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OBJECTIVES: To assess in newborns with neonatal encephalopathy (NE), presumptively related to a peripartum hypoxic-ischemic event, the frequency of dysglycemia and its association with neonatal adverse outcomes. STUDY DESIGN: We conducted a secondary analysis of LyTONEPAL (Long-Term Outcome of Neonatal hypoxic EncePhALopathy in the era of neuroprotective treatment with hypothermia), a population-based cohort study including 545 patients with moderate-to-severe NE. Newborns were categorized by the glycemia values assessed by routine clinical care during the first 3 days of life: normoglycemic (all glycemia measurements ranged from 2.2 to 8.3 mmol/L), hyperglycemic (at least 1 measurement >8.3 mmol/L), hypoglycemic (at least 1 measurement <2.2 mmol/L), or with glycemic lability (measurements included at least 1 episode of hypoglycemia and 1 episode of hyperglycemia). The primary adverse outcome was a composite outcome defined by death and/or brain lesions on magnetic resonance imaging, regardless of severity or location. RESULTS: In total, 199 newborns were categorized as normoglycemic (36.5%), 74 hypoglycemic (13.6%), 213 hyperglycemic (39.1%), and 59 (10.8%) with glycemic lability, based on the 2593 glycemia measurements collected. The primary adverse outcome was observed in 77 (45.8%) normoglycemic newborns, 37 (59.7%) with hypoglycemia, 137 (67.5%) with hyperglycemia, and 40 (70.2%) with glycemic lability (P < .01). With the normoglycemic group as the reference, the aORs and 95% 95% CIs for the adverse outcome were significantly greater for the group with hyperglycemia (aOR 1.81; 95% CI 1.06-3.11). CONCLUSIONS: Dysglycemia affects nearly two-thirds of newborns with NE and is independently associated with a greater risk of mortality and/or brain lesions on magnetic resonance imaging. TRIAL REGISTRATION: NCT02676063.
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Hiperglicemia , Hipoglicemia , Hipotermia Induzida , Hipotermia , Hipóxia-Isquemia Encefálica , Doenças do Recém-Nascido , Humanos , Recém-Nascido , Estudos de Coortes , Hipoglicemia/terapia , Hipoglicemiantes , Hipotermia Induzida/métodos , Hipóxia-Isquemia Encefálica/terapia , Doenças do Recém-Nascido/terapiaRESUMO
Type 1 diabetes mellitus is a clinical condition characterized by insufficient insulin production due to progressive loss of pancreatic islet ß-cells mediated by an autoimmune response. This deregulation of the immune system is caused by the action of genetic, epigenetic, and environmental factors in varying combinations for each individual. Although the inflammation of the islets with immune cell infiltration, known as insulitis, is an important element in pathogenesis, other factors are necessary for disease initiation. Associations with variants of HLA and other genes related to immune system function, mainly haplotypes HLA-DR3-DQ2 and HLA-DR4-DQ8, are more evident. The influence of polymorphisms and epigenetic modifications, as well as the microbiome, is convincing proof of the existence of a complex interaction between genetic, immune, and environmental factors in the etiology and pathogenesis of this metabolic disorder. Loss of selftolerance to autoimmunity is a critical point in the development of the disease, and regulatory T cells play a key role in this process. Thus, any failure of these cells, either due to an insufficient number or altered expression of cytokines and transcription factors, may be the trigger for the onset of the disease. The protective action of regulatory T cells is controlled by gene expression that is modulated by epigenetic modifications, including the dysregulation of noncoding RNAs. This review takes an updated approach to the natural history of type 1 diabetes, focusing on the factors involved in the etiology and pathogenesis.
