Background
The prevalence of overweight and obesity is a major global health concern [
1] that now extends beyond high-income nations to low- and middle- income nations [
2]. Obesity is positively associated with developing several chronic disorders, including cardiovascular disease (CVD; i.e., type II diabetes, insulin resistance, hypertension, and cholesterol levels), mortality and life expectancy, and can be reduced by adherence to a healthy lifestyle [
3‐
6]. Consequently, early detection of weight gain is crucial to preventing adverse long-term effects on individuals’ lifestyle [
5].
Central, visceral or subcutaneous fat, is strongly associated with the risk of developing several chronic disorders. It has been discussed in the literature that other deposits of fat may also contribute to the CVD [
7]. Neck circumference (NC) has been associated with waist circumference (WC), body mass index (BMI) and with components of metabolic syndrome [
8‐
12]. NC is a simple and valid measure of fat mass, more practicable and may have better association with triglycerides, HOMA, HDL-C than BMI and WC [
9].
Physical activity, a cornerstone in the prevention and treatment of obesity and CVD, has been shown to be inversely related to fatness [
13,
14]. The prevalence of physical inactivity in Latin America (LA) was reported the highest worldwide [
15] and ranked fifth as a risk factor for mortality in the Southern Cone of LA [
16]. LA is the most urbanized region in the world (80% of its population lives in cities) [
17] and has rising prevalence of obesity, chronic diseases, and physical inactivity [
18,
19]. Obesity and physical inactivity are now especially important public health challenges in LA [
20].
The objective assessment of moderate-to-vigorous physical activity (MVPA) using accelerometers has become more common practice in research originating from high-income countries [
14,
21]. In contrast, given the cost associated with using objective measures like accelerometers and the lack of research in this field in most LA countries [
22], there are relatively few studies using this technology in LA countries [
23]. To our knowledge, there has been no examination of the association between objective assessment of MVPA using accelerometers with NC in a nationally representative sample from LA. Thus, the purpose of this article is to investigate the association of accelerometer-determined MVPA with NC in adolescents and adults from eight LA countries.
Results
The sample included 2370 participants, aged from 15 to 65 years old (M = 36.6, SD = 14.2), who used the accelerometer, which represented 29.6% of the total sample of the ELANS project (n = 9218). There were no significant differences between the participants who used the accelerometer and those who did not concerning sex (p = 0.937), SEL (p = 0.501), or educational level (p = 0.235). However, the distribution by age group was different (p = 0.018); the participants with accelerometer were slightly older.
The participants used the accelerometer between 5 and 7 days. On average, the accelerometer was used for 15.3 h/day, which represented a total time of 100.7 h. This time ranged from 14.8 h/day in Costa Rica to 15.8 h/day in Peru (Supplementary material 1).
There were slightly more female (52.2%) than male (47.8%) participants. About 2 out of 3 participants were aged from 20 to 49 years old (65.8%). About half (51.2%) were from low SEL, and more than half (60.1%) had a basic educational level or lower. Only 10.0% were from a high SEL, and 10.2% had a university degree (Table
1).
Table 1
Descriptive analysis (%) of sample profile concerning sex, age group, socioeconomic, and educational level of adolescents and adults from eight Latin America countries
Argentina | 293 | 44.4 | 55.6 | 10.6 | 30.7 | 33.1 | 25.6 | 53.9 | 41.3 | 4.8 | 73.7 | 23.9 | 2.4 |
Brazil | 563 | 46.2 | 53.8 | 11.0 | 36.2 | 29.0 | 23.8 | 41.7 | 50.4 | 7.8 | 44.9 | 46.7 | 8.3 |
Chile | 297 | 46.5 | 53.5 | 10.8 | 36.7 | 27.6 | 24.9 | 41.4 | 47.5 | 11.1 | 61.6 | 23.6 | 14.8 |
Colombia | 339 | 49.9 | 50.1 | 10.0 | 35.7 | 27.4 | 26.8 | 64.0 | 31.0 | 5.0 | 66.4 | 22.1 | 11.5 |
Costa Rica | 273 | 47.6 | 52.4 | 13.6 | 35.5 | 30.0 | 20.9 | 34.1 | 54.2 | 11.7 | 83.9 | 11.4 | 4.8 |
Ecuador | 268 | 50.4 | 49.6 | 13.4 | 40.3 | 29.9 | 16.4 | 44.8 | 40.7 | 14.6 | 79.1 | 11.9 | 9.0 |
Peru | 330 | 48.2 | 51.8 | 14.5 | 39.7 | 24.8 | 20.9 | 47.0 | 30.0 | 23.0 | 20.6 | 67.6 | 11.8 |
Venezuela | 367 | 49.9 | 50.1 | 13.4 | 42.2 | 27.8 | 16.6 | 80.9 | 14.2 | 4.9 | 69.2 | 13.1 | 17.7 |
Full sample | 2730 | 47.8 | 52.2 | 12.1 | 37.2 | 28.6 | 22.2 | 51.2 | 38.8 | 10.0 | 60.1 | 29.7 | 10.2 |
The average time of MVPA was 34.88 min/day, ranging from 31.16 in Venezuela to 40.27 in Chile. Concerning NC, 37.0% of the full sample was classified as having elevated NC. Chile was the country with the highest percentage of people with elevated NC with more than half (56.9%), and Colombia had the lowest percentage (24.8%) (Table
2).
