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OBJECTIVE: Guidelines recommend case finding for dysglycemia (prediabetes and type 2 diabetes [T2D]) in adults or youth older than 10 years with overweight/obesity, but increased adiposity has not been associated with dysglycemia in some Hispanic populations. This study aims to determine the prevalence of dysglycemia in this population using simplified criteria independent of body mass index and age to request an oral glucose tolerance test (OGTT). METHODS: Cross-sectional retrospective analysis of medical records from a clinical center in Chile (2000-2007). OGTT was obtained from any patient with 1 cardiometabolic risk factor (CMRF) independent of age and body mass index. RESULTS: In total, 4969 adults (mean age ± SD) 45.7 ± 15.9 years and 509 youths 16.6 ± 3.0 years were included. The prevalence (%, 95% CI) of prediabetes doubled that of T2D in youths (14.1%, 1.4-17.4 vs 6.3%, 4.5-8.7) and tripled it in adults (36.0%, 34.7-37.4 vs 10.7%, 9.8-11.5). In underweight and normal-weight adults, 22% (12.0-36.7) and 29.2% (26.4-32.1) had prediabetes, whereas 4.9% (1.3-16.1) and 8.8% (7.2-10.7) had T2D, respectively. In normal weight youths, 10.5% (6.7-15.9) and 2.9% (1.2-6.6) had prediabetes and T2D, respectively. In adults, but not in youths, most dysglycemia categories were related to overweight/obesity. CONCLUSION: This study supports a public health policy to identify more people at risk for cardiovascular disease by implementing a revised case finding protocol for dysglycemia using OGTT in even normal weight patients over 6 years of age when there is at least 1 CMRF. Reanalysis of case finding protocols for cardiometabolic risk in other populations is warranted.
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Diabetes Mellitus Tipo 2 , Estado Pré-Diabético , Adulto , Adolescente , Humanos , Estado Pré-Diabético/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Glicemia , Sobrepeso/epidemiologia , Estudos Retrospectivos , Estudos Transversais , Chile/epidemiologia , Obesidade/epidemiologia , Obesidade/complicaçõesRESUMO
OBJECTIVES: This study compared the relationships of social determinants with cardiometabolic risk in different socioeconomic contexts: sociopolitically unstable Venezuela (VE) and stable Czechia (CZ). DESIGN: cross-sectional analysis involving two population-based studies. SETTING: Brno, Czechia and 23 cities of Venezuela. PARTICIPANTS: 25-64 years old subjects from CZ (2013-2014, n=1579, 56% females) and VE (2014-2017, n=1652, 70% females). MAIN OUTCOME MEASURES: The composite cardiometabolic risk score (CMRS) (scaled 0-8) was calculated using eight biomarkers (body mass index, waist circumference, blood glucose, systolic and diastolic blood pressure, total and high-density lipoprotein-cholesterol, triglycerides). Social characteristics included education in both countries, income in CZ and a composite measure of social position (SP) in VE. Sex stratified ordinal regression examined the social gradient in having less favourable CMRS. RESULTS: In CZ, men and women with low education and women with low income had higher odds of higher CMRS compared with those with high education and income with OR 1.45 (95% CI 1.01 to 2.21), 2.29 (95% CI 1.62 to 3.24) and 1.69 (95% CI 1.23 to 2.35). In VE, women with low education and low SP had higher odds to have higher CMRS OR 1.47 (95% CI 1.09 to 1.97) and 1.51 (95% CI 1.16 to 1.97), while men with low education and low SP had lower odds to have higher CMRS OR 0.64 (95% CI 0.41 to 1.00) and 0.61 (95% CI 0.40 to 0.97), compared with those with high education and high SP. Independently of age, sex and socioeconomic characteristics, Venezuelans had higher odds to have higher CMRS than Czechs (OR 2.70; 95% CI 2.37 to 3.08). CONCLUSIONS: The results suggest that the associations of socioeconomic status indices and cardiometabolic risk differed between CZ and VE, likely reflecting differences in the social environment among countries. Further research is needed to confirm and quantify these differences.
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Doenças Cardiovasculares , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Estudos Transversais , Doenças Cardiovasculares/epidemiologia , República Tcheca/epidemiologia , Venezuela/epidemiologia , Fatores de Risco , Classe Social , Índice de Massa CorporalRESUMO
Heart failure (HF) is a complex clinical syndrome, associated with high rates of mortality, hospitalization, and impairment of quality of life. Obesity and type 2 diabetes are major cardiometabolic drivers, represented as distinct stages of adiposity- and dysglycemia-based chronic disease (ABCD, DBCD), respectively, and leading to cardiometabolic-based chronic disease (CMBCD). This review focuses on one aspect of the CMBCD model: how ABCD and DBCD influence genesis and progression of HF phenotypes. Specifically, the relationships of ABCD and DBCD stages with structural and functional heart disease, HF risk, and outcomes in overt HF are detailed. Also, evidence-based lifestyle, pharmacological, and procedural interventions that promote or reverse cardiac remodeling and outcomes in individuals at risk or with HF are discussed. In summary, driver-based chronic disease models for individuals at risk or with HF can expose prevention targets for more comprehensive interventions to improve clinical outcomes. Future randomized trials that investigate structured lifestyle, pharmacological, and procedural therapies specifically tailored for the CMBCD model are needed to develop personalized care plans to decrease HF susceptibility and improve outcomes.