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Diabetes Mellitus Tipo 1 , Humanos , Diabetes Mellitus Tipo 1/genética , Haplótipos , Antígeno HLA-DR3/genéticaRESUMO
Background: Oxidized lipid mediators such as eicosanoids play a central role in the inflammatory response associated with tuberculosis (TB) pathogenesis. Diabetes mellitus (DM) leads to marked changes in lipid mediators in persons with TB. However, the associations between diabetes-related changes in lipid mediators and clearance of M. tuberculosis (Mtb) among persons on anti-TB treatment (ATT) are unknown. Quantification of urinary eicosanoid metabolites can provide insights into the circulating lipid mediators involved in Mtb immune responses. Methods: We conducted a multi-site prospective observational study among adults with drug-sensitive pulmonary TB and controls without active TB; both groups had sub-groups with or without dysglycemia at baseline. Participants were enrolled from RePORT-Brazil (Salvador site) and RePORT-South Africa (Durban site) and stratified according to TB status and baseline glycated hemoglobin levels: a) TB-dysglycemia (n=69); b) TB-normoglycemia (n=64); c) non-TB/dysglycemia (n=31); d) non-TB/non-dysglycemia (n=29). We evaluated the following urinary eicosanoid metabolites: 11α-hydroxy-9,15-dioxo-2,3,4,5-tetranor-prostane-1,20-dioic acid (major urinary metabolite of prostaglandin E2, PGE-M), tetranor-PGE1 (metabolite of PGE2, TN-E), 9α-hydroxy-11,15-dioxo-2,3,4,5-tetranor-prostane-1,20-dioic acid (metabolite of PGD2, PGD-M), 11-dehydro-thromboxane B2 (11dTxB2), 2,3-dinor-6-keto-PGF1α (prostaglandin I metabolite, PGI-M), and leukotriene E4 (LTE4). Comparisons between the study groups were performed at three time points: before ATT and 2 and 6 months after initiating therapy. Results: PGE-M and LTE4 values were consistently higher at all three time-points in the TB-dysglycemia group compared to the other groups (p<0.001). In addition, there was a significant decrease in PGI-M and LTE4 levels from baseline to month 6 in the TB-dysglycemia and TB-normoglycemia groups. Finally, TB-dysglycemia was independently associated with increased concentrations of PGD-M, PGI-M, and LTE4 at baseline in a multivariable model adjusting for age, sex, BMI, and study site. These associations were not affected by HIV status. Conclusion: The urinary eicosanoid metabolite profile was associated with TB-dysglycemia before and during ATT. These observations can help identify the mechanisms involved in the pathogenesis of TB-dysglycemia, and potential biomarkers of TB treatment outcomes, including among persons with dysglycemia.
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Mycobacterium tuberculosis , Tuberculose Pulmonar , Adulto , Dinoprostona , Eicosanoides , Humanos , África do Sul , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
Numerous host and environmental factors contribute to persistent and intermittent nasal Staphylococcus aureus carriage in humans. The effects of worsening glycemia on the odds of S. aureus intermittent and persistent nasal carriage was established in two cohorts from an adult Mexican American population living in Starr County, Texas. The anterior nares were sampled at two time points and the presence of S. aureus determined by laboratory culture and spa-typing. Persistent carriers were defined by the presence of S. aureus of the same spa-type at both time points, intermittent carriers were S. aureus-positive for 1 of 2 swabs, and noncarriers were negative for S. aureus at both time points. Diabetes status was obtained through personal interview and physical examination that included a blood draw for the determination of percent glycated hemoglobin A1c (%HbA1c), fasting plasma glucose, and other blood chemistry values. Using logistic regression and general estimating equations, the odds of persistent and intermittent nasal carriage compared to noncarriers across the glycemic spectrum was determined controlling for covariates. Increasing fasting plasma glucose and %HbA1c in the primary and replication cohort, respectively, were significantly associated with increasing odds of S. aureus intermittent, but not persistent nasal carriage. These data suggest that increasing dysglycemia is a risk factor for intermittent S. aureus nasal carriage potentially placing those with poorly controlled diabetes at an increased risk of acquiring an S. aureus infection. IMPORTANCE Factors affecting nasal S. aureus colonization have been studied primarily in the context of persistent carriage. In contrast, few studies have examined factors affecting intermittent nasal carriage with this pathogen. This study demonstrates that the odds of intermittent but not persistent nasal carriage of S. aureus significantly increases with worsening measures of dysglycemia. This is important in the context of poorly controlled diabetes since the risk of becoming colonized with one of the primary organisms associated with diabetic foot infections can lead to increased morbidity and mortality.
