RESUMEN
The objective of this comparative cross-sectional study was to determine the prevalence of dyslipidemias and examine its association with food intake and metabolic variables in urban and rural elder Mexican populations. Three different communities (urban areas of medium and low income and a rural area) were studied. A total of 344 subjects aged 60 years and older and 273 aged 35 to 59 years were included. The evaluated parameters were personal medical data, 24-hour diet recall, and fasting plasma lipids, insulin, and glucose levels. Older subjects, especially men, living in the rural area had lower cholesterol levels (5.02 +/- 0.97 v 5.6 +/- 1.07 mmol/L; P <.05) and insulin levels (12 +/- 10 v 42 +/- 68 mU/mL) and higher high-density lipoprotein cholesterol concentrations (1.31 +/- 0.36 v 1.07 +/-0.28 mmol/L) than the elders from the urban medium-income group. Possible explanations for these differences are found in the dietary habits of the groups. Rural elders had higher amounts of fiber (20 +/- 11 v 10 +/- 6 g/d) and carbohydrate (70% +/- 0.08% v 52% +/- 0.11% of calories) and lower fat (18% +/- 0.07% v 33% +/- 0.1% of calories) in their diets. In the urban groups, low-density lipoprotein hypercholesterolemia was present in 17.8% of adult and 39.1% of elderly women (P =.00001). In conclusion, environmental factors still play a prominent role in the pathophysiology of the dyslipidemias in the elderly.
Asunto(s)
Envejecimiento/fisiología , Apolipoproteínas B/sangre , Hiperlipidemias/epidemiología , Lípidos/sangre , Salud Rural , Salud Urbana , Adulto , Distribución por Edad , Envejecimiento/sangre , Enfermedad Coronaria/etiología , Estudios Transversales , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Distribución por SexoRESUMEN
BACKGROUND: HbA1c is considered the gold standard of long-term glycemic control and is recommended as a routine test for every diabetic patient. However, its common use in clinical practice has some problems related to lack of standardization and its relative cost. Recent studies have suggested, that postprandial blood glucose could be better than a fasting sample, as a marker of diabetes control. The objective of the present study was to evaluate the relative value of plasma glucose samples at different times of the day, and easy and accessible programs for home blood and urinary glucose measurements compared with HbA1c in assessing the mean glycemic control of type 2 diabetic patients. METHODS: Sixty type 2 diabetic patients were instructed to do home blood and urine glucose monitoring for two months, at the end, plasma glucose profiles were obtained. RESULTS: The mean of all the capillary BG measurements had the best correlation with the HbA1c (r = 0.84, p < 0.001), followed by the mean of the capillary BG measurements before breakfast and supper (r = 0.82, p < 0.001), and the 2 hr. postbreakfast plasma glucose (r = 0.79 p < 0.001). The fasting PG had a low correlation (r = 0.65, p < 0.001), but a good sensitivity to predict a fair or a poor metabolic control. Diabetes duration and type of treatment explained 17% and 28% of variance in HbA1c levels. CONCLUSIONS: A bimonthly fasting PG correlated well with the glycosylated hemoglobin and is the easiest and cheapest way of monitoring glycemic control in type 2 diabetic patients with some preserved insulin reserve (diabetes for less than 10 years and on treatment with only one hypoglycemic agent). A sample of capillary BG, fasting, once per week correlates better with the HbA1c than a fasting PG every 2-3 months. The 2 hr and 5 hr postbreakfast PG have a good correlation with the HbA1c, but are not a substitute for doing BG monitoring. Glycosuria may be a useful parameter to rule out a fair or poor metabolic control in some patients.
