Riesgo de enfermedades crónicas no transmisibles en trabajadores de un centro de rehabilitación de la salud J. Adv. Educ. Sci. Humanit. (January - June 2024) 2(1): 1-10 https://doi.org/10.5281/zenodo.14602192 ISSN: XXXX-XXXX ORIGINAL ARTICLE Risk of chronic non-communicable diseases in workers at a health rehabilitation center  Patricia M. Espinel patricia.espinel@mspz4.gob.ec Received: 16 October 2023 / Accepted: 4 January 2024 / Published online: 31 January 2024 © The Author(s) 2024 Patricia M. Espinel 1 · Jesenia E. Rodríguez 2 Abstract A cross-sectional study was conducted in a health rehabilitation center to identify workers’ risks of chronic non- communicable diseases. Food preferences, physical activity, and toxic habits were analyzed through surveys. Anthropo- metric indicators (BMI, waist circumference, and waist/hip ratio) and biochemical indicators (hemoglobin, total cho- lesterol, triglycerides, and glycemia) were determined. The results showed that most workers were overweight, with 13.69% obese. More than 75% had central obesity, correlat-ed with waist circumference and waist/hip ratio. The 62.7% had a sedentary lifestyle, while 28% showed impairments in iron nutritional status. A signi icant percentage presented high risks of chronic diseases related to glycemia, cholesterol, and triglycerides; 7% of cases showed severe impairments in two of these variables. Frequent cigarette consumption was reported by 22% of workers, a habit that elevates the risk of degenerative diseases. Keywords non-communicable diseases, diet, lifestyles, sedentary lifestyle, occupational healths. Resumen Se realizó una investigación transversal un cen- tro de rehabilitación de salud para identiﬁcar riesgos de en- fermedades crónicas no transmisibles en trabajadores. Me- diante encuestas se analizaron las preferencias alimentarias, actividad física y hábitos tóxicos. Se determinaron indicado- res antropométricos (IMC, circunferencia de cintura e índice cintura/cadera) y bioquímicos (hemoglobina, colesterol to- tal, triglicéridos y glicemia). Los resultados mostraron que la mayoría de los trabajadores tenía sobrepeso, con un 13,69 % de obesidad. Más del 75 % presentó obesidad central, corre-lacionada con la circunferencia de cintura e índice cintura/cadera. El 62,7 % tenía un estilo de vida sedentario, mientras que el 28 % mostró afectaciones en el estado nutricional del hierro. Un porcentaje signi icativo presentó riesgos elevados de enfermedades crónicas relacionados con glicemia, coles-terol y triglicéridos; un 7 % de los casos mostró afectaciones graves en dos de estas variables. El 22 % de los trabajadores tenía un consumo frecuente de cigarrillos, lo que incrementa el riesgo de enfermedades degenerativas. Palabras clave enfermedades no transmisibles, dieta, estilos de vida, sedentarismo, salud laboral. How to cite Espinel, P. M., & Rodríguez, J. E. (2024). Risk of chronic non-communicable diseases in workers at a health rehabilitation center. Journal of Advances in Education, Sciences and Humanities, 2(1), 1-10. https://doi.org/10.5281/zenodo.14602192 1 Ministerio de Salud Pública, Manabí. Portoviejo, Ecuador. 2 Yachay Experimental Technology Research University, Imbabura, Ecuador.