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Infecções Estafilocócicas , Staphylococcus aureus , Adulto , Glicemia , Portador Sadio/epidemiologia , Hemoglobinas Glicadas , Humanos , Americanos Mexicanos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/genéticaRESUMO
A growing body of evidence indicates that dietary polyphenols could be used as an early intervention to treat glucose-insulin (G-I) dysregulation. However, studies report heterogeneous information, and the targets of the intervention remain largely elusive. In this work, we provide a general methodology to quantify the effects of any given polyphenol-rich food or formulae over glycemic regulation in a patient-wise manner using an Oral Glucose Tolerance Test (OGTT). We use a mathematical model to represent individual OGTT curves as the coordinated action of subsystems, each one described by a parameter with physiological interpretation. Using the parameter values calculated for a cohort of 1198 individuals, we propose a statistical model to calculate the risk of dysglycemia and the coordination among subsystems for each subject, thus providing a continuous and individual health assessment. This method allows identifying individuals at high risk of dysglycemia-which would have been missed with traditional binary diagnostic methods-enabling early nutritional intervention with a polyphenol-supplemented diet where it is most effective and desirable. Besides, the proposed methodology assesses the effectiveness of interventions over time when applied to the OGTT curves of a treated individual. We illustrate the use of this method in a case study to assess the dose-dependent effects of Delphinol® on reducing dysglycemia risk and improving the coordination between subsystems. Finally, this strategy enables, on the one hand, the use of low-cost, non-invasive methods in population-scale nutritional studies. On the other hand, it will help practitioners assess the effectiveness of an intervention based on individual vulnerabilities and adapt the treatment to manage dysglycemia and avoid its progression into disease.
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BACKGROUND: Dysglycemia (i.e., prediabetes or diabetes) in patients with tuberculosis (PWTB) is associated with increased odds of mortality and treatment failure. Whether such association holds true when dysglycemia is transient or persistent is unknown. In this study, we tested the association between persistent dysglycemia (PD) during anti-tuberculosis (TB) treatment and unfavorable treatment outcomes in PWTB from Lima, Peru. METHODS: PWTB enrolled between February and November 2017 were followed for 24-months. Dysglycemia was measured through fasting glucose and HbA1c at baseline during the 2nd- and 6th-month of TB treatment. PD was defined as dysglycemia detected in 2 different visits. The association between PD and unfavorable TB treatment outcome was evaluated using logistic regression. RESULTS: Among 125 PWTB, PD prevalence was 29.6%. PD was associated with more lung lesion types, higher bacillary loads, low hemoglobin (Hb), and high body mass index (BMI). Unfavorable TB treatment outcome was associated with older age, higher BMI, more lung lesion types, and PD. After adjusting for age, Hb levels, smoking, and smear grade, PD was independently associated with unfavorable treatment outcomes (adjusted odds ratio (aOR): 6.1; 95% CI: 1.9-19.6). CONCLUSION: PD is significantly associated with higher odds of unfavorable TB treatment outcomes. Dysglycemia control during anti-TB treatment gives the opportunity to introduce appropriate interventions to TB management.
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Estado Pré-Diabético , Tuberculose Pulmonar , Tuberculose , Humanos , Peru/epidemiologia , Estado Pré-Diabético/complicações , Estado Pré-Diabético/epidemiologia , Resultado do Tratamento , Tuberculose/complicações , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologiaRESUMO
BACKGROUND: Impaired fasting glucose (IFG) is a prevalent and potentially reversible intermediate stage leading to type 2 diabetes that increases risk for cardiometabolic complications. The identification of clinical and molecular factors associated with the reversal, or regression, from IFG to a normoglycemia state would enable more efficient cardiovascular risk reduction strategies. The aim of this study was to identify clinical and biological predictors of regression to normoglycemia in a non-European population characterized by high rates of type 2 diabetes. METHODS: We conducted a prospective, population-based study among 9637 Mexican individuals using clinical features and plasma metabolites. Among them, 491 subjects were classified as IFG, defined as fasting glucose between 100 and 125 mg/dL at baseline. Regression to normoglycemia was defined by fasting glucose less than 100 mg/dL in the follow-up visit. Plasma metabolites were profiled by Nuclear Magnetic Resonance. Multivariable cox regression models were used to examine the associations of clinical and metabolomic factors with regression to normoglycemia. We assessed the predictive capability of models that included clinical factors alone and models that included clinical factors and prioritized metabolites. RESULTS: During a median follow-up period of 2.5 years, 22.6% of participants (n = 111) regressed to normoglycemia, and 29.5% progressed to type 2 diabetes (n = 145). The multivariate adjusted relative risk of regression to normoglycemia was 1.10 (95% confidence interval [CI] 1.25 to 1.32) per 10 years of age increase, 0.94 (95% CI 0.91-0.98) per 1 SD increase in BMI, and 0.91 (95% CI 0.88-0.95) per 1 SD increase in fasting glucose. A model including information from age, fasting glucose, and BMI showed a good prediction of regression to normoglycemia (AUC = 0.73 (95% CI 0.66-0.78). The improvement after adding information from prioritized metabolites (TG in large HDL, albumin, and citrate) was non-significant (AUC = 0.74 (95% CI 0.68-0.80), p value = 0.485). CONCLUSION: In individuals with IFG, information from three clinical variables easily obtained in the clinical setting showed a good prediction of regression to normoglycemia beyond metabolomic features. Our findings can serve to inform and design future cardiovascular prevention strategies.