Asunto(s)
Glucemia/análisis , Diabetes Mellitus Tipo 2/sangre , Adulto , Anciano , Automonitorización de la Glucosa Sanguínea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
It is well known that infections in patients with diabetes mellitus are more severe, although there is controversy for increased susceptibility to them. Non-specific immune response mechanisms could be related to defense and/or susceptibility to pathogens. The aim of this study was to investigate the activity of several enzymes involved in the primary host defense mechanisms in non-insulin dependent diabetes mellitus (NIDDM). Twenty NIDDM females with a mean HbA(1c) level of 8.19% were included. No patient had clinical evidence of infection. As controls 20 healthy females were studied. The enzymes tested were dipeptidyl-peptidase I (DPP-I), cathepsin B and D, NADPH oxidase and superoxide dismutase (oxidative burst) and collagenase. Isolated leukocytes were incubated with the specific substrates in pyrogen free conditions. The intracellular enzyme activity was analyzed by flow cytometry. Collagenase enzymatic activity was similar in the three leukocyte subpopulations studied. Oxidative burst induction in monocytes was comparable between both groups. Enzyme activity of cathepsin B and D in all cell subsets, oxidative burst in PMN cells, and DPP-I in lymphocytes and monocytes from patients, was higher than those from healthy females (P<0.05). Overall, our findings demonstrate an enhanced functional status of several intracellular leukocyte enzymes in NIDDM. Furthermore, the increased oxidative burst induction and the consequent production of free radicals, may contribute to vascular complications. Other mechanisms - either from the non-specific or specific immune response - deserve investigation to establish if diabetic patients are more susceptible to infectious diseases.
Asunto(s)
Diabetes Mellitus Tipo 2/inmunología , Citometría de Flujo/métodos , Subgrupos Linfocitarios/enzimología , Macrófagos/enzimología , Neutrófilos/enzimología , Adulto , Linfocitos T CD8-positivos/enzimología , Catepsina B/sangre , Catepsina C/sangre , Catepsina D/sangre , Colagenasas/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/enzimología , Susceptibilidad a Enfermedades , Femenino , Humanos , Infecciones/etiología , Células Asesinas Naturales/enzimología , Persona de Mediana Edad , NADPH Oxidasas/sangre , Estallido Respiratorio , Superóxido Dismutasa/sangreRESUMEN
BACKGROUND: Urinalysis is one of the most common studies performed on the diabetic patient at every visit. The presence of leukocyturia is relatively common but it is not clear what the attitude of the physician toward this particular finding should be. The main objective of the present study was to investigate the clinical significance of leukocyturia in diabetic women. METHODS: Ninety-eight diabetic women (84.7% type 2) aged 57 +/- 13 years who were being seen at the diabetic out-patient clinic were randomly selected. All patients underwent a clinical and gynecologic examination and a urinalysis. A Papanicolaou smear and a urine culture were also obtained. RESULTS: The overall prevalence of leukocyturia (>5 cells/high power field (hpf)) was 46.5%. Patients with urinary tract infections (UTI) were 7.5 times more likely to have leukocyturia, while a leukocyte count <5cells/hpf predicted the absence of UTI in 96% of the women. In the comparison of patients with and without leukocyturia, we found that proteinuria (p = 0.06) and bacteriuria (p <0.002) were more common in the women with leukocyturia. A significant association with leukorrhea was not demonstrated. The empirical use of antibiotics was 12 times more frequent in the patients with leukocyturia. CONCLUSIONS: A urinary culture should be requested in all diabetic patients with leukocyturia. The possibility of a UTI is remote when leukocyturia is absent.
Asunto(s)
Diabetes Mellitus/orina , Recuento de Leucocitos , Orina/citología , Adulto , Anciano , Antibacterianos/uso terapéutico , Actitud del Personal de Salud , Bacteriuria/etiología , Bacteriuria/orina , Comorbilidad , Complicaciones de la Diabetes , Susceptibilidad a Enfermedades , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Prevalencia , Infecciones Urinarias/complicaciones , Infecciones Urinarias/epidemiología , Infecciones Urinarias/orina , Cervicitis Uterina/epidemiología , Cervicitis Uterina/orinaRESUMEN
The structural abnormalities of the genitourinary tract and cervical/vaginal infections are common in patients with diabetes mellitus. The objective was to determine the prevalence of gynecological abnormalities in diabetic women and to investigate its association with different variables. Diabetic women, aged 20 years and older who were attending the diabetic outpatient clinic, were randomly selected. All patients underwent a clinical and gynecological examination and a urianalysis, and papanicolaou. Smear were obtained. A total of 98 women, 84.7% type 2 diabetics, with a mean age of 57 +/- 13 years were included. Uretherocele, cystocele and/or rectocele were present in 19% and cervicitis in 22% of the patients. Urinary incontinence (OR 3.1, p = 0.03) and the history of multiparity (OR 4.2, p = 0.03) were statistically associated with these structural abnormalities. The symptom of vaginal discharge (OR 3.8, p = 0.01) was the only one variable that correlated with cervicitis. By comparing patients with and without cervicitis or gynecologic abnormalities, no significant differences were observed related to the type, duration or treatment of diabetes, blood glucose control or the evidence of leukocyturia in the urine sample. There is an elevated prevalence (31%) of gynecological abnormalities (cervicitis and/or structural abnormalities) in diabetic women, and are mostly asymptomatic.