J. Adv. Educ. Sci. Humanit. (January - June 2024) 2(1): 1-10 2 Introduction Health status is fundamentally conditioned by genetic and environmental factors, where the most critical external varia- ble is nutrition. An adequate diet must meet daily nutritional needs and incorporate cultural, gastronomic, and personal satisfaction values (Rakha et al., 2022). Changes in eating habits, lower energy expenditure associated with sedentary lifestyles, population aging, smoking, and alcohol consump- tion are the main risk factors for noncommunicable diseases and constitute an increasing health challenge (Majić et al., 2023). The type and amount of food and drink consumed play a role in the struggle for weight control and overall good health. Less attention has been paid to how much energy we expend if physically active, but the two aspects are closely linked (Esquivel, 2021). The rapid expansion of various relevant scientiﬁc ﬁelds and abundant population-based epidemiological data have helped to clarify the role of diet in preventing and contro- lling morbidity and premature mortality caused by noncom- municable diseases (Pham et al., 2022). Some speciﬁc die- tary components that increase the likelihood of developing these diseases in individuals and appropriate interventions to modify their impact have been identiﬁed (Gherasim et al., 2020). Diet has been shown to have a signiﬁcant inﬂuence, both positive and negative, on health throughout life. Dietary ad- justments inﬂuence current health and can determine whe- ther or not an individual suﬀers from diseases such as cardio- vascular disease, cancer, obesity, and diabetes in later life. However, these insights have not led to changes in policy or practice. In many developing countries, dietary policies focus only on malnutrition and do not consider preventing chronic diseases (Gherasim et al., 2020). This research ai- med to identify some risks of chronic noncommunicable di- seases in health rehabilitation workers. Methodology The study was conducted in a health rehabilitation cen- ter during April and May. A descriptive cross-sectional de- sign was used to evaluate anthropometric and biochemical parameters, lifestyle habits, and nutritional adequacy of the workers’ diet. Ninety-ﬁve workers were selected through non-probabilistic convenience sampling. Inclusion criteria were active workers during the study period, voluntary par- ticipation with a willingness to perform measurements and answer surveys, age between 18 and 60 years, and absence of medical conditions that signiﬁcantly aﬀected anthropome- tric or biochemical variables (e.g., pregnancy, severe meta- bolic diseases). Workers who refused to participate in measurements or surveys, had physical or psychological conditions that made obtaining reliable data impossible or were absent during data collection activities were excluded. Weight, height, waist, and hip circumference were mea- sured using standardized anthropometric techniques. Weight was measured with a precision scale (SECA brand, Double Roman model), expressed in kilograms. Height was deter- mined with a measuring tape in an erect position, expressed in meters. Workers were assessed for waist and hip circum- ference and body mass index (BMI) (Hewage et al., 2023). Structured questionnaires were applied to evaluate phy- sical activity (frequency and intensity of physical exercise, more than 30 minutes and more than days a week) and toxic habits (smoking and alcohol consumption, classiﬁed accor- ding to frequency. Venous blood samples were obtained after 12 hours of fasting, and each sample was processed using a Hitachi model 912 autoanalyzer. Glycemia, cholesterol, tri- glycerides, and hemoglobin were determined. The menus consumed during the study period were recor- ded, and the adequacy of energy and nutrient recommen- dations was analyzed using a frequency of consumption questionnaire. The data were analyzed using SPSS software, version 11.1. Descriptive statistics were used to calculate means, standard deviations, and percentage distributions. The Chi-square test was used with a confidence level of 95% (p ≤ 0.05) to determine significant associations between an-thropometric and biochemical variables and habits. Results and discussion Table 1 presents the composition by sex and age of the sample studied. Thirty-two men and 63 women were studied, representing 33.7% and 66.3% of the sample. Table 1. Percentage distribution of the population sample, according to age and sex Age (years) Sex Frequency Percentage 18-30 Male 6 6.32 Female 8 8.42 30-60 Male 25 26.32 Female 54 56.84 > 60 Male 1 1.05 Female 1 1.05 Total 95 100