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Diabetes Mellitus Tipo 2 , Insuficiência Cardíaca , Humanos , Adiposidade , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Qualidade de Vida , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Obesidade/complicações , Obesidade/epidemiologia , Doença CrônicaRESUMO
Effective preventive care programs are urgently needed during humanitarian crises, as has been especially obvious during the COVID-19 pandemic. A pragmatic trial was designed: hybridized intervention (Diabetes Prevention Program [DPP] + medical nutrition therapy + liquid diet [LD]; LD group) vs. DPP only (DPP group). The participants were adults who were overweight/obese and at high risk of type 2 diabetes mellitus (T2DM). The LD consisted of a "homemade" milk- and fruit-juice-based beverage. Pandemic restrictions delayed the program by nine months, tripled the amount of time required for screening, and reduced the total sample to 60%. Eventually, 127 participants were randomized, and 94/127 participants (74.0%) completed the first phase. Participant dropout was influenced by migration, COVID-19 symptoms, education level, and socioeconomic status. In two months, the LD group lost 2.9 kg (p < 0.001) and the DPP group, 2.2 kg (p < 0.001) (between-group p = 0.170), with improvements in their cardiometabolic risk factors. At this stage, the DPP was shown to be feasible and effective, demonstrating weight loss with the improvement of cardiometabolic risk factors in a primary setting in Venezuela, a middle-income country with a chronic humanitarian crisis, during the COVID-19 pandemic.
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COVID-19 , Diabetes Mellitus Tipo 2 , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Estudos de Viabilidade , Humanos , Pandemias/prevenção & controle , SARS-CoV-2 , Venezuela/epidemiologiaAssuntos
Humanos , Doenças Cardiovasculares/terapia , Internato e Residência , Brasil , Doença CrônicaRESUMO
BACKGROUND: The complex humanitarian crisis (CHC) in Venezuela is characterized by food insecurity, hyperinflation, insufficient basic services, and the collapse of the healthcare system. The evolution of the epidemiology of cardiometabolic risk factors in this context is unknown. AIM: To compile the last 20 years evidence on the prevalence of cardiometabolic risk factors in adults of Venezuela in the context of the CHC. METHODS: A comprehensive literature review of population-based studies of adults in Venezuela from 2000 to 2020. RESULTS: Seven studies (National EVESCAM 2014-2017, 3 regions VEMSOLS 2006-2010, Maracaibo city 2007-2010, Merida city 2015, Mucuchies city 2009, Barquisimeto city CARMELA 2003-2005, and Zulia state 1999-2001) with samples sizes ranging from 109 to 3414 subjects were included. Over time, apparent decrease was observed in smoking from 21.8% (2003-2005) to 11.7% (2014-2017) and for obesity from 33.3% (2007-2010) to 24.6% (2014-2017). In contrast, there was an apparent increase in diabetes from 6% (2003-2005) to 12.3% (2014-2017), prediabetes 14.6% (2006-2010) to 34.9% (2014-2017), and hypertension 24.7% (2003-2005) to 34.1% (2014-2017). The most prevalent dyslipidemia - a low HDL-cholesterol - remained between 65.3% (1999-2001) and 63.2% (2014-2017). From 2006-2010 to 2014-2017, the high total cholesterol (22.2% vs 19.8%, respectively) and high LDL-cholesterol (23.3% vs 20.5%, respectively) remained similar, but high triglycerides decreased (39.7% vs 22.7%, respectively). Using the same definition across all the studies, metabolic syndrome prevalence increased from 35.6% (2006-2010) to 47.6% (2014-2017). Insufficient physical activity remained steady from 2007-2010 (34.3%) to 2014-2017 (35.2%). CONCLUSION: Changes in the prevalence of cardiometabolic risk factors in Venezuela are heterogeneous and can be affected by various social determinants of health. Though the Venezuelan healthcare system has not successfully adapted, the dynamics and repercussions of the CHC on population-based cardiometabolic care can be instructive for other at-risk populations.
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Hiperlipidemias , Síndrome Metabólica , Adulto , Fatores de Risco Cardiometabólico , Colesterol , Humanos , Síndrome Metabólica/epidemiologia , Prevalência , Fatores de Risco , Venezuela/epidemiologiaRESUMO
Diabetes prevalence is increasing worldwide, especially in low- and middle-income countries (LMIC), posing the need for improved detection and management strategies. Chronic disease models and lifestyle medicine provide structures for action. Community health workers (CHWs) can significantly contribute to chronic disease care if they are trained and integrated into low-resource health systems. Although most current CHWs worldwide are performing maternal/child health and infectious disease-related tasks, other programs involving CHWs for noncommunicable disease prevention and management are increasing. In this article, we discuss the advantages, challenges, and questions regarding possible roles assigned to CHWs in the prevention and management of diabetes. These roles include performing simple screening tests, implementing lifestyle/behavioral interventions, and connecting patients with alternatives to biomedicine. Specifically, CHWs can aid diabetes epidemiological surveillance by conducting risk score-based screening or capillary glucose testing, and they can facilitate diabetes self-management by delivering interventions described in the transcultural diabetes nutrition algorithm. Furthermore, while this role has not formally been assigned, CHWs can leverage their intimate knowledge of local practices to provide decision-making support to patients in environments with pluralistic health systems. Ethnocultural differences in CHW functions and transcultural adaptations of their roles in diabetes care should also be considered. In summary, CHWs can improve diabetes care by screening high-risk individuals and implementing lifestyle interventions, especially in LMIC.
