Multimorbidity data typically are analyzed by tallying disease counts, an approach that overlooks nuanced relationships among conditions. We identified clusters of multimorbidity and subpopulations with varying risks and examined their association with all-cause mortality using a data-driven approach. We analyzed 8-year follow-up data of people aged 35 years or older who were part of the CRONICAS Cohort Study, a multisite cohort from Peru. First, we used Partitioning Around Medoids and multidimensional scaling to identify multimorbidity clusters. We then estimated the association between multimorbidity clusters and all-cause mortality. Second, we identified subpopulations using finite mixture modeling. Our analysis revealed three clusters of chronic conditions: respiratory (cluster 1: bronchitis, chronic obstructive pulmonary disease, and asthma); lifestyle, hypertension, depression, and diabetes (cluster 2); and circulatory (cluster 3: heart disease, stroke, and peripheral artery disease). Although only the cluster comprising circulatory diseases showed a significant association with all-cause mortality in the overall population, we identified two latent subpopulations (named I and II) exhibiting differential mortality risks associated with specific multimorbidity clusters. These findings underscore the importance of considering multimorbidity clusters and sociodemographic characteristics in understanding mortality risks. They also highlight the need for tailored interventions to address the unique needs of different subpopulations living with multimorbidity to reduce mortality risks effectively.

Dementia is a global health challenge, especially in low- and middle-income countries like Peru, where diagnosis, access, and awareness are limited. Within the IMPACT Dementia project, a component focuses on developing, testing, and implementing an mHealth-enabled system for dementia screening and diagnosis, and assessing its cost-effectiveness. Phase I. To develop a dementia diagnostic screening mHealth system : The features of the screening tool will be locally adapted using a co-design approach including community members and community health workers (CHW) in four regions in Peru (Lima, Tumbes, Iquitos, and Huancayo) to enhance adaptability and efficacy. The final tool will be applied to older adults (60+) in the community by CHW. Phase II. To assess the accuracy and acceptability, and characterization of older adults (60+) at the population level in Peru (n≈32,000) : Using the mHealth system developed in Phase I, assessments including AD8, RUDAS-PE, and PFAQ, will be conducted. Accuracy for dementia diagnosis will be determined through gold-standard assessments involving interviews, neuropsychological testing, and the CDR in a subgroup of participants conducted by neurologists. The system will also collect data on socio-demographic information, carers, co-morbidities, quality of life, resource usage and costs. Phase III. To integrate the mHealth diagnostic system into Peru’s primary healthcare (PHC) level : After validation, a 3-month quasi-experimental study in 2 centres per region will assess system performance, using waiting room recruitment and provider-conducted screenings for older adults. Indicators will evaluate integration success, sensitivity, and specificity of the tool, cost-effectiveness, and stakeholder perspectives through a process evaluation, guiding future scalability. Early phases suggest that the IMPACT Dementia project will offer insights into dementia challenges in Peru. The co-design phase prioritises cultural relevance. Phase II anticipates a comprehensive dataset characterising older adults, informing prevalence and risk factors, and validating the mHealth diagnostic system. Phase III aims to assess the integration feasibility of the diagnostic system into PHC. This component of IMPACT Dementia addresses the challenges of dementia in Peru, emphasizing diagnosis, comorbidity, and resource optimization through mHealth. The participation of CHW means a strategic change, which aims to alleviate the burden on health systems.

BACKGROUND AND AIMS:Impaired glucose intolerance (IGT) and impaired fasting glucose (IFG) are totally different. Lifestyle modification is effective in moving from prediabetes to normoglycaemia. There is a lack of information showing the effect of lifestyle modification according to each prediabetes and assessing its effect on the degree of reversibility to normoglycaemia and on cardiometabolic markers. METHODS AND RESULTS:We searched for randomized controlled trials (RCT) that enrolled individuals with IGT or IFG. Meta-analysis was performed to compare the proportion of subjects progressing to type 2 diabetes mellitus (T2DM); proportion reversing to normoglycaemia and mean differences in glucose level and cardiometabolic parameters. Thirty-six RCTs were included. The proportion of subjects progressing from impaired glycaemia to T2DM was higher among those with IGT (16.3% vs. 10.9%), whereas reversion to normoglycaemia was higher in subjects with IFG (27.2% vs. 24.8%). The effect of lifestyle modification on glucose level was significant on those with IFG (mean difference [MD] = -1.56 mg/dL, 95% CI: -2.71, -0.40), but not on those with IGT of (MD = 1.47 mg/dL, 95% CI: -1.33, 4.28). CONCLUSION:Diverse lifestyle modification interventions improved glucose levels in people with IFG, but not in those with IGT. Our findings imply that different non-pharmacological interventions are warranted for IGT and IFG.

