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ABSTRACT Latin America is undergoing a rapid demographic and nutritional transition. A recent WHO/PAHO
survey on obesity in the region revealed an increasing trend in obesity as countries emerge from poverty, especially
in urban areas. In contrast, in middle income countries, obesity tends to decline as income increases; this is
especially so in women. Dietary changes and increasing inactivity are considered the crucial contributory factors
that explain this rise. The end result is a progressive rise in overweight and obesity, especially in low income groups
who improve their income and buy high fat/high carbohydrate energy-dense foods. Intake of these foods increases
to the detriment of grains, fruits and vegetables. Most aboriginal populations of the Americas have changed their
diet and physical activity patterns to fit an industrialized country model. They now derive most of their diet from
Western foods and live sedentary and physically inactive lives. Under these circumstances they develop high rates
OBESITY TRENDS IN LATIN AMERICA as a proxy indicator of type of malnutrition present at the
population level. As obesity rises, deaths from cardiovascular
Latin America is undergoing a rapid demographic and disease and cancer also increase; conversely, if death from
nutritional transition. Significant changes in the causes of infection predominates, malnutrition tends to be high and
death have occurred over a relatively short period of time. As obesity low.
an example of this, Figure 1 illustrates the trends in causes of Information on obesity trends in Latin America is limited
death by disease categories in Guatemala, Mexico, Chile and to specific country data for selected countries and to data of
Uruguay (1). These data give a clear indication of how death women of reproductive age and children under 5 y of age
from infections is on the decline while death from noncom- obtained from the Demographic and Health Surveys Institute
municable chronic disease is on the rise. Guatemala has re- for Resource Development (DHS/IRD). Martorell et al. (2)
cently initiated the transition while Mexico is clearly in the reviewed DHS surveys conducted since 1982 and evaluated
midst of the process. Chile has recently finished the period of the prevalence of obesity in women and children. The mean
rapid change while Uruguay can be considered to be in the value for obesity in women for the eight countries evaluated
posttransition phase. In the absence of systematically collected was 8 –10%. Table 1 summarizes results for five countries using
data on distribution of causes of death, these categories serve a BMI cutoff of ⱖ 30 kg/m2 according to WHO or a BMI index
of ⱖ 27.3 following USA Hanes I (3). The lowest prevalence
was found in Honduras while the highest is found in Bolivia
1
Presented as part of the symposium “Obesity in Developing Countries: and Peru, depending on cutoff point defined. In the case of
Biological and Ecological Factors” given at the Experimental Biology 2000 meet-
ing held in San Diego, CA on April 15–19, 2000. This symposium was sponsored children under 5 y of age a weight-for-height ⬎ 1 SD was
by the American Society for Nutritional Sciences and was supported in part by an considered as overweight, and ⬎ 2 SD as obesity. The lowest
educational grant from Monsanto Company. Symposium proceedings are pub- figures are found in Bolivia while the highest are found in the
lished as a supplement to The Journal of Nutrition. Guest editors for the sympo-
sium publication were Benjamin Caballero, Center for Human Nutrition, Johns Dominican Republic. An increasing prevalence of obesity in
Hopkins University, Baltimore, MD and Najat Mokhtar, Ibn Tofaı̈l University, women was found in countries with higher per capita income
Kenitra, Morocco. and in those with lower rates of stunting in children. A recent
2
To whom correspondence and reprint requests should be addressed at
Universidad de Chile, Instituto de Nutricion y Tecnologia de los Alimentos (INTA), PAHO/WHO publication on obesity in Latin America (4)
Casilla 138-11, Santiago, Chile. E-mail: uauy@uchile.cl. revealed an increasing trend for obesity as countries emerge
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whereas for the Mapuche group, only BMI was associated to dietary factors and gene/environment interactions may deter-
leptin after controlling for gender and insulin. The comparison mine a potential epigenetic effect. However, the low preva-
of plasma leptin levels adjusted for BMI, gender and age lence of type 2 diabetes in Aymara and rural Mapuche subjects
showed significant ethnic differences. Mean concentration of (30) is in sharp contrast to the high prevalence of this con-
plasma leptin in Caucasian individuals was approximately dition in most aboriginal groups in North America, including
twofold higher compared to that of Mapuche subjects. Fasting the Pima from Arizona and Mexican-American minorities in
insulin levels adjusted for age, gender and BMI, indicative of the United States (21,32). Although the distribution of BMI
glucose sensitivity, were also significantly higher in Cauca- observed in the Aymara is similar to that in the general
sians. Only 4.1% of rural Mapuche were classified as diabetics, population of urban Santiago, mean values of insulin resis-
compared to 9.8% observed in urban Mapuche and 5.3% in tance, determined by HOMA, indicate improved glucose tol-
the Caucasian population of Santiago. Glucose intolerance erance in the Aymara subjects (30). Low mean values of
was identified in 3.4% of the rural and in 6.1% of the urban HOMA-IR and insulin levels in Aymara subjects could be in
Mapuche. Our study also revealed a higher prevalence of part a consequence of their high level of physical activity and
obesity (P ⬍ 0.05) in urban Mapuche compared to that in their traditional high complex carbohydrate diet. The preva-
rural natives. Moreover, these data suggest that the change in lence of diabetes in the rural Aymara population who live in
environment may increase disease susceptibility beyond that high altitudes in the north of Chile is lower than the preva-
observed in Caucasian populations. The early report of a low lence in the urban Caucasian population of Santiago, Chile,
prevalence of diabetes in the presence of high rates of obesity and much lower than the prevalence in other Amerindian
in the Mapuche was not upheld by our recent studies, suggest- groups from North America. Prevalence of diabetes in this
ing that aboriginal populations lose their protection from the Aymara population is similar to, or slightly lower than, the
metabolic complications of obesity as they undergo urbaniza- prevalence reported for the rural Mapuche population. Both
tion and lifestyle, including dietary changes (27). Table 2 populations have preserved a rural physically active lifestyle
summarizes these findings. and have maintained their traditional diet (30).
TABLE 2
Obesity and metabolic complications in aboriginal and Caucasian populations in Chile according
to gender and rural/urban condition
TABLE 4
Distribution of weight-for-height Z scores of children
beneficiaries of JUNJI on entry and after 3 y of program1
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