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Países em Desenvolvimento , Diabetes Mellitus , Brasil , Criança , Agentes Comunitários de Saúde , Atenção à Saúde , Diabetes Mellitus/prevenção & controle , Humanos , PobrezaRESUMO
Abstract Objective: Waist circumference (WC) value reflects abdominal adiposity, but the amount abdominal fat that is associated to cardiometabolic risk factors varies among ethnicities. Determination of metabolic abnormalities has not undergone a WC adaptation process in Venezuela. The aim of the study was (1) to determine the optimal WC cutoff value associated with ≥2 cardiometabolic alterations and (2) incorporating this new WC cutoff, to determine the prevalence of abdominal obesity and cardiometabolic risk factors related in Venezuela. Methods: The study was national population-based, cross-sectional, and randomized sample, from 2014 to 2017. To assess performance of WC for identifying cardiometabolic alterations, receiver operating characteristics curves, area under the curve (AUC), sensitivity, specificity, and positive likelihood ratios were calculated. Results: Three thousand three hundred eighty-seven adults were evaluated with mean age of 41.2 ± 15.8 years. Using the best tradeoff between sensitivity and specificity, WC cutoffs of 90 cm in men (sensitivity = 72.4% and specificity = 66.1%) and 86 cm in women (sensitivity = 76.2% and specificity = 61.4%) were optimal for aggregation of ≥2 cardiometabolic alterations. AUC was 0.75 in men and 0.73 in women using these new cutoffs. Prevalence of abdominal obesity and metabolic syndrome was 59.6% (95 CI; 57.5-61.7) and 47.6% (95 CI; 45.2-50.0), respectively. Cardiometabolic risk factors were associated with being men, higher age, adiposity, and living in northern or western regions. Conclusion: The optimal WC values associated with cardiometabolic alterations were 90 cm in men and 86 cm in women. More than half of the Venezuelan population had abdominal obesity incorporating this new WC cutoff.
Resumen Objetivo: El valor de la circunferencia abdominal (CA) refleja la adiposidad abdominal, pero la cantidad de grasa abdominal asociada a factores de riesgo cardiometabólicos varía según la etnia. La determinación de anomalías metabólicas no se ha adaptado a la CA en Venezuela. 1) Detrerminar el valor de corte óptimo de CA asociados a ≥ 2 alteraciones cardiometabólicas. 2) Incorporando este nuevo límite de CA, determinar la prevalencia de obesidad abdominal y factores de riesgo cardiometabólicos relacionados en Venezuela. Métodos: Fue un estudio poblacional, transversal, de muestreo aleatorio de 2014 a 2017. Para evaluar el valor de CA para identificar alteraciones cardiometabólicas, se realizaron curvas características operativa del receptor y se calculó área bajo la curva (ABC), sensibilidad, especificidad y razón de similitud. Resultados: se evaluaron 3387 adultos con una edad promedio de 41.2 ± 15.8 años. Utilizando la mejor relación entre sensibilidad y especificidad, se determinó que los valores de corte de 90 cm en hombres (sensibilidad = 72.4% y especificidad = 66.1%) y 86 cm en mujeres (sensibilidad = 76.2% y especificidad = 61.4%) fueron óptimos para la agregación de ≥ 2 alteraciones cardiometabólicas. El ABC fue de 0,75 en hombres y de 0,73 en mujeres usando estos nuevos puntos de corte. La prevalencia de obesidad abdominal y síndrome metabólico fue 59.6% (95IC; 57.5 - 61.7) y 47.6% (95CI; 45.2 - 50.0), respectivamente. La presencia de factores de riesgo cardiometabólicos se asoció con ser hombre, mayor edad, adiposidad y vivir en regiones del norte o del oeste. Conclusión: Los valores óptimos de CA asociados con alteraciones cardiometabólicas fueron 90 cm en hombres y 86 cm en mujeres. Más de la mitad de la población venezolana tenía obesidad abdominal al incorporar este nuevo corte de CA.
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BACKGROUND: No previous study in Venezuela and few in the Region of the Americas have reported national cardiometabolic health data. OBJECTIVES: To determine the prevalence and distribution of cardiometabolic risk factors (CMRF) in adults of Venezuela. METHODS: A population-based, cross-sectional, and randomized cluster sampling national study was designed to recruit 4454 adults with 20 years or older from the eight regions of the country from July 2014 to January 2017. Sociodemographic, clinical, physical activity, nutritional, and psychological questionnaires; anthropometrics, blood pressure, and biochemical measurements were obtained. The results were weighted by gender, age, and regions. RESULTS: Data from 3414 participants (77% of recruited), 52.2% female, mean age of 41.2 ± 15.8 years, were analyzed. CMRF adjusted-prevalence were: diabetes (12.3%), prediabetes (34.9%), hypertension (34.1%), obesity (24.6%), overweight (34.4%), abdominal obesity (47.6%), underweight (4.4%), hypercholesterolemia (19.8%), hypertriglyceridemia (22.7%), low HDL-cholesterol (63.2%), high LDL-c (20.5%), daily consumption of fruits (20.9%) and vegetables (30.0%), insufficient physical activity (35.2%), anxiety (14.6%) and depression (3.2%) symptoms, current smoker (11.7%), and high (≥ 20%) 10-year fatal cardiovascular risk (14.0%). CMRF prevalence varied according to gender, age and region of residence. CONCLUSIONS: Cardiometabolic risk factors are highly prevalent in Venezuelan adults. This situation can be affected by the severe socio-economic crisis in the country. The joint action of different stakeholders to implement public health strategies for the prevention and treatment of these risk factors in Venezuela is urgently needed.
