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Challenges and perspectives of the double burden of malnutrition in Latin America
Desafíos y perspectivas de la doble carga de la malnutrición en América Latina
Ángela Hernández-Ruiza, Casandra Madrigala,b, María José Soto-Méndeza, Ángel Gila,c,d,e,f,
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agil@ugr.es

Corresponding author.
a Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3.ª pta., Armilla 18016, Granada, Spain
b Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, Granada, Spain
c Department of Biochemistry and Molecular Biology II University of Granada, University of Granada, Granada, Spain
d Institute of Nutrition and Food Technology “José Mataix,” Biomedical Research Center, University of Granada, Granada, Spain
e Biosanitary Research Institute IBS.GRANADA, Granada University Hospital Complex, Granada, Spain
f CIBEROBN (Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">At all stages of the life cycle&#44; diet and nutrition&#44; are key factors associated with the development of numerous non-communicable chronic diseases &#40;NCCDs&#41;&#44; including cardiovascular diseases &#40;CVD&#41;&#44; hypertension&#44; type 2 diabetes mellitus &#40;T2DM&#41;&#44; and cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">International public health has been successful in overcoming major deficiencies with health consequences&#46; In Latin-American countries&#44; there is a continuing struggle to fight the issues of undernutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">2</span></a> These countries are starting to have an even greater burden due to overnutrition&#46; This situation is due to the nutrition transition and changes in dietary habits and lifestyles&#44; which have resulted in new conditions with notable consequences on health&#46; The variables associated with the nutrition transition and the obesity epidemics can be grouped into approaches&#44; which include the following domains with respect to different environments&#58; health&#47;biological&#44; economic&#47;food&#44; physical&#47;built&#44; and socio-cultural&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In relation to &#8220;severe acute undernutrition&#8221; the World Health Organization &#40;WHO&#41; defines it as a weight-for-length&#47;height below &#8722;3 <span class="elsevierStyleItalic">z</span>-scores of the median WHO growth standards or severe wasting&#59; &#8220;moderate to acute undernutrition&#8221; is characterized by weight-for-age between &#8722;2 and &#8722;3 <span class="elsevierStyleItalic">z</span>-scores below the median growth standards and may refer to low weight-for-height or low height-for-age&#44; or a combination&#46; The term &#8220;chronic undernutrition&#8221; refers to linear growth failure&#44; failure to thrive or stunting&#46; This type of malnutrition is based on the child being below &#8722;2 standard deviations for the length&#47;height-for-age growth indicator&#46; The term &#8220;hidden hunger&#8221; refers to lack of compliance with micronutrient intake targets&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The &#8220;double burden of malnutrition&#8221; &#40;DBM&#41; is the coexistence of undernutrition and overnutrition in the same population across the life-course&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">4</span></a> DBM concerns all countries and is particularly worrying in regions with high levels of stunting&#46; The consequences of DBM are huge and have important repercussions associated with impaired child growth and development&#44; increased susceptibility to infectious diseases&#44; and increased risk of overweight&#44; especially in terms of increased risk of visceral fat and of NCCDs&#44; later in life&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Solutions to fight the effects of DBM are well recognized in each of its aspects&#44; both undernutrition and overnutrition&#46; However&#44; at the present time the solutions have not been combined with each other and with the overall policy and programmatic frameworks&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">5</span></a> Awareness raising&#44; and joint study and research in each approach is therefore essential to avoid serious future consequences&#44; especially for low- and middle-income countries&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although malnutrition in all its forms and the DBM have been studied for decades&#44; they continue to be public health problems of great importance that affect different countries of Latin America in widely differing levels&#46; Indeed&#44; it seems necessary to update the main issues and solutions to these problems in the region&#46; Therefore&#44; the objective of the present perspective study is to compile the latest evidence on undernutrition in all its forms and the DBM in the main countries of Latin America&#44; as well as to describe the main lines of action and opportunities to intervene comprehensively on these issues&#44; with a special focus in the prevention of NCCDs&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Undernutrition</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Origin and causes</span><p id="par0035" class="elsevierStylePara elsevierViewall">Since 1980 the United Nations system&#44; guided by the framework created by UNICEF&#44; has described the manifestations of undernutrition&#46; The basic causes include the lack or inadequate distribution of resources&#46; Lack of resources impairs access to food&#44; the provision of care&#44; and the availability of health services&#44; which are referred to as underlying causes&#46; Immediate causes include insufficient food consumption and the occurrence of disease&#46; The six possible causes of all nutrient deficiencies have been defined globally&#58; insufficient intake&#44; reduced absorption&#44; increased expenditure&#44; increased destruction&#44; inadequate utilization&#44; and increased requirements&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The issue is extremely complex because of the synergistic and adverse interactions between nutrient limitations and inflammation-infection stress&#44; e&#46;g&#46;&#44; energy intake during infections could decrease due to insufficient caloric intake&#44; poor appetite or to impaired nutrient absorption&#59; in addition&#44; malnourished children are more likely to suffer from infections which&#44; in turn&#44; lead to increased malnutrition&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The research approaches to malnutrition have focused on undernutrition in terms of insufficient energy or protein intake&#44; micronutrient deficiencies or food insecurity&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">4</span></a> Undernutrition in the first years of life is an underlying cause associated with one third of young child deaths&#46; Among survivors who are stunted in the first two years of life&#44; their ability to resist disease&#44; perform physical labor&#44; and progress in school is impaired throughout life&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Prevalence of undernutrition and micronutrient deficiencies</span><p id="par0050" class="elsevierStylePara elsevierViewall">With regard to stunting&#44; it is notable that children in marginalized areas are most affected by linear growth failure&#44; starting from pregnancy until 24 months of age&#46; Living in a poor community increases the risk of stunting in children under 5 years of age&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In 2015&#44; a study on the prevalence of stunting using data from Latin American countries was published&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">2</span></a> Haiti and Honduras had a high prevalence &#40;30&#8211;39&#37;&#41; and Guatemala a very high prevalence &#40;&#62;40&#37;&#41; of stunting&#46; Peru&#44; El Salvador&#44; Belize&#44; Nicaragua&#44; Saint Vincent and the Grenadines&#44; Bolivia&#44; and Ecuador had a medium prevalence of stunting &#40;20&#8211;29&#37;&#41;&#46; In a review published in 2017&#44;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">8</span></a> comparing Brazilian regions&#46; The northern region had the worst living conditions&#44; and children under five years of age had significant height-for-age&#44; weight-for-age&#44; and weight-for-height deficits&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">According to the publication of L&#243;pez de Roma&#241;a et al&#46; in 2015<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">9</span></a> micronutrient deficiencies&#44; especially iron&#44; zinc&#44; and vitamins A and D are of enormous importance in Latin American countries and are issues of great public health relevance&#46; More details of the specific deficiencies are provided in different studies and reviews&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">9&#8211;15</span></a> Data of undernutrition and the main micronutrient deficiencies observed in Latin America is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Early life programming</span><p id="par0065" class="elsevierStylePara elsevierViewall">Exposure to undernutrition early in life&#44; with subsequent excess weight gain&#44; increases the risk of developing NCCDs&#46; This situation is due to the establishment of a high metabolic burden based on a depleted homeostasis capacity&#46; These trajectories through the stages of the life cycle are defined by social factors&#44; including rapid changes in dietary patterns and physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">4</span></a> In 2015&#44; it was suggested that the higher prevalence of CVD and metabolic diseases in Latin American countries may be the result of the disparity between a restrictive nutritional environment during fetal development and infancy&#44; and a nutritionally abundant environment later in life&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">16</span></a> Consequently&#44; Latin American populations may be more vulnerable to the health consequences of obesity than individuals with similar lifestyles in high-income countries&#46; These negative effects may be mediated by an increase in pro-inflammatory markers and a decrease in muscle mass and strength&#44; conditions that can be observed in subjects with low birth weight&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In a study that followed 7&#46;3 years &#40;642&#44;552 person-years&#41;&#44; 1372 incident cases of T2DM were identified&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">17</span></a> Participants exposed during childhood to hunger showed an increased risk of developing T2DM later in life&#46; The coexistence of prenatal undernutrition and abdominal obesity in adulthood has been associated with an increased risk of T2DM&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In a study published in 2020&#44; underweight was found to be negatively associated with systolic and diastolic blood pressure&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">18</span></a> In this research&#44; stunting was associated with lower systolic blood pressure levels and underweight was associated with increased diastolic blood pressure&#46; Stunting and underweight were associated with lower school performance&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Epigenetic modifications are a mechanism leading to early disease programming&#46; Recent research has examined environmental factors that interact during critical windows in early life and would indicate epigenetic signals related to hypertension&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">19</span></a> These mechanisms include malnutrition&#44; oxidative stress&#44; inflammation&#44; and microbiota modification&#46; Some epigenetic keys are related to DNA methylation&#44; histone covalent modifications and the potential relationship of microRNAs in blood vessels&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A systematic review and meta-analysis concluded that fetal and childhood exposure to famine &#40;respectively&#41; were positively associated with the risk of diabetes &#40;RR 1&#46;37&#44; RR 1&#46;33&#41;&#44; metabolic syndrome &#40;MS&#41; &#40;RR 1&#46;26&#44; RR 1&#46;24&#41;&#44; hypertension &#40;RR 1&#46;30&#59; RR 1&#46;33&#41;&#44; hyperglycemia &#40;RR 1&#46;27&#59; RR 1&#46;25&#41;&#44; dyslipidemia &#40;RR 1&#46;48&#59; RR 1&#46;27&#41;&#44; obesity &#40;RR 1&#46;19&#59; RR 1&#46;13&#41;&#44; overweight &#40;RR 1&#46;17&#59; RR 1&#46;07&#41;&#44; coronary heart disease &#40;RR 1&#46;22&#59; RR 1&#46;21&#41; and moderate to severe non-alcoholic fatty liver disease &#40;RR 1&#46;66&#59; RR 1&#46;68&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">20</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">A review has recently been published on the effects of micronutrient deficiencies in relation to metabolic health&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">21</span></a> The stress response due to amino acid deprivation and dyslipidemia and how these conditions modulate diseases such as atherosclerosis have been described&#46; Metabolic starvation and inflammation are strongly regulated by environmental &#40;nutrition of the gut microbiome&#41; and non-environmental &#40;genetics&#41; factors&#46; The relationship between nutritional status and the risk of atrial fibrillation has also been shown to be U-shaped&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">22</span></a> Individuals who are obese or underweight or who had a low birth weight may have an increased risk associated with atrial fibrillation&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Overweight and obesity</span><p id="par0095" class="elsevierStylePara elsevierViewall">In adults&#44; the WHO defines overweight as BMI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> and obesity as BMI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; For children under 5 years of age&#44; overweight is defined as being more than two standard deviations above the median weight-for-height WHO child growth indicator and obesity is defined as being more than three standard deviations above the median weight-for-height WHO indicator&#46; For children aged 5&#8211;19 years&#44; overweight is defined as being more than one standard deviation above the median BMI-for-age growth indicator and obesity is defined as greater than two standard deviations above the median BMI-for-age WHO child growth standard&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In the last two decades&#44; the prevalence of obesity has increased drastically worldwide&#44; being one of the main causes of disability and mortality in the world&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">23</span></a> In Latin America&#44; the transition from a predominantly underweight to an overweight and obese population has increased more rapidly than other regions in the world and even more in lower-income individuals &#40;prevalence<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60&#37; overweight and obesity has been reported&#41;&#46; In a 2016 consensus statement&#44; the Latin American Federation of Obesity Societies &#40;FLASO&#41; reported that Bolivia&#44; Mexico&#44; and Guatemala were at the highest point of obesity prevalence of all the Latin American countries&#44; each with prevalence above 30&#37;&#46; In contrast&#44; Ecuador had the lowest prevalence of obesity &#40;14&#46;2&#37;&#41;&#44; although recent reports indicate higher levels in this country&#46; Overweight and