BACKGROUND:The extent to which people with newly diagnosed diabetes exhibit similar insulin resistance profiles across countries is unknown. Understanding the heterogeneity in glycemic and cardiometabolic profiles at the time of diabetes diagnosis could provide insights for precision medicine. METHODS:We analyzed 14 nationally representative surveys (STEPS). We used anthropometric measures, fasting glucose, triglycerides and HDL cholesterol to calculate eight non-insulin-based markers of insulin resistance: triglyceride and glucose ratio (TyG), TyG with BMI (TyGBMI), TyG with waist circumference (TyGwaist), TyG with waist-to-height ratio (TyGWHtR), triglyceride-to-HDL ratio (TGHDL_r), metabolic score for insulin resistance (METS-IR), lipid accumulation product (LAP), and visceral adiposity index (VAI). We only included subjects with newly diagnosed diabetes. Age- and sex-adjusted multilevel linear regression models were used to estimate country-specific margins of the z-scores for each insulin resistance surrogate (_z suffix refers to predicted z-score margins). RESULTS:A total of 2531 individuals were analyzed (mean age 47.4 years; 56.6 % were women). The widest disparities across countries in predicted z-scores were observed for TyG-based markers. For instance, the predicted margins for TyGBMI_z ranged from -0.985 (Ethiopia) to 0.682 (Kuwait). In contrast, narrower disparities were noted for other markers, with the smallest gap observed for VAI_z ranging from -0.688 (Bhutan) to 0.491 (Guyana). CONCLUSIONS:The study highlights heterogeneity in metabolic profiles at diabetes diagnosis across countries. These findings emphasize the importance of incorporating population-specific factors into strategies for understanding and addressing the global diabetes burden, particularly in recognizing the diverse cardiometabolic profiles at the time of diagnosis.

Diabetic foot infections (DFIs) are a prevalent diabetes-related complication. Managing DFIs requires timely antibiotic treatment but identifying the best antibiotic often depends on microbiological cultures, which can take days and may be unavailable or prohibitively expensive in resource-limited settings. We aimed to develop a classification model that uses readily available clinical and laboratory data to differentiate between DFIs that are Gram+ resistant, Gram- resistant, or none. We used retrospective data from patients treated for DFIs at a hospital in Lima, Peru. Gram+ multidrug-resistant bacteria (MDRB) included MDR species of Staphylococcus aureus, other Staphylococcus, and Enterococcus, whereas Gram- MDRB included MDR species of Enterobacteriaceae, Pseudomonas, and Acinetobacter. Twenty clinical (e.g., Wagner classification) and laboratory (e.g., HbA1c) variables were used as predictors in a XGBoost model which was internally validated. One hundred forty-seven patients, predominantly male (75.1

Peru does not have official prevalence data of dementia, however, particular studies indicate that in urban areas 6.85% of the population over 65 years of age has it. Countries such as Peru have significant drivers of the condition such as low socio-economic (monetary poverty 27.5%) and educational levels (21.9% of the population has only primary education). In order to prepare the health system and society in general, it is necessary to start multisectoral studies to understand the complexity of the challenge ahead. The IMPACT project aims to contribute to this. Mixed methods approach. Semi-structured interviews with different stakeholders as well as secondary data review to cover 11 themes from the health system (policy environment, financing, infrastructure, service delivery in prevention and management issues, etc.) in three levels (macro, meso and micro) nnd in four different areas of Peru The presentation still does not show results, as it is still ongoing. However, we are sharing some of the insights and learnings we have gained so far. Some of these are the following: limited and heterogeneous response due to the highly fragmented system, lack of political support, first level of care not designed or prepared to deal with dementia cases, reduced amount of specialists, adequate training for health providers attending this group, no guidelines for medical practices and limited research about its characteristics and needs. Also, age stereotypes and lack of awareness about dementia as a medical condition persist in all levels of the health system and society, negatively affecting the effectiveness of its response to their needs These are some preliminary Conclusions: more research is needed, to address stereotypes, increase training for health providers, use technology to facilitate access to services, create models of effective implementation to generate impact on urgent issues and inclusion of preventive and long-term care approaches