Assuntos
Fatores de Risco Cardiometabólico , Doenças Cardiovasculares , Adulto , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Venezuela/epidemiologiaRESUMO
Diabetes prevalence is increasing worldwide, especially in low- and middle-income countries (LMIC), posing the need for improved detection and management strategies. Chronic disease models and lifestyle medicine provide structures for action. Community health workers (CHWs) can significantly contribute to chronic disease care if they are trained and integrated into low-resource health systems. Although most current CHWs worldwide are performing maternal/child health and infectious disease-related tasks, other programs involving CHWs for noncommunicable disease prevention and management are increasing. In this article, we discuss the advantages, challenges, and questions regarding possible roles assigned to CHWs in the prevention and management of diabetes. These roles include performing simple screening tests, implementing lifestyle/behavioral interventions, and connecting patients with alternatives to biomedicine. Specifically, CHWs can aid diabetes epidemiological surveillance by conducting risk score-based screening or capillary glucose testing, and they can facilitate diabetes self-management by delivering interventions described in the transcultural diabetes nutrition algorithm. Furthermore, while this role has not formally been assigned, CHWs can leverage their intimate knowledge of local practices to provide decision-making support to patients in environments with pluralistic health systems. Ethnocultural differences in CHW functions and transcultural adaptations of their roles in diabetes care should also be considered. In summary, CHWs can improve diabetes care by screening high-risk individuals and implementing lifestyle interventions, especially in LMIC.
A prevalência do diabetes está aumentando em nível global, sobretudo nos países de renda baixa e média, o que exige melhor detecção e manejo da doença. O modelo de doenças crônicas e a medicina de estilo de vida fornecem estruturas para a ação nesse sentido. Os agentes comunitários de saúde (ACS) podem contribuir de maneira significativa para a assistência às doenças crônicas, desde que sejam capacitados e integrados aos sistemas de saúde, que dispõem de recursos limitados. Embora a maioria dos ACS no mundo esteja desempenhando tarefas relacionadas à saúde materno-infantil e doenças infecciosas, estão crescendo outros programas que envolvem a prevenção e manejo das doenças não transmissíveis. O artigo discute as vantagens, desafios e questões relacionados aos possíveis papéis definidos para os ACS na prevenção e manejo do diabetes. Esses papéis incluem testes simples de triagem, implementação de intervenções comportamentais e de estilo de vida e recomendação de alternativas à biomedicina para os pacientes. Especificamente, os ACS podem auxiliar na vigilância epidemiológica do diabetes, realizando triagem baseada em pontuação de risco ou testagem de glicemia capilar, e podem facilitar o auto-manejo do diabetes através de intervenções baseadas no algoritmo nutricional transcultural do diabetes. Além disso, embora o papel não tenha sido definido formalmente, os ACS podem alavancar seu conhecimento íntimo das práticas locais para apoiar decisões pelos pacientes em contextos com sistemas de saúde pluralistas. Devem ser consideradas as diferenças etnoculturais nas funções dos ACS e nas adaptações transculturais de seus papéis durante a assistência ao diabetes. Em resumo, os ACS podem melhorar a assistência ao diabetes através da triagem e da implementação oportuna de intervenções de estilo de vida, principalmente nos países de renda baixa e média.
La prevalencia de diabetes está aumentando en todo el mundo, especialmente en los países de bajos y medios ingresos (LMIC por sus siglas en inglés), imponiendo la necesidad de una detección y gestión mejoradas. Un modelo de enfermedad crónica y la medicina del estilo de vida proporcionan estructuras para la acción. Los trabajadores comunitarios de salud (CHWs por sus siglas en inglés) pueden contribuir significativamente al cuidado de la enfermedad crónica, si son entrenados e integrados en sistemas con pocos recursos de salud. A pesar de que la mayoría de los actuales CHWs en todo el mundo están desarrollando tareas relacionadas con enfermedades infecciosas en la salud maternal/infantil, otros programas que implican a los CHWs para la prevención y gestión de enfermedades no comunicables están aumentando. En este artículo, discutimos las ventajas, desafíos, y preguntas respecto a los posibles roles asignados a los CHWs, en la prevención y gestión de la diabetes. Estos roles incluyen realizar simples pruebas de detección, implementando intervenciones de estilo de vida/comportamentales, y conectando pacientes con alternativas a la biomedicina. Específicamente, los CHWs pueden ayudar en la vigilancia epidemiológica de la diabetes, llevando a cabo pruebas de detección basadas en marcadores de riesgo o pruebas de glucosa capilares, y pueden facilitar el autocontrol de la diabetes proporcionando intervenciones descritas en el algoritmo transcultural de nutrición en diabetes. Asimismo, mientras este rol no se les haya asignado formalmente, los CHWs pueden potenciar su conocimiento profundo de prácticas locales para proporcionar apoyo en la toma de decisiones a pacientes en entornos con sistemas de salud plurales. Las diferencias etnoculturales en las funciones de los CHW y las adaptaciones transculturales de sus papeles en el cuidado de la diabetes deberían también ser consideradas. En resumen, los CHWs pueden mejorar el cuidado de la diabetes detectando e implementando oportunamente las intervenciones de estilo de vida, especialmente en LMIC.