Asunto(s)
Complicaciones de la Diabetes , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Femeninos/etiología , Anciano , Femenino , Humanos , PrevalenciaRESUMEN
OBJECTIVE: Reactive hypoglycemia is a common medical problem whose pathophysiology is not completely understood. The objective of this study was to investigate the prevalence of autonomic nervous system abnormalities in patients with reactive hypoglycemia compared with controls. METHODS: Six women, mean age 31 +/- 5 years, with reactive hypoglycemia, and 5 healthy controls women aged 24 +/- 4 years were studied. We investigated the heart rate variability and blood pressure changes after an upright tilt with and without an isoproterenol infusion. A positive result was defined as syncope or presyncope associated with bradycardia, hypotension or both. RESULTS: In response to the orthostatic stress alone or in conjunction with a 4 micrograms isoproterenol infusion, 5 of 6 patients had a positive test as did one of the five control subjects. Patients had a baseline hyperadrenergic tone, with a sympathetic to parasympathetic ratio of 2.3 +/- 0.8 under basal conditions and 10.1 +/- 4.1 during the isoproterenol infusion, compared to 0.7 +/- 0.3 (p = 0.06) and 0.5 +/- 0.1 (p < 0.01) respectively, in the control group. CONCLUSION: Patients with reactive hypoglycemia may be at the extreme end of a spectrum of normal biologic variability, they may have an hyperadrenergic tone and, after a provocative stimulus, sympathetic nerve firing and or synaptic release of NE may not be sufficient to maintain an adequate vascular tone. Alternatively, the vascular response to NE may be impaired. An excessive and paradoxic vasovagal or parasympathetic response was not observed.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/etiología , Hipoglucemia/complicaciones , Adulto , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Femenino , Frecuencia Cardíaca , Humanos , Hipoglucemia/fisiopatología , Pruebas de Mesa InclinadaRESUMEN
OBJECTIVE: To determine the prevalence of obesity and its association to different variables in urban and rural older Mexican populations. METHODS AND PROCEDURES: A cross-sectional study of three different Mexican communities. A total of 121 men and 223 women 60 years and older and 93 men and 180 women aged 35 to 59 years old were selected randomly for inclusion in the survey. A personal interview assessed demographic information, personal medical history and functional status and a 24-hour diet recall was obtained. The physical examination included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin and glucose. RESULTS: Obesity was highly prevalent in women, in individuals from the urban communities and diminished with advancing age. A BMI > or =30 kg/m2 was observed in 23.6% younger vs. 15.6% older adult men (p=0.21) and 28.4% younger vs. 19.7% older adult women (p = 0.06). The association of obesity with other variables was estimated using a stepwise multivariate logistic regression, increased insulin levels [Odds Ratio (OR) 1.68, p=0.006] and living in an urban area (OR 5.90, p<0.007) were variables independently associated to obesity in adult older individuals. In the younger adults, obesity was associated with hypertension (OR 2.74, p<0.0009), higher insulin levels (OR 1.31, p<0.03) and central adiposity (OR 2.97, p = 0.05), these relationship were not observed with gender, distribution of food or alcohol intake or other coronary risk factors. CONCLUSIONS: The present survey confirms the high prevalence of obesity in the Mexican urban population that declines with advanced age. Studies in elderly population must consider the bias produced by increased early mortality in those individuals with a more unfavorable risk profile.