Mental health recovery outcomes are scarcely used and monitored in low- and middle-income countries, despite their importance on assessing the results of the care provided and potential areas of improvements. In Peru, the Mental Health Directorate (MHD) monitors mental health services mainly based on the number of people served and not on the improvements or recovery of their patients. This study aims to conduct a co-prioritization process with key stakeholders to introduce recovery outcomes and scales in community mental health centers (CMHC) in Peru. The co-prioritization methodology combined periodic meetings with MHD’s heads; a literature search and conversations with nine international mental health experts; and eight participatory workshops with Peruvian key stakeholders (policymakers, CMHC workers, and patients). All the information was analyzed using matrices and thematic analysis. Nine outcomes were identified in the literature search and conversations with mental health experts, and five outcomes were finally prioritized by key stakeholders. After revision and discussion of several scales for each outcome, two scales were prioritized by all stakeholders: WHODAS-12 and DIALOG. Policymakers, workers, and patients prioritized three of these outcomes: psychosocial functioning, quality of life, and psychiatric symptoms. The first two were the most important for the three groups, whereas symptoms were more important for policymakers and workers than for patients. Additionally, patients prioritized emotional balance and personal growth, two emerging outcomes that were not identified in our previous literature search and conversations with experts. Scales were prioritized based on their relevance, usability, and feasibility to integrate them into the CMHC routines: WHODAS-12 to assess psychosocial functioning and DIALOG for quality of life. Stakeholders did not agree on a single scale to assess symptoms due to the large array of symptoms that their patients present, and no scale was assessed for emotional balance and personal growth since they only emerged in the final set of workshops. Based on a participatory methodology, key stakeholders at different levels of the Peruvian mental health system prioritized five recovery outcomes to use routinely in CMHC: psychosocial functioning, quality of life, psychiatric symptoms, emotional balance, and personal growth. The first two were deemed as the most important for all stakeholders; and the latter two were novel outcomes that emerged from patients. Two scales were selected to assess the first two of these outcomes. Defining a scale for the latter three outcomes and test their use in CMHC routines remain as pending tasks.

Objetivo: determinar la prevalencia y los factores asociados a somnolencia diurna excesiva (SDE) en una población adulta entre 30 y 69 años de Tumbes. Materiales y métodos: análisis de datos secundarios de un estudio poblacional realizado entre 2016 y 2017 (prepandemia). La SDE fue evaluada usando la escala de somnolencia de Epworth (versión peruana modificada). Los potenciales factores asociados fueron variables demográficas, conductuales, obesidad y de salud mental. Las asociaciones de interés fueron evaluadas usando modelos crudos y ajustados de regresión de Poisson, reportándose razones de prevalencia (RP) e intervalos de confianza al 95% (IC 95%). Resultados: se incluyeron los datos de 1609 individuos con una media de edad de 48,2 ± 10,6 años; 810 (50,3%) mujeres, y 105 (6,5%; IC 95%: 5,4% - 7,8%) presentaron SDE. En el modelo multivariable, la SDE fue más frecuente en mujeres (RP: 1,78; IC 95%: 1,11–2,85), en aquellos de 50-59 años (RP:1,94; IC 95% 1,09–3,48), los que reportaron estar trabajando (RP: 2,54; IC 95%: 1,62–3,97), aquellos con obesidad (RP: 2,19; IC 95%: 1,27–3,76) y los que presentaron síntomas depresivos (RP: 3,08; IC 95%: 1,97–4,80). De otro lado, la educación superior (RP: 0,47; IC 95%: 0,23–0,96) fue el único factor inversamente asociado a SDE. Conclusiones: se encontró una prevalencia prepandemia de somnolencia diurna excesiva del 6,5%. Las mujeres, ciertos grupos de edad, estar trabajando, tener obesidad y tener síntomas depresivos mostraron asociación positiva con la presencia de SDE, mientras que solo la educación superior mostró una asociación negativa.

