RESUMO
The aim of this study was to determine the association between oral health-related quality of life (OHRQoL) and social marginalization in people aged 60 years and older enrolled in social security in Mexico. A cross-sectional and analytical study was carried out in older adults. To assess the OHRQoL, the OHIP-14 instrument was applied, and the degree of social marginalization and sociodemographic characteristics were analyzed. Measures of central tendency and dispersion, simple frequencies and proportions were estimated. Student's t-test was used for comparison of means, and prevalence ratio (PR) and logistic regression were used to assess associations, all with a significance value of 0.05 and 95% confidence intervals. Perceived OHRQoL in the population measured through the OHIP-14 reached an average value of 9.84 ± 8.91, with the highest value in the dimension of physical pain (2.06 ± 1.91). Perceived treatment need was higher among people with social marginality (p = 0.011). The multivariate analysis shows that marginalized people have a lower OHRQoL. Socially marginalized older adults showed a low a better perception of OHRQoL, independent of demographic and clinical factors.
Assuntos
Saúde Bucal , Qualidade de Vida , Humanos , Pessoa de Meia-Idade , Idoso , Estudos Transversais , Marginalização Social , México , Inquéritos e QuestionáriosRESUMO
Resumen Objetivo: Se estimó la carga económica directa e indirecta de la hipercolesterolemia en población con alto riesgo de presentar un evento cardiovascular. Para ello se definieron específicamente cinco grupos de pacientes: 1) aquellos con hipercolesterolemia familiar; 2, 3 y 4) personas con hipercolesterolemia más el antecedente de diabetes, infarto o evento vascular cerebral; 5) pacientes con hipercolesterolemia más diabetes y antecedente de infarto agudo de miocardio (definidos como pacientes de muy alto riesgo cardiovascular). Los cálculos se hicieron desde la perspectiva de las instituciones de salud pública en México. Método: Para la estimación de los costos directos se incluyó la atención ambulatoria, el tratamiento farmacológico, la atención hospitalaria y las intervenciones quirúrgicas relacionadas con las enfermedades cardiovasculares. Para la carga económica indirecta, se consideraron las muertes reportadas específicamente por causa de hipercolesterolemia, en un momento anterior al final de la edad productiva (muerte prematura). Resultados: La carga económica directa de las cinco categorías de pacientes en riesgo consideradas es de MXN $39,601,464,154 (USD $1,987,526,432), mientras que la carga económica indirecta asciende a MXN $121,646,689 (USD $6,105,229). Conclusiones: El impacto económico de la hipercolesterolemia en población con alto riesgo cardiovascular correspondía a $39,723,110,843 en 2020 (equivalente a USD $1,993,631,661), equivalente al 0.16% del PIB nacional.
Abstract Objective: To estimate the direct and indirect economic burden of hypercholesterolemia in patients with high risk of a cardiovascular event, specifically there were defined 5 groups of patients: 1) familial hypercholesterolemia; 2, 3 and 4) patients with hypercholesterolemia and background of diabetes, myocardial infarction or stroke; 5) diabetes, myocardial infarction and hypercholesterolemia (very high-risk patients) from the Mexican public healthcare institutions. Methods: For the estimation of the direct costs the items included correspond to: outpatient care, pharmacological treatment, inpatient hospital care, and surgical procedures. For indirect economic burden, death certificates, before the end of the productive age due to hypercholesterolemia were calculated (premature mortality). Results: The direct economic burden for the 5 groups of patients at risk is MXN $39,601,464,154 (USD $1,987,526,432), while the indirect economic burden amounts to MXN $121,646,689 (USD $6,105,229). Conclusions: The economic impact of hypercholesterolemia in patients with high cardiovascular risk is $39,723,110,843 (equivalent to USD $1,993,631,661) and corresponds to the 0.16% of GDP.
RESUMO
OBJECTIVE: To estimate the direct and indirect economic burden of hypercholesterolemia in patients with high risk of a cardiovascular event, specifically there were defined 5 groups of patients: 1) familial hypercholesterolemia; 2, 3 and 4) patients with hypercholesterolemia and background of diabetes, myocardial infarction or stroke; 5) diabetes, myocardial infarction and hypercholesterolemia (very high-risk patients) from the Mexican public healthcare institutions. METHODS: For the estimation of the direct costs the items included correspond to: outpatient care, pharmacological treatment, inpatient hospital care, and surgical procedures. For indirect economic burden, death certificates, before the end of the productive age due to hypercholesterolemia were calculated (premature mortality). RESULTS: The direct economic burden for the 5 groups of patients at risk is MXN $39,601,464,154 (USD $1,987,526,432), while the indirect economic burden amounts to MXN $121,646,689 (USD $6,105,229). CONCLUSIONS: The economic impact of hypercholesterolemia in patients with high cardiovascular risk is $39,723,110,843 (equivalent to USD $1,993,631,661) and corresponds to the 0.16% of GDP.
