Maria Lazo-Porras

Bio: Maria Lazo-Porras is an academic researcher from Cayetano Heredia University. The author has contributed to research in topics: Medicine & Population. The author has an hindex of 15, co-authored 54 publications receiving 669 citations. Previous affiliations of Maria Lazo-Porras include University of Geneva.

Understanding the rise of cardiometabolic diseases in low- and middle-income countries

Abstract: Increases in the prevalence of noncommunicable diseases (NCDs), particularly cardiometabolic diseases such as cardiovascular disease, stroke and diabetes, and their major risk factors have not been uniform across settings: for example, cardiovascular disease mortality has declined over recent decades in high-income countries but increased in low- and middle-income countries (LMICs). The factors contributing to this rise are varied and are influenced by environmental, social, political and commercial determinants of health, among other factors. This Review focuses on understanding the rise of cardiometabolic diseases in LMICs, with particular emphasis on obesity and its drivers, together with broader environmental and macro determinants of health, as well as LMIC-based responses to counteract cardiometabolic diseases. The rise of cardiometabolic diseases in low- and middle-income countries is tied to a multitude of environmental, social and commercial determinants, which are discussed in this Review along with a strategy to counteract those factors.

Repositioning of the global epicentre of non-optimal cholesterol

Abstract: High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Abstract: From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Preventing foot ulcers in patients with diabetes

Abstract: Context:Among persons diagnosed as having diabetes mellitus, the prevalence of foot ulcers is 4%to 10%, the annual population-based incidence is 1.0%to 4.1 %, and the lifetime incidence may be as high as 25%. These ulcers frequently b ecome infected, cause great morbidity, engender considerable financial costs, an d are the usual first step to lower extremity amputation. Objective:To systemat ically review the evidence on the efficacy of methods advocated for preventing d iabetic foot ulcers in the primary care setting. Data Sources, Study Selection, and Data Extraction:The EBSCO, MEDLINE, and the National Guideline Clearinghous e databases were searched for articles published between January 1980 and April 2004 using database-specific keywords. Bibliographies of retrieved articles wer e also searched, along with the Cochrane Library and relevant Web sites. We revi ewed the retrieved literature for pertinent information, paying particular atten tion to prospective cohort studies and randomized clinical trials. Data Synthesi s:Prevention of diabetic foot ulcers begins with screening for loss of protecti ve sensation, which is best accomplished in the primary care setting with a brie f history and the Semmes-Weinstein monofilament. Specialist clinics may quantif y neuropathy with biothesiometry, measure plantar foot pressure, and assess lowe r extremity vascular status with Doppler ultrasound and ankle-brachial blood pr essure indices. These measurements, in conjunction with other findings from the history and physical examination, enable clinicians to stratify patients based o n risk and to determine the type of intervention. Educating patients about prope r foot care and periodic foot examinations are effective interventions to preven t ulceration. Other possibly effective clinical interventions include optimizing glycemic control, smoking cessation, intensive podiatric care, debridement of c alluses, and certain types of prophylactic foot surgery. The value of various ty pes of prescription footwear for ulcer prevention is not clear. Conclusions:Sub stantial evidence supports screening all patients with diabetes to identify thos e at risk for foot ulceration. These patients might benefit from certain prophyl actic interventions, including patient education, prescription footwear, intensi ve podiatric care, and evaluation for surgical interventions.