J. Adv. Educ. Sci. Humanit. (January - June 2024) 2(1): 1-10 3 This result was consistent with the composition of the uni- verse of workers at the center. The average age of the partici- pants was 38 years; the majority (83.12%) were between 30 and 60 years old. Figure 1 shows the percentage distribution of the BMI of the center’s workers, highlighting that the majority weigh- ted the reference for their height, representing half of the sample. Within this group, 13.69% were classiﬁed as obese, including three men who were in the morbidly obese ran- ge. Overweight predominated in women, with 77% of them aﬀected, while obesity was more prevalent in men, aﬀecting 54% of male participants. Figure 1. Percentage distribution of body mass index (BMI) of the analyzed population. Almost half of the sample had an adequate weight for their height, with 23 men and 46 women in this category. The remaining 4% of workers had weights below the reference range for adequate weight, with one in chronic energy deﬁ- ciency grade III. BMI was used to estimate the prevalence of overweight and obesity in the study population and the associated risks (Al-Ghamdi et al., 2018). However, due to variations in body proportions, this indicator may not reﬂect the same degree of obesity in diﬀerent populations (Jeong et al., 2023). The risks associated with increasing BMI follow a conti- nuous gradient starting from a BMI greater than 25. In this study, 35.79% of individuals were at increased risk, whi- le just over 10% showed moderate or severe risks. This is worrying in a health institution where the prevention and treatment of diseases, especially chronic noncommunicable diseases, are a primary objective. These conditions are the leading causes of mortality worldwide (Ouyang et al., 2022). Among adults, there is clear evidence that modest weight reduction in susceptible individuals can signiﬁcantly slow the development of type 2 diabetes and even prevent it alto- gether. Weight loss can reverse the type 2 diabetic state (Ko & Kim, 2022). It has been noted that the interpretation of risk associated with BMI may vary across populations. BMI and measures of body fat distribution are relevant for estimating comorbi- dity risk, especially concerning cardiovascular disease and other chronic conditions (Powell-Wiley et al., 2021). In the distribution of body fat according to the waist-hip ratio of the workers, the central type of obesity predomina- ted, also known as abdominal, android, or male (Gadekar et al., 2020). This pattern was represented in 80% of the sam- ple, with a higher prevalence in the female sex, which cove- red 83% of the cases classiﬁed in this category. Table 2 compares body mass index according to sex and waist circumference. In both sexes, obesity was directly and signiﬁcantly associated with central fat distribution. In wo- men, overweight also showed a signiﬁcant relationship with increased and remarkably increased risk of these diseases (13.9% and 24.8% of women, respectively). This pattern was not evident in the male group. Table 2. Relationship between waist circumference and body mass index BMI Men Women Waist circumference Waist circumference MR (%) RI (%) RMI (%) MR (%) RI (%) RMI (%) Low Weight 4.1 0.0 0.0 4.0 0.0 0.0 Normal 42.9 4.1 0.0 16.8 17.8 10.9 Overweight 16.3 6.1 2.0 2.0 13.9 24.8 Obese 6.1 8.2 10.2 1.0 1.0 7.9 Signiﬁcance statistics X 2 =27.48; p=0.000 X 2 =35.32; p=0.000 BMI: Body Mass Index, SR: No risk, RI: Increased risk, RMI: Very increased risk.

J. Adv. Educ. Sci. Humanit. (January - June 2024) 2(1): 1-10 4 Central fat distribution is considered metabolically active, which increases the risk of chronic noncommunicable disea- ses, such as cardiovascular diseases, hypertension, type II diabetes, and atherosclerosis. This risk is due to increased metabolically active intra-abdominal adipocytes (Dhawan & Sharma, 2020). These adipocytes release free fatty acids di- rectly into the portal circulation, which could interfere with insulin clearance by the liver, thus aﬀecting several metabo- lic (Chait & den Hartigh, 2020) and pathophysiological pro- cesses, which can trigger lipid alterations (such as decrea- sed HDL and increased LDL), vascular alterations, arterial hypertension, and non-insulin-dependent diabetes mellitus, among others (Strikić et al., 2023). An increased risk of mortality, as well as diseases such as diabetes, hypertension, heart attacks, and strokes, has