Patrones alimentarios y exposición a plaguicidas: su asociación con la ocurrencia de cáncer en el sudeste de la provincia de Córdoba, Argentina

Abstract

El presente estudio tuvo como objetivo identificar patrones alimentarios y niveles de exposición a plaguicidas y establecer posibles asociaciones entre estas exposiciones ambientales y la ocurrencia de cáncer, en la localidad de Monte Buey, ubicada en el sudeste de la provincia de Córdoba, Argentina. Numerosas investigaciones han demostrado la interacción entre elementos naturales y sociales en los riesgos y problemas de salud, evidenciando el rol del ambiente en el incremento o reducción de la morbimortalidad por enfermedades no transmisibles, entre ellas el cáncer. La importancia de la alimentación en el proceso de salud‐enfermedad, y particularmente en el proceso carcinogénico, cuenta con evidencia suficiente y convincente. En cambio, poco se conoce aún acerca del impacto en la salud de exposiciones a plaguicidas, crónicas y a bajas dosis, como aquellas que podría sufrir la población de referencia. A lo largo de la historia, la agricultura ha tenido un importante papel en el desarrollo integral de Argentina, incluyendo su economía; el notable incremento de la actividad agropecuaria desde 1990, fenómeno conocido como "agriculturalización”, trajo aparejado, entre otras consecuencias, el incremento de los volúmenes de uso de plaguicidas y la aplicación de nuevas mezclas para mejorar o prolongar el control de malezas. Este fenómeno se acompañó de una creciente preocupación en la sociedad por la conservación de los recursos naturales. De esta manera, la agricultura intensiva ha sido responsable de su degradación y los plaguicidas, asociados a daños en la salud humana, flora y fauna. Asimismo, las rápidas trasformaciones experimentadas por los sistemas alimentarios en la región en las últimas cuatro décadas coinciden con cambios de los patrones alimentarios de su población. En este estudio, se diseñó y relevó una muestra aleatoria de base poblacional en la localidad de Monte Buey (2015-16), de tamaño suficiente para exponer resultados con un 95% de confianza (n=416). Se aplicó una encuesta estructurada con los siguientes módulos: a) sociodemográficos; b) hábitos de vida, alimentación y condiciones de salud percibida; c) ambiente y exposición a plaguicidas. Se realizaron análisis descriptivos, uni y bivariados, mediante la construcción de tablas de distribución de frecuencia y medidas resumen, aplicándose test de chi2 para análisis de asociación entre variables cualitativas. Se realizó un análisis factorial de componentes principales para la construcción de patrones alimentarios típicos de esta población y se estimaron niveles de exposición a partir de la elaboración de un score que incluyó una selección de variables de significativas según la literatura, y se definieron tres niveles. Finalmente se ajustaron modelos de correspondencias múltiples para identificar grupos vulnerables a partir del rol de estos factores de exposición descriptos. La población estudiada estuvo integrada en proporciones similares por mujeres y varones, (50,4%, y 49,6%, respectivamente) con una media de edad de 46,60 años (DE 14,74), 51,03 años (DE 13,92) y 42,08 años (DE 14,19), entre mujeres y varones respectivamente. A partir de los consumos medios individuales de veintiún grupos de alimentos, se construyeron cuatro nuevas variables, identificadas como patrones alimentarios, que caracterizan los hábitos alimentarios de los monteboyenses. El patrón principal es aquel relacionado con la ingesta de vegetales A B (lechuga, repollo, acelga, zanahoria y tomates entre otras), frutas, frutas secas y aceites, denominado como Patrón Vegetal. Asimismo, se diseñó un score de exposición a plaguicidas, y se observó que el 50% de la población se concentra en los niveles de exposición más altos. Se reportaron 23 casos de cáncer, de los cuales 20 fueron diagnosticados en mujeres y 3 en varones. Casi el 70% de las personas con cáncer tenían antecedentes de cáncer en familiares de primer grado, 47,14% entre las mujeres que refirieron esta enfermedad. Las personas con un nivel de adhesión medio al patrón alimentario carnes rojas grasas presentaron un riesgo 4,35 veces mayor de desarrollar algún tipo de cáncer. El 47,8% de las personas con cáncer se encuentra en el tercil medio de nivel de exposición a plaguicidas mientras que el 17,4% en el tercil más alto, no encontrando asociación entre la ocurrencia de cáncer y el nivel de exposición a plaguicidas. Este estudio permitió reconocer que, en comunidades como Monte Buey, se establece un estrecho entramado entre prácticas productivas y espacios de la vida cotidiana, visibilizando así diversos modos de implicación directa de las poblaciones del núcleo agrícola en el modelo productivo imperante en la región. Ello invita a reflexionar de una manera holística sobre el modelo agrícola y su paquete tecnológico, considerando sus impactos en la salud, entre otros. Finalmente, se propone invitar a todos los actores claves a compartir el análisis de la problemática y sus posibles alternativas de resolución, no sólo para democratizar el conocimiento, sino también para dotar al modelo de sustentabilidad humana y ambiental.