obesity affected three out of four adults in the Southern Cone of Latin America&#46;<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In addition&#44; data presented by the Non-Communicable Diseases Risk Factor Collaboration show a more rapid increase in childhood and adolescent obesity than in adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">26</span></a> However&#44; the rise in prevalence in recent decades has affected all age groups&#46; The prevalence of overweight in children under five years in Latin American and the Caribbean is currently at 7&#46;5&#37;&#44; while globally&#44; it is 5&#46;9&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">26&#44;27</span></a> Moreover&#44; two out of every three overweight children in Latin America live in a South American country&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">26</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">This high prevalence is probably associated with changes in food systems and living environments&#44; characterized by increased availability&#44; accessibility&#44; and affordability of ultra-processed foods&#44; which have led to changing dietary patterns and diet quality&#44; promoting excessive energy and critical nutrients intake &#40;sugar&#44; salt&#44; and saturated and <span class="elsevierStyleItalic">trans</span> fat&#41; across all age groups and socioeconomic levels&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Moreover&#44; obesity is a major risk factor for several NCCDs&#44; such as hypertension&#44; MS&#44; T2DM&#44; CVD&#44; and other health outcomes that affect adult&#39;s health but now are emerging within children and adolescents&#46; In terms of disease burden in Latin American countries&#44; NCCDs account for 50&#37; of the disability-adjusted life-years &#40;DALYs&#41;&#44; led by CVD&#46;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">23&#44;28</span></a></p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Early life programming</span><p id="par0120" class="elsevierStylePara elsevierViewall">Obesity during pregnancy has been proposed as a condition that impacts on the developing child through early life programming&#46; Maternal obesity has been associated with the risk of obesity&#44; metabolic dysregulation&#44; hypertension&#44; and dyslipidemia in child&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">29</span></a> A review has indicated that undernutrition in utero alters the structure&#44; and metabolism of the organism&#44; increasing the risk of developing atherosclerosis and insulin resistance at later stages of life&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">30</span></a> Disturbances between prenatal and postnatal environments have effects on body fat and insulin resistance&#46; Insulin-like growth factor I mass concentrations and plasma lipoprotein levels in the neonatal period would be related to fat accumulation&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Obesity and Non-Communicable Chronic Diseases</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Hypertension</span><p id="par0125" class="elsevierStylePara elsevierViewall">Epidemiological data&#44; show that obesity or overweight is highly prevalent among hypertensive populations&#44; and that obesity could predispose people to hypertension and CVD&#44;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">31</span></a> the second being the main risk factor of death in Latin American countries&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">32</span></a> By 2025&#44; according to current projections&#44; it is estimated that 80&#8211;90&#37; of the Latin American urban population will be affected by hypertension and obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">32</span></a> Compared with other populations&#44; Latin Americans seem to have a prevalence of clustering of hypertension with T2DM and lipid abnormalities&#46; The prevalence of the MS in Latin America ranges from 25&#37; to 45&#37; and it is increasing&#46; Finally&#44; a systematic review <a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">31</span></a>suggests that hypertension may be associated with socio-economic inequalities in Latin America and Caribbean populations&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Type 2 Diabetes Mellitus</span><p id="par0130" class="elsevierStylePara elsevierViewall">Among the NCCDs&#44; T2DM has become a global health challenge with particular effects in Latin America&#46; T2DM prevalence has been steadily increasing in all Latin America and the Caribbean for the past three decades with special emphasis in the Caribbean region where it reaches 15&#37;&#44; causing it to become one of the most urgent public health problems to undertake in the region&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">33</span></a> In 2019&#44; it was estimated that the number of persons with diabetes in Latin America was 31&#46;6 million and is predicted that by 2030&#44; the number will increase to 40&#46;2 million&#44; and to 49&#46;1 million by 2045&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">34</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">From 2005 to 2020&#44; the prevalence of T2DM across Latin America has been assessed within individual countries and through multinational studies and ranged between 3 and 36&#46;3&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">34</span></a> The International Diabetes Federation estimates that Brazil &#40;with 16 million&#41; and Mexico &#40;with 12 million&#41; contribute the highest volume of adults living with T2DM&#44; followed by Colombia&#44; Argentina&#44; Venezuela&#44; and Chile that contribute the second-highest amount of prevalent diabetes cases&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">33</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Observational studies have characterized a higher prevalence of T2DM in women compared to men&#44; although the underlying mechanisms are not fully understood&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">35</span></a> T2DM risk increases significantly with age&#44; especially in Latin America and the Caribbean&#46; Also&#44; obesity has a highly suggestive association with T2DM<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">33</span></a>&#59; for instance&#44; the increasing prevalence of overweight and obesity documented across Latin America has paralleled the rising prevalence of diabetes in the region&#46; It is important to emphasize that childhood obesity&#44; in turn&#44; predicts the long-term risks of T2DM independently of adult obesity&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dyslipidemia</span><p id="par0145" class="elsevierStylePara elsevierViewall">Several studies have shown that lipid metabolism disorders are significantly associated with the pathogenesis of atherosclerosis&#44; a key process for the development of CVD&#46; One third of coronary artery disease cases are attributable to elevated serum low-density lipoprotein &#40;LDL&#41; cholesterol levels&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">36</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The INTERHEART study &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#44;972&#41; showed that obesity&#44; dyslipidemia and smoking together account for 78&#37; of the population attributable risk in Latin American countries&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">24</span></a> Data from the CARMELA study &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#44;550&#41; reinforces the concept&#44; showing the high prevalence of these risk factors in Latin American cities &#40;Barquisimeto&#44; Bogota&#44; Buenos Aires&#44; Lima&#44; Mexico City&#44; Quito&#44; and Santiago&#41;&#46; These studies and other