• Children and adolescent school recreational facilities availability out of school hours were only present in less than half of the US schools. • School recreational facilities were positively associated with moderate to vigorous physical activity. • The average daily minutes of MVPA differed by 4.4 min (95 % CI 2.6, 6.2) if participants had school recreational facilities. • Physical activity with friends and disagreeing with family physical inactivity status was also associated with daily minutes of moderate to vigorous physical activity.

Objectives: Validate a questionnaire to establish the perception of difficulties in the development of research projects in the students of the research area of ​​the Faculty of Human Medicine of the Peruvian University Los Andes. Methods: Validation study of a questionnaire designed and based on a Likert scale applied to the students of the subjects of Research process, Thesis seminar I and Thesis seminar II with stratified random probability sampling, content validity analysis and construct by expert judgment and statistical analysis of reliability with Cronbach's alpha. Results: The sample consisted of 85 students who agreed to be part of the study, of which 64,70% belonged to the female gender with an average age of 23 ± 5 years, subject of thesis seminar I 36,47%, Process research 34,12%, thesis seminar II 29,41%; 64,71% expressed difficulties in preparing the research project in formulating the theoretical framework and methodology, 62,35% in writing the bibliography and annexes, 61,18% in posing the problem and formulating hypotheses, in definition of the title 58,82% and in preparation of the administration of the project plan 47,06%. Cronbach's alpha reliability was 0,969. Conclusions: The questionnaire is reliable and valid, it has high internal consistency and valid criteria.

The Association Between Lean-to-Fat Mass Ratio and Cardiometabolic Abnormalities: An Analytical Cross-Sectional Study

To examine factors associated with abdominal obesity among normal-weight individuals from the Demographic and Health Survey of Peru (2018–2021). Cross-sectional analytical study. The outcome variable was abdominal obesity defined according to JIS criteria. Crude (cPR) and adjusted prevalence ratios (aPR) were estimated for the association between sociodemographic and health-related variables and abdominal obesity using the GLM Poisson distribution with robust variance estimates. A total of 32,109 subjects were included. The prevalence of abdominal obesity was 26.7%. The multivariate analysis showed a statistically significant association between abdominal obesity and female sex (aPR: 11.16; 95% CI 10.43–11.94); categorized age 35 to 59 (aPR: 1.71; 95% CI 1.65–1.78); 60 to 69 (aPR: 1.91; 95% CI 1.81–2.02); and 70 or older(aPR: 1.99; 95% CI 1.87–2.10); survey year 2019 (aPR: 1.22; 95% CI 1.15–1.28); 2020 (aPR: 1.17; 95% CI 1.11–1.24); and 2021 (aPR: 1.12; 95% CI 1.06–1.18); living in Andean region (aPR: 0.91; 95% CI 0.86–0.95); wealth index poor (aPR: 1.26; 95% CI 1.18–1.35); middle (aPR: 1.17; 95% CI 1.08–1.26); rich (aPR: 1.26; 95% CI 1.17–1.36); and richest (aPR: 1.25; 95% CI 1.16–1.36); depressive symptoms (aPR: 0.95; 95% CI 0.92–0.98); history of hypertension (aPR: 1.08; 95% CI 1.03–1.13), type 2 diabetes (aPR: 1.13; 95% CI 1.07–1.20); and fruit intake 3 or more servings/day (aPR: 0.92; 95% CI 0.89–0.96). Female sex, older ages, and low and high income levels increased the prevalence ratio for abdominal obesity, while depressive symptoms, living in the Andean region, and fruit intake of 3 or more servings/day decreased it.