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Humanos , Criança , Países em Desenvolvimento , Diabetes Mellitus/prevenção & controle , Pobreza , Brasil , Agentes Comunitários de Saúde , Atenção à SaúdeRESUMO
BACKGROUND: Waist circumference (WC) value reflects abdominal adiposity, but the amount abdominal fat that is associated to cardiometabolic risk factors varies among ethnicities. Determination of metabolic abnormalities has not undergone a WC adaptation process in Venezuela. AIMS: The aim of the study was (1) to determine the optimal WC cutoff value associated with ≥2 cardiometabolic alterations and (2) incorporating this new WC cutoff, to determine the prevalence of abdominal obesity and cardiometabolic risk factors related in Venezuela. METHODS: The study was national population-based, cross-sectional, and randomized sample, from 2014 to 2017. To assess performance of WC for identifying cardiometabolic alterations, receiver operating characteristics curves, area under the curve (AUC), sensitivity, specificity, and positive likelihood ratios were calculated. RESULTS: Three thousand three hundred eighty-seven adults were evaluated with mean age of 41.2 ± 15.8 years. Using the best tradeoff between sensitivity and specificity, WC cutoffs of 90 cm in men (sensitivity = 72.4% and specificity = 66.1%) and 86 cm in women (sensitivity = 76.2% and specificity = 61.4%) were optimal for aggregation of ≥2 cardiometabolic alterations. AUC was 0.75 in men and 0.73 in women using these new cutoffs. Prevalence of abdominal obesity and metabolic syndrome was 59.6% (95 CI; 57.5-61.7) and 47.6% (95 CI; 45.2-50.0), respectively. Cardiometabolic risk factors were associated with being men, higher age, adiposity, and living in northern or western regions. CONCLUSION: The optimal WC values associated with cardiometabolic alterations were 90 cm in men and 86 cm in women. More than half of the Venezuelan population had abdominal obesity incorporating this new WC cutoff.
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BACKGROUND: Cardiovascular health status of the Venezuelan population has not been evaluated. The American Heart Association recommends the Cardiovascular Health Score (CHS) to assess cardiovascular health. OBJECTIVES: This study sought to determine the prevalence of CHS categories in a nationally representative sample of Venezuelan adults. METHODS: EVESCAM (Venezuelan Study of Cardio-Metabolic Health) was a national population-based, cross-sectional, randomized cluster sampling study performed from July 1, 2014 to January 31, 2017, which assessed 3,454 adults, age ≥20 years, with a response rate of 77.3%. The American Heart Association's CHS evaluates 4 behaviors (smoking, body mass index, physical activity, and diet) and 3 risk factors (total cholesterol, blood pressure, and blood glucose), assigning 1 point to those meting an ideal behavior or factor or 0 points if are not. Subjects were categorized as having ideal (5 to 7 points), intermediate (3 to 4), or poor (<3) cardiovascular health. Weighted prevalence by age, sex, and regions are presented. RESULTS: A total of 2,992 participants completed the data. Mean age and CHS were 41.4 ± 15.8 years and 4.3 ± 1.1 points, respectively. The prevalence of ideal CHS was 37.9% (95% confidence interval: 35.0 to 40.7); two-thirds presented with intermediate to poor CHS. Ideal CHS was most prevalent in women, in the youngest participants, and in those with higher education degree and living in a rural area. The prevalence of 7 components was 0.13%. Subjects evaluated since mid-2016 had a higher prevalence of ideal CHS (≈47%) than those evaluated before it (≈32%) (p < 0.001). CONCLUSIONS: A high prevalence of ideal CHS was observed in Venezuelan adults compared with other reports; however, a large proportion remain with high risk for cardiovascular disease.
