Enfermedades crónicas
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Item Traditional rural dietary pattern and all-cause mortality in a prospective cohort study of elderly Costa Ricans: the Costa Rican Longevity and Healthy Aging Study (CRELES)(The American Journal of Clinical Nutrition, 2024) Zhang, Yundan; Cortés Ortiz, Mónica V.; Leung, Cindy W.; Baylin, Ana; Rosero Bixby, Luis; Ruiz Narváez, Edward A.Costa Rica, as many other Latin American countries, is experiencing a fast demographic aging. It is estimated that by 2030, 18.5% of the population, or almost 1 of every 5 Costa Ricans, will be 60 y or older, compared with 7.9% or 1 of every 13 Costa Ricans in 1999 [1]. As the population ages, chronic health conditions such as cardiovascular diseases (CVDs) and neurodegenerative disorders are expected to increase in prevalence posing growing challenges to the health of the Costa Rican population. With the demographic shift toward an aging population, there is an urgent need to study determinants of longevity and healthy aging. Diet—as part of a healthy lifestyle—is a key modifiable factor that may help to minimize the burden of age-related health conditions. Beans are a major source of protein and fiber in Costa Rican adults and part of traditional diets in most Latin American countries. High bean consumption has been found associated with a protective cardiometabolic prolife such as low total cholesterol and LDL cholesterol [2,3]. In the Costa Rican population specifically, intake of beans has been associated with lower risk of nonfatal myocardial infarction in middle-aged adults [4]. We recently reported that a traditional Costa Rican rural dietary pattern, rich in beans and rice, was associated with longer leukocyte telomeres—a marker of biologic aging—in Costa Rican adults 60 y and older [5]. However, no studies have examined whether adherence to a traditional diet in elderly Costa Ricans may also be associated with lower mortality. Because of the nutrition transition (i.e., a shift from traditional diets to an increased consumption of processed foods highs in sugars, fats, and salt) experienced by Costa Rica in the last decades [4,6,7], it is essential to evaluate the potential impact of traditional diets on promoting healthy aging and longevity within an aging population. In this study, we assessed the association between a traditional rural dietary pattern, as well as their major food components beans and rice, and all-cause mortality among elderly Costa Ricans aged 60 y and older at baseline. We hypothesized that higher scores on the traditional dietary pattern are associated with lower all-cause mortality in elderly Costa Ricans. We also assessed whether additional dietary patterns may be associated with all-cause mortality. We used longitudinal and nationally representative data from the Costa Rican Longevity and Healthy Aging Study (CRELES).Item Impact of common cardio-metabolic risk factors on fatal and non-fatal cardiovascular disease in Latin America and the Caribbean: an individual-level pooled analysis of 31 cohort studies(The Lancet Regional Health - Americas, vol.4, 2021) Cohorts Consortium of Latin America and the Caribbean (CC-LAC)Background: Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains un- known. Methods: We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n = 168,287) and non-fatal (13 cohorts, n = 27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor. Results: Our RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 10 0,0 0 0 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana. Interpretation: RRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those esti- mated from cohorts in high-income countries.Item Helicobacter pylori infection and serum pepsinogen concentrations in an elderly population representative of Costa Rica(Población y Salud en Mesoamérica 19(2), 2022) Une, Clas Allan; Malespín Bendaña, Wendy Karina; Ramírez Mayorga, Vanessa; Rosero Bixby, Luis; Sierra Ramos, RafaelaINTRODUCTION: Costa Rica has among the highest mortality rates from gastric cancer in the world, largely due to late detection. It is therefore important that economically and logistically sustainable screening is implemented in order to detect risk of developing cancer. We have previously shown that low pepsinogen (PG) values and infection with Helicobacter pylori-CagA+ are associated with risk of gastric atrophy and cancer in Costa Rican populations. OBJECTIVES: To determine how markers for gastric cancer risk are distributed in an elderly population representative of Costa Rica in order to design a screening strategy. METHODS: The population studied consists of 2,652 participants in a nationally representative survey of ageing. Information concerning epidemiologic, demographic, nutritional and life style factors is available. Serum PG concentrations as well as H. pylori and CagA status were determined by serology. Possible associations were determined by regression analyses. RESULTS: Antibodies to H. pylori were present in 72% of the population and of those, 58% were CagA positive. Infection with H. pylori was associated with higher PGI concentrations (p=0.000) and infection with H. pylori-CagA+ with lower PGI concentrations (p=0.025). Both showed association with lower PGI/PGII (p=0.006 and p=0.000). Higher age was associated with lower prevalence of H. pylori infection (OR=0.98; p=0.000) and CagA+ (OR=0.98; p=0.000) but not with PG values. Regions with high risk of gastric cancer showed lower PGI (p=0.004) and PGI/PGII values (p=0.021) as well as higher prevalence of H. pylori infection (OR=1.39; p=0.013) but not CagA+. Using cut-off values of PGI<100 μg/L and PGI/PGII<2.0, 2.5 and 3.0, 7-15% of the population would be considered at risk. CONCLUSIONS: H. pylori alone is not a useful marker for risk of gastric cancer. Screening using serum pepsinogen concentrations and infection with H. pylori-CagA+ is feasible in the general elderly population of Costa Rica but appropriate cut-off values have to be determined based on more clinical data and follow up capacity.Item Gender differences in perceived stress and its relationship to telomere length in Costa Rican adults(Frontiers in Psychology, vol.13, 2022) Méndez Chacón, ErickaIntroduction: Stress is associated with disease and reduced leukocyte telomere length (LTL). The objective of this research is to determine if self-perceived stress is associated with telomere length in Costa Rican adults and the gender differences in this association. Findings may help explain how some populations in apparent socioeconomic disadvantage and with limited access to specialized medical services have a remarkably high life expectancy. Methodology: Data come from the pre-retirement cohort of the Costa Rican Longevity and Healthy Aging Study (CRELES), a population based survey conducted in the households to 2,327 adults aged 53 to 66 years. The DNA to measure LTL was extracted from blood cells in laboratories of the University of Costa Rica whereas the Blackburn laboratory at the University of California performed the telomere length measurement applying the quantitative polymerase chain reaction (Q-PCR). The relationship between telomere length and perceived stress was measured using least-squares multiple regression. Perceived stress was measured by a set of questions about family, job, finances and, health reasons to be stressed. Models included the control variables: (1) age and sex of the participant, (2) whether he or she resides in the Nicoya area, a “blue zone” known for its high longevity, and (3) the aforementioned sociodemographic, health and lifestyles characteristics. Results: Stress perception and LTL are significantly different by sex. Women perceived higher stress levels than men in almost all aspects studied, except work. Women have significantly longer telomeres. Shorter telomeres are significantly associated with caregiving stress in men and with parental health concerns in women. Counter-intuitive telomere lengthenings were observed among women who feel stressed about caring for family members; and among men who feel stressed due to their family relationships as well as concerns about their own health. Discussion: Results confirm that people with self-perceived stress due to caregiving or health issues have shorter telomeres. The relationship between stress and telomere length differs between men and women. Gender relations exert a strong modifier effect on the relationship between stress and LTL: gender is related to perceived stress, telomere length, and apparently also to the way stress and LTL are related.