Table 2
Descriptive analysis of moderate-to-vigorous physical activity (Mean and SD) and neck circumference (frequency and %) of adolescents and adults from eight Latin America countries (n = 2730)
Argentina | 32.81 (22.63) | 169 (57.7%) | 124 (42.3%) |
Brazil | 33.37 (24.63) | 405 (71.9%) | 158 (28.1%) |
Chile | 40.27 (23.66) | 128 (43.1%) | 169 (56.9%) |
Colombia | 34.84 (24.63) | 255 (75.2%) | 84 (24.8%) |
Costa Rica | 32.41 (28.19) | 149 (54.6%) | 124 (45.4%) |
Ecuador | 40.04 (30.58) | 188 (70.1%) | 80 (29.9%) |
Peru | 36.43 (26.60) | 212 (64.2%) | 118 (35.8%) |
Venezuela | 31.16 (21.91) | 213 (58.0%) | 154 (42.0%) |
Full sample | 34.88 (25.40) | 1719 (63.0%) | 1011 (37.0%) |
Tables
3 and
4 present the results of the multilevel logistic regression analysis describing the association between MVPA and NC. The effect of daily MVPA (min/day) on NC, considering two hierarchical levels (country and region) and adjusted for sex, age, SEL, and educational level, is presented in Table
3. Overall, the increase of one min/day of MVPA is associated with a decrease of 0.6% in the chance of having an elevated NC (OR = 0.994, CI95% = 0.990–0.998,
p = 0.003). The association was similar across all countries but only significant in two: Costa Rica (OR = 0.980, CI95% = 0.964–0.997,
p = 0.024) and Peru (OR = 0.989, CI95% = 0.980–0.999,
p = 0.031) (Table
4).
Table 3
Multilevel logistic models for moderate-to-vigorous physical activity (min/day) with neck circumference of adolescents and adults from eight Latin America countries-full sample (n = 2730)
MVPA (min/day) | 0.994 (0.990, 0.998) | 0.003 |
Sex female (vs. male) | 0.739 (0.624, 0.875) | < 0.001 |
Age (years) | 1.013 (1.007, 1.019) | < 0.001 |
Socioeconomic level medium (vs. low) | 1.143 (0.947, 1.380) | 0.164 |
Socioeconomic level high (vs. low) | 1.003 (0.731, 1.378) | 0.983 |
Educational level high school (vs. basic or lower) | 0.756 (0.613, 0.932) | 0.009 |
Educational level university degree (vs. basic or lower) | 0.780 (0.573, 1.062) | 0.114 |
Table 4
Multilevel logistic models for moderate-to-vigorous physical activity (min/day) with neck circumference of adolescents and adults from eight Latin America countries-in each country (n = 2730)
MVPA (min/day) |
Argentina | 0.996 (0.984, 1.008) | 0.490 |
Brazil | 0.990 (0.975, 1.006) | 0.214 |
Chile | 0.998 (0.982, 1.015) | 0.846 |
Colombia | 0.990 (0.979, 1.002) | 0.105 |
Costa Rica | 0.980 (0.964, 0.997) | 0.024 |
Ecuador | 0.997 (0.984, 1.010) | 0.643 |
Peru | 0.989 (0.980, 0.999) | 0.031 |
Venezuela | 0.990 (0.976, 1.004) | 0.178 |
Discussion
This study aimed to investigate the association of accelerometer-determined MVPA with NC in adolescents and adults from eight LA countries. The average time of MVPA was 34.88 min/day, and 37.0% of the full sample was classified as having elevated NC. Overall, the increase of one min/day of MVPA is associated with a decrease of 0.6% in the chance of having an elevated NC. When analyzed by country, the association was similar across all countries but only significant in Costa Rica and Peru. The effect significance of MVPA (min/day) on NC, considering two hierarchical levels (country and region), was adjusted for sex, age, SEL, and education level.