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Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Intolerância à Glucose/sangue , Síndrome Metabólica/sangue , Adulto , Fatores Etários , Biomarcadores/sangue , Índice de Massa Corporal , Fatores de Risco Cardiometabólico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Progressão da Doença , Feminino , Intolerância à Glucose/diagnóstico , Intolerância à Glucose/epidemiologia , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Metaboloma , Metabolômica , México/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de TempoRESUMO
BACKGROUND: There are scarce data on the prevalence and disease presentation of HIV in patients with tuberculosis (TB) and dysglycemia (diabetes [DM] and prediabetes [PDM]), especially in TB-endemic countries. METHODS: We assessed the baseline epidemiological and clinical characteristics of patients with culture-confirmed pulmonary TB, enrolled in a multicenter prospective cohort in Brazil (RePORT-Brazil) during 2015-2019. Dysglycemia was defined by elevated glycated hemoglobin and stratified as PDM or DM. Additionally, we used data from TB cases obtained through the Brazilian National Notifiable Diseases Information System (SINAN), during 2015-2019. In SINAN, diagnosis of diabetes was based on self-report. Logistic regression models were performed to test independent associations between HIV, dysglycemia status, and other baseline characteristics in both cohorts. RESULTS: In the RePORT-Brazil cohort, the prevalence of DM and of PDM was 23.7 and 37.8%, respectively. Furthermore, the prevalence of HIV was 21.4% in the group of persons with TB-dysglycemia and 20.5% in that of patients with TBDM. In the SINAN cohort, the prevalence of DM was 9.2%, and among the TBDM group the prevalence of HIV was 4.1%. Logistic regressions demonstrated that aging was independently associated with PDM or DM in both the RePORT-Brazil and SINAN cohorts. In RePORT-Brazil, illicit drug use was associated with PDM, whereas a higher body mass index (BMI) was associated with DM occurrence. Of note, HIV was not associated with an increased risk of PDM or DM in patients with pulmonary TB in both cohorts. Moreover, in both cohorts, the TBDM-HIV group presented with a lower proportion of positive sputum smear and a higher frequency of tobacco and alcohol users. CONCLUSION: There is a high prevalence of dysglycemia in patients with pulmonary TB in Brazil, regardless of the HIV status. This reinforces the idea that DM should be systematically screened in persons with TB. Presence of HIV does not substantially impact clinical presentation in persons with TBDM, although it is associated with more frequent use of recreational drugs and smear negative sputum samples during TB screening.
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OBJECTIVE: To assess whether the prevalence of low physical activity levels and time spent watching TV differ depending on glycemia status. METHODS: A secondary analysis using data from a population-based study was conducted. Two were the outcomes: physical activity levels, derived from the International Physical Activity Questionnaire, and sitting time watching TV. The exposure was glycemia status, defined based on results of the oral glucose tolerance tests (OGTT): euglycemia, dysglycemia, and T2DM. The T2DM group was further split into: aware and unaware of T2DM diagnosis. Prevalence ratios (PR) and 95% CI were reported using Poisson regression models. RESULTS: Data of 1607 individuals, mean age 48.2 (SD: 10.6) years, 809 (50.3%) females, were analyzed. Dysglycemia and T2DM was present in 16.9% (95% CI: 15.1%-18.8%) and 11.0% (95% CI: 9.5%-12.6%) of participants, respectively. A total of 605 (37.6%; 95% CI: 35.2%-39.9%) participants had low levels of physical activity and 1019 (63.3%; 95% CI: 60.9%-65.7%) subjects spent ≥2 h per day sitting watching TV. In multivariable model, there was no significant association between glycemia status and physical activity levels (PR = 1.14; 95% CI: 0.95-1.36). Similar result was found between glycemia status and sitting time watching TV. However, those aware of T2DM diagnosis were more likely to have low levels of physical activity (PR = 1.31; 95% CI: 1.06-1.61) compared to the euglycemia group. CONCLUSIONS: We found a no relationship between glycemia status and physical activity level or sitting time watching TV, pointing out similar levels of physical (in)activity among those with euglycemia, dysglycemia and T2DM. Individuals aware of having T2DM were 30% more likely to have low physical activity levels compared to the euglycemic group. There is a need to increase physical activity levels among T2DM individuals.
