Nutrition and cardiovascular diseases in the adult population of Paraguay
DOI:
https://doi.org/10.5281/zenodo.22135518Keywords:
cardiovascular diseases, nutrition, Mediterranean diet, dietary sodium, ultra-processed foods, ParaguayAbstract
Introduction: Stroke is the second leading cause of death worldwide and one of the main causes of disability in adults; most of this burden falls on low- and middle-income countries, and more than 90% is attributable to modifiable risk factors. In Latin America stroke ranks among the leading causes of death, and in Paraguay hospital series and surveys describe a profile dominated by arterial hypertension, followed by diabetes, dyslipidemia and smoking. The aim was to gather evidence available through 2024 on the burden, risk factors and prevention of stroke in the adult population, with emphasis on Paraguay. Materials and methods: Narrative review of evidence available through 2024. Results: Arterial hypertension concentrates the largest population-attributable risk and its control is the most cost-effective preventive intervention: each 10 mmHg reduction in systolic blood pressure lowers stroke risk by about one quarter, and each percentage-point improvement in population hypertension control is associated with lower stroke mortality in the Region of the Americas. Evidence also supports treatment of dyslipidemia and diabetes, smoking cessation, physical activity, healthy diet, detection of atrial fibrillation and, after an event, secondary prevention with high-intensity statins and antithrombotic therapy. Conclusions: Epidemiological information specific to Paraguay comes from case series from a few centers, which reinforces the need for national stroke registries and sustained prevention programs in primary care.References
Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982-3021. https://doi.org/10.1016/j.jacc.2020.11.010
GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393(10184):1958-72. https://doi.org/10.1016/S0140-6736(19)30041-8
Lichtenstein AH, Appel LJ, Vadiveloo M, Hu FB, Kris-Etherton PM, Rebholz CM, et al. 2021 dietary guidance to improve cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2021;144(23):e472-87. https://doi.org/10.1161/CIR.0000000000001031
Popkin BM, Corvalan C, Grummer-Strawn LM. Dynamics of the double burden of malnutrition and the changing nutrition reality. Lancet. 2020;395(10217):65-74. https://doi.org/10.1016/S0140-6736(19)32497-3
Chaves G, Brítez N, Maciel V, Klinkhof A, Mereles D. Prevalencia de factores de riesgo cardiovascular en una población adulta ambulatoria urbana: estudio AsuRiesgo, Paraguay. Rev Panam Salud Publica. 2015;38(2):136-43.
Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34. https://doi.org/10.1056/NEJMoa1800389
Delgado-Lista J, Alcala-Diaz JF, Torres-Peña JD, Quintana-Navarro GM, Fuentes F, Garcia-Rios A, et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. Lancet. 2022;399(10338):1876-85. https://doi.org/10.1016/S0140-6736(22)00122-2
Filippou CD, Tsioufis CP, Thomopoulos CG, Mihas CC, Dimitriadis KS, Sotiropoulou LI, et al. Dietary Approaches to Stop Hypertension (DASH) diet and blood pressure reduction in adults with and without hypertension: a systematic review and meta-analysis of randomized controlled trials. Adv Nutr. 2020;11(5):1150-60. https://doi.org/10.1093/advances/nmaa041
Schwingshackl L, Schwedhelm C, Hoffmann G, Knüppel S, Iqbal K, Andriolo V, et al. Food groups and risk of hypertension: a systematic review and dose-response meta-analysis of prospective studies. Adv Nutr. 2017;8(6):793-803. https://doi.org/10.3945/an.117.017178
Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet. 2019;393(10170):434-45. https://doi.org/10.1016/S0140-6736(18)31809-9
Sacks FM, Lichtenstein AH, Wu JHY, Appel LJ, Creager MA, Kris-Etherton PM, et al. Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association. Circulation. 2017;136(3):e1-23. https://doi.org/10.1161/CIR.0000000000000510
Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020;8(8):CD011737. https://doi.org/10.1002/14651858.CD011737.pub3
Malik VS, Li Y, Pan A, De Koning L, Schernhammer E, Willett WC, et al. Long-term consumption of sugar-sweetened and artificially sweetened beverages and risk of mortality in US adults. Circulation. 2019;139(18):2113-25. https://doi.org/10.1161/CIRCULATIONAHA.118.037401
Pagliai G, Dinu M, Madarena MP, Bonaccio M, Iacoviello L, Sofi F. Consumption of ultra-processed foods and health status: a systematic review and meta-analysis. Br J Nutr. 2021;125(3):308-18. https://doi.org/10.1017/S0007114520002688
Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. 2013;346:f1326. https://doi.org/10.1136/bmj.f1326
Neal B, Wu Y, Feng X, Zhang R, Zhang Y, Shi J, et al. Effect of salt substitution on cardiovascular events and death. N Engl J Med. 2021;385(12):1067-77. https://doi.org/10.1056/NEJMoa2105675
Popkin BM, Reardon T. Obesity and the food system transformation in Latin America. Obes Rev. 2018;19(8):1028-64. https://doi.org/10.1111/obr.12694
Ortellado Maidana J, Ramírez A, González G, Olmedo Filizzola G, Ayala de Doll M, Sano M, et al. Consenso Paraguayo de Hipertensión Arterial 2015. Rev Virtual Soc Parag Med Int. 2016;3(2):11-57. https://doi.org/10.18004/rvspmi/2312-3893/2016.03(02)11-057
Vierci GE, Ferro EA. Capacidad antioxidante total vinculada a la ingesta de frutas y verduras en adultos jóvenes de Asunción, Paraguay. Nutr Hosp. 2019;36(1):118-24. https://doi.org/10.20960/nh.02074
Padilla-Moseley J, Blanco-Metzler A, L'Abbé MR, Arcand J. A program evaluation of a dietary sodium reduction research consortium of five low- and middle-income countries in Latin America. Nutrients. 2022;14(20):4311. https://doi.org/10.3390/nu14204311
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Copyright (c) 2024 Kalybia Moreira de Oliveira Cavalcanti, Victor Hugo Espindola Olmedo, Francisco Vieira Soares Junior, Rossana Cañete Lentini (Autor/a)
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