Risk of chronic diseases in indigenous Totonacs from Mexico short running title: Risk of chronic diseases in indigenous Totonacs.

Aim: The purpose of this study was to determine the risk of noncommunicable diseases (NCDs) development in four indigenous Totonac communities.

Background: Poverty and low education levels increase the risk of unhealthy lifestyles, leading to a higher incidence of NCDs in indigenous communities. In addition, limited access to health services significantly reduces the opportune screening of risk factors.

Methods: This was a cross-sectional observational study, in which we evaluated the incidence and/or the risk (%) to develop NCDs in adults from indigenous Totonac communities of Puebla State, Mexico. The sample consisted of 255 adults over 20 years old. Analysis of variance (ANOVA), Student's t-test, and Pearson's correlation were used for statistical analysis.

Results: We found significant differences between communities regarding the risk of diabetes (p < 0.05) and hypertension (p < 0.01). However, there were no significant differences in terms of CVD risk (p > 0.05). Men were at higher risk for hypertension and CVD than women (37.8% vs 27.3% and 20.9% vs 12.2%, respectively), whereas women were at a higher risk of diabetes than men based on the FINDRISC score (11.7 vs 9.7, respectively).

Conclusion: The Zapotitlan community showed a higher risk of developing both diabetes and hypertension compared with the other communities. Men showed higher risks of hypertension and CVD compared with women. Women are at higher risk of diabetes than men.