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Exercício Físico , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Peru/epidemiologia , PrevalênciaRESUMO
RESUMEN Introducción: En Cuba, no existe consenso acerca de qué valor del índice cintura/cadera debe ser considerado de riesgo para identificar disglucemias. Objetivos: Determinar el punto de corte del índice cintura/cadera como predictor de disglucemias para ambos sexos, en personas con sospecha de padecer diabetes mellitus. Métodos: Estudio descriptivo transversal con 975 personas, de ellas 523 mujeres y 452 hombres. La muestra no fue obtenida de población general y no fue aleatoria. A los sujetos se les realizó interrogatorio, examen físico y estudios complementarios. Se determinaron distribuciones de frecuencia de las variables cualitativas y cuantitativas. Se utilizó para el procesamiento estadístico el coeficiente de correlación de Pearson, análisis de regresión logística y el análisis de curvas Receiver Operator Characteristic. Se empleó la prueba Chi Cuadrado para evaluar la significación estadística. Resultados: En ambos sexos observamos una correlación directamente proporcional y significativa entre el índice cintura/cadera y las diferentes variables estudiadas, entre ellas: glucemia en ayunas y a las 2h, insulinemia en ayunas, triglicéridos, ácido úrico y el índice de resistencia a la insulina (HOMA-IR). El colesterol se comportó de la misma forma en los hombres, pero en las mujeres se verificó una correlación débil y no significativa. El punto de corte óptimo del índice cintura/cadera, como predictor independiente de disglucemias, fue de 0,85 en las mujeres y 0,93 en los hombres. El índice cintura/cadera presentó un buen poder predictivo para identificar a sujetos con y sin disglucemias para ambos sexos y superior al de la edad. Conclusiones: El punto de corte óptimo del índice cintura/cadera, como predictor independiente de disglucemias, es de 0,85 en las mujeres y 0,93 en los hombres. Su poder predictor de disglucemias fue bueno(AU)
ABSTRACT Introduction: In Cuba, there is no consensus about what value of the waist-hip ratio must be considered as a risk to identify dysglycemia. Objectives: To determine the cut-off point of the waist-hip ratio as a predictor of dysglycemias for both sexes, in people suspected of suffering from diabetes mellitus. Methods: Descriptive cross-sectional study with 975 people, including 523 women and 452 men. The sample was not obtained from general population and it was not random. The subjects underwent interrogation, physical examination and complementary studies. There were identified frequency distributions of qualitative and quantitative variables. It was used for the statistical processing the Pearson's correlation coefficient, logistic regression analysis and the curves analysis called Receiver Operator Characteristic. It was used the chi-square test to assess the statistical significance. Results: In both sexes, it was observed a directly proportional and significant correlation between the waist-hip ratio and the different variables studied, including: fasting and after 2 hours glycemia, fasting insulinemia, triglycerides, uric acid and the insulin resistance index (HOMA-IR). Cholesterol behaved the same way in men, but in women there was a weak and not significant correlation. The optimal cut-point of the waist-hip ratio, as an independent predictor of dysglycemia, was 0.85 in women and 0.93 in men. The waist-hip ratio presented a good predictive power to identify subjects with and without dysglycemia for both sexes and it was higher than that of the age. Conclusions: The optimal cut-point of the waist-hip ratio, as an independent predictor of dysglycemia, was 0.85 in women and 0.93 in men. Its power as predictor of dysglycemia was good(AU)
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Humanos , Masculino , Feminino , Estado Pré-Diabético/epidemiologia , Pesos e Medidas Corporais/métodos , Relação Cintura-Quadril , Obesidade/diagnóstico , Exame Físico/métodos , Resistência à Insulina , Epidemiologia Descritiva , Estudos TransversaisRESUMO
RESUMEN Introducción: En Cuba no existe consenso acerca del valor del índice de conicidad que debe ser considerado de riesgo para identificar disglucemias. Objetivos: Determinar el punto de corte del índice de conicidad como predictor de disglucemia en ambos sexos. Métodos: Estudio descriptivo transversal con 975 personas (523 mujeres y 452 hombres), que asistieron a consulta externa del Instituto Nacional de Endocrinología por sospecha de diabetes mellitus entre abril de 2008 y abril de 2013. Se les realizó interrogatorio, examen físico y estudios complementarios (prueba de tolerancia oral a la glucosa, insulinemia en ayunas, lípidos y ácido úrico). Se utilizó para el procesamiento estadístico el coeficiente de correlación de Pearson, análisis de regresión logística y el análisis de curvas Receiver Operator Characteristic. Resultados: En el sexo femenino se observó una correlación directamente proporcional y significativa entre el índice de conicidad y las variables glucemia en ayunas y a las 2 h, insulinemia en ayunas, colesterol, triglicéridos, ácido úrico y el índice "homeostasis model assessment of insulin resistance". En el sexo masculino se observó una correlacióndirectamente proporcional y significativa entre el índice de conicidad y las variables estudiadas, excepto con los triglicéridos. El índice de conicidad tuvo su mayor poder predictor de disglucemia con un punto de corte de 1,18 para las mujeres y 1,20 en hombres. Conclusiones: El punto de corte óptimo del índice de conicidad como predictor de disglucemia fue de 1,18 para las mujeres y 1,20 para los hombres; es decir que tuvo un buen poder predictivo de disglucemias en el sexo femenino, no así en el masculino(AU)
ABSTRACT Introduction: In Cuba, there is no consensus about the value of the conicity index that should be considered as risk to identify dysglycemia. Objective: To determine the cut-off point of conicity index as a predictor of dysglycemia in both sexes. Methods: Cross-sectional descriptive study was conducted with 975 people (523 women and 452 men), who attended an outpatient consultation at the National Endocrinology Institute for suspected diabetes mellitus from April 2008 to April 2013. Interrogation, physical examination and complementary studies (oral glucose tolerance test, fasting insulinemia, lipids and uric acid) were performed. Pearson's correlation coefficient, logistic regression analysis and Receiver Operator Characteristic curve analysis were used for statistical processing. Results: In the female subjects, a directly proportional and significant correlation was observed between the conicity index and the fasting blood glucose variables and at 2 h, fasting insulinemia, cholesterol, triglycerides, uric acid and the index homeostasis model assessment of insulin resistance. In the male subjects, a directly proportional and significant correlation was observed between the conicity index and the variables studied, except with triglycerides. The conicity index had its highest predictive power of dysglycemia with a cut-off point of 1.18 in women and 1.20 in men. Conclusions: The optimal cut-off point of conicity index as a predictor of dysglycemia was 1.18 for women and 1.20 for men; that is to say, it was a good predictor of dysglycemias in the female subjects, but not so for male subjects(AU)
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Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Resistência à Insulina/fisiologia , Diabetes Mellitus/etiologia , Teste de Tolerância a Glucose/métodos , Epidemiologia Descritiva , Estudos Transversais , Análise de RegressãoRESUMO
Introducción: el índice cintura/cadera se presenta como un elemento más de la valoración clínica de la obesidad y sus consecuencias. Objetivo: describir la utilidad del empleo del índice cintura/cadera en la detección del riesgo cardiometabólico. Métodos: se utilizó Google Académico como motor de búsqueda y se obtuvo un total de 97 artículos, de los cuales 61 fueron referenciados por cumplir con el objetivo enunciado. Resultados: la obesidad se comporta como una enfermedad multifactorial, de evolución crónica, con importantes consecuencias para la salud. El incremento del tejido adiposo abdominal, propicia una mayor síntesis y liberación de adipoquinas y otras sustancias, que pueden deteriorar el metabolismo lipídico y glucídico a través del aumento de la resistencia a la insulina, e incrementan el riesgo cardiovascular. El índice cintura/cadera evalúa de forma indirecta la grasa abdominal. Es un indicador poco costoso, sencillo de aplicar y fácil de interpretar en los 3 niveles de atención de salud de nuestro país. Se debe determinar su punto de corte para cada zona geográfica, ya que este puede variar de acuerdo con la entidad nosológica que estemos investigando y la muestra de pacientes estudiados, pues varía con el sexo y las características étnicas. Su empleo ayuda a predecir el riesgo cardiometabólico y de mortalidad en las personas estudiadas. Conclusiones: el índice cintura/cadera es útil en la predicción del riesgo cardiometabólico. Su correcto empleo mejoraría la calidad de los servicios en los 3 niveles de atención de salud en nuestro país(AU)