OBJETIVO: Se estimó la carga económica directa e indirecta de la hipercolesterolemia en población con alto riesgo de presentar un evento cardiovascular. Para ello se definieron específicamente cinco grupos de pacientes: 1) aquellos con hipercolesterolemia familiar; 2, 3 y 4) personas con hipercolesterolemia más el antecedente de diabetes, infarto o evento vascular cerebral; 5) pacientes con hipercolesterolemia más diabetes y antecedente de infarto agudo de miocardio (definidos como pacientes de muy alto riesgo cardiovascular). Los cálculos se hicieron desde la perspectiva de las instituciones de salud pública en México. MÉTODO: Para la estimación de los costos directos se incluyó la atención ambulatoria, el tratamiento farmacológico, la atención hospitalaria y las intervenciones quirúrgicas relacionadas con las enfermedades cardiovasculares. Para la carga económica indirecta, se consideraron las muertes reportadas específicamente por causa de hipercolesterolemia, en un momento anterior al final de la edad productiva (muerte prematura). RESULTADOS: La carga económica directa de las cinco categorías de pacientes en riesgo consideradas es de MXN $39,601,464,154 (USD $1,987,526,432), mientras que la carga económica indirecta asciende a MXN $121,646,689 (USD $6,105,229). CONCLUSIONES: El impacto económico de la hipercolesterolemia en población con alto riesgo cardiovascular correspondía a $39,723,110,843 en 2020 (equivalente a USD $1,993,631,661), equivalente al 0.16% del PIB nacional.
Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Hipercolesterolemia , Infarto do Miocárdio , Humanos , Hipercolesterolemia/complicações , Hipercolesterolemia/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , México/epidemiologia , Estresse Financeiro , Custos de Cuidados de SaúdeRESUMO
Resumen Antecedentes: Se ha demostrado que el impacto de la diabetes mellitus se expresa de manera diferenciada entre los grupos sociales. Objetivo: Estimar las brechas en la desigualdad en la mortalidad por diabetes mellitus a través de medidas absolutas y relativas según distribución geográfica y condiciones sociales. Material y métodos: Se analizaron las muertes registradas en México por diabetes mellitus entre 2010 y 2019 y se calcularon las mediciones de desigualdad a nivel estatal por sexo. Resultados: La tasa de mortalidad nacional por diabetes mellitus ajustada por edad mostró un incremento durante el periodo estudiado. Conclusión: Las desigualdades presentes en la mortalidad por diabetes deben considerarse para el diseño de estrategias de salud.
Abstract Background: The impact of diabetes mellitus has been shown to be differentially expressed between social groups. Objective: To estimate inequality gaps in diabetes mellitus mortality through absolute and relative measures according to geographic distribution and social conditions. Material and methods: Diabetes mellitus-related deaths recorded in Mexico between 2010 and 2019 were analyzed, and inequality measurements at the state level were calculated by gender. Results: National age-adjusted diabetes mellitus mortality rate showed an increase during the study period. Conclusion: The inequalities present in diabetes mortality should be considered for the design of health strategies.
RESUMO
Background: The impact of diabetes mellitus has been shown to be differentially expressed between social groups. Objective: To estimate inequality gaps in diabetes mellitus mortality through absolute and relative measures according to geographic distribution and social conditions. Material and methods: Diabetes mellitus-related deaths recorded in Mexico between 2010 and 2019 were analyzed, and inequality measurements at the state level were calculated by gender. Results: National age-adjusted diabetes mellitus mortality rate showed an increase during the study period. Conclusion: The inequalities present in diabetes mortality should be considered for the design of health strategies.