Latin America is the most urbanized region in the world (80% of Latin Americans live in cities) with demographic and epidemiological changes. Furthermore, high population density, disorganized transit systems, traffic congestion, pronounced income inequality, and important and rapid nutritional transition are some of the characteristics of LA. However, one point stands out: the marked increase in the prevalence of obesity and chronic diseases in nearly all of LA [
44‐
46]. More than 20% of population from LA, including youth are overweight or obese, and the indices has increased to a greater scale specifically in Mexico, Argentina, and Chile. [
47] and in 2030, up to 81.9% of the LA adult population could be either overweight or obese [
48]. This is the first study to report NC for a representative sample of LA adolescents and adults from an urban setting; therefore, the only possible comparison was against previous reports that used other anthropometric methods. The prevalence of obesity (BMI ≥ 30 kg/m
2) in São Paulo, Brazil, was more than 23% and in Santiago, Chile, was more than 31% [
49]. In our study, we found 28.1% elevated NC in Brazil and 56.7% in Chile.
The prevalence of overweight and obesity is increasing in LA, and high rate of body fat is a risk factor for increase closely associated factors (i.e., chronic disease, hypertension and type II diabetes) [
50]. Epidemiologic study have identified each 5 kg/m
2 higher BMI was associated, on average, with 30% higher overall mortality, specifically 40% for vascular diseases; 60–120% for diabetes; 10% for cancer; and 20% for respiratory diseases and all other causes [
51].
NC provide high values in prediction of distribution of upper-body subcutaneous, is valid marker and the data collection is simple to execute [
52‐
56]. BMI and others anthropometric indicators have long been suggested of defining the overweight and obesity of person [
57]. Upper body fat distribution has been considered a risk factor of CVD. It has been reported that free fatty acids are released in larger proportion from upper body subcutaneous fat than lower body subcutaneous fat [
58]. Moreover, NC has been used as an index for such an adverse risk profile [
59,
60]. Joshipura et al. [
9] showed that NC was significantly associated with metabolic factors, including components of metabolic syndrome (hypertension, triglycerides, glucose ≥100, HOMA-IR); the magnitude of the associations is modest, ranging from 0.45–0.66. Importantly, compared to traditional anthropometric measures such as BMI, WC, and body fat percent, NC showed higher significant association with prediabetes and with HDL-C, [
9].
This is the first study reporting significant association of accelerometer-determined MVPA with NC of nationally representative samples from urban populations from LA countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela). This study supports previous research that has shown negative relationships between accelerometer-determined MVPA and body composition variables [
61,
62]. Our results corroborate those of Van Dyck et al. [
62], who reported significant associations of accelerometer-determined MVPA with BMI in adults from 12 countries, independent of country and SEL. Our study showed significant association between MVPA and NC, independent of sex, age, SEL, and educational level. Both our study and the Van Dick et al. [
62] study used the cut-point of ≥1952 cpm for MVPA [
28]. Higher levels of physical activity may have important additional beneficial effects on fitness or other health outcomes [
63]. However, one must keep in mind that the present results are cross-sectional; therefore, no true dose–response relationships can be assumed.