BACKGROUND:Hypertension is a global health challenge, particularly in low- and middle-income countries. Peri-urban areas such as Pampas de San Juan de Miraflores, Peru, face challenges that the COVID-19 pandemic exacerbated. OBJECTIVE:To assess the post-COVID-19 hypertension care cascade and mean systolic blood pressure (SBP) levels in Pampas de San Juan de Miraflores and to determine the proportion of individuals with hypertension who are diagnosed, treated, and have controlled blood pressure across age groups. METHODS:A cross-sectional survey (October 2022-January 2023) including adults aged >35 years from the 2010 CRONICAS study and a geographically based sample of households nearby. Data collection included a hypertension awareness questionnaire and standardized blood pressure measurements. Descriptive analyses characterized the age-specific hypertension care cascade and calculated mean blood pressure in four groups: healthy, unaware, aware and untreated, and aware and treated. RESULTS:Among 2,856 adults, age-specific hypertension prevalence based on self-reported medication use and current blood pressure screening was 13.3% (35-44 years) to 54.6% (>75 years). Awareness was 85%; of those, 85% were treated, and 76.8% of them had controlled blood pressure. Mean SBP was highest in the unaware group (n = 102, 146.0 mmHg) and lowest in the healthy group (n = 1,929, 111.0 mmHg). These values were comparable among diagnosed patients, whether treated (n = 333, 126.0 mmHg) or untreated (n = 492, 128.0 mmHg). CONCLUSIONS:Despite high awareness and relatively adequate control among untreated individuals, a substantial proportion remain undiagnosed or untreated after COVID-19. These findings underscore the need for interventions to improve early detection, treatment, and follow-up of hypertension.

Background Despite substantial declines in burden over time, stroke remains a public health threat in the Americas. This study aimed to assess the current magnitude, trends, and disparities in the estimates of stroke burden by sex and age in the Americas from 1990 to 2021. Methods Estimates from the Global Burden of Disease, Injuries and Risk Factors Study 2021 were used to analyze incidence, prevalence, mortality, years of life lost due to premature death, years lived with disabilities, and disability- adjusted life years (DALYs) caused by stroke and its major subtypes stratified by age, and sex in the Americas from 1990 to 2021. We used Joinpoint regression analysis to estimate the average annual percent change (AAPC) of stroke mortality and disease burden outcomes and assessed trends. Findings In 2021, there were 1.1 million (95% uncertainty interval: 1.0-1.2) new cases, 12.9 million (12.3-13.7) prevalent cases, 0.5 million (0.5-0.6) deaths, and 11.4 million (10.6-12.1) DALYs due to stroke in the Americas. The absolute number of stroke burden outcomes increased from 1990 to 2021, but their corresponding age-standardized rates significantly declined. A deceleration in reduction rates of burden outcomes for all strokes and most stroke subtypes occurred over the last decade, with pronounced difference between sexes mainly in incidence among younger groups. From 2015 to 2021, trends in incidence rates from all stroke and stroke subtypes reversed to increase in most age groups, and strikingly, trends in mortality and DALY rates from ischemic stroke among younger populations reversed to upward with AAPC over 1.4%. A substantial number of countries contributed to these increasing trends. Interpretation Regionally, the annual number of stroke cases and deaths significantly increased from 1990 to 2021, despite reductions in age-standardized rates. The declining pace in age-standardized stroke rates has decelerated in recent years, while trends in incidence, and ischemic stroke mortality and DALY among middle-aged adults and adults, reversed towards upward in the period 2015-2021. Further studies are needed to understand the determinants of this recent pattern and identify the most cost-effective interventions to stem this alarming trend. Copyright (c) 2025 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND IGO license (http://creativecommons.org/licenses/by-nc-nd/3.0/igo/).

PURPOSE:This study aimed to (1) examine the association between comorbid anxiety and depressive symptoms and quality of life (QoL) among adolescents and young adults and assess whether perceived social support modifies this relationship; and (2) explore the association between comorbid symptoms and use of mental health (MH) services, considering QoL as a potential effect modifier. METHODS:A cross-sectional study was conducted with 1816 adolescents and young adults aged 15-24 years from socioeconomically disadvantaged urban areas of Bogotá, Buenos Aires, and Lima. The analysis included descriptive statistics, bivariate tests, and multivariable generalised linear models to assess associations with QoL. Poisson regression models were used to examine the association with MH service use. Interaction terms were included to assess potential effect modification by social support and QoL, with all models adjusted for relevant sociodemographic and contextual confounders. RESULTS:Comorbidity of depressive and anxiety symptoms was associated with lower QoL scores (β = -0.71; p < 0.001). Higher perceived social support was positively associated with QoL and significantly moderated the comorbidity and QoL relationship (p < 0.001). Additionally, comorbidity was linked to increased use of MH services (PR = 1.98; p < 0.001). Each QoL additional point was associated with a reduction of 25 % in MH service use (p < 0.001); but QoL did not modify the association between comorbidity and service use, despite being close to significance (p = 0.063). DISCUSSION:Addressing both emotional symptoms and social factors is essential for improving youth well-being. Findings support strengthening social support networks and expanding access to services for vulnerable groups.