been found in people with central obesity (Cercato & Fonseca, 2019). Dehesh et al. (2023) found that abdominal obesity can predict the risk of breast cancer in women, this risk aﬀecting 9.7% of the study participants. Physical exercise is essential to prevent excess weight and reduce the risks of noncommunicable diseases, such as heart disease, high blood pressure, and diabetes mellitus (Saqib et al., 2020), as well as counteracting stress (Kim & Han, 2016). Figure 2 shows the percentage distribution of people ac- cording to their habit of exercising for 30 minutes or more each time they do it. As can be seen, most respondents did not exercise (62.7%) or did so for less than 30 minutes each session, which favors a sedentary lifestyle and a reduction in total energy expenditure. Figure 2. Percentage distribution of people’s frequency according to whether they perform 30 minutes of physical exercise weekly. This behavior promotes body weight gain and other me- tabolic disorders, such as diabetes mellitus (Carbone et al., 2019) and metabolic syndrome, which is characterized by hypertriglyceridemia, elevated LDL levels, reduced HDL cholesterol, arterial hypertension, overweight with central fat accumulation (intra-abdominal), and reduced insulin se- cretion with impaired glucose tolerance. These are high-in- cidence diseases worldwide (Jha et al., 2023). Figure 3 shows the percentage distribution of individuals who presented values associated with a higher risk of suﬀe- ring from chronic noncommunicable diseases, according to the biochemical indicators of nutritional status. Figure 3. Percentage distribution of individuals with alte- rations in biochemical parameters. More than a quarter of individuals (28%) presented he- moglobin values below normal ranges, with women contri- buting most to this result (19.4%). The prevalence of anemia was notable in men (26%), indicating possible severe iron deﬁciencies. 11.3% of cases showed elevated glucose levels, with 6% exceeding 6.1 mmol/L, indicating a risk of diabetes mellitus. The remaining 5.3% presented glycemia levels be- tween 5.6 mmol/L and 6.1 mmol/L, which increases the risk of developing diabetes. Elevated cholesterol levels were observed in 20% of sub- jects, while 22.6% had elevated triglyceride levels. A slight bias was noted towards men for elevated cholesterol, with 14% of men aﬀected compared to 13% of women. The pre- valence of elevated triglycerides was consistent between se- xes, at 22%. When combining biochemical risk parameters (choleste- rol, triglycerides, and blood sugar), none of the individuals had elevated levels of all three indicators. However, 11 indi- viduals (4 men and 5 women) showed combinations of ele-

J. Adv. Educ. Sci. Humanit. (January - June 2024) 2(1): 1-10 5 vated cholesterol and triglycerides, indicating an increased risk of cardiovascular and cerebrovascular diseases. Diabetes is considered one of the signiﬁcant health challen- ges of the 21st century. Its complications, such as coronary artery disease, peripheral vascular disease, cerebrovascular events, diabetic neuropathy, amputations, kidney failure, and blindness, will increase disability, reduce life expectancy, and drive-up healthcare costs globally (Zakir et al., 2023). It is estimated that nearly 500 million people worldwide have diabetes, and this number is projected to increase by 25% by 2030 and 51% by 2045 (Saeedi et al., 2019). Epidemiological studies have shown that coronary artery disease and cerebrovascular disease are two to three times more common in people with diabetes than in those without the condition. Cardiovascular disease is the leading cause of death in people with type 2 diabetes (Colom et al., 2021). Diabetes can cause cardiovascular injury in a variety of ways. Pathological processes are not independent, and each can accelerate or worsen the others. As the disease progres- ses, the heart and blood vessels suﬀer multiple damages (Ga- licia-Garcia et al., 2020). Diabetes is associated with a higher prevalence of other risk factors, such as hypertension and dyslipidemia, in ad- dition to being a risk factor itself. These factors combined signiﬁcantly increase cardiovascular risk. For each risk fac- tor present, the risk of cardiovascular death is three times higher in people with diabetes compared to those without the disease. Consequently, people with diabetes are two to four times more likely to develop cardiovascular disease than the general population (Bays et al., 2021). The relationship between cholesterol