Antecedentes: Se ha demostrado que el impacto de la diabetes mellitus se expresa de manera diferenciada entre los grupos sociales. Objetivo: Estimar las brechas en la desigualdad en la mortalidad por diabetes mellitus a través de medidas absolutas y relativas según distribución geográfica y condiciones sociales. Material y métodos: Se analizaron las muertes registradas en México por diabetes mellitus entre 2010 y 2019 y se calcularon las mediciones de desigualdad a nivel estatal por sexo. Resultados: La tasa de mortalidad nacional por diabetes mellitus ajustada por edad mostró un incremento durante el periodo estudiado. Conclusión: Las desigualdades presentes en la mortalidad por diabetes deben considerarse para el diseño de estrategias de salud.
RESUMO
Abstract The aim of this study was to determine the association between oral health-related quality of life (OHRQoL) and social marginalization in people aged 60 years and older enrolled in social security in Mexico. A cross-sectional and analytical study was carried out in older adults. To assess the OHRQoL, the OHIP-14 instrument was applied, and the degree of social marginalization and sociodemographic characteristics were analyzed. Measures of central tendency and dispersion, simple frequencies and proportions were estimated. Student's t-test was used for comparison of means, and prevalence ratio (PR) and logistic regression were used to assess associations, all with a significance value of 0.05 and 95% confidence intervals. Perceived OHRQoL in the population measured through the OHIP-14 reached an average value of 9.84 ± 8.91, with the highest value in the dimension of physical pain (2.06 ± 1.91). Perceived treatment need was higher among people with social marginality (p = 0.011). The multivariate analysis shows that marginalized people have a lower OHRQoL. Socially marginalized older adults showed a low a better perception of OHRQoL, independent of demographic and clinical factors.
RESUMO
BACKGROUND: Dementia is a priority public health issue due to its high prevalence worldwide and its economic, social, and health impact. However, there are few reports in Mexico based on formal tests and with a clinical approach based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). OBJECTIVE: This study estimates the prevalence of the main types of dementia among elderly people living in the community in Mexico City. METHODS: A population-based, two-step study was conducted, including 6,204 elderly individuals aged 60 or above with in-home assessment. All participants were screened for cognitive impairment; those who presented some cognitive problem underwent a standardized neurological examination. Each diagnosis was based on the criteria for dementia in the DSM-5, and the final consensus diagnosis of dementia was determined by an expert panel. RESULTS: The global estimated prevalence of dementia in the Mexican population was 7.8% met the criteria for Alzheimer's disease, 4.3% for vascular dementia, and 2.1% for mixed dementia. The prevalence of dementia was higher in women than in men (15.3% versus 12.5%, respectively). CONCLUSION: These results provide evidence to propose strategies for Latin American countries where dementia represents a challenge due to the heterogeneity of the populations and socioeconomic disparities, requiring early diagnosis and at the first levels of care.
Assuntos
Doença de Alzheimer , Demência , Idoso , Envelhecimento , Doença de Alzheimer/diagnóstico , Demência/diagnóstico , Demência/epidemiologia , Demência/psicologia , Feminino , Humanos , Masculino , México/epidemiologia , PrevalênciaRESUMO
INTRODUCTION: Objective: the aim of this study was to identify dietary patterns in a sample of patients with type-2 diabetes, and to evaluate their association with markers of metabolic control. Methods: a cross-sectional study in 395 patients with type-2 diabetes in primary care was conducted. Fasting blood levels of glycated hemoglobin (A1c), glucose, total cholesterol, low- (LDL-c) and high-density lipoprotein cholesterol (HDL-c), and triglycerides were measured. Waist circumference, body mass index (BMI), and blood pressure were evaluated. Dietary intake was assessed by a food frequency questionnaire, and dietary patterns were derived by cluster analysis. Three dietary patterns were identified: 'fruits and vegetables', 'dairy and sweetened beverages', and 'diverse with alcohol'. Results: an association between the 'dairy and sweetened beverages' dietary pattern and A1c levels was identified (ß = 0.61; 95 % CI: 0.09, 1.12, p = 0.021), considering the 'fruits and vegetables' dietary pattern as the reference group. We also observed a trend towards an adjusted increased risk of A1c ≥ 7 % (odds ratio [OR]: 1.56; 95 % CI: 0.92, 2.64; p = 0.099) and an increased risk of BMI ≥ 25 kg/m2 (OR: 2.62, 95 % CI: 1.20, 5.71, p = 0.015) among patients in the 'dairy and sweetened beverages' dietary pattern as compared to the reference group. Conclusions: a dietary pattern characterized by a high intake of full-fat dairy and sweetened beverages was associated with higher A1c levels and increased risk of high glucose and BMI when compared to a dietary pattern with a higher consumption of fruits and vegetables.