Table
4 presents the results of the multi-level logistic regression analysis describing the significant association between MVPA and NC for Costa Rica (OR = 0.980, CI95% = 0.964–0.997) and Peru (OR = 0.989, CI95% = 0.980–0.999), considering two hierarchical levels (country and region) and adjusted for sex, age, SEL, and educational level. One conclusion from these results is that different patterns of MVPA are associated with high prevalence estimates of elevated NC, so countries could tailor physical activity and obesity promotion strategies to local infrastructure, available programs, and culture. The results shows the variety and diversity of countries from LA, and, thus, the need to better understand these realities for to expand healthy eating habits in LA [
64,
65]. For example, Peruvian people have increased their BMI during fifteen years (1996–2011), and more than global female trend rate [
66]. Worldwide, adult BMI has increased by 0.4–0.5 kg/m
2 per decade [
66]. Moreover, adult obesity levels have been augmented from 6.4 to 12.0% [
67]. In addition, sedentary activities and physical inactivity due to rapid urbanization have been contributing to escalating levels of over-nutrition [
45]. In a region experiencing escalating rates of obesity and inactivity, there is an opportunity to promote effective interventions as interdisciplinary strategies (i.e., coordination between health, sports and education departments) to increase physical activity, healthy eating habits and prevent noncommunicable diseases.
The results of the study may not be directly generalizable to other countries. Nevertheless, no study has evaluated the accelerometer-determined MVPA and NC of adolescent and adult populations in LA using a standardized methodology across a consortium of several participating countries. The present study had several strengths: the number of participants; comparable data collection protocols; the inclusion of objective data on physical activity makes ELANS a unique Latin American data source. To date, most studies in low- and middle-income countries have had to rely on self-reported physical activity data [
68,
69]; and it expands the existing literature by reporting the association of physical activity with NC. However, the ELANS employed a cross-sectional design, the cut-off point of counts/min for classifying the intensity of physical activity (light, moderate and vigorous) was the same for adolescents and adults and to the number of participants that did not have any information on the MVPA.
Acknowledgments
We would like to thank the following individuals at each of the participating sites who made substantial contributions to the ELANS: Luis A. Moreno, Beate Lloyd, Brenda Lynch, Mariela Jauregui, Alejandra Guidi, Luis Costa, and Regina Mara Fisberg.
The following are members of ELANS Study Group: Chairs: Mauro Fisberg and Irina Kovalskys; Co-chair: Georgina Gómez Salas; Core Group members: Attilio Rigotti, Lilia Yadira Cortés Sanabria, Georgina Gómez Salas, Martha Cecilia Yépez García, Rossina Gabriella Pareja Torres, and Marianella Herrera-Cuenca; Steering Committee: Berthold Koletzko, Luis A. Moreno, Michael Pratt, and Katherine L. Tucker; Project Managers: Viviana Guajardo and Ioná Zalcman Zimberg; International Life Sciences Institute-Argentina: Irina Kovalskys, Viviana Guajardo, María Paz Amigo, Ximena Janezic, and Fernando Cardini; Universidad I Salud: Myriam Echeverry and Martin Langsman; Instituto Pensi-Hospital Infantil Sabara-Brazil: Mauro Fisberg, Ioná Zalcman Zimberg, and Natasha Aparecida Grande de França; Pontificia Universidad Católica de Chile: Attilio Rigotti, Guadalupe Echeverría, Leslie Landaeta, and Óscar Castillo; Pontificia Universidad Javeriana-Colombia: Lilia Yadira Cortés Sanabria, Luz Nayibe Vargas, Luisa Fernanda Tobar, and Yuri Milena Castillo; Universidad de Costa Rica: Georgina Gómez Salas, Rafael Monge Rojas, and Anne Chinnock; Universidad San Francisco de Quito-Ecuador: Martha Cecilia Yépez García, María Elisa Herrera Fontana, Mónica Villar Cáceres, and María Belén Ocampo; Instituto de Investigación Nutricional-Perú: Rossina Pareja Torres, María Reyna Liria, Krysty Meza, Mellisa Abad, and Mary Penny; Universidad Central de Venezuela: Marianella Herrera-Cuenca, Maritza Landaeta, Betty Méndez, Maura Vasquez, Omaira Rivas, Carmen Meza, Servando Ruiz, Guillermo Ramirez, and Pablo Hernández; Statistical advisor: Alexandre D.P. Chiavegatto Filho; Accelerometry analysis: Priscila Bezerra Gonçalves and Claudia Alberico; Physical activity advisor: Gerson Luis de Moraes Ferrari.
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