concentrations and coronary mortality is direct and continuous, with no speciﬁc threshold value for the onset of risk of ischemic complica- tions of atherosclerosis. The risk of coronary heart disease increases progressively as cholesterol levels are between 3.9 mmol/L and 5.2 mmol/L. From 5.2 mmol/L, the risk in- creases signiﬁcantly, such that an individual with cholesterol between 6.24 mmol/L and 7.8 mmol/L has a coronary risk four times higher than those with levels below 5.2 mmol/L (Lloyd-Jones et al., 2003). The physical activity of the population ranged from light sedentary to very active, depending on the job occupation of each respondent and the frequency and duration of physical exercise outside the workplace (van As et al., 2022), with the analyzed group having a weighted average energy value of 2432 kcal. Table 3 presents the average energy and macro- nutrient values of the foods oﬀered during the two months of registration, observing that the energy oﬀered is above 110% Table 3. Macronutrient diet contribution Indicator Mean (Standard deviation) Recommendations Adequacy (%) Energy (kcal) 3025.32 (232.1) 2432 124.40 Proteins (g) 98.08 (55.2) 73 134.36 Fats (g) 81.57 (23.04) 54.2 150.50 Carbohydrates (g) 467.86 (24.4) 413.3 113.20 adequacy, which is why it is classiﬁed as excessive. A similar result was observed for macronutrients; the va- lues for the dietary variables analyzed suggest a positive energy balance if maintained steadily, which may be a con- tributing factor to some extent to weight gain, whose long- term expression may be obesity (Hollstein & Piaggi, 2020). Table 4 presents the percentage adequacy of vitamins and minerals in the diet. Thiamine and niacin met the nutritio- nal recommendations regarding B vitamins, reaching the adequacy values (Mielgo-Ayuso et al., 2018). The average amounts of riboﬂavin, pyridoxine, and folic acid in the diets were below the minimum recommended values for both wo- men and men. Folic acid deﬁciency was reported to be considered an in- dependent risk factor in cardiovascular disease since, toge- ther with deﬁciencies in other vitamins such as pyridoxine, increases in the concentration of the amino acid homocystei- ne were observed, which seems to promote coagulation and deterioration of the arterial wall (Wang et al., 2019). Cyanocobalamin showed average levels that exceeded the recommended limit in the population analyzed, possibly due to the daily presence of meat on the institution’s menus. Al- though deﬁcits of these micronutrients could cause deﬁcien- cy diseases in the medium and long term, excesses are not re- commended either; however, in the case of cyanocobalamin, the excess is easily eliminated through body ﬂuids since it is a water-soluble vitamin (González-Montaña et al., 2020). It must ensure the adequate daily intake of B vitamins

J. Adv. Educ. Sci. Humanit. (January - June 2024) 2(1): 1-10 6 since they perform essential functions in the body as coen- zymes and cofactors in energy metabolism reactions. They are essential for functioning the muscular, nervous, and he- matopoietic systems, the skin, and the gastrointestinal tract (Hanna et al., 2022). Table 4. Adequacy of vitamins and minerals Indicator Adequacy (%) Vitamins Vitamin A 89 Vitamin C 52 Vitamin E 62 Thiamine 111 Riboﬂavin 78 Niacin 90 Pyridoxine 87 Acid folic acid 65 Cyanocobalamin 140 Minerals Copper 324 Zinc 130 Iron 64 Calcium 88 Regarding mineral intake, copper and zinc exceeded the maximum adequacy limit (110%). These minerals are bene- ﬁcial in the diet, as they are part of enzymes that inactivate free radicals, which could help prevent DNA damage and the oxidation of proteins and lipids, preventing radical reactions and the appearance of chronic diseases (Weyh et al., 2022). The high levels of copper in the diet were due to the daily consumption of various beans on the menus. On the other hand, red meat, chicken, and legume grains were the main foods contributing to zinc levels exceeding the maximum adequacy limit. The calcium and iron content of the foods oﬀered was in- ferior. The deﬁcit could have compromised the nutritional status of these nutrients, aﬀecting the nutritional status and health of the population analyzed early on. In this case, cal- cium is essential for forming and renewing bone tissue, so women, who made up the majority of the sample, could be at risk of osteoporosis (Šromová et al., 2023). Iron may contribute to the development of iron deﬁcien- cy anemia, the most common nutritional deﬁciency in the world, which causes