Background: Stroke remains a major public health concern with marked disparities across populations, particularly in the Americas. Despite documented declines in overall burden, limited data exist on how modifiable risk factors contribute to contemporary stroke trends across the continent. Methods: Using data from the Global Burden of Disease 2021 study, we analyzed age-standardized mortality rates and age-standardized disability-adjusted life-years (DALYs) rates from stroke attributable to 23 modifiable risk factors across 39 countries and territories in the Americas. Estimates were stratified by age, sex, stroke subtype, and Socio-Demographic Index (SDI). Temporal trends from 1990 to 2021 were assessed using the average annual percent change (AAPC), which was estimated applying Joinpoint regression analysis. Results: In 2021, 78% of stroke deaths and 77% of stroke DALYs were attributable to modifiable risk factors in the Americas. High systolic blood pressure was the leading risk factor (20.87 deaths [95% uncertainty interval: 15.17-25.8] and 453.30 DALYs [333.16-556.41] per 100,000), contributing over half of stroke burden. From 1990-2021, the largest reductions occurred in household air pollution (deaths AAPC 5.09% [5.17 5.02]; DALYs AAPC 4.92% [4.98 4.86]) and secondhand smoke (deaths AAPC 3.45% [3.49 3.41]; DALYs AAPC 3.37% [3.41 3.33]). In contrast, several risk factors showed minimal progress: high body-mass index (deaths AAPC 0.54% [ 0.59 0.49]; DALYs AAPC 0.42% [ 0.46 0.37]) and high fasting glucose (deaths AAPC 1.10% [ 1.14 1.06]; DALYs AAPC 0.99% [ 1.05 0.93]). High temperature demonstrated increases, with AAPCs exceeding +3.5% in select countries. High systolic blood pressure declined moderately (deaths AAPC 1.89% [ 1.93 1.85]; DALYs AAPC 1.84% [ 1.89 1.80]), with stroke burden remaining disproportionately higher in low-SDI countries. Conclusion: Although encouraging declines in stroke burden attributable to risk factors have been observed over three decades, substantial variation persists by geography and SDI. High systolic blood pressure remains the leading modifiable risk factor. Minimal progress in diet and metabolic factors highlights the need for equity-focused strategies to address persistent and emerging stroke risks across the Americas. ### Competing Interest Statement CA: received honoraria as Speaker from Boehringer Ingelheim; TFA: received honoraria as Speaker from Boehringer Ingelheim; PA: received honoraria as Speaker from Boehringer Ingelheim, Abbott, Ipsen, Boston Scientific and Knigth therapeutics; CSA: Receives Grants and fellowship from the National Health and Medical Research Council (NHMRC) of Australia, Medical Research Foundation of the UK, Consulting fees as Advisory Board for AstraZeneca Australia, is the Vice-President of the World Stroke Organisation and the Editor-in-Chief of Cerebrovascular Diseases journal; MAB: received honoraria as Speaker from Roche and Boehringer Ingelheim; HB: Received payment or honoraria for lectures, presentations from Novartis and Adium Colombia; ACS: Received speaker fees from Boehringer Ingelheim; PML: Received Research grant from Boehringer-Ingelheim, payment as part of Steering Committee from Johnson & Johnson and Advisory Board from Bristol Meyer Squib and Pfizer, honoraria for lectures from Pfizer, Angels educational events from Boehringer Ingelheim, Support for attending meetings and/or travel from the Iberoamerican Stroke Society and Global Stroke Initiative, President of the Chilean Stroke Association (ACEVE) and Vice-president of the Iberoamerican stroke society (SIECV); BO: Editor-in-Chief, Journal of the American Heart Association, President, Society for Equity Neuroscience, Member, World Stroke Organization Board; OPN: Received speaker fees from Boehringer-Ingelheim and Astra-Zeneca and Servier; GSS: Received grant from the Brazilian Ministry of Health, Consulting fees from Astrazeneca and Bayer, Payment or honoraria for lectures from Astrazeneca, Bard, Support for attending meetings from Boehringer Ingelheim; SS: Received Grant from NIH Grant support; VU: Received Grant from Genentech, Inc; SA: Received payment or honoraria from Astra Zeneca and Silanes, Support for attending meetings from Astra Zeneca and Raffo, Participation on a Data Safety Monitoring Board from Astra Zeneca, VCN: Received payment or honoraria from Boehringer Ingelheim, AstraZeneca and Sanofi, Support for attending Meetings from Boehringer Ingelheim, LAC: Received grant from World Stroke Organization, Consulting fees from Allm Inc, IschemaView, AstraZeneca, Payment or honoraria for lectures from AstraZeneca, Boehringer Ingelheim, IschemaView, Support for attending Meetings from Boehringer Ingelheim, IschemaView, PMV: Received Research grants from ANID Fondecyt Regular 1221837 and Pfizer Research grant 76883481, Grant from Boehringer Ingelheim; AR: Participation on a Data Safety Monitoring Board or Advisory Board from Boston Scientific, Astra Zeneca, Shionogi, Brainomix, Chiesi. VVO: received research grant from Boehringer Ingelheim and payment or honoraria for lectures from Pfizer and Novo Nordisk; LAS: Unrestricted grants from GORE, Medtronic, AstraZeneca, Philips; Speaker honoraria from Boehringer Ingelheim, Pfizer, AstraZeneca; Advisory board for J&J/BMS, Medtronic, AstraZeneca; FDT: Editor-in-Chief of the Journal of Stroke and Cerebrovascular Diseases and receives honoraria from Elsevier. All other authors declare no conflicts of interest with the content of this manuscript. ### Funding Statement This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study used de-identified, aggregate data from the Global Burden of Disease 2021 study. No institutional review board approval was required as no individual-level data or human subjects were involved in this secondary data analysis. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data used in this study are publicly available from the Global Burden of Disease (GBD) 2021 study. The datasets can be accessed through the Institute for Health Metrics and Evaluation (IHME) Global Health Data Exchange (GHDx) at http://ghdx.healthdata.org/gbd-results-tool.