Asunto(s)
Ingestión de Alimentos , Obesidad/epidemiología , Población Rural , Población Urbana , Adulto , Factores de Edad , Anciano , Glucemia/análisis , Índice de Masa Corporal , Colesterol/sangre , Estudios Transversales , Femenino , Humanos , Insulina/análisis , Entrevistas como Asunto , Masculino , México/epidemiología , Persona de Mediana Edad , Análisis Multivariante , Prevalencia , Análisis de Regresión , Encuestas y Cuestionarios , Triglicéridos/sangreRESUMEN
OBJECTIVE: To assess the effect of the new American Diabetes Association (ADA) diagnostic criteria for diabetes in the Mexico City survey. METHODS: The data available from the Mexico City study were included. This cross-sectional survey was conducted from January 1991 to March 1992 and involved 805 adults (20 years of age or older; mean age, 41 years). Survey procedures and results were previously published. Of the residents with diabetes, 74.2% had a previous diagnosis, and 25.8% were diagnosed on the basis of fasting plasma glucose (FPG) levels obtained during the survey. For the current report, these data were reanalyzed on the basis of the new ADA diagnostic criteria. RESULTS: The prevalence of newly diagnosed diabetes with use of the old and the new criteria was 23.1% versus 32.3% in men (P = 0.31) and 27.5% versus 36.3% in women (P = 0.32), respectively. The crude prevalence rate of diabetes increased from 8.7% to 9.3% (P = 0.42), and the age-adjusted rate increased from 10.6% to 11.2% for women (P = 0.64) and from 6.0% to 6.5% for men (P = 0.49). The prevalence of impaired FPG was 4.8%. Those patients with impaired FPG or newly diagnosed diabetes with FPG levels between 126 and 140 mg/dL had a more atherogenic risk profile than did those with normal carbohydrate metabolism. CONCLUSION: On the basis of the 1990 population census in Mexico City, the new ADA criteria will add 28,331 patients with diabetes (6.9%) to an already insufficient medical system. For those patients with impaired FPG or newly diagnosed diabetes on the basis of the new criteria, management should be focused on the control of the diverse and highly prevalent coronary risk factors.
RESUMEN
OBJECTIVE: To investigate the relationship between fasting insulin concentrations and several metabolic and anthropometric variables in the Mexico City population. DESIGN: Cross-sectional, randomized, stratified by age, sex and economically active and inactive. SUBJECTS: 700 healthy adults, older than 20 years, 396 males and 304 females. MEASUREMENTS: Body mass index, waist to hip ratio, systolic and diastolic blood pressure, insulin, glucose, triglycerides, total, HDL and LDL cholesterol and lipoprotein(a). RESULTS: Means for age were 39 +/- 13 years for men and 41 +/- 12 for women (p < 0.05). In males, the mean values of body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, triglycerides, glucose and LDL-cholesterol : HDL-cholesterol increased significantly with higher insulin levels. A significant inverse tendency was observed for the mean concentrations of HDL-cholesterol and lipoprotein(a). Age, total cholesterol and LDL-cholesterol were not related to the insulin levels. A similar pattern was observed in women, significance, however, was only obtained for the body mass index, triglycerides, glucose, HDL-cholesterol and lipoprotein(a). Age-adjusted multiple regression analysis showed that insulin was directly and independently associated to triglyceride levels and inversely with lipoprotein(a) concentrations for both sexes, and with HDL-C, only in males. CONCLUSIONS: The prevalence of insulin resistance related metabolic disorders was high in a random sample of the Mexico City population. Increased cardiovascular risk factors associated with the insulin resistance syndrome were observed with higher insulin levels, and lipoprotein(a) was inversely and significantly related to insulin. Preventive strategies are urgently needed to avoid the already increased incidence of morbidity and mortality associated to atherosclerotic disease.