fatigue, decreased productivity, and alterations in cognitive development (Kumar et al., 2022), which is reﬂected in this study, given the high percentages of women and men with hemoglobin values below the mi- nimum desirable value. Variations in dietary habits, reduced energy expenditure associated with a sedentary lifestyle, and population aging, together with smoking and alcohol con- sumption, were the risk factors for suﬀering from chronic noncommunicable diseases (Ejigu & Tiruneh, 2023). Figure 4 shows the toxic habits of the population studied. It was observed that most people were not dependent on the- se products. However, a relatively high percentage smoked more than six cigarettes a day (22% of the population), which classiﬁed them as frequent smokers. Regarding alcohol, it was not presented as a concern since only 25% of individuals consumed it occasionally, with a frequency less than once a week (Surma & Więcek, 2022). Figure 4. Percentage distribution of individuals with toxic habits. One of the factors that possibly favored the surveyed wor- kers could have been the ban on smoking and drinking in health facilities or a higher cultural and educational level than individuals working in other state agencies. Smoking is the leading cause of morbidity and mortality in most deve- loped countries and is associated with a risk factor for res- piratory and cardiovascular diseases and diﬀerent types of cancer. It is especially harmful during pregnancy (Gallucci et al., 2020). The exact number of cigarettes that constituted a risk for chronic noncommunicable diseases was not found because smokers generally have other risk factors, such as alcohol, high consumption of saturated fats, and cholesterol, mainly from red meat, among other foods (Kopp, 2022). It has been reported that a single cigarette could increase heart rate, res- piratory rate, and blood pressure (Linneberg et al., 2015). The relationship between alcohol consumption and mor-

J. Adv. Educ. Sci. Humanit. (January - June 2024) 2(1): 1-10 7 Bays, H.E., Taub, P.R., Epstein, E., Michos, E.D., Ferra- ro, R.A., Bailey, A.L., Kelli, H.M., Ferdinand, K.C., Echols, M.R., Weintraub, H., Bostrom, J., Johnson, H.M., Hoppe, K.K., Shapiro, M.D., German, C.A., Vi- rani, S.S., Hussain, A., Ballantyne, C.M., Agha, A.M., & Toth, P.P. (2021). Ten things to know about ten car- diovascular disease risk factors. American Journal of Preventive Cardiology, 5, 100149. https://doi.or- g/10.1016/j.ajpc.2021.100149 Carbone, S., Del Buono, M.G., Ozemek, C., & Lavie, C.J. (2019). Obesity, risk of diabetes and role of physical activity, exercise training and cardiorespiratory ﬁtness. Progress in Cardiovascular Diseases, 62(4), 327-333. https://doi.org/10.1016/j.pcad.2019.08.004 Cercato, C., & Fonseca, F.A. (2019). Cardiovascular risk and obesity. Diabetology & Metabolic Syndrome, 11, 74. ht- tps://doi.org/10.1186/s13098-019-0468-0 Chait, A., & den Hartigh, L.J. (2020). Adipose Tissue Dis- tribution, Inﬂammation and Its Metabolic Consequen- ces, Including Diabetes and Cardiovascular Disease. Frontiers in Cardiovascular Medicine, 7. https://doi. org/10.3389/fcvm.2020.00022 Chiva-Blanch, G., & Badimon, L. (2019). Beneﬁts and Ris- ks of Moderate Alcohol Consumption on Cardiovascu- lar Disease: Current Findings and Controversies. Nu- trients, 12(1), 108. https://doi.org/10.3390/nu12010108 Colom, C., Rull, A., Sanchez-Quesada, JL, & Pérez, A. (2021). Cardiovascular Disease in Type 1 Diabetes Me- llitus: Epidemiology and Management of Cardiovas- cular Risk. Journal of Clinical Medicine, 10(8), 1798. https://doi.org/10.3390/jcm10081798 Dehesh, T., Fadaghi, S., Seyedi, M., Abolhadi, E., Ilaghi, M., Shams, P., Ajam, F., Mosleh-Shirazi, M.A., & Dehesh, P. (2023). The relationship between obesity and breast cancer risk in women by considering menstruation sta- tus and geographical variations: a systematic review and meta-analysis. BMC Women’s Health, 23, 392. ht- tps://doi.org/10.1186/s12905-023-02543-5 Dhawan, D., & Sharma, S. (2020). Abdominal Obesity, Adipokines and Noncommunicable Diseases. Journal of Steroid Biochemistry and Molecular Biology, 203, 105737. https://doi.org/10.1016/j.jsbmb.2020.105737 Ejigu, B.A., & Tiruneh, F.N. (2023). The Link between Overweight/Obesity and Noncommunicable Diseases in Ethiopia: Evidences from Nationwide WHO STEPS Survey 2015. International Journal of Hypertension, 2023, 2199853. https:// doi.org/10.1155/2023/2199853 Esquivel, M.K. (2021). Energy Balance Dynamics: Exerci- tality risk has been compared in numerous