INTRODUCCIÓN: Objetivo: el objetivo de este estudio fue identificar los patrones dietéticos de una muestra de pacientes con diabetes de tipo 2 y evaluar su asociación con los marcadores de control metabólico. Métodos: se realizó un estudio transversal de 395 pacientes con diabetes de tipo 2 en atención primaria. Se estimaron los niveles de hemoglobina glicosilada (A1c), glucosa, colesterol total, colesterol de lipoproteínas de baja (LDL-c) y alta densidad (HDL-c), y triglicéridos en ayunas. Se evaluaron el perímetro de la cintura, el índice de masa corporal (IMC) y la presión arterial. La ingesta dietética se evaluó mediante un cuestionario de frecuencia de alimentos y los patrones dietéticos se obtuvieron mediante un análisis de conglomerados. Se identificaron tres patrones dietéticos: "frutas y verduras", "lácteos y bebidas azucaradas" y "diversos con alcohol". Resultados: se identificó una asociación entre el patrón dietético de "productos lácteos y bebidas azucaradas" y los niveles de A1c (ß = 0,61; IC del 95 %: 0,09, 1,12, p = 0,021), considerando el patrón dietético de "frutas y verduras" como grupo de referencia. También se observó una tendencia a un mayor riesgo ajustado de A1c ≥ 7 % (odds ratio [OR]: 1,56; IC del 95 %: 0,92, 2,64; p = 0,099) y un mayor riesgo de IMC ≥ 25 kg/m2 (OR: 2,62; IC del 95 %: 1,20, 5,71, p = 0,015) entre los pacientes del patrón "lácteos y bebidas azucaradas" en comparación con el grupo de referencia. Conclusiones: el patrón dietético caracterizado por un alto consumo de lácteos y bebidas azucaradas se asoció con niveles más altos de A1c y un mayor riesgo de elevación de la glucosa y el IMC, en comparación con un patrón dietético con mayor consumo de frutas y verduras.
Assuntos
Diabetes Mellitus Tipo 2 , Bebidas Adoçadas com Açúcar , Bebidas , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Dieta , Comportamento Alimentar , Hemoglobinas Glicadas , Humanos , Fatores de RiscoRESUMO
OBJECTIVE: To identify the association of diabetes education or medical nutrition therapy with the goals of control of cardiovascular risk indicators and dietary habits in patients with type 2 diabetes mellitus. METHODS: Analytical cross-sectional study in 395 primary care patients. HbA1c, fasting glucose and lipid profile, blood pressure, weight, waist circumference, and body composition were measured. Dietary habits were measured using the «Instrument for measuring lifestyle in patients with type 2 diabetes mellitus¼ (IMEVID), in the nutrition dimension. Medical nutrition therapy (MNT) and diabetes education (DE) were considered as received by the patient when provided in their healthcare clinic. RESULTS: Women comprised 68% of the patients, with a median of 6 years from diabetes diagnosis. Of the patients, 21% received DE and MNT, 28% DE or MNT, and 51% received neither. The HbA1c was lower in the patients with DE and MNT (7.7% ± 1.9% vs. 8.7% ± 2.3%, 8.4% ± 2.2%; p = .003) respectively. In the patients with DE and MNT, a higher proportion took physical exercise, consumed less tobacco, and had better dietary habits (p < .05). Patients who received DE and MNT achieved HbA1c and HDL-c control levels. A greater risk of HbA1c > 7% was identified when they only received DE or MNT or neither, a longer time since diagnosis of the disease and less frequent adherence to a diet to control the disease (p < .05). CONCLUSION: Diabetes education and medical nutritional therapy favour the goal of cardiovascular risk control and better dietary habits in the patient with type 2 diabetes.