local research also suggested that low high-density lipoprotein &#40;HDL&#41; cholesterol was the most common dyslipidemia&#46;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Carrillo-Larco et al&#46; reviewed about 200 previous studies from across Latin America and the Caribbean&#46; They found that&#44; since 2005&#44; the most frequent and common dyslipidemia trait was low HDL-cholesterol in this region&#44; followed by elevated triacylglycerols&#44; and in third place&#44; high LDL-cholesterol&#46;<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">38</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Lipid biomarkers are key cardio-metabolic risk factors and successful improvement of these at the patient and population level could benefit reduced cardiovascular outcomes&#46; Therefore&#44; lipid profiles are relevant for public health and for clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">39</span></a> Indeed&#44; they are a major risk factor for cardiovascular events&#44; including ischemic heart disease and stroke&#46;<a class="elsevierStyleCrossRefs" href="#bib0565"><span class="elsevierStyleSup">40&#44;41</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Cardiovascular disease</span><p id="par0165" class="elsevierStylePara elsevierViewall">The CVD and diabetes mellitus are the leading cause of morbidity and mortality worldwide and in Latin America and the Caribbean&#44; with ischemic heart disease and stroke being the leading cause of premature mortality and DALYs&#46;<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">28&#44;42</span></a> In terms of CVD&#44; first myocardial infarction is the most common cause of death among all CVD deaths in Latin America and occurs 5&#8211;10 years earlier than in higher-income countries&#44; such as the U&#46;S&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">28</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">In Latin America&#44; the most prevalent cardiovascular risk factors are overweight&#44; obesity&#44; hypertension&#44; dyslipidemia&#44; and T2DM&#46; Multiple studies have identified the same risk factors for myocardial infarction or stroke in different populations&#44; although other regions have different prevalence and burden of disease&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">42</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">The results of the CESCAS &#40;<span class="elsevierStyleItalic">Centro de Excelencia en Salud Cardiovascular para el Cono Sur</span>&#41; I study &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7524&#41;&#44; indicate that behavioral and metabolic risk factors for CVD are high in the general adult population of the Southern Cone of Latin America &#40;Argentina&#44; Chile&#44; Uruguay&#41;&#46; Only 0&#46;1&#37; of the population met the seven criteria &#40;no smoking&#44; body mass index&#44; physical activity&#44; blood pressure&#44; total cholesterol&#44; glucose&#41; that define the Ideal Cardiovascular Health&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">42</span></a> In the DISCOVER study &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1616&#41;&#44; developed in Mexico&#44; Costa Rica&#44; Panama&#44; Colombia&#44; Argentina&#44; and Brazil&#44; the prevalence of hyperlipidemia and hypertension was 45&#46;9&#37; and 55&#46;55&#37;&#44; respectively&#44; and the overweight or obesity was reported in 83&#46;8&#37; of the cases&#46;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">43</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Finally&#44; CVD disproportionately affects the poorest segments of the population&#44; affecting families&#44; communities&#44; and governments because of the costs of treatment and the potential years of life and productivity lost due to premature death and disability&#46; More than 80&#37; of CVD deaths occur in low- and middle-income&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">44</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">A detailed description of obesity and the main NCCDs observed in Latin America is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">The double burden of malnutrition</span><p id="par0190" class="elsevierStylePara elsevierViewall">Malnutrition has historically been investigated through two different approaches&#58; focusing on undernutrition&#44; food insecurity and micronutrient deficiencies&#44; or on overweight&#44; obesity and dietary excesses&#46; Due to the rapid global nutrition transition&#44; an increasing proportion of people are at risk of different forms of malnutrition throughout life&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">4</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Although research on DBM is a leading area of interest&#44; there is no global consensus on definitions&#46; The DBM&#44; defined as the coexistence of overnutrition &#40;overweight&#47;obesity&#41; and undernutrition &#40;stunting and wasting&#41;&#44; needs to be approached at all levels&#58; population-country&#44; city&#44; community&#44; household&#44; and individual&#46; In addition&#44; it is noteworthy that many Latin American countries indicate that multiple forms of malnutrition can coexist in the same country&#44; household or individual&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">56</span></a> Recently&#44; a review of operational definitions proposed to organize DBM by three dimensions&#58; level of assessment&#44; target population&#44; and forms of malnutrition&#46; The most frequent definitions included coexistence of overweight&#47;obesity and thinness&#44; wasting or underweight &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>289&#41;&#59; overweight&#47;obesity and stunting &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>161&#41;&#59; overweight&#47;obesity and anemia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>74&#41;&#59; and overweight&#47;obesity and micronutrient deficiency &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>73&#41;&#46; The authors concluded that structuring these definitions could facilitate the selection of the most appropriate indicators to intervene on public health priorities more effectively&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Biological and social pathways are highly complex and interact with all forms of malnutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">57</span></a> The health impacts of DBM include remarkably those associated with undernutrition&#44; impaired child development&#44; and increased susceptibility to infectious diseases and those related to excess weight and an increased risk of developing NCCD&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">56</span></a> Preventing malnutrition&#44; especially in the first 1000 days of life&#44; has health and economic benefits that impact all stages of life&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">4</span></a></p><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Situation of the double burden of malnutrition in Latin American countries</span><p id="par0205" class="elsevierStylePara elsevierViewall">An update on data in Latin American countries in the DBM &#40;overnutrition&#44; and undernutrition&#41; has recently been published&#46;<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">58</span></a> In these studies&#44; national health&#44; and nutrition surveys&#44; it has been possible to evaluate the situation through cross-sectional analyses&#46; Detailed data can be found in a number of studies and reviews&#46;<a class="elsevierStyleCrossRefs" href="#bib0660"><span class="elsevierStyleSup">59&#8211;66</span></a> A description of all forms of malnutrition in different Latin American countries by age groups is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0210" class="elsevierStylePara