epidemiological studies, with many indicating that the risk of primary ische- mic heart disease decreased at all levels of alcohol intake, taking into account recognized cardiac risk factors (Nors- tröm & Landberg, 2023). High alcohol consumption and its relationship with blood pressure was associated with an in- creased risk of hemorrhagic and ischemic stroke. High con- sumption was a widely recognized and highly prevalent risk factor for hypertension, but few studies evaluated the eﬀect of more moderate consumption on the risk of hypertension (Tumwesigye et al., 2020). The short-term beneﬁcial eﬀect of moderate alcohol con- sumption on atherothrombotic events, including ischemic stroke, coronary heart disease, and peripheral arterial di- sease, as well as congestive heart failure, has been demons- trated. This hypothesis supports slowing clot formation by stimulating tissue plasminogen activators (Chiva-Blanch & Badimon, 2019). Conclusions Most of the health center workers were overweight, and a signiﬁcant group was obese. In these cases, the risk of de- veloping cardiovascular diseases and other non-communica- ble diseases is directly correlated with waist circumference, and over three-quarters of the participants had central obe- sity, conﬁrmed by the waist-hip ratio. A considerable per- centage of the individuals were classiﬁed as sedentary. The workers had iron-related conditions. High risks of chronic noncommunicable diseases were identiﬁed based on blood sugar, cholesterol, and triglyceride results. A small part of the sample showed a very high risk, presenting alterations in at least two of the biochemical indicators evaluated. The risk of chronic diseases could be increased due to the regular consumption of foods with high energy density, such as pro- ducts rich in sugars, fried foods, fats, and meats. Among the habits considered to be risky, frequent cigarette consumption stood out as a signiﬁcant factor that increases the probability of developing degenerative diseases. References Al-Ghamdi, S., Shubair, M.M., Aldiab, A., Al-Zahrani, J.M., Aldossari, K.K., Househ, M., Nooruddin, S., Razzak, H.A., & El- Metwally, A. (2018). Prevalence of overweight and obesity based on the body mass in- dex; a cross-sectional study in Alkharj, Saudi Arabia. Lipids in Health and Disease, 17(1), 134. https://doi. org/10.1186/s12944-018-0778-5

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J. Adv. Educ. Sci. Humanit. (January - June 2024) 2(1): 1-10 10 ta-analysis. Medicine (Baltimore), 98(37), e17095. ht- tps://doi.org/10.1097/MD.0000000000017095 Weyh, C., Krüger, K., Peeling, P., & Castell, L. (2022). The Role of Minerals in the Optimal Functioning of the Immune System. Nutrients, 14(3), 644. https://doi. org/10.3390/nu14030644 Zakir, M., Ahuja, N., Surksha, M.A., Sachdev, R., Kalari- ya, Y., Nasir, M., Kashif, M., Shahzeen, F., Tayyab, A., Khan, M.S.M., Junejo, M., Manoj, F., Varrassi, G., Ku- mar, S., Khatri, M., & Mohamad, T. (2023). Cardiovas- cular Complications of Diabetes: From Microvascular to Macrovascular Pathways. Cureus, 15(9), e45835. https://doi.org/10.7759/cureus.45835 Conﬂicts of interest The authors declare that they have no conﬂicts of interest. Author contributions Conceptualization: Patricia M. Espinel, Jesenia E. Rodrí- guez. Data curation: Jesenia E. Rodríguez. Formal analy- sis: Patricia M. Espinel, Jesenia E. Rodríguez. Research: Patricia M. Espinel, Jesenia E. Rodríguez. Methodology: Patricia M. Espinel, Jesenia E. Rodríguez. Software: Jese- nia E. Rodríguez. Supervision: Patricia M. Espinel, Jese- nia E. Rodríguez. Validation: Patricia M. Espinel, Jesenia E. Rodríguez. Visualization: Patricia M. Espinel, Jesenia E. Rodríguez. Writing the original draft: Patricia M. Espinel, Jesenia E. Rodríguez. Writing, review and editing: Patricia M. Espinel, Jesenia E. Rodríguez. Data availability statement The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Statement on the use of AI The authors acknowledge the use of generative AI and AI-assisted technologies to improve the readability and cla- rity of the article. Disclaimer/Editor’s note The statements, opinions, and data contained in all publi- cations are solely those of the individual authors and contri- butors and not of Journal of Advances in Education, Scien- ces and Humanities. Journal of Advances in Education, Sciences and Humani- ties and/or the editors disclaim any responsibility for any in- jury to people or property resulting from any ideas, methods, instructions, or products mentioned in the content.