Abdominal Obesity and Diabetes are on the Rise in Latin America

Walmir Coutinho

doi:10.1177/155989771102009

Summary

Obesity is replacing malnutrition as an urgent public health concern throughout Latin America, especially among lower-income populations. This article discusses the adverse consequences of obesity on the cardiometabolic risk profiles in this region.

Obesity
Cardiometabolic Disorder
Diabetes Mellitus

Obesity is replacing malnutrition as an urgent public health concern throughout Latin America, especially among lower-income populations. Walmir Coutinho, MD, Catholic University, Rio de Janeiro, Brazil, described the adverse consequences of obesity on the cardiometabolic risk profiles in this region.

In Chile, obesity increases with age and is most common among those in the lowest socioeconomic class. The overall prevalence of obesity is 15.7% among men and 23% among women [Jadue L et al. Rev Med Chil Nutr 1999]. Rates of obesity are similar among men (16%) and women (23.5%) in Peru, where obesity is also inversely associated with socioeconomic status [Jacoby et al. Prev Med 2003].

Latin American populations may be particularly susceptible to central fat deposition. Mexican women are significantly more likely than North American women to have central adiposity, particularly when BMI is low. Among those with a BMI of 18–25 kg/m², 76% of Mexican-American women and 42% of North American women have a waist circumference >80 cm (p<0.001) [ENSA 2000. Mexico]. In Peru, 59% of women and 13% of men with normal body weight have an abdominal circumference that exceeds recommended thresholds, defined as <80 cm for women and <94 cm for men [Jacoby et al. Prev Med 2003].

Diabetes is also on the rise in Latin America; yet, it remains poorly recognized. The estimated prevalence of diabetes in urban areas is 12.7% in Mexico, 10.7% in Bolivia, and 8.9% in Paraguay. In rural areas, such as Choachi, Columbia, approximately 1.4% of the population has diabetes (Figure 1) [ALAD. Rev Assoc Latinoam Diab 2000]. Overall, 30% to 50% of diabetes cases are undiagnosed. In rural areas, where up to 40% of the population resides, the rate of undiagnosed cases approaches 100%.

Figure 1.

Prevalence of Type 2 Diabetes in Latin American Populations.

Reproduced with permission from W. Coutinho, MD.

Cardiometabolic risk factors, such as psychological stress, may have a stronger detrimental impact on Latin American populations. In the INTERHEART Study, the presence of moderate/severe stress increased the risk of myocardial infarction (MI) by 54% across all regions (OR, 1.54; 95% CI, 1.39 to 1.71). Specifically, within South America, moderate/severe stress more than doubled the risk of MI (OR, 2.26; 95% CI, 1.70 to 3.00) [Yusuf S et al. Lancet 2004].

Population growth, aging, and urbanization are among the many factors that contribute to a rise in obesity and diabetes among Latin American populations. Managing the emerging obesity epidemic will require education, early diagnosis of diabetes and other risk factors, and aggressive intervention, including increased physical activity and healthier food options, Prof. Coutinho concluded.

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