Assuntos
Diabetes Mellitus Tipo 2 , Objetivos , Glicemia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Jejum , Feminino , Hemoglobinas Glicadas/análise , HumanosRESUMO
One of the hypotheses that have emerged to explain the origin of dementia relates the disease with altered lipid metabolism, particularly cholesterol. To maintain cholesterol homeostasis, the ACAT1 enzyme has an important function to regulate the production of Aß. Moreover, APOE is the main cholesterol carrier in the brain, and it has been reported as a risk factor for this disease. This study evaluates the relationship between ACAT1 and APOE genetic variants with susceptibility for the development of Alzheimer's disease and other dementias. We examined four ACAT1 polymorphisms (rs2247071, rs2862616, rs3753526, rs1044925) and two in the APOE gene (rs7412, rs429358) in a group of 204 controls and 196 cases of dementia. Our results show one protective haplotype: CGCA (OR = 0.34, 95% CI = 0.23-0.46; p < 0.001) and one risk haplotype: CGGA (OR = 1.87, 95% CI = 1.34-2.60; p < 0.001) for the development of dementia. Subjects identified as APOE-ε4 allele carriers had a higher risk of developing dementia compared with non-carriers, OR = 13.33 (95% CI = 3.14-56.31). The results support the hypothesis that the ACAT1 gene, together with the APOE gene, plays an important role in susceptibility to the development of dementia and shows genetic characteristics of the Mexican population that can be used to identify the population at risk.
Assuntos
Apolipoproteínas E/genética , Demência/genética , Predisposição Genética para Doença , Variação Genética , Esterol O-Aciltransferase/genética , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Haplótipos/genética , Heterozigoto , Humanos , Desequilíbrio de Ligação/genética , Masculino , Polimorfismo GenéticoAssuntos
Diabetes Mellitus , Multimídia , Adulto , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estilo de VidaRESUMO
BACKGROUND: Health beliefs are relevant to consider in patients with type 2 diabetes since disease control depends mainly on the patient's behaviour. The aim of this study was to assess the association between health beliefs and glycated hemoglobin levels in Mexican patients with type 2 diabetes. METHODS: An analytical cross-sectional study was conducted, and 336 patients were included. Fasting blood levels of glycated hemoglobin, glucose, cholesterol; triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) were measured. Body fat percentage, weight, height; waist circumference, and systolic and diastolic blood pressures were also obtained. A previously validated self-administered questionnaire was used to assess the health beliefs with regards to non-pharmacological treatment. Health beliefs were classified as positive, neutral, and negative. RESULTS: The average age of patients was 54.7 ± 8.5 years, with a higher proportion of females (69%). The questionnaire had a good internal consistency with a Cronbach's alpha score of 0.83. More than 90% of patients attributed a health benefit to diet and exercise, 30 to 40% experienced barriers, and more than 80% had a perception of complications associated to uncontrolled diabetes. Patients with positive health beliefs had lower HbA1c levels (8.2 ± 1.7%) compared to those with neutral (9.0 ± 2.3%), or negative (8.8 ± 1.8%; p = 0.042). The LDL-c levels were lower (p = 0.03), and HDL-c levels were higher (0.002) in patients with positive heath beliefs. CONCLUSIONS: Positive health beliefs are associated with better metabolic control indicators in patients with type 2 diabetes.
Assuntos
Glicemia/análise , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Colesterol/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/metabolismo , Hemoglobinas Glicadas/análise , Lipoproteínas LDL/sangue , Triglicerídeos/sangue , Pressão Sanguínea , Índice de Massa Corporal , Estudos Transversais , Dieta , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , México , Pessoa de Meia-IdadeRESUMO
Background Education is the mainstay of medical management of chronic non communicable diseases such as diabetes mellitus. Aim To assess the effects of a multimedia diabetes education intervention and nutritional therapy on lifestyle changes and metabolic control of patients with type 2 diabetes mellitus. Material and Methods We studied 219 patients with type 2 diabetes mellitus aged 56 ± 8 years (28% males). They received education through a multimedia site about control indicators, complications, nutrition and physical exercise, among others. They also received a personalized nutritional therapy. They were followed-up for one year. At baseline and the end of follow up they were weighed, and their waist circumference and blood pressure were measured. A fasting blood sample was withdrawn to measure glucose, glycosylated hemoglobin and lipid profile. Lifestyles were assessed using a self-administered questionnaire called IMEVID. Results The median duration of diabetes was six years. During the follow up, patients had a significant reduction in body weight, waist circumference and blood pressure and improvements in glycosylated hemoglobin, HDL and LDL cholesterol. Seven and 13% of patients reported favorable lifestyles at baseline and the end of follow up, respectively (p < 0.01). Compared with their counterparts with unfavorable lifestyles, patients with a favorable lifestyle had a significantly lower weight and glycosylated hemoglobin at the end of follow up. Conclusions The educational intervention along with nutritional therapy improved metabolic control and lifestyles in this group of diabetic patients.