Asunto(s)
Glucemia/metabolismo , Insulina/sangre , Lípidos/sangre , Adulto , Presión Sanguínea , Constitución Corporal , Índice de Masa Corporal , Enfermedades Cardiovasculares/sangre , LDL-Colesterol/sangre , Estudios Transversales , Femenino , Humanos , Resistencia a la Insulina , Lipoproteína(a)/sangre , Lipoproteínas HDL/sangre , Masculino , México/epidemiología , Persona de Mediana Edad , Distribución Aleatoria , Factores de Riesgo , Triglicéridos/sangreRESUMEN
OBJECTIVE: To investigate the prevalence of microalbuminuria in children and teenagers with IDDM and its relationship with other variables. METHODS: We studied 160 IDDM children and teenagers with a mean age of 13 +/- 4 years from our endocrine department outpatient clinic. A complete medical history was obtained as well as a fasting blood sample for glycemia, glycosilated hemoglobin and lipid profile and a urine sample for microalbuminuria using laser immunonephelometry. RESULTS: 13 patients (8%) had microalbuminuria (20-200 micrograms/min) and 5 (3%) clinical proteinuria (> 200 micrograms/min). The abnormal excretion was more prevalent in females with the poorest metabolic control, the longest duration of diabetes, and the highest age (13-18 years). The presence of microalbuminuria or clinical proteinuria associated with a more atherogenic risk profile compared to patients with a normal urinary albumin excretion. CONCLUSIONS: There was a poor metabolic control in our IDDM population. In addition, our current findings in a population with a relatively short duration of their diabetes point out the need to improve an integral management strategy to prevent or delay the late complications associated with IDDM.
Asunto(s)
Albuminuria/epidemiología , Diabetes Mellitus Tipo 1/orina , Angiopatías Diabéticas/epidemiología , Nefropatías Diabéticas/epidemiología , Adolescente , Albuminuria/etiología , Glucemia/análisis , Niño , Preescolar , Diabetes Mellitus Tipo 1/sangre , Femenino , Humanos , Masculino , Prevalencia , Factores de RiesgoRESUMEN
In Mexico, the incidence and prevalence of coronary heart disease (CHD) has increased over the past three decades and has become the leading cause of death in the country. Hypercholesterolemia is a major risk factor for coronary atherosclerosis and most developed countries currently have public health strategies that attempt to reduce the level of cholesterol. In order to determine the mean total cholesterol values and the prevalence of hypercholesterolemia, an epidemiologic survey was carried out in a representative national population sample that included men and women aged 1 to 98 years. In this report, we present the findings in all individuals older than 20 years (n = 33,558). Considering the country as a whole, the mean serum total cholesterol (TC) was 4.80 +/- 1.16 mmol/l, the prevalence of borderline hypercholesterolemia (TC between 5.17 and 6.20 mmol/l) was 22.8% and the prevalence of high risk hypercholesterolemia (TC > or = 6.20 mmol/l) was 10.6%. This cross sectional study demonstrated the existence of significant geographic differences in serum TC, with mean state values ranging from 4.43 +/- 1.05 mmol/l in the south to 5.48 +/- 1.36 mmol/l in the north. The prevalence of high risk hypercholesterolemia was as high as 24.8% in Baja California Norte and as low as 4.0% in the state of Guerrero. These large differences in mean TC values are probably diet related and reinforce the need to carry out prospective and intervention trials related to CHD and its risk factors.