Introduction: waist/hip index is presented as another element of the clinical assessment of obesity and its consequences. Objective: to describe the usefulness of waist / hip index in the detection of cardiometabolic risk. Methods: Google Scholar was used as a search engine and a total of 97 articles were obtained, of which 61 were referenced for fulfilling the stated objective. Results: obesity behaves like a multifactorial disease of chronic evolution, with important consequences for health. The increase in abdominal adipose tissue promotes greater synthesis and release of adipokines and other substances, which can impair lipid and carbohydrate metabolism through increased insulin resistance, and increase cardiovascular risk. Waist/hip index evaluates abdominal fat indirectly. It is an inexpensive indicator, easy to apply and easy to interpret in the 3 levels of health care in our country. Its cut-off point must be determined for each geographical area, since this may vary according to the nosological entity we are investigating and the sample of patients studied, as it varies with sex and ethnic characteristics. Its use helps to predict cardiometabolic risk and mortality in the people studied. Conclusions: Waist/hip index is useful in the prediction of cardiometabolic risk. Its correct use would improve the quality of services in the 3 levels of health care in our country(AU)
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Humanos , Literatura de Revisão como Assunto , Doenças Cardiovasculares/prevenção & controle , Síndrome Metabólica/epidemiologia , Relação Cintura-Quadril/estatística & dados numéricos , Obesidade/etiologia , Pesos e Medidas Corporais/métodos , Comportamento de Redução do RiscoRESUMO
BACKGROUND: The aim of this study was to examine the role of C-peptide as a biological marker of cardiometabolic risk in polycystic ovary syndrome (PCOS). METHODS: This case-control study enrolled 385 PCOS patients and 240 normal cycling women. Anthropometric and clinical variables were taken at first visit. Fasting C-peptide, glucose, lipids, and hormone measurements were performed. Simple and multiple correlations between C-peptide and other variables associated with dysmetabolism and cardiovascular disease were examined. RESULTS: C-peptide was well correlated with several anthropometric, metabolic, and endocrine parameters. In PCOS patients, stepwise multiple regression including C-peptide as the criterion variable and other predictors of cardiovascular disease risk provided a significant model in which the fasting C-peptide/glucose ratio, glucose, body weight, and free estrogen index (FEI) were retained (adjusted R2 = 0.988, F = 7.161, P = 0.008). CONCLUSION: C-peptide levels alone or combined with C-peptide/glucose ratio, glucose, body weight, and FEI provided a significant model to identify PCOS patients with higher risk of future cardiometabolic diseases.
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Introducción: la prevalencia de diabetes y prediabetes ha ido en aumento a nivel global y en Cuba. Para identificar individuos en riesgo de disglucemia se han desarrollado varias escalas. Objetivo: evaluar el desempeño de la escala de Bang y otros, para identificar individuos con disglucemia, en una población cubana laboralmente activa. Métodos: se realizó un estudio transversal en 2 902 pacientes, fueron clasificados en portadores o no de disglucemia, a través de las pruebas de glucemia en ayunas, de tolerancia a la glucosa y hemoglobina glucosilada. Se determinó la frecuencia de factores de riesgo de diabetes mellitus tipo 2 comprendidos en la escala de Bang y otros, y en el proceder enfocado en factores de riesgo de American Diabetes Association. Se determinó sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y Odds Ratio de ambas estrategias. En ambos se calculó el área bajo la curva operativa del receptor. Resultados: se encontró relación entre cada uno de los factores de riesgo previstos en ambos procederes con el diagnóstico de disglucemia. Se encontró sensibilidad de 96,5 por ciento y 79,9 por ciento; especificidad de 20,9 por ciento y 59,1 por ciento; valor predictivo positivo de 10,7 por ciento y 16,1 por ciento; valor predictivo negativo de 98,4 por ciento y 96,8 por ciento; OR de 7,33 y 6,76 y área bajo la curva 0,77 y 0,79 para la escala de Bang y otros, y el procedimiento enfocado en factores de riesgo, respectivamente. Conclusiones: ambos procederes identificaron de forma aceptable el grupo de pacientes con disglucemia(AU)
Introduction: The prevalence of diabetes and prediabetes has been increasing globally and also in Cuba. Several scales have been developed to identify individuals at risk for dysglycemia. Objective: To evaluate the performance of the Bang et al. scale to identify individuals with dysglycemia in a Cuban labor-active population. Methods: A cross-sectional study was carried out on 2 902 patients, classified as having or not suffering from dysglycemia, through fasting glycemia, glucose tolerance test and glycosylated hemoglobin. The frequencies of risk factors for type 2 diabetes mellitus included in the Bang et al. scale and in the risk factor approach of the American Diabetes Association were determined. Sensitivity, specificity, positive predictive value, negative predictive value and Odds Ratio of both strategies were determined. In both, the area under the receiver operating curve was calculated. Results: A relationship was found between each of the predicted risk factors in both procedures with the diagnosis of dysglycemia. Sensitivity was 96.5 percent and 79.9 percent; Specificity of 20.9 percent and 59.1 percent; Positive predictive value of 10.7 percent and 16.1 percent; Negative predictive value of 98.4 percent and 96.8 percent; OR of 7.33 and 6.76 and area under the curve 0.77 and 0.79 for the scale of Bang et al. and the procedure focused on risk factors respectively. Conclusions: Both procedures identified in an acceptable manner the group of patients with dysglycemia(AU)