Assuntos
Humanos , Adulto , Multimídia , Diabetes Mellitus , Conhecimentos, Atitudes e Prática em Saúde , Estilo de VidaRESUMO
Frailty is a geriatric syndrome, characterized by a loss in functional reserve with an increase in morbidity and mortality. There are no reports that link the genetic polymorphisms between interleukin 10 (IL10) and frailty; for this reason, our objective was used to analyze the role of the polymorphisms of IL10 (rs1800896, rs1800871) in the susceptibility to frailty in a Mexican population. Our study included 984 participants divided into 368 nonfrail, 309 prefrail, and 307 frail. The models for the polymorphisms rs1800896 and rs1800871 were recessive models in association with frailty (OR = 2.3, CI 95% = 1.6-3.2; OR = 1.53, CI 95% = 1.0-2.6), respectively. Two risk haplotypes were identified: ACG and CCG (p < .0001), and three protective haplotypes were identified: ACA, ATG, and ATA (p < .05). This study evaluated the relationship between IL10 and the three subtypes of this geriatric syndrome (frail, prefrail, and nonfrail). These results support a greater susceptibility to frailty for the minor alleles of rs1800871 and rs1800896. In addition, we found two risk haplotypes supporting the participation of the IL10 in the susceptibility for frailty in the Mexican population.
Assuntos
Fragilidade/genética , Haplótipos , Interleucina-10/genética , Modelos Genéticos , Polimorfismo de Nucleotídeo Único , Idoso , Feminino , Fragilidade/epidemiologia , Predisposição Genética para Doença , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Kidney disease is one of the main complications in the diabetic patient. Risk factors such as obesity, dyslipidemia, and hyperglycemia have been associated with increased urinary albumin excretion (UAE) and decreased glomerular filtration rates (GFR). However, the data are inconsistent. The objective of this study was to identify the primary risk factors associated with kidney disease in Mexican patients with type 2 diabetes. METHODS: A cross-sectional study was done in 395 patients with type 2 diabetes from four primary-care clinics. From fasting venous blood samples, the serum creatinine, glucose, glycated hemoglobin (HbA1c), and lipid profiles were measured. The diagnosis of diabetic kidney disease (DKD) was made by measuring GFR with the CKD-EPI equation, and the UAE from the first morning urination, according to the KDIGO 2012 Guidelines. Weight and waist circumference (WC), as well as body composition through the method of bioimpedance, were measured. RESULTS: Fourteen percent of the study population was diagnosed with DKD. Higher age and higher triglyceride levels were associated with a greater risk of DKD (p <0.05). In a multivariate analysis, higher age (OR = 1.06, 95% CI 1.02-1.11), triglyceride level (OR = 2.4, 95% CI 1.18-4.92), WC (OR = 1.09, 95% CI 1.03-1.15), and smoking (OR 2.6, 95% CI 1.07-6.49) were associated to DKD. CONCLUSION: Higher triglyceride levels, greater WC, and smoking are risk factors associated to DKD. An early diagnosis and opportune treatment for several cardiometabolic risk factors associated to DKD and cardiovascular disease should be identified and treated.