The association between waist circumference (WC) and hypertension, and if this association varies by sex or by body mass index (BMI) categories have not deeply been assessed in the American continent. We aimed to evaluate whether an association between abdominal obesity and hypertension exists and if sex and BMI configure effect modifiers of such association. A secondary analysis of the Peruvian Demographic Family Health Survey data was conducted. Subjects aged from 20 to 69 years were included. Hypertension, defined by the Eighth Joint National Committee, was chosen as the outcome, whereas abdominal obesity (using WC cutoffs based on the 2001 National Cholesterol Education Program Adult Treatment Panel III) was selected as exposure. Poisson regression was used to report prevalence ratios (PR) and 95% confidence intervals (95%CI). Data from 144,156 subjects [mean age 41.4 (SD = 13.4), 54.8% of whom were women] were analyzed. Prevalence of abdominal obesity and hypertension totaled 45.4 and 19.5%, respectively. The adjusted model associated abdominal obesity with greater hypertension prevalence (PR = 1.31; 95%CI: 1.24-1.39). BMI, but nor sex, was an effect modifier of the association. Thus, those obese by BMI and abdominally obese had the strongest association with hypertension (PR = 2.76; 95%CI: 2.58-2.94) than those with normal BMI and no abdominal obesity. Our results evince a positive association between abdominal obesity and hypertension depending on BMI category. Those obese by both BMI and WC had the strongest association with hypertension. Our results suggest that BMI and WC offer useful markers for hypertension.

Introduction:In South America, the rise in chronic respiratory diseases and weight-related issues due to the ongoing epidemiological transition has prompted research into their interrelationship. Methods:We sought to assess the association between body mass index (BMI) and bronchodilator responsiveness (BDR) among adults in Peru, Chile, Uruguay, and Argentina, using population-based data from 2 cohort studies. We defined BDR as a ≥12% and ≥200mL increase in either forced expiratory volume in 1 second (FEV1) or forced vital capacity (FVC) after administration of a short-acting bronchodilator. The analysis also distinguished between FEV1- and FVC-specific BDR. We used logistic regression adjusted for confounders to evaluate associations with BMI. Results:Among 7160 participants (55.2% men, mean age 57.3 years), 23.7% had a BMI <25kg/m2 and 35.5% had a BMI ≥30 kg/m2. Overall, 9.5% met the criteria for BDR; with 7.8% showing FEV1-specific and 4.9% FVC-specific responses. Compared to a BMI of 20-24.9kg/m2, a BMI ≥30kg/m2 was associated with higher odds of FVC-specific BDR (adjusted odds ratio = 1.47, 95% confidence interval 1.08-2.03), whereas a BMI <20kg/m2 was associated with FEV1-specific BDR among participants with asthma (6.61, 1.23-35.6) and chronic bronchitis (4.71, 1.28-15.9), and with higher odds of any BDR in those with chronic bronchitis (3.90, 1.19-11.9). Conclusion:There was a differential relationship between BMI and types of BDR: higher BMI was associated with FVC-specific responsiveness, whereas lower BMI was linked to FEV1-specific BDR in individuals with asthma and chronic bronchitis and to overall BDR in those with chronic bronchitis.