Objectives: To estimate the incidence rate of hypertension and assess the association between relative fat mass (RFM) index and five-year hypertension incidence in a Peruvian adult cohort. Methods: A longitudinal analytical study was conducted using secondary data from the PERU MIGRANT study (n = 731 adults at baseline, n = 647 adults with information on hypertension status at 5 years). RFM was calculated from height and waist circumference, with obesity defined as ≥30% for men and ≥40% for women. The outcome was 5-year incident hypertension (systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or antihypertensive use). Incidence rates per 100 person-years and 95% confidence intervals (95% CI) were calculated using individual follow-up time. Relative risks (RR) with 95% CI were estimated using Poisson regression with robust variance for the binary outcome assessed at five-year follow-up, adjusted for sociodemographic and lifestyle covariates. A sensitivity analysis using propensity score matching (PSM) was performed to estimate the ATET (average treatment effect on the treated). Results: Of the participants, 50.6% were women, with a mean age of 45.6 years (standard deviation [SD]: 10.6). RFM-defined obesity prevalence was 36.4%. The incidence of hypertension was higher in participants with RFM-defined obesity (1.87 per 100 person-years) than in those without (1.01 per 100 person-years). In the fully adjusted model, obesity was associated with a 2.43-fold higher risk of hypertension (RR: 2.43; 95% CI: 1.32-4.50; p = 0.004). The use of PSM further reinforced the robustness of our findings (ATET: 6.6%, 95% CI: 2.7-10.4%; p = 0.001). Conclusion: RFM-defined obesity was statistically significantly associated with a higher risk of developing hypertension over five years in this Peruvian cohort. The RFM index is a practical tool that could be useful for identifying individuals at increased cardiometabolic risk in clinical and public health settings.

Traditional obesity classification based on body mass index (BMI) fails to capture body fat distribution or clinical dysfunction, and may therefore fail to identify people at highest cardiometabolic risk. The Lancet Diabetes & Endocrinology Commission recently proposed a new framework distinguishing preclinical from clinical obesity based on excessive adiposity and clinical dysfunction. We aimed to estimate the prevalence of clinical and preclinical obesity in Peruvian adults using the Commission’s criteria and adapted regional cutoffs, and to generate ethnicity-specific reference curves for waist circumference (WC) and waist-to-height ratio (WHtR). This cross-sectional analysis used nationally representative data from 2021 to 2023 Peruvian Demographic and Health Surveys (ENDES), including 84,622 adults aged ≥20 years. Clinical obesity was defined as excess body fat (BMI, WC, or WHtR) plus diabetes or hypertension diagnosis. Preclinical obesity was defined as excess body fat without clinical dysfunction. Age-adjusted prevalence estimates were calculated using four anthropometric criteria and stratified by sex. Ethnicity-specific WC and WHtR reference curves were generated using GAMLSS models, stratified by age and sex. A total of 84,622 participants were included in the study. Among these participants, mean age was 44.1 (range: 20–97) years, and 48,300 participants (51.7%) were female. Clinical obesity age-adjusted prevalence ranged from 15.7% to 22.1%, and preclinical obesity from 28.7% to 53.8%, depending on cutoffs used. Up to 13.5% of individuals with normal BMI and 21% of those overweight met criteria for clinical obesity. Women showed the highest prevalence estimates of preclinical obesity, ranging from 33.4% to 65.8%, whereas men reached their highest prevalence (41.3%) when the International Diabetes Federation (IDF) cutoffs were applied. In the case of clinical obesity, women had higher prevalence estimates of clinical obesity when applying the Lancet Commission approach (18.7%) and the Peruvian national guidelines (21.4%). Men showed higher prevalence estimates when using the cutoffs proposed by the Latin American Consortium of Studies in Obesity (LASO) (16.8%) and the IDF (22.8%). Reference curves showed that Quechua-Aymara individuals had lower WC and WHtR values compared to Afro-Peruvian and other groups at the 97th percentile, in both men and women. Reliance on BMI alone underestimates a large proportion of clinically relevant cases. Incorporating WC-measurements and clinical dysfunction into diagnostic frameworks could improve identification, prevention, and policy responses to obesity in Peru and similar settings. The authors received no financial support.