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Doenças Cardiovasculares/epidemiologia , Nível de Saúde , Adulto , Distribuição por Idade , Idoso , Análise por Conglomerados , Escolaridade , Feminino , Estilo de Vida Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Venezuela/epidemiologia , Adulto JovemRESUMO
AIMS: To evaluate the performance of the Latin American Finnish Diabetes Risk Score (LA-FINDRISC) compared with the original O-FINDRISC in general population. To establish the best cut-off to detect unknown type 2 diabetes (uT2D) and prediabetes. METHODS: The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3454 adults from July 2014 to January 2017. Those with self-report of diabetes were excluded; a total of 3061 subjects were analyzed. Waist circumference adapted for Latin America was the difference between the LA-FINDRISC and the O-FINDRISC. The area under the curve (AUC), sensitivity, and specificity were calculated. RESULTS: The prevalence of uT2D and prediabetes were 3.3% and 38.5%. The AUC with the LA-FINDRISC vs. the O-FINDRISC were: for uT2D, 0.722 vs. 0.729 in men (p=0.854) and 0.724 vs. 0.732 in women (p=0.896); for prediabetes (impaired fasting glucose [IFG] + impaired glucose tolerance [IGT], 0.590 vs. 0.587 in men (p=0.887) and 0.621 vs. 0.627 in women (p=0.777); for IFG, 0.582 vs. 0.580 in men (p=0.924) and 0.607 vs. 0.617 in women (p=0.690); for IGT, 0.691 vs. 0.692 in men (p=0.971) and 0.672 vs. 0.671 in women (p=0.974). Using the LA-FINDRISC, the best cut-offs to detect uT2D were 9 in men and 10 in women and to detect IGT was 9 in both genders. CONCLUSION: LA-FINDRISC has similar performance than O-FINDRISC in Venezuelan adults and showed a good performance to detect uT2D and IGT, but not IFG. The best cut-offs to detect glucose alterations were established.
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Glicemia/metabolismo , Diabetes Mellitus/diagnóstico , Vigilância da População , Pontuação de Propensão , Adulto , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Feminino , Teste de Tolerância a Glucose/métodos , Humanos , Masculino , Morbidade/tendências , Estudos Retrospectivos , Fatores de Risco , Venezuela/epidemiologiaRESUMO
BACKGROUND: In 2017 the American Heart Association (AHA)/American College of Cardiology (ACC) changed the criteria to define hypertension (HTN). OBJECTIVE: To re-analyze Venezuelan data to update HTN prevalence rates and estimate the number of adults with uncontrolled blood pressure (BP) using AHA/ACC criteria. METHODS: The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3,420 adults from July 2014 to January 2017, with a response rate of 77.3%. The mean of two BP measurements was obtained using a standard oscillometric device protocol. HTN was defined using both 2017 AHA/ACC guideline (BP ≥ 130/80 mmHg) and JNC7 (BP ≥ 140/90 mmHg) criteria. FINDINGS: The crude prevalence of HTN using 2017 AHA/ACC guideline criteria was 60.4%, 13% higher than with the JNC7 criteria. The age-standardized prevalence was 55.4% in men and 49.0% in women (p < 0.001), 17.5% and 12.7% higher, respectively, compared with the JNC7 criteria. In subjects without self-reported HTN, the age-standardized prevalence of HTN was 43.4% in men and 32.3% in women, of whom, 22.9% and 19.2% were between 130-139/80-89 mmHg, respectively. In those with self-reported HTN, the prevalence of uncontrolled BP (≥130/80 mmHg) on antihypertensive medication was 66.8% in men and 65.8% in women. The total estimated number of subjects with HTN in Venezuela increased to 11 million, and only about 1.8 million are controlled. CONCLUSION: Using the new 2017 AHA/ACC guideline, the prevalence of HTN in Venezuela is approximately half of the adult population and associated with relatively poor BP control.
Assuntos
Hipertensão/classificação , Hipertensão/epidemiologia , Adulto , Idoso , American Heart Association , Determinação da Pressão Arterial/instrumentação , Análise por Conglomerados , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevalência , Estados Unidos , Venezuela/epidemiologiaRESUMO
BACKGROUND: Evidence suggests that depression is more common in patients with diabetes than in the general population. However, contradictory results expose controversy in this association. OBJECTIVE: To evaluate the relationship between diabetes and depression in a national sample of Venezuelan adults. METHODS: The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3,454 adults from July 2014 to January 2017 (response rate of 77.3%). Diabetes was defined using fasting blood glucose and a 2-hour oral glucose tolerance test. Depressive symptoms were determined using the Hospital Anxiety and Depression Scale. RESULTS: 3255 subjects were assessed. Depressive symptom score was different between genders and among age groups (p<0.001), and similar in those subjects with or without diabetes (p=0.899). Depressive symptoms prevalence was higher in women than in men and increased with age (p<0.05), but was similar in those with and without diabetes (p=0.215). Using a multivariate regression analysis model, the association of depressive symptoms and diabetes remains non-significant after adjusting for age and gender (Odds ratio=0.98; 95% Confidence Intervals 0.95 - 1.02, p=0.504). CONCLUSION: Diabetes and depression were not associated in a large sample of Venezuelan adults.