This study aimed to evaluate the longitudinal association between overbasalization and glycemic control. Retrospective cohort study including subjects with T2DM diagnosis, insulin users and treated in the Endocrinology Service of EsSalud through the National Telemedicine Center, part of the Social Security (EsSalud) in Lima, Peru. Data was taken from January 2023 to December 2024, and only those with at least two assessments were considered. Hospitalized participants, chronic users of corticosteroids, those with transfusions, and pregnant women during the study period were excluded. The dependent variable was glycemic control, defined using glycated hemoglobin (HbA1c < 53 mmol/mol [< 7

Obesity is commonly defined using body mass index (BMI), but BMI alone does not capture the metabolic and functional consequences of excess weight. We examined the prevalence of clinical obesity, a new definition that incorporates BMI alongside metabolic and functional impairments. We analyzed nationally representative surveys. Clinical obesity was defined as BMI ≥ 30 kg/m2 and waist-to-height ratio ≥0.5 or BMI ≥ 40 kg/m2 with at least: self-reported diabetes, fasting plasma glucose ≥126 mg/dl, self-reported hypertension, blood pressure ≥140/90 mmHg, or total cholesterol ≥200 mg/dl. We estimated the survey-weighted and age-standardized prevalence of clinical obesity and BMI-only obesity by country and sex. Data from 56 countries were included (n = 142,250). The prevalence of clinical obesity ranged between 0% and 29%. The prevalence of clinical obesity was < 10% in 41 countries for men and 30 for women. In men, the largest shift in prevalence of BMI-only obesity and clinical obesity was observed in Malawi (0.7% vs 0.2%, relative change: -68%); in women, the largest shifts in prevalence were seen in Malawi (5.6% vs. 2.6%, relative change: -53%) and Rwanda (2.7% vs. 1.3%, relative change: -52%). The adoption of clinical obesity criteria revises obesity prevalence estimates and highlights metabolic and functional impairments beyond BMI. Our results emphasize the need to carefully consider how obesity is defined in population surveillance to ensure its relevance to health outcomes.

BackgroundDementia is a global health priority with significant challenges due to its complex nature and increasing prevalence. Health systems worldwide struggle to address chronic conditions like dementia, often providing fragmented care. However, information about how health systems respond to the needs of people with dementia and their carers, and the quality of care provided, is scarce in low- and middle-income countries. ObjectiveThis study aims to assess the quality of the health system to provide diagnosis and care for people with dementia and their carers in Peru. In order to do this, the study will explore the response of the Peruvian health system to people with dementia and their carers, and explore the experiences of people with dementia of receiving their diagnosis, management, and quality of care for this condition. MethodsThis study is part of a research program called “IMPACT Salud: Innovations using Mhealth for people with dementia and Co-morbidities,” aimed at strengthening health systems to provide care for people with dementia and their carers. The study has a descriptive, cross-sectional design that uses a qualitative methodology, including stakeholder interviews and documentation review, and consists of 2 substudies, a health system assessment (HSA) and an exploration of the patient journey. The first substudy uses an HSA methodology suitable for low- and middle-income countries, conducting 160 structured interviews with 12 different stakeholder types across 3 levels of the health system (micro, meso, and macro) in 4 Peruvian regions, each with distinct geographical and urbanization profiles. The second substudy uses a patient journey methodology, which involves conducting 40 in-depth interviews with people with dementia, carers, and health care workers from the same 4 regions. The insights into the people with dementia patient and caregiver experience within the health system from the interviews will be used to produce a patient journey map. The analysis will be guided by the high-quality health system framework, and the findings from the HSA and patient journey will be structured using the domains included in the framework through the lens of quality of services. ResultsData collection began in March 2024. As of the end of September 2024, a total of 156 interviews from the HSA and 38 interviews from the patient journey study have been conducted across 4 regions. ConclusionsThis study will provide a national, multilevel insight into the current operation of the Peruvian health system, including an analysis of the quality of services provided with regard to dementia diagnosis, management, and care from the perspectives of stakeholders, patients, and their carers. International Registered Report Identifier (IRRID)DERR1-10.2196/60296