Assuntos
Doenças Cardiovasculares/patologia , Diabetes Mellitus Tipo 2/patologia , Nefropatias Diabéticas/epidemiologia , Obesidade/epidemiologia , Albuminúria/patologia , Glicemia/análise , Doenças Cardiovasculares/complicações , Creatinina/sangue , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/diagnóstico , Dislipidemias/epidemiologia , Feminino , Taxa de Filtração Glomerular/fisiologia , Hemoglobinas Glicadas/análise , Humanos , Hiperglicemia/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Triglicerídeos/sangue , Circunferência da Cintura/fisiologiaRESUMO
PURPOSE: To evaluate the effect of a multimedia education program and nutrition therapy on metabolic control in patients with type 2 diabetes. RESEARCH QUESTION: What is the effect of a multimedia education program and nutritional therapy on metabolic control in type 2 diabetes? PATIENTS AND METHODS: A randomized clinical trial was conducted in 351 patients randomly assigned to either an experimental group receiving a multimedia diabetes education program (MDE) and nutrition therapy (NT) (NT + MDE: n = 173), or to a control group who received nutrition therapy only (NT: n = 178). At baseline, 7, 14, and 21 months, the glycated hemoglobin (HbA1c), glucose, cholesterol, triglycerides, LDL-cholesterol, and HDL-cholesterol were measured. Weight, body mass index (BMI), waist circumference (WC), fat percentage, fat and lean mass, systolic blood pressure (SBP), and diastolic (DBP) were also recorded. RESULTS: Glycated hemoglobin decreased in both groups, although the group with NT + MDE had a greater reduction, with a difference of -0.76% (95%CI -1.33 to -0.19) at 7 months and -0.73% (95%CI -1.37 to -0.09) at 21 months. Only in the NT + MDE did the glucose decrease at 7 (-41.2 mg/dL; 95%CI -52.0 to -30.5), 14 (-27.8 mg/dL; 95%CI -32.6 to -23.1), and 21 months (-36.6 mg/dL; 95%CI -46.6 to -26.6). Triglycerides and the atherogenic index decreased in both groups at 7 and 14 months; while only in the NT + MDE group did it decrease at 21 months. (p < 0.05). Weight decreased at 21 months in the NT + MDE group (-1.23, -2.29 at -0.16; p < 0.05). CONCLUSION: Nutrition therapy and a multimedia diabetes education program have a favorable impact on achieving metabolic control goals in type 2 diabetes.
Assuntos
Peso Corporal/fisiologia , Diabetes Mellitus Tipo 2/terapia , Hemoglobinas Glicadas/análise , Lipídeos/sangue , Multimídia , Terapia Nutricional , Educação de Pacientes como Assunto , Adulto , Glicemia/metabolismo , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Objective. To assess the association of dietary fiber on current everyday diet and other dietary components with glycated hemoglobin levels (HbA1c), glucose, lipids profile, and body weight body weight, in patients with type 2 diabetes. Methods. A cross-sectional survey of 395 patients with type 2 diabetes was performed. HbA1c, fasting glucose, triglycerides, and lipids profile were measured. Weight, waist circumference, blood pressure, and body composition were measured. Everyday diet with a semiquantitative food frequency questionnaire was evaluated. ANOVA, Kruskal-Wallis, chi-square tests and multivariate logistic regression were used in statistical analysis. Results. Higher fiber intake was associated with a low HbA1c, high HDL-c levels, low weight, and waist circumference. The highest tertile of calories consumption was associated with a higher fasting glucose level and weight. The highest tertile of carbohydrate consumption was associated with a lower weight. The lowest tertile of total fat and saturated fat was associated with the highest tertile of HDL-c levels, and lower saturated fat intake was associated with lower weight (p < 0.05). Conclusions. A higher content of fiber in the diet reduces HbA1c and triglycerides, while improving HDL-c levels. Increasing fiber consumption while lowering calorie consumption seems to be an appropriate strategy to reduce body weight and promote blood glucose control.
Assuntos
Glicemia/metabolismo , HDL-Colesterol/metabolismo , LDL-Colesterol/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Dieta , Fibras na Dieta , Hemoglobinas Glicadas/metabolismo , Triglicerídeos/metabolismo , Peso Corporal , Estudos Transversais , Carboidratos da Dieta , Gorduras na Dieta , Ingestão de Energia , Feminino , Humanos , Modelos Logísticos , Masculino , México , Pessoa de Meia-Idade , Análise Multivariada , Razão de ChancesRESUMO
OBJECTIVE: To estimate the prevalence of dyslipidemias in Mexico city and its relation to other cardiovascular risk factors. METHODS: A cross sectional study was conducted to measure cardiovascular risk factors in Mexico City. All subjects were interviewed and anthropometric measures performed, as well as cholesterol, high-density lipoproteins (HDL-C) and triglycerides. Low-density lipoprotein (LDL-C) values were calculated. Means- as well as dyslipidemia-weighted prevalence were measured, with 95% confidence intervals. RESULTS: 833 males and 889 females were studied. The prevalence of cholesterol ≥ 240 mg/dl was 16.4% (95% CI: 14.2-18.7), and 34.1% (95% CI: 31.6-36.5) had values between 200 and 240 mg/dl. Very high values of triglycerides were seen in 2.6% of studied subjects and 29.9% (95% CI: 26.9-32.8) had high values. The prevalence of hypertriglyceridemia was higher in males (43.3%) than females (23%). Mean values of assessed parameters were in general higher in those with other cardiovascular risk factors. CONCLUSIONS: Lipid values in the population of Mexico City are high and so is the prevalence of dyslipidemias. There is an urgent need to implement health policies directed to diminish cardiovascular risk factors, mainly dyslipidemias.
