet recall method) was extracted. Dietary patterns were identified by principal component factor analysis. Their association with obesity occurrence was assessed by using multilevel Poisson regression models (8750 subjects nested in 33 geographic units). Thematic maps were constructed. The obesity prevalence was 18.0% (95% CI, 16.7-19.4). Four dietary patterns were identified for the study group. An inverse (negative) association was found in people with high adherence (vs. low adherence) to the "prudent pattern" (dairy products, fruits, vegetables) (prevalence ratio, 0.87; 95% CI, 0.78-0.96; P = .01). People with high adherence to the "soft drinks and snacking pattern" (sugary drinks, meat products, snacks) tended to show a direct (positive) association with obesity occurrence (prevalence ratio, 1.12; 95% CI, 0.99-1.27; P = .06). Maps showed higher adherence levels to the prudent pattern in departments with higher socioeconomic conditions and lower obesity prevalence. To conclude, a prudent dietary pattern emerges as a key factor in obesity occurrence in Colombia. Obesity spatial distribution may be conditioned by contextual factors that represent social inequalities in health.

Assuntos

RESUMO

RESUMEN Las enfermedades cardiovasculares (ECV) son la principal causa de mortalidad en todo el mundo; sus implicaciones no solo son letales sino también muy costosas para los sistemas de salud. También representa un lastre para las economías, debido a los altos derivados de la no productividad causados por la discapacidad de los empleados. Se analizará si las Políticas de Salud Pública sobre la población colombiana han logrado controlar o reducir las estadísticas de mortalidad por ECV. Materiales y métodos: Los datos de mortalidad se tomaron entre 1993 y 2017; las muertes se clasificaron según el estándar de Clasificación Internacional de Enfermedades (CIE-10). Se calculó el porcentaje promedio de muertes por ECV; se identificó factores asociados. Se realizó una aproximación en torno a políticas públicas y la acción del Estado para garantizar el derecho a la salud. Resultados: El porcentaje promedio ECV fue de 29.2 %. En el grupo de edad de 15 a 45 años hubo un mayor porcentaje de muertes en hombres. Desde 2011 se superó el promedio mundial de 30 %; desde 1993 a 2017 hubo un incremento de 18.2 %. Conclusión: En Colombia existen políticas públicas sobre el control de la carga y la mortalidad de las enfermedades no transmisibles; estas políticas se ajustan a las convenciones internacionales, aunque las estadísticas han mostrado resultados contrarios a los esperados. Se necesita con urgencia una aplicación rigurosa de las políticas adoptadas por el Estado y una participación activa del sector privado.

SUMMARY The cardiovascular diseases (CVD) is the leading cause of mortality worldwide, its implications are not only lethal but highly costly to the health systems. It also represent a drag on economies due to non-productivity caused by employee's disability. It will be analyzed if the Public Health Policies on the Colombian population have managed to control or reduce the mortality statistics by CVD. Method: It was considered the mortality records between 1993 thru 2017. The deaths were classified according to the International Classification of diseases standard (ICD-10). It will be calculated by the average percentage of deaths due to cardiovascular diseases per year, sex and the georeferencing by states. An approximation will be made around the legal and political aspects of Colombian legislation regarding the role the State has played in guaranteeing the right to health. Results: The average percentage of deaths due to CVD from 1993 to 2017 was 29.2 %. This incidence was seen with higher frequency at age 45, in the age group of 15 to 45 years old it was a higher percentage of death in men. Beginning in 2011 the percentage exceeds the global median; from 1993 to 2017 the average percentage of mortality was increased by 18.2 %. Conclusion: Public policies regarding controlling the burden and mortality of noncommunicable diseases, although these policies conform to international conventions, statistics have shown results contrary to those expected. It urges a rigorous application of the policies adopted by the State and an active participation of the private sector.

RESUMO

Resumen La Organización Mundial de la Salud (OMS) ha catalogado la obesidad infantil como la mayor crisis de la salud pública en el mundo. En su informe de 2014 indica que se registraron cuarenta y dos millones de niños menores de 5 años con sobrepeso; de ellos, treinta y cinco millones viven en países en desarrollo. La obesidad infantil es una enfermedad que tiene como origen una cadena causal compleja, de etiología multifactorial, en la que interactúan factores individuales y contextuales; en ellos el niño se encuentra inmerso, y ejercen influencia sobre su comportamiento, en diversos entornos y en diferentes niveles de jerarquía. Esta revisión presenta una descripción de algunos estudios y esfuerzos realizados para caracterizar, prevenir y controlar la epidemia de obesidad en esta etapa del ciclo vital. Se propone, así mismo, un abordaje para el estudio de la obesidad, denominado 'Enfoque de sistemas complejos', el cual permite analizar cómo los factores individuales y contextuales se relacionan, y cómo esa interacción genera nuevas propiedades que no pueden explicarse a partir de los procedimientos habituales de análisis epidemiológico; para ello será necesario el trabajo en equipo, con enfoque multidisciplinario, que incluya médicos, pediatras, nutricionistas, epidemiólogos, salubristas, estadísticos, ingenieros, entre otros profesionales, que aporten sus conocimientos y habilidades, que permitan entender la obesidad como un fenómeno dinámico que requiere ser abordado con un enfoque integral e integrador, que trascienda la mirada reduccionista de los factores de riesgo del proceso salud - enfermedad. Solo entonces se podrá mejorar la capacidad para comprender la salud desde una perspectiva clásica hasta un sistema verdaderamente dinámico.

Summary The World Health Organization (WHO) has ranked childhood obesity as the greatest public health crisis in the world. In its 2014 report, it indicates that 42 million children under 5 are overweight, of whom 35 million live in developing countries. Childhood obesity is a disease, which has its origin in a complex causal chain of multifactorial etiology, where individual and contextual factors interact where the child is immersed. They exert influence on their behavior in different environments and at different levels of hierarchy. This review presents an overview of some studies and efforts carried out to characterize, prevent, and control the obesity epidemic in this stage of the life cycle. Likewise, it proposes, an approach to the study of obesity, called 'complex systems approach', which allows to analyze how individual and contextualfactors relate and how this interaction generates new properties that cannot be explained by the standard procedures that classical statistics offer. This will require work in interdisciplinary team, with a multidisciplinary approach involving physicians, pediatricians, nutritionists, epidemiologists, public health specialists, statisticians, engineers, and others who contribute their knowledge and skills to enable understanding obesity as a dynamic phenomenon, which needs to be approached by an integrative approach that transcends the reductionist view of the risk factors of the health disease process. Only then will it be possible to improve the capacity to understand health from a classical perspective to a truly dynamic system.