Assuntos
Humanos , Estado Pré-Diabético/epidemiologia , Fatores de Risco , Índice Glicêmico , Diabetes Mellitus/epidemiologia , Teste de Tolerância a Glucose/métodos , Epidemiologia Descritiva , Estudos Transversais , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
Introducción: El exceso de peso se relaciona con condiciones que afectan la salud y la calidad de vida. La ubicación o distribución de la grasa corporal reviste especial interés desde el punto de vista clínico, y varía según sea difusa o localizada, básicamente en el abdomen.Objetivo: describir, en nuestros pacientes, la utilidad de índice cintura/talla en la detección de riesgo cardiovascular y metabólico.Desarrollo: un aumento clínicamente visible de la grasa abdominal y/o visceral obliga a realizar la búsqueda activa de algunos trastornos bioquímicos y clínicos, que se pueden ver como consecuencia de la presencia de obesidad central, la cual puede incrementar el riesgo cardiovascular y metabólico. El índice cintura/talla representa una correlación relativamente simple, útil y no invasiva, para ser aplicado en individuos vulnerables, y es una alternativa bastante utilizada en estudios poblacionales sobre obesidad y distribución regional de la grasa, teniendo en cuenta su eficacia para detectar riesgo cardiometabólico. La circunferencia de la cintura debe estar en menos de la mitad de la talla, de ahí que si es mayor de 0,5, es diagnóstica de obesidad abdominal, cifras mayores han mostrado tener una elevada correlación con el porcentaje de masa grasa corporal, y algunos profesionales lo reconocen como el mejor predictor de riesgo en pacientes con síndrome metabólico, equiparable al índice de masa corporal en la predicción de diabetes mellitus tipo 2, según algunos autores.Consideraciones finales: el índice cintura/talla es una de las correlaciones antropométricas de utilidad para detectar riesgo cardiovascular y metabólico(AU)
Introduction: Excessive weight is related to conditions affecting health and quality of life. Location or distribution of body fat arouses special interest from the clinical viewpoint and varies whether it is diffuse or localized, basically in the abdomen.Objective: to describe in our patients the usefulness of the waist-to-height ratio in the detection of the cardiovascular and metabolic risk.Development: clinically visible increase of the abdominal and/or visceral fat points to the active search of some biochemical and clinical disorders that may derive from the presence of central obesity which can in turn raise the cardiovascular and metabolic risk. The waist-to-height ratio represents a relatively simple, useful and non-invasive correlation index to be applied in vulnerable individuals. It is also a pretty used alternative in population-based studies on obesity and the regional distribution of fat, taking into account its efficacy for detection of the cardiometabolic risk. The waist circumference should measure less than the half of height, so if it is over 0.5, it indicates abdominal obesity. Higher figures have also shown great correlation with the percentage of body fat mass and some professionals admit that it is the best risk forecast in patients with metabolic syndrome. According to some authors, the waist circumference is comparable to the body mass index in type 2 diabetes mellitus prediction.Conclusions: the waist-to-height ratio is one of the useful anthropometric correlations to detect the cardiovascular and metabolic risk(AU)
Assuntos
Humanos , Doenças Cardiovasculares/epidemiologia , Síndrome Metabólica/epidemiologia , Obesidade Abdominal/epidemiologia , Razão Cintura-EstaturaRESUMO
The objective of this study was to identify intravascular ultrasound (IVUS), angiographic and metabolic parameters related to restenosis in patients with dysglycemia. Seventy consecutive patients (77 lesions) selected according to inclusion and exclusion criteria were evaluated by the oral glucose tolerance test and the determination of insulinemia after a successful percutaneous coronary intervention (PCI) with a bare-metal stent. The degree of insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR). Six-month IVUS and angiogram follow-up were performed. Thirty-nine patients (55.7 percent) had dysglycemia. The restenosis rate in the dysglycemic group was 37.2 vs 23.5 percent in the euglycemic group (P = 0.299). The predictors of restenosis using bivariate analysis were reference vessel diameter (RVD): £2.93 mm (RR = 0