Asunto(s)
Colesterol/sangre , Hipercolesterolemia/sangre , Hipercolesterolemia/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Enfermedad Coronaria/epidemiología , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de RiesgoRESUMEN
OBJECTIVE: To determine the prevalence of diabetes and associated coronary risk factors in the Mexico City population. RESEARCH DESIGN AND METHODS: A sample of 805 adults was selected from Mexico City. The participants, 20-90 years of age and living in the city, were selected by the method of multistage cluster sampling with proportional allocation. Diabetes was diagnosed by previous history or if fasting blood glucose was > or = 7.8 mmol/l ( > or = 7.8 mmol/l ( > or = 140 mg/dl). RESULTS: The crude rate prevalence of NIDDM was 8.7%, with an age-adjusted rate of 10.6% for women and 6.0% for men. Age strongly influenced diabetes prevalence, with a chi 2 of risk tendency of 39.1 (P < 0.00005). A significant proportion (5.9%) of younger individuals (35-44 years of age) was affected by the disease. Diabetes was associated with advanced age, had a greater impact in the low-income group, and showed increased odds ratio for hypertension, dyslipidemias, and myocardial infarction in men and women and for obesity only in women. CONCLUSION: There is a high prevalence of NIDDM in Mexico City that also strikes a significant group of younger individuals. Associated coronary risk factors are also common and more prevalent in diabetic individuals. Current epidemiological data in Mexico and Mexican-Americans in the U.S. suggest that we may be on the ascending limb for diabetes and cardiovascular disease. There is a critical need for resources to be allocated to programs for primary and secondary prevention, which must be well structured and organized so that proper standards of care are followed to prevent progression of the disease.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antropometría , Enfermedades Cardiovasculares/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Factores Sexuales , Población UrbanaRESUMEN
OBJECTIVE: To assess the effects of two controlled diets, one rich in oleic acid obtained from avocado and olive oil and the other rich in complex carbohydrates, on fasting and postprandial serum lipids and glycemic control in 12 women with NIDDM. RESEARCH DESIGN AND METHODS: A randomized crossover study was designed. During a 4-week baseline period, all patients received the isocaloric diets recommended by the American Diabetes Association. After this period the patients were randomly assigned to receive the two study diets alternatively during two 4-week periods. One diet was high in monounsaturated fatty acids (HMUFA) and the other was high in complex carbohydrates (high-CHO). There also was a 4-week washout period in between the two 4-week periods during which the patients followed the American Diabetes Association's isocaloric diet. Blood samples were obtained before and after each dietary period. RESULTS: Both diets had a minor hypocholesterolemic effect with no major changes in high-density lipoprotein cholesterol. The HMUFA diet was associated with a greater decrement in plasma triglycerides (20 vs. 7% in the high-CHO diet). Glycemic control was similar with both diets. CONCLUSIONS: Partial replacement of complex digestible carbohydrates with monounsaturated fatty acids (avocado as one of its main sources) in the diet of patients with non-insulin-dependent diabetes mellitus improves the lipid profile favorably, maintains an adequate glycemic control, and offers a good management alternative.
Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/dietoterapia , Dieta para Diabéticos , Carbohidratos de la Dieta , Grasas de la Dieta , Ácidos Grasos Monoinsaturados , Verduras , Biomarcadores/sangre , Peso Corporal , Colesterol/sangre , LDL-Colesterol/sangre , Diabetes Mellitus Tipo 2/sangre , Grasas Insaturadas en la Dieta , Femenino , Fructosamina , Hexosaminas/sangre , Humanos , Persona de Mediana Edad , Aceite de Oliva , Aceites de Plantas , Triglicéridos/sangreRESUMEN
Cholesterol, triglycerides and lipoprotein levels were assayed in serum of 152 children and teenagers with IDDM and in 228 non-diabetic siblings. A poor control of diabetes, reflected by high levels of glycosylated hemoglobin and/or high fasting blood glucose, was associated with statistically significant increases in total cholesterol, LDL-cholesterol and triglycerides, and a reduction in HDL-cholesterol. Mean total cholesterol levels in diabetic patients (171 +/- 33 mg/dL for males and 199 +/- 53 mg/dL for females) were statistically higher than those in their siblings (158 +/- 30 mg/dL and 164 +/- 33 mg/dL respectively). The prevalence of hypercholesterolemia (HC) and hypertriglyceridemia (HTG) were higher in the diabetic patients but statistically significant exclusively in females (prevalences of 40% vs 12% for HC and 30% vs 9% for HTG with a p value < 0.005). The diabetic patients in good metabolic control had similar lipid levels to those of their non-diabetic siblings. These data support the hypothesis that poor control of blood glucose is associated with atherogenic lipid profiles. The prevalence of hypercholesterolemia is impressively high in our diabetic population and indicates that all IDDM patients should have a serum lipid and lipoprotein analysis done annually; blood glucose control and dietary guidelines should be improved in these cases.