Assuntos
Depressão/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Vigilância da População/métodos , Psicometria/métodos , Medição de Risco/métodos , Adulto , Idoso , Glicemia/metabolismo , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Venezuela/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To determine the prevalence of obesity according to the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) framework based on a complications-centric model with further application of the Cardiometabolic Disease Staging (CMDS) system in a Venezuelan population. METHODS: A total of 1,320 adults were randomly selected from 3 regions. The AACE/ACE framework definitions were as follows: overweight, body mass index (BMI) 25 to 29.9 kg/m2 and no obesity-related complications (ORC); obesity stage 0, BMI ≥30 and no ORC; stage 1, BMI ≥25 and 1 or more mild-to-moderate ORC; and stage 2, BMI ≥25 and 1 or more severe ORC. CMDS definitions were as follows: stage 0, no metabolic syndrome (MS) components; stage 1, 1 to 2 MS components without impaired fasting glucose (IFG); stage 2, IFG or ≥3 MS components but without IFG; stage 3, IFG and MS; and stage 4, type 2 diabetes (T2D) or cardiovascular disease. RESULTS: The mean age was 44.8 ± 0.4 years, and 68.5% were female. The prevalence of obesity according to the AACE/ACE framework was 63.1%: overweight 3.0% (95% confidence interval [CI]: 2.1-3.9); obesity stage 0: 0.1% (0.07-0.27); obesity stage 1: 26.6% (24.2-29.0); and obesity stage 2: 36.4% (33.8-39.0). Most subjects with a BMI <25 were CMDS 0 or 1. In those with BMI ≥ 25, only 4.6% were CMDS 0. The prevalence of obesity according to the World Health Organization (WHO, BMI ≥30) was 29.3% (24.7-33.7). CONCLUSION: In a general population study, applying the AACE/ACE framework for obesity and CMDS increased the detection of ORC and therefore higher risk subjects compared to classic anthropometric measurements. ABBREVIATIONS: AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; BMI = body mass index; CMDS = Cardiometabolic Disease Staging; DALY = disability-adjusted life years; LA = Latin America; MS = metabolic syndrome; ORC = obesity-related complications; WC = waist circumference; WHO = World Health Organization.
Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Intolerância à Glucose/epidemiologia , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Adulto , Glicemia/metabolismo , Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/metabolismo , HDL-Colesterol/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Endocrinologia , Feminino , Intolerância à Glucose/metabolismo , Humanos , Hipertensão/epidemiologia , Masculino , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Obesidade/metabolismo , Sobrepeso/epidemiologia , Sobrepeso/metabolismo , Prevalência , Índice de Gravidade de Doença , Sociedades Médicas , Triglicerídeos/metabolismo , Estados Unidos , Venezuela/epidemiologia , Circunferência da Cintura , Organização Mundial da SaúdeRESUMO
OBJECTIVE: The prevalence of diabetes in multiple regions of Venezuela is unknown. To determine the prevalence of diabetes in five populations from three regions of Venezuela. METHODS: During 2006-2010, 1334 subjects ≥20years were selected by multistage stratified random sampling from all households from 3 regions of Venezuela. Anthropometric measurements and biochemical analysis were obtained. Statistical methods were calculated using SPSS 20 software. FINDINGS: Mean (SE) age was 44.8 years (0.39) and 68.5% were females. The prevalence of diabetes was 8.3% (95% CI, 6.9%-10.0%), higher in men than women (11.2% and 7.0% respectively; p=0.01). The prevalence adjusted by age and gender was 8.0% (95% CI, 6.9%-9.9%). This figure increased with age, with the lowest prevalence in the 20-29year old group (1.8% [95% CI, 0.6%-4.8%]) and the highest in the oldest group (26.8% [95% CI, 16.2%-40.5%]). Subjects with overweight or obesity had no increased risk of diabetes compared with those with normal weight. However, in women, the presence of abdominal obesity was associated with an increase of the risk of diabetes by 77% (OR 1.77 [95% CI, 1.1%-2.9%]). The prevalence of prediabetes was 14.6% (95% CI, 12.8%-16.7%), and only 48.2% were aware of their diabetes condition. CONCLUSION: In this study, 8.3% of the subjects had diabetes and 14.6% prediabetes. Less than half of the subjects with diabetes were aware of their condition. These results point to a major public health problem, requiring the implementation of diabetes prevention programs.
Assuntos
Diabetes Mellitus/epidemiologia , Adulto , Distribuição por Idade , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/psicologia , Diabetes Mellitus/terapia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Estado Pré-Diabético/epidemiologia , Prevalência , Fatores de Risco , Distribuição por Sexo , Fatores de Tempo , Venezuela/epidemiologia , Adulto JovemRESUMO
The relationship between smokeless tobacco (ST) use and type-2 diabetes (T2D) has only been reported in Swedish men, though with contradictory results. In Venezuela, chimó is the most common ST preparation. The relationship between chimó and T2D in Venezuela is unknown. The objective of the study was to evaluate the relationship between chimó use and T2D in a population with high prevalence of ST use in the Andes region of Venezuela. An observational, cross-sectional, correlational study was designed. During 2013-2014, 759 consecutive subjects aged 20 years or older were evaluated in a medical center. Anthropometric measurements and responses to a standard questionnaire were obtained. Blood glucose and lipid concentrations were measured. The mean age was 53.1 years, 58% were female, and 24.1% reported ST use. ST use was more frequent in men than women (32.9% vs. 17.7%; p < 0.001). ST users showed lower body mass index (BMI), body fat and total cholesterol, but a higher frequency of T2D, than non-ST users. Logistic regression analysis, adjusted by age, family history of T2D, and hypertriglyceridemia, demonstrated that ST use was associated with an increased odd for T2D by 77% (OR 1.77; 95% CI 1.15 - 2.72) among ST-users. In conclusion, chimó, a ST form frequently used in the Andes region of Venezuela, is associated with a higher frequency of T2D and lower fat mass. Implications of these findings are discussed.