The present study aimed to identify dietary patterns and levels of exposure to pesticides, and establish possible associations between these environmental exposures and the occurrence of cancer, in the town of Monte Buey, located in the southeast of the province of Córdoba, Argentina. Numerous investigations have demonstrated the interaction between natural and social elements in health risks and problems, showing the role of the environment in increasing or reducing morbidity and mortality from non- communicable diseases, including cancer. The importance of diet in the health-disease process, and particularly in the carcinogenic process, has produced sufficient and convincing evidence. On the other hand, little is still known about the impact on health of exposures to pesticides, chronic and at low doses, such as those that the reference population could suffer. Throughout history, agriculture has played an important role in the overall development of Argentina, including its economy. The notable increase in agricultural activity since 1990, a phenomenon known as "agriculturalization", brought with it, among other consequences, the increase in the volumes of pesticide use and the application of new mixtures to improve or prolong weed control. This phenomenon has been accompanied by a growing concern in society for the conservation of natural resources. Thus, intensive agriculture has been responsible for their degradation and pesticides, associated with damage to human health, flora and fauna. Furthermore, the rapid transformations experienced by food systems in the region in the last four decades coincide with changes in the eating patterns of its population. In this study, a random population-based sample was designed and surveyed in the town of Monte Buey (2015-16), which was large enough to obtain results with 95% confidence (n = 416). A structured survey was applied with the following modules: a) sociodemographic; b) life habits, diet and perceived health conditions; c) environment and exposure to pesticides. Descriptive, uni and bivariate analyses were carried out by constructing tables of frequency distribution and summary measures, applying the chi-squared test to analyze the association between qualitative variables. A factorial analysis of the main components was carried out for the construction of the typical eating patterns of this population and exposure levels were estimated through the elaboration of a score containing a selection of significant variables according to the literature, defining three levels. Finally, multiple correspondence models were adjusted to identify vulnerable groups based on the role of the exposure factors described. The study population was made up of similar proportions of women and men (50.4% and 49.6%, respectively) with a mean age of 46.60 years (SD 14.74), 51.03 years ( SD 13.92) and 42.08 years (SD 14.19), between women and men, respectively. From the average individual consumptions of twenty-one food groups, four new variables were constructed, identified as eating patterns, which characterize the eating habits of the inhabitants of Monte Buey. The main pattern is that related to the intake of vegetables A B (lettuce, cabbage, chard, carrots and tomatoes among others), fruit, dried fruit and oils, called the Vegetable Pattern. Besides, a pesticide exposure score was designed which revealed that 50% of the population was concentrated in the highest exposure levels. 23 cases of cancer were reported, of which 20 were diagnosed in women and 3 in men. Almost 70% of the people with cancer had a first-degree family history of cancer, 47.14% among women who reported this disease. People with a medium level of adherence to the fatty red meat eating pattern had a 4.35 times greater risk of developing some type of cancer. 47.8% of people with cancer are in the middle tertile of exposure to pesticides while 17.4% are in the highest tertile, revealing no association between the occurrence of cancer and the level of exposure to pesticides. This study acknowledges that, in communities such as Monte Buey, a narrow network is established between productive practices and spaces of daily life, thus visualizing different modes of direct involvement of the populations of the agricultural core area in the prevailing productive model in the region. This invites us to reflect in a holistic way on the agricultural model and its technological package, considering its impacts on health, among others. Finally, all key participants are invited to share the analysis of this problem and find solutions to it, not only to democratize knowledge but also to provide the model with human and environmental sustainability.

Descriptive, uni and bivariate analyses were carried out by constructing tables of frequency distribution and summary measures, applying the chi-squared test to analyze the association between qualitative variables. A factorial analysis of the main components was carried out for the construction of the typical eating patterns of this population and exposure levels were estimated through the elaboration of a score containing a selection of significant variables according to the literature, defining three levels. Finally, multiple correspondence models were adjusted to identify vulnerable groups based on the role of the exposure factors described. The study population was made up of similar proportions of women and men (50.4% and 49.6%, respectively) with a mean age of 46.60 years (SD 14.74), 51.03 years ( SD 13.92) and 42.08 years (SD 14.19), between women and men, respectively. From the average individual consumptions of twenty-one food groups, four new variables were constructed, identified as eating patterns, which characterize the eating habits of the inhabitants of Monte Buey. The main pattern is that related to the intake of vegetables A B (lettuce, cabbage, chard, carrots and tomatoes among others), fruit, dried fruit and oils, called the Vegetable Pattern. Besides, a pesticide exposure score was designed which revealed that 50% of the population was concentrated in the highest exposure levels. 23 cases of cancer were reported, of which 20 were diagnosed in women and 3 in men. Almost 70% of the people with cancer had a first-degree family history of cancer, 47.14% among women who reported this disease. People with a medium level of adherence to the fatty red meat eating pattern had a 4.35 times greater risk of developing some type of cancer. 47.8% of people with cancer are in the middle tertile of exposure to pesticides while 17.4% are in the highest tertile, revealing no association between the occurrence of cancer and the level of exposure to pesticides. This study acknowledges that, in communities such as Monte Buey, a narrow network is established between productive practices and spaces of daily life, thus visualizing different modes of direct involvement of the populations of the agricultural core area in the prevailing productive model in the region. This invites us to reflect in a holistic way on the agricultural model and its technological package, considering its impacts on health, among others. Finally, all key participants are invited to share the analysis of this problem and find solutions to it, not only to democratize knowledge but also to provide the model with human and environmental sustainability.