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Obesity
Trajectories of body mass index and waist circumference in four Peruvian settings at different level of urbanisation: the CRONICAS Cohort Study
  1. Rodrigo M Carrillo-Larco1,
  2. J Jaime Miranda1,2,
  3. Robert H Gilman1,3,4,
  4. William Checkley1,5,
  5. Liam Smeeth1,6,
  6. Antonio Bernabé-Ortiz1,6
  7. CRONICAS Cohort Study Group
    1. 1 CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
    2. 2 Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
    3. 3 Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
    4. 4 Área de Investigación y Desarrollo, AB PRISMA, Lima, Peru
    5. 5 Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
    6. 6 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
    1. Correspondence to Dr J Jaime Miranda, CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, San Martín de Porres 15102, Peru; Jaime.Miranda{at}upch.pe

    Abstract

    Background Studies have reported the incidence/risk of becoming obese, but few have described the trajectories of body mass index (BMI) and waist circumference (WC) over time, especially in low/middle-income countries. We assessed the trajectories of BMI and WC according to sex in four sites in Peru.

    Methods Data from the population-based CRONICAS Cohort Study were analysed. We fitted a population-averaged model by using generalised estimating equations. The outcomes of interest, with three data points over time, were BMI and WC. The exposure variable was the factorial interaction between time and study site.

    Results At baseline mean age was 55.7 years (SD: 12.7) and 51.6% were women. Mean follow-up time was 2.5 years (SD: 0.4). Over time and across sites, BMI and WC increased linearly. The less urbanised sites showed a faster increase than more urbanised sites, and this was also observed after sex stratification. Overall, the fastest increase was found for WC compared with BMI. Compared with Lima, the fastest increase in WC was in rural Puno (coefficient=0.73, P<0.001), followed by urban Puno (coefficient=0.59, P=0.001) and Tumbes (coefficient=0.22, P=0.088).

    Conclusions There was a linear increase in BMI and WC across study sites, with the greatest increase in less urbanised areas. The ongoing urbanisation process, common to Peru and other low/middle-income countries, is accompanied by different trajectories of increasing obesity-related markers.

    • cardiovascular disease
    • cohort studies
    • epidemiology
    • epidemiology of cardiovascular disease
    • obesity

    This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

    https://doi.org/10.1136/jech-2017-209795

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      Footnotes

      • Contributors RMCL, ABO and JJM conceived the idea of the manuscript. RMCL drafted the first version of the manuscript and led the statistical analysis with the support of ABO. JJM, RHG, WC and LS conceived, designed and supervised the overall study. JJM, ABO and WC coordinated and supervised fieldwork activities in Lima, Tumbes and Puno. All authors participated in the writing of the manuscript, provided important intellectual content and gave their final approval of the version submitted for publication.

      • Funding This project has been funded in whole with federal funds from the US National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, under contract number HHSN268200900033C. WC was further supported by a Pathway to Independence Award (R00HL096955) from the National Heart, Lung and Blood Institute. RMCL has received support as a research trainee from the Inter-American Institute for Global Change Research (IAI CRN3036). LS is a Senior Clinical Fellow and ABO is a Research Training Fellow in Public Health and Tropical Medicine (103994/Z/14/Z), both funded by the Wellcome Trust.

      • Competing interests None declared.

      • Patient consent Obtained.

      • Ethics approval Institutional Review Boards at Universidad Peruana Cayetano Heredia and Asociación Benéfica PRISMA in Lima, Peru, and Johns Hopkins University in Baltimore, USA.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Collaborators *CRONICAS Cohort Study Group. Juan P Casas; George Davey Smith; Shah Ebrahim; Héctor H. García; Luis Huicho; Germán Málaga; Víctor M Montori; Gregory B Diette; Fabiola León-Velarde; María Rivera; Robert A Wise; Katherine Sacksteder.