La relación entre el uso de tabaco no inhalado (TBNI) y la diabetes mellitus tipo 2 (DM2) ha sido únicamente reportada en hombres de Suecia, con resultados contradictorios. En Venezuela, el chimó es la preparación más común de TBNI. La relación entre el chimó y la DM2 en Venezuela es desconocida. El objetivo de este estudio fue evaluar la relación entre el uso de chimó y la DM2 en una población con elevada prevalencia de uso de TBNI en la región de los Andes de Venezuela. Se diseñó un estudio observacional, transversal, tipo correlacional. Durante 2013-2014, 759 sujetos de 20 o más años fueron evaluados de forma consecutiva en un centro médico. La edad promedio fue 53,1 años, 58% fueron mujeres y 24,1% reportó uso de TBNI. El uso de TBNI fue más frecuente en hombres que en mujeres (32,9% vs. 17,7%; p < 0,001). Los consumidores de TBNI mostraron menor índice de masa corporal (IMC), grasa corporal y colesterol total, pero mayor frecuencia de DM2 que los no consumidores de TBNI. El análisis de regresión logística ajustado por edad, historia familiar de DM2 e hipertrigliceridemia, demostró que el uso de TBNI se asoció con un incremento de 77% de probabilidad de presentar DM2 (OR 1,77; 95% CI 1,15 - 2,72). En conclusión, el chimó, una forma de TBNI frecuentemente usada en la región de los Andes de Venezuela, está asociada con una mayor frecuencia de DM2 y con una menor masa grasa. Se discuten las implicaciones de este hallazgo.
RESUMO
Fundamentos: O uso do tabaco e a hipertensão arterial sistêmica (HAS) são as principais causas preveníveis de morte a nível global. O tabaco é apresentado nas formas com ou sem fumaça (TSF). O uso do TSF tem sido relacionado à doença cardiovascular, diabetes tipo 2 (DM2) e câncer. Na Venezuela, o chimó é a preparação de TSF mais comum e a sua relação com a HAS é desconhecida. Objetivo: Avaliar a relação entre o uso de chimó e HAS em uma população com alta prevalência de uso de TSF na Venezuela. Métodos: Entre 2013-2014, um total de 1.938 indivíduos com 20 anos ou mais foram avaliados consecutivamente em um centro médico. Foram obtidas medidas antropométricas e de pressão arterial (PA), além de respostas a um questionário padrão. Resultados: Os participantes tinham uma média de idade de 49,2 anos, 59,5% eram do sexo feminino, 38,9% apresentavam HAS, 23,2% relataram uso de TSF e 11,6% relataram ter DM2. Um terço dos indivíduos com DM2 eram usuários de TSF, e este grupo mostrou valores mais baixos de frequência cardíaca, PA sistólica, índice de massa corporal (IMC) e frequência de HAS quando comparado a sujeitos com DM2 não usuários de TSF (p < 0,05). Em indivíduos com DM2 com 50 anos ou mais, o uso de TSF foi associado a uma frequência 69% mais baixa de HAS quando comparados a indivíduos que não usavam TSF. Em regressão logística ajustada pela frequência cardíaca, idade, ocorrência de DM2, sobrepeso/obesidade e história familiar de HAS, o uso de TSF esteve associado a uma frequência 30% mais baixa de HAS (razão de chances 0,70; intervalo de confiança de 95% 0,55 - 0,90). Conclusão: O chimó, um TSF frequentemente utilizado na região dos Andes na Venezuela, está associado a valores mais baixos de PA, frequência cardíaca, IMC e frequência mais baixa de HAS em indivíduos com DM2 com mais de 50 anos. Esta associação contraintuitiva negativa entre o chimó e alguns fatores de risco cardiometabólicos realça o caráter complexo destas relações e a necessidade de estudos adicionais
Background: Tobacco use and hypertension are leading preventable causes of death globally. Tobacco is presented as smoked or smokeless tobacco (ST). ST use has been related to cardiovascular disease, type 2 diabetes (T2D), and cancer. In Venezuela, chimó is the most common ST preparation, and its relationship with hypertension is unknown. Objective: To evaluate the relationship between chimó use and hypertension in a population with a high prevalence of ST use in Venezuela. Methods: From 2013-2014, a total of 1,938 consecutive subjects aged 20 years or older were evaluated in a medical center. Anthropometrics and blood pressure (BP) measurements, and responses to a standard questionnaire were obtained. Results: The participants had a mean age of 49.2 years, 59.5% were female, 38.9% had hypertension, 23.2% reported ST use, and 11.6% reported having T2D. One-third of the subjects with T2D were ST users, and this group showed lower heart rate, systolic BP, body mass index (BMI), and frequency of hypertension when compared with T2D subjects who were not ST users (p < 0.05). In subjects with T2D who were 50 years or older, ST use was associated with a 69% lower frequency of hypertension when compared with subjects without ST use. On logistic regression adjusted by heart rate, age, occurrence of T2D, overweight/obesity, and family history of hypertension, ST use was associated with a 30% lower frequency of hypertension (odds ratio 0.70; 95% confidence interval 0.55 0.90). Conclusion: Chimó, a ST frequently used in the Andes region of Venezuela, is associated with lower BP, heart rate, BMI, and frequency of hypertension in subjects with T2D older than 50 years. This counter-intuitive negative association of chimó with some cardiometabolic risk factors highlights the complex nature of these relationships and the need for further studies