BACKGROUND:Global evidence has shown rising trends in the prevalence of cardiometabolic risk factors. Whether the same trends are observed according to body mass index (BMI) cut-offs is unknown, though critical to focus on specific BMI populations. METHODS:We conducted a pooled analysis of national health surveys in Peru, grouped into three-year periods (2015-17 [n = 97,079], 2018-20 [n = 98,540], 2021-23 [n = 94,850]). BMI (kg/m²) was classified into four categories: normal weight (18-24.9), overweight (25-29.9), obesity I (30-34.9), and obesity II (≥35). For each period-BMI category, we computed the age-sex-standardized prevalence of cardiometabolic risk factors: raised blood pressure with and without self-reported antihypertensive treatment, self-reported diabetes with and without treatment, daily smoking, alcohol consumption in the last month, and fruits/vegetables consumption in the last week. RESULTS:The proportion of people with raised blood pressure increased in the overweight and obesity groups, with the largest increase observed in the obesity II group (22 % relative increase). Diabetes prevalence rose substantially among normal weight (89 %) and overweight individuals (58 %). Smoking, alcohol, and fruit/vegetable consumption showed no major changes across BMI categories. CONCLUSIONS:The prevalence of raised blood pressure has increased between 2015 and 17 and 2020-23, with greater increases observed in the overweight and obesity groups; conversely, the prevalence of self-reported diabetes has increased across BMI categories. These findings highlight the need for tailored interventions targeting both overweight/obese individuals and normal weight populations with diabetes risk.

Background The skeletal muscle has mainly a structural function and plays a role in human’s metabolism. Besides, the association between sleep quality and muscle mass, in the form of sarcopenia, has been reported. This study aimed to assess whether changes of skeletal muscle mass (SMM) over time are associated with baseline sleep duration and disturbances in a resource-constrained adult Peruvian population. Materials and Methods Secondary analysis using information of a population-based intervention. The outcome was SMM assessed using bioimpedance and the second version of the Lee’s formula. The exposures were baseline self-reported sleep duration (normal, short and long sleepers) and disturbances (sleep difficulties and awakening at nights). Crude and adjusted linear mixed models were used to assess the associations of interest, and coefficients (β) and 95% confidence intervales (95% CI) were reported. Results Data from 2,310 individuals at baseline, mean age 43.4 (SD: 17.2), and 1,163 (50.4%) females were analyzed. Sleep duration was 7.8 (SD: 1.3) hours/day, with 15.3% short sleepers and 11.6% long sleepers, whereas 24.2% reported sleep difficulties and 25.1% awakening at nights. In multivariable model, SMM among short and long sleepers did not vary significantly over time using the Lee’s formula; however, SMM was lower at the end of follow-up for long sleepers using bioimpedance (-0.26 kg; 95% CI: -0.47 to -0.06). Sleep disturbances were associated with a gradual SMM reduction: 0.36 kg using bioimpedance and 0.25 kg using the formula at the end of follow-up. Conclusions Using bioimpedance and formula estimations, sleep disturbances were associated with a reduction of SMM over a period of 2.4 years. Regarding sleep duration, no SMM changes over time were seen in short sleepers, but findings were discordant in long sleepers: a reduction of SMM using bioimpedance, but no change using the formula.

OBJECTIVE:To determine the association between relative leg length and insulin resistance according to rural, urban, and rural-urban migrant groups. METHODS:Cross-sectional study using data from the PERU MIGRANT study (2007-2008). The exposure was relative leg length categorized as short, normal, or long, and the outcome was insulin resistance (logarithm of homeostatic model assessment log-HOMA2-IR). Linear regression models with log transformation, adjusted for sex, age, parental education, hip circumference, and physical activity level, were employed to estimate geometric mean ratios of insulin resistance across leg length categories. Interaction effects of population groups (rural, urban, and migrants) on insulin resistance were explored, along with mediation analysis of central obesity and excess body fat in the main relationship. RESULTS:Using data from 947 participants, 52.7% female, mean age 47.7 years (SD = 11.9), we found a robust inverse association between relative leg length and insulin resistance. The geometric mean of insulin resistance in subjects with long leg length was 43% (eβ1: 0.57, 95% CI: 0.47-0.69) lower than those in the normal category. A significant interaction effect of the population group on relative leg length categories (p < 0.001) was observed, particularly in the migrant and rural groups. Excess body fat and abdominal obesity explained 33% and 12% of the association between relative leg length and insulin resistance, respectively. CONCLUSIONS:Longer leg length was associated with lower insulin resistance values, with a greater interaction effect observed among the rural-urban migrant and urban groups. These findings support the hypothesis that metabolic disorders in adults may be traceable to nutritional and developmental conditions early in life.