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Diabetes Mellitus Tipo 1/sangre , Hipercolesterolemia/etiología , Hipertrigliceridemia/etiología , Hipolipoproteinemias/etiología , Lípidos/sangre , Lipoproteínas HDL/deficiencia , Adolescente , Glucemia/análisis , Niño , Preescolar , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/genética , Dieta , Femenino , Hemoglobina Glucada/análisis , Humanos , Hipercolesterolemia/epidemiología , Hipertrigliceridemia/epidemiología , Hipolipoproteinemias/epidemiología , Insulina/uso terapéutico , Masculino , PrevalenciaRESUMEN
In Mexico, the incidence and prevalence of coronary heart disease has increased over the past three decades and has become the leading cause of death in some areas of the country. Hypercholesterolemia (HC) is a major risk factor for coronary atherosclerosis and most developed countries currently have public health strategies that attempt to reduce the level of cholesterol. In order to learn the mean total cholesterol values and the prevalence of HC, an epidemiologic survey was carried out in a representative population sample that included men and women aged 1 to 98 years, across the nation. In this report, we present the findings in children and teenagers of both sexes (n = 34369). Considering the country as a whole, the mean serum TC was 147 +/- 35 mg/dl, the prevalence of borderline hypercholesterolemia (TC between 170 and 199 mg/dl) was 14.7% and the prevalence of high risk hypercholesterolemia (TC > or = 200 mg/dl) was 6.7%. This cross sectional study demonstrated the existence of significant geographic differences in serum TC, with mean state values ranging from 133 mg/dl in the south to 164 mg/dl in the north. The prevalences of high risk hypercholesterolemia was as high as 18.2% in Baja California Norte and as low as 2.5% in the state of Morelos. These geographic differences in total cholesterol and prevalence of hypercholesterolemia were already present at one year of age and persisted throughout childhood and adolescence.
Asunto(s)
Colesterol/sangre , Hipercolesterolemia/epidemiología , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Hipercolesterolemia/sangre , Lactante , Masculino , México/epidemiologíaRESUMEN
Previous reports suggest that morbidity and mortality post acute myocardial infarction (AMI) are increased in patients with non-insulin-dependent diabetes (NIDDM). To obtain information in our population related to the prognosis after an AMI in diabetic patients and its major determinants, we studied 96 NIDDM patients admitted consecutively with a diagnosis of AMI. We used a control group (CG) of age and sex matched non-diabetic individuals. Patients with NIDDM had more frequently a history of angina (40 vs 23%, p < 0.001) and previous MI (30 vs 15%, p < 0.05). The AMI localization and extension, and the presence of arrhythmias were similar for both groups. Early mortality after the AMI was 22% in the NIDDM group and 12% in the CG with Odds ratio of 1.9 (CI 95% 0.91-5.15), being higher in diabetic females [2.3 (CI 95% 0.77-14.6) vs female CG and 1.5 (CI 95% 0.8-7.6) vs male NIDDM]. Extended MIs predicted higher mortality rate, especially among NIDDM patients (p < 0.05). Stepwise logistic regression test supported diabetes mellitus, per se, as a major contributor for mortality (p < 0.02), followed by MI localization and extension. The worst outcome was in NIDDM female patients of advanced age and hypertensive (p < 0.00001).
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Diabetes Mellitus Tipo 2/mortalidad , Infarto del Miocardio/mortalidad , Factores de Edad , Anciano , Estudios de Cohortes , Intervalos de Confianza , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Humanos , Modelos Logísticos , Masculino , México/epidemiología , Persona de Mediana Edad , Infarto del Miocardio/etiología , Oportunidad Relativa , Pronóstico , Factores de Riesgo , Factores Sexuales , Factores de TiempoRESUMEN
Diabetic cardiomyopathy apparently has an important role in the increased cardiovascular morbi-mortality of diabetic patients and its cause is likely to be secondary to small vessel disease. We undertook the present study to compare small and large vessel disease in hearts of patients who died with coronary disease, and determine how diabetes and/or hypertension correlates with these findings. The paraffin blocks of 52 hearts were used in this study. Cases were selected if they died from coronary artery disease and excluded if they had a previous angioplasty, revascularization surgery, congenital, rheumatic or other causes of heart disease. They were divided in two groups; diabetics and non-diabetics and each group was subdivided in hypertensives an non hypertensives. They were matched by age and sex. DM duration was 11 +/- 6 years and known hypertension of 10 +/- 4 years with no significant differences between both groups. The results were recorded without knowledge of patients clinical findings. Atherosclerotic heart disease was more advanced in DM patients, with an increased prevalence of three vessels disease, and more extensive myocardial infarctions. Diabetic subjects had increased (non significant) basal membrane thickening of the capillaries. We could not find differences in parenchymal hypertrophy, interstitial edema, proliferative endothelial lesions and luminal width in middle and large size vessels. Hypertensive patients had increased perivascular fibrosis (NS). Our results suggest that advanced atherosclerotic heart disease is more common in diabetic patients and diabetic cardiomyopathy, if present, seems not to related to a particular structural microvascular disease.