Assuntos
Dislipidemias/epidemiologia , Adulto , Distribuição por Idade , Biomarcadores/sangue , Colesterol/sangue , Cidades/epidemiologia , Dislipidemias/sangue , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Distribuição por Sexo , Triglicerídeos/sangue , Adulto JovemRESUMO
BACKGROUND: Several studies in type 2 diabetes patients have shown significant associations between the SOD2 gene Val16Ala polymorphism and albuminuria, but this association has not been explored in the Mexican population. METHODS: We evaluated the association between the SOD2 gene Val16Ala polymorphism (rs4880) and macroalbuminuria in a sample of 994 unrelated Mexican type 2 diabetes patients. The study included 119 subjects with urinary albumin >300 mg/dL and 875 subjects with urinary albumin ≤ 30 mg/dL. Genotyping of the SOD2 gene Val16Ala SNP was carried out with Real-Time Polymerase Chain Reaction (RT-PCR). RESULTS: The frequency of the TT genotype was 6.7% higher in participants with macroalbuminuria than in the normoalbuminuria group (16.8% vs. 10.1%). Using a logistic regression analysis, we observed that individuals with the CC genotype had significantly lower risks of macroalbuminuria than those with the TT genotype (OR=0.42, p=0.034). We carried out a meta-analysis combining our data with data from four previous studies and estimated an odds ratio (95% CI) for the C allele (with respect to the reference T allele) of 0.65 (0.52-0.80, p<0.001). CONCLUSIONS: A significant association was found between the SOD2 Val16Ala polymorphism and macroalbuminuria in a sample of Mexican type 2 diabetes patients.
Assuntos
Albuminúria/genética , Diabetes Mellitus Tipo 2/genética , Superóxido Dismutase/genética , Idoso , Albuminúria/complicações , Alelos , Diabetes Mellitus Tipo 2/complicações , Feminino , Frequência do Gene , Genótipo , Humanos , Modelos Logísticos , Masculino , México/etnologia , Pessoa de Meia-Idade , Razão de Chances , Polimorfismo de Nucleotídeo ÚnicoRESUMO
Silent myocardial ischemia (SMI) is a multifactorial and polygenic disorder that results from an excessive inflammatory response. Considering the prominent role of IL-10 and TGF-B1 as regulators of the inflammatory process and vascular physiology, the aim of the present study was to analyze whether IL-10 and TGF-B1 single nucleotide polymorphisms (SNPs) are associated with SMI. The IL-10-1082 A>G (rs1800896), IL-10-819 T>C (rs1800871), IL-10-592 A>C (rs1800872), TGF-ß1-509 T>C (rs1800469), and TGF-ß1 T29C (rs1800470) SNPs were analyzed by 5'exonuclease TaqMan genotyping assays in a group of 149 SMI patients and 248 healthy controls. The IL-10-1082 A>G (rs1800896) SNP was significantly associated with an increased risk of SMI as compared to controls under both dominant and heterozygous models (OR=1.77, Pdom=0.029 and OR=1.69, PHet=0.043). On the other hand, the TGF-ß1 509 T>C (rs1800469) SNP was significantly associated with increased risk of SMI as compared to controls under a dominant and additive models (OR=1.82, Pdom=0.035, OR=1.50, Padd=0.026). Finally, the TGF-ß1 T29C (rs1800470) SNP was significantly associated with increased risk of SMI as compared to controls under a co-dominant, dominant, recessive, and additive models (OR=3.63, PCod=0.004, OR=2.24, Pdom=0.002, OR=2.46, Prec=0.03 and OR=1.94, Padd=0.001). After adjusted for gender, age, and smoking, two haplotypes (CC and TT) were associated with decreased risk of SMI (OR=0.26, P<0.0001 and OR=0.15, P=0.017). In summary, our data suggest that the IL-10-1082 A>G (rs1800896), TGF-ß1-509 T>C (rs1800469), and TGF-ß1 T29C (rs1800470) SNPs play an important role in the risk of developing SMI. In our study, it was possible to distinguish two protective haplotypes in TGF-ß1 for SMI development.