elsevierViewall">All forms of malnutrition have shown a strong relationship with socio-economic and educational inequalities&#46;<a class="elsevierStyleCrossRef" href="#bib0660"><span class="elsevierStyleSup">59</span></a> Malnutrition disproportionately affects individuals at the lowest levels of income&#44; ethnic minorities&#44; women&#44; and those with lower levels of education&#46;<a class="elsevierStyleCrossRefs" href="#bib0665"><span class="elsevierStyleSup">60&#44;62&#8211;64&#44;66&#44;67</span></a></p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Public health challenges&#44; policies&#44; and future research</span><p id="par0215" class="elsevierStylePara elsevierViewall">DBM is a major cause of disability and premature death&#44; which could be targeted by comprehensive policies such as the Action Plan for the Prevention of Obesity in Children and Adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">46</span></a> The current epidemiological situation and major policy developments provide an opportunity for all agencies involved to engage in collaborative efforts&#46; This situation encourages the development of comprehensive&#44; intersectoral policies to address DBM by strengthening national nutrition surveillance systems&#44; incorporating detailed monitoring&#44; evaluating the guidelines developed and encouraging increased investments in nutrition&#46; Subsequently&#44; the effectiveness of these actions should be evaluated with the aim of promoting robust long-term political commitment&#46;<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">70</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">The Sustainable Development Goals have as a global priority the goal of combating malnutrition in all its forms by 2030&#46;<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">57</span></a> The UN Decade of Action on Nutrition &#40;2016&#8211;2025&#41; aims to accelerate these actions&#46; Food systems must provide healthy&#44; safe&#44; accessible&#44; and sustainable diets&#46; The necessary changes require several actions&#58; production&#44; trade and distribution processing&#44; price policy&#44; marketing&#44; front-of-package labeling and waste management&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Research is very limited in the Latin American region and lack of funding severely hampers tackling complicated nutritional problems&#46; Some institutions have strengthened their commitment to improve research capacity&#44; as well as to further identify opportunities for action to eliminate health disparities&#46;<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">71</span></a> To evaluate the nutrition landscape in Latin American countries and to guide future efforts&#44; the Pan American Health Organization and the Micronutrient Initiative identified knowledge gaps&#46; Even though Latin American countries have made progress and have policies in place to address undernutrition and micronutrient deficiencies&#44; comprehensive and intersectoral policies to address obesity are lacking&#46; The support programs in some countries such as Brazil&#44; Colombia and Mexico offer an opportunity to integrate nutrition actions into intersectoral platforms to improve health&#46;<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">70</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">It seems that T2DM is the cause and result of a risk cycle that is not interrupted and healthcare systems of the region will be overwhelmed by the combined snowballing of risk factors and complications&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">33</span></a> While obesity and T2DM have a negative correlation with HDL-cholesterol&#44; exercise positively affects this lipid fraction<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">72</span></a>&#59; to successfully increase HDL-cholesterol in Latin American countries&#44; it is also necessary to reduce obesity and diabetes while providing opportunities for physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">55</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">The economic&#44; social&#44; and environmental costs of hunger hinder the growth and development of individuals and societies&#46; It is suggested that nutritional interventions should consider economic evaluation to target dual-function interventions as an alternative to separate stunting and overweight programming&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">56</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Several countries are implementing the Caribbean Public Health Agency&#39;s Plan of Action&#44; which is supported by the Ministries of Health&#44; Education and Sport to develop nutrition policies and strategies&#46; Examples include &#8220;<span class="elsevierStyleItalic">Chile Crece</span><span class="elsevierStyleItalic">Contigo</span>&#8221;&#44; which integrates health&#44; social development&#44; and education activities to optimize children&#39;s growth and cognitive-motor development&#46; Brazil is implementing policies to engage with international targets on food security&#44; nutrition and risk factors and chronic diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">46</span></a> Eighteen countries have policies to address undernutrition and few nations maintain specific policies for overweight and obesity&#46; Nutrition actions must be incorporated into food security policies and should be part of education&#44; environment&#44; agriculture&#44; development&#44; and employment policies&#46; Integrated and specific nutrition promotion and chronic disease prevention policies need to be developed in each country through intersectoral engagement&#46;<a class="elsevierStyleCrossRef" href="#bib0730"><span class="elsevierStyleSup">73</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0245" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0250" class="elsevierStylePara elsevierViewall">The DBM represents a major risk factor for the occurrence of NCCDs in Latin America and the presence of those diseases represents a major public health burden&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0255" class="elsevierStylePara elsevierViewall">Latin America is making progress in reducing undernutrition and micronutrient deficiencies&#46; However&#44; progress in the reduction of overnutrition is lacking overall&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0260" class="elsevierStylePara elsevierViewall">There is a need of policies that integrate social&#44; health&#44; developmental&#44; and educational aspects to impact both sides of the malnutrition burden with the determination that these actions can be sustainable&#44; applicable to region-specific environments&#44; and maintained over time&#46;</p></li></ul></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Financing</span><p id="par0265" class="elsevierStylePara elsevierViewall">This research has not received specific aid from public sector agencies&#44; commercial sector or non-profit entities&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest</span><p id="par0270" class="elsevierStylePara elsevierViewall">No author presents any conflict of interest with this research&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nutrition is a key factor in the development of non-communicable chronic diseases &#40;NCCDs&#41;&#44; especially cardiovascular diseases &#40;CVD&#41; and their risk factors&#46; The &#8220;double burden of malnutrition&#8221; &#40;DBM&#41; is the coexistence of undernutrition and overnutrition in the same population across the life-course&#46; In Latin America&#44; the transition from a predominantly underweight to an overweight and obese population has increased more rapidly than in other regions in the world&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Undernutrition and the micronutrient deficiencies particularly iron&#44; zinc&#44; and vitamins A and D&#44; present high heterogeneity in Latin American countries&#44; and are currently considered important public health problems&#46; In this region&#44; NCCDs account for 50&#37; of the disability-adjusted life-years&#44; led by CVD&#46; The most prevalent cardiovascular risk factors are overweight&#44; obesity&#44; hypertension&#44; dyslipidemia and type 2 diabetes mellitus&#46; Because of the cost of treatment and the potential years of life lost due to premature death&#44; CVD is known to affect the poorest segments of the population&#44; affecting communities&#44; and governments&#46; More than 80&#37; of CVD deaths occur in low- and middle-income countries&#46; The persistence of damage in some cells due to undernutrition may explain certain findings regarding the increase in NCCD&#46; These aspects together with epigenetic changes have highlighted the importance of a lifelong approach to nutritional policy development&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Reducing DBM requires major societal interventions in public health and nutrition to achieve holistic change that can be sustained over the long term and spread throughout the global food system&#46; The implementation of effective state policies of double impact actions should influence both sides of the burden and be considered an urgent priority&#44; considering country-specific inequalities and socio-demographic differences in the Latin American region&#44; using diverse and multidisciplinary strategies&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La nutrici&#243;n es un factor clave en el desarrollo de las enfermedades cr&#243;nicas no transmisibles &#40;ECNT&#41;&#44; especialmente las enfermedades cardiovasculares &#40;ECV&#41; y sus factores de riesgo&#46; La &#8220;doble carga de la malnutrici&#243;n&#8221; &#40;DCM&#41; es la coexistencia de desnutrici&#243;n por defecto y por exceso de nutrientes en la misma poblaci&#243;n a lo largo del curso de vida&#46; En Am&#233;rica Latina&#44; la transici&#243;n de una poblaci&#243;n predominantemente desnutrida a otra con sobrepeso y obesidad ha aumentado m&#225;s r&#225;pidamente que en otras regiones del mundo&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La desnutrici&#243;n y las deficiencias de micronutrientes&#44; especialmente de hierro&#44; zinc y vitaminas A y D&#44; presentan una gran heterogeneidad en los pa&#237;ses latinoamericanos y se consideran actualmente importantes problemas de salud p&#250;blica&#46; En esta regi&#243;n&#44; las ECNT representan el 50&#37; de los a&#241;os de vida ajustados por discapacidad&#44; encabezados por las ECV&#46; Los factores de riesgo cardiovasculares m&#225;s prevalentes son el sobrepeso&#44; la obesidad&#44; la hipertensi&#243;n&#44; la dislipidemia y la diabetes mellitus tipo 2&#46; Debido al coste del tratamiento y a los a&#241;os de vida potencialmente perdidos debido a la muerte prematura&#44; se sabe que las ECV afectan a los segmentos m&#225;s pobres de la poblaci&#243;n&#44; implicando a las comunidades y a los gobiernos&#46; M&#225;s del 80&#37; de las muertes por ECV se producen en pa&#237;ses de ingresos bajos y medios&#46; La persistencia del da&#241;o en algunas c&#233;lulas debido a la desnutrici&#243;n puede explicar ciertos hallazgos relacionados con el aumento de las ECNT&#46; Estos aspectos&#44; junto con los cambios epigen&#233;ticos&#44; han puesto de manifiesto la importancia de un enfoque permanente en el desarrollo de pol&#237;ticas nutricionales&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La reducci&#243;n de la DCM requiere importantes intervenciones sociales en materia de salud p&#250;blica y nutrici&#243;n para lograr un cambio hol&#237;stico que pueda mantenerse a largo plazo y extenderse a todo el sistema alimentario mundial&#46; La implementaci&#243;n de pol&#237;ticas estatales efectivas de acciones de doble impacto debe influir en ambos lados de la carga y ser considerada una prioridad urgente&#44; teniendo en cuenta las desigualdades espec&#237;ficas de cada pa&#237;s y las diferencias sociodemogr&#225;ficas en la regi&#243;n latinoamericana&#44; utilizando estrategias diversas y multidisciplinarias&#46;</p></span>"
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                  \t\t\t\t" scope="col">Women&#40;12&#8211;51 y&#41; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Argentina<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">2&#44;10</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Bolivia<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">2&#44;10</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Brazil<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">2&#44;10&#44;11</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#46;923&#46;1&#8211;80&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&#46;416&#46;1&#8211;81&#46;8&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total population&#47;adults&#40;&#62;18 y&#41; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t">Overweight and obesity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Worldwide<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Latin America<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">45</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;527&#46; 7 &#40;M&#41;33&#46;1 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Latin America<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">26&#44;46</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;528&#46;6 &#40;OB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;2&#8211;7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Latin American countries &#40;Argentina&#44; Brazil&#44; Chile&#44; Colombia&#44; Dominican Republic&#44; Ecuador&#44; Guatemala&#44; Jamaica&#44; M&#233;xico&#44; Peru&#44; Trinidad and Tobago&#44; Venezuela&#41;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">47</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#233;xico&#44; Argentina&#44; and Brazil<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">48</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Argentina<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">37&#44;49&#44;50</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;7 &#40;OB&#41;23&#46;1 &#40;OB&#59; M&#41;16&#46;8 &#40;OB&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#8211;42<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bolivia<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">50</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;2&#8211;12&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brazil<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">50</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;4 &#40;OW&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>7&#46;3&#8211;22&#46;2 &#40;OB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chile<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;6 &#40;OB&#41;23&#46;6 &#40;OB&#59; M&#41;29&#46;4 &#40;OB&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colombia<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">37&#44;50&#44;51</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;0 &#40;OB&#41;12&#46;8 &#40;OB&#59; M&#41;22&#46;0 &#40;OB&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;7 &#40;OW&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>3&#46;4 &#40;OB&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>4&#46;3&#8211;18&#46;9 &#40;OW&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>0&#46;5&#8211;5&#46;2 &#40;OB&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ecuador<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">37&#44;50</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;3 &#40;OB&#41;10&#46;3 &#40;OB&#59; M&#41;22&#46;4 &#40;OB&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Guatemala<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">50</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;9 &#40;OB&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haiti<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">51</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;3 &#40;M&#41;7&#46;8 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mexico<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">37&#44;50&#44;51</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;OW&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">d</span></a>10&#8211;31 &#40;OB&#41;31&#46;0 &#40;OB&#59; M&#41;30&#46;4 &#40;OB&#59; W&#41;43&#46;9 &#40;OW&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>13&#46;3 &#40;OB&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>13&#46;3&#8211;33&#46;5 &#40;OW&#41;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">e</span></a>3&#46;9&#8211;14&#46;6 &#40;OB&#41;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peru<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">37&#44;50</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;3 &#40;OB&#41;21&#46;1 &#40;OB&#59; M&#41;23&#46;4 &#40;OB&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;8&#8211;5&#46;81&#46;3 &#40;OB&#41;19&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venezuela<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;1 &#40;OB&#41;23&#46;5 &#40;OB&#59; M&#41;26&#46;1 &#40;OB&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
            1 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total population&#47;adults&#40;&#62;18 y&#41; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Children&#40;&#60;5 y&#41; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Latin America<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">24&#44;45</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;2&#8211;29&#46;121&#46;1 &#40;M&#41;19&#46;4 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mexico&#44; Argentina&#44; and Brazil<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">48</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Argentina<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">37&#44;44&#44;52&#44;53</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;0&#8211;50&#46;837&#46;7 &#40;M&#41;21&#46;7 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9 &#40;pre-hypertension&#41;4&#46;3&#8211;14&#46;9<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brazil<a class="elsevierStyleCrossRefs" href="#bib0585"><span class="elsevierStyleSup">44&#44;52</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;5&#8211;52&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chile<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">37&#44;44&#44;52</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;8&#8211; 46&#46;727&#46;3 &#40;M&#41;20&#46;7 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colombia<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">37&#44;52&#44;54</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;4&#8211;5714&#46;6 &#40;M&#41;12&#46;4 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ecuador<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;67&#46;2 &#40;M&#41;10&#46;1 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mexico<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;711&#46;2 &#40;M&#41;12&#46;1 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peru<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">37&#44;44</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;6&#8211;19&#46;314&#46;4 &#40;M&#41;10&#46;7 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uruguay<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">44</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venezuela<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;727&#46;5 &#40;M&#41;22&#46;9 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
            2 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total population&#47;adults&#40;&#62;18 y&#41; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Children&#40;&#60;5 y&#41; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Latin America<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">45</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;05&#46;1 &#40;M&#41;4&#46;8 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Latin American countries &#40;Argentina&#44; Brazil&#44; Chile&#44; Colombia&#44; Dominican Republic&#44; Ecuador&#44; Guatemala&#44; Jamaica&#44; Mexico&#44; Peru&#44; Trinidad and Tobago&#44; Venezuela&#41;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">47</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;M&#41;10 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Argentina<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">34&#44;37&#44;55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;2&#8211;12&#46;77&#46;9 &#40;M&#41;4&#46;8 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brazil<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">34&#44;55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;4&#8211;8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bolivia<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chile<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">34&#44;37&#44;55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;2&#8211;12&#46;36&#46;8 &#40;M&#41;7&#46;6 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colombia<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">34&#44;37&#44;55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;1&#8211;11&#46;27&#46;4 &#40;M&#41;8&#46;7 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Costa Rica<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">34&#44;55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;5&#8211;10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dominican Republic<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ecuador<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">34&#44;37&#44;55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;7&#8211;5&#46;94&#46;6 &#40;M&#41;7&#46;3 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">El Salvador<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">34&#44;55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;7&#8211;12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Guatemala<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">34&#44;55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;4&#8211;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haiti<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;1&#40;W&#41;8&#46;2 &#40;M&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Honduras<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mexico<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">34&#44;37&#44;55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;9&#8211;13&#46;78&#46;0 &#40;M&#41;9&#46;7 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nicaragua<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paraguay<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">34&#44;55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;4&#8211;9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peru<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;44&#46;3 &#40;M&#41;4&#46;6 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Puerto Rico<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;8<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uruguay<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">34&#44;55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;0&#8211;6&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venezuela<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">34&#44;37&#44;55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;0&#8211;8&#46;05&#46;6 &#40;M&#41;6&#46;3 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
            3 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total population&#47;adults&#40;&#62;18 y&#41; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Children&#40;&#60;5&#41; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Latin America<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">24&#44;38&#44;45&#44;48</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;5&#8211;42 &#40;High TG&#41;29&#46;9 &#40;High TG&#59; M&#41;23&#46;3 &#40;High TG&#59; W&#41;8&#46;9&#8211;40&#46;5 &#40;High TC&#41;8&#46;2 &#40;High TC&#59; M&#41;9&#46;6 &#40;High TC&#59; W&#41;8&#46;5&#8211;20 &#40;High LDL-C&#41;7&#46;6 &#40;High LDL-C&#59; M&#41;9&#46;3 &#40;High LDL-C&#59; W&#41;48&#8211;53&#46;3 &#40;Low HDL-C&#41;32&#46;8 &#40;Low HDL-C&#59; M&#41;32&#46;8 &#40;Low HDL-C&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Argentina<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;7 &#40;High TC&#41;19&#46;6 &#40;High TC&#59; M&#41;17&#46;8 &#40;High TC&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chile<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;3 &#40;High TC&#41;15&#46;9 &#40;High TC&#59; M&#41;14&#46;8 &#40;High TC&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colombia<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;0 &#40;High TC&#41;12&#46;4 &#40;High TC&#59; M&#41;11&#46;7 &#40;High TC&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ecuador<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;2 &#40;High TC&#41;21&#46;6 &#40;High TC&#59; M&#41;18&#46;8 &#40;High TC&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mexico<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;4 &#40;High TC&#41;17&#46;5 &#40;High TC&#59; M&#41;15&#46;4 &#40;High TC&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peru<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;6 &#40;High TC&#41;10&#46;1 &#40;High TC&#59; M&#41;13&#46;0 &#40;High TC&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venezuela<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;7 &#40;High TC&#41;4&#46;5 &#40;High TC&#59; M&#41;6&#46;5 &#40;High TC&#59; W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
            4 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CVD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total population&#47;adults&#40;&#62;18 y&#41; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Children&#40;&#60;5 y&#41; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Worldwide<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">47</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;M&#41;13 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Latin American countries &#40;Argentina&#44; Brazil&#44; Chile&#44; Colombia&#44; Dominican Republic&#44; Ecuador&#44; Guatemala&#44; Jamaica&#44; Mexico&#44; Peru&#44; Trinidad and Tobago&#44; Venezuela&#41;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">47</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;M&#41;18 &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Latin America<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;8 &#40;Macro&#41;15&#46;2 &#40;Micro&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central America &#40;Costa Rica and Panama&#41;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;6 &#40;Macro&#41;4&#46;1 &#40;Micro&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Argentina<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;0 &#40;Macro&#41;10&#46;0 &#40;Micro&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brazil<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;3 &#40;Macro&#41;19&#46;2 &#40;Micro&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colombia<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;0 &#40;Macro&#41;21&#46;4 &#40;Micro&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mexico<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;0 &#40;Macro&#41;17&#46;1 &#40;Micro&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:6 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">&#60;12<span class="elsevierStyleHsp" style=""></span>m&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Adolescents&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">5&#8211;14 y&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">5&#8211;11 y&#46;</p>"
            ]
            4 => array:3 [
              "identificador" => "tblfn0035"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">School-age children&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">&#62;45 y&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Data of overweight&#47;obesity and the main NCCDs observed in Latin America&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#46; M&#58; men&#59; W&#58; women&#59; y&#58; years old&#46; Overweight&#47;obesity&#58; BMIZ<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#254;2 for children aged<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5 years&#59; BMIZ<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#254;1 for girls&#47;boys aged 11&#8211;19 years&#59; and BMI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>25&#46;0<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> for women&#47;men aged 20&#8211;49 years&#46; Wasting&#58; WHZ<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2 for children aged<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5 years&#46; Underweight&#58; BMIZ<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2 for girls&#47;boys aged 11&#8211;19 years&#59; and BMI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>18&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> for women&#47;men aged 20&#8211;49 years&#46; Stunting&#58; HAZ<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2 for children aged<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5 years&#59; HAZ<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2 for girls&#47;boys aged 11&#8211;19 years&#46; Short stature&#58; height<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#46;49<span class="elsevierStyleHsp" style=""></span>m for women&#47;men aged 20&#8211;49 years&#46;</p>"
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                  \t\t\t\t" scope="col">Country&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Overnutrition</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Overweight&#47;obesity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wasting-underweight&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Stunting&#47;short stature&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Overweight&#47;obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wasting- underweight&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Stunting&#47;short stature&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anaemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Overweight&#47;obesity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wasting-underweight&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Stunting&#47;short stature&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Argentina<a class="elsevierStyleCrossRef" href="#bib0660"><span class="elsevierStyleSup">59</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">19&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Bolivia<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">62</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Brazil<a class="elsevierStyleCrossRef" href="#bib0705"><span class="elsevierStyleSup">68</span></a>&nbsp;\t\t\t\t\t\t\n
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