Asunto(s)
Diabetes Mellitus Tipo 2/patología , Angiopatías Diabéticas/patología , Anciano , Distribución de Chi-Cuadrado , Intervalos de Confianza , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/patología , Diabetes Mellitus Tipo 2/epidemiología , Angiopatías Diabéticas/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/patología , Masculino , México/epidemiología , Microcirculación/patología , Persona de Mediana Edad , Isquemia Miocárdica/epidemiología , Isquemia Miocárdica/patología , Miocardio/patología , Oportunidad RelativaRESUMEN
We present a prospective study of 88 patients with thyroid nodules seen in our institution in 1985-86 and the results of a 5 year follow up. The algorithm for resolution among different therapeutic options was established in regard to the clinical characteristics, imaging and particularly the histopathologic studies. Their age ranged from 18 to 79 years; 94% of the patients were females. Most of the nodules were solid (69%) and measured 1-4 cm in diameter. The image of 62% of the thyroid scans was of a non-functioning nodule and 13% were hyperfunctioning. In 80% the ultrasonographic pattern was solid or mixed. Surgery was undertaken in 19 patients (21%). In 58%, a diagnosis of malignancy was established. The biopsy (aspiration and tru-cut) suggested the presence of the malignant tumors when taken together in 90% of the cases. Hormonal treatment was given to 62 patients; in 40-45% of them there was a significant reduction in the size of the nodule. Aspiration and sclerosis of cystic nodules were performed in 19 patients with significant shrinkage in 82%. Radioactive iodine was used in 11 patients. Our algorithm reduces costs and precludes unnecessary morbidity in patients with thyroid nodules.
Asunto(s)
Nódulo Tiroideo/diagnóstico , Adolescente , Adulto , Anciano , Algoritmos , Biopsia con Aguja , Estudios de Cohortes , Quistes/diagnóstico , Quistes/patología , Quistes/terapia , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Sensibilidad y Especificidad , Enfermedades de la Tiroides/diagnóstico , Enfermedades de la Tiroides/patología , Enfermedades de la Tiroides/terapia , Hormonas Tiroideas/uso terapéutico , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/terapia , Nódulo Tiroideo/epidemiología , Nódulo Tiroideo/patología , Nódulo Tiroideo/terapia , TiroidectomíaRESUMEN
The postprandial (PP) elevations in triglyceride rich lipoproteins (TRL) are potentially atherogenic. We compared PP lipemia in non insulin dependent diabetes mellitus (NIDDM) with hypoalphalipoproteinemia (HA) and patients with primary HA. Eight males in each group, mean age +/- SD 54 +/- 10 years, were studied for 12 hours after the ingestion of a fat load (65 g of fat/square meter of body surface). Plasma glucose, triglycerides (TG) and cholesterol (C) in plasma and in the different lipoprotein fractions were measured. The PP triglyceridemia was significantly greater in NIDDM patients with HA and correlated with the fasting TG concentrations. The curve pattern of the lipemia (% delta) was otherwise similar in the patients with secondary or primary HA; only the triglyceridemia persisted for a longer period of time in the latter but was otherwise similar to that of the NIDDM patients with lower basal triglyceride values. Patients with primary HA may have a disturbed metabolism of triglyceride rich lipoproteins which have a delayed depuration during the postprandium. Basal HDL-C in patients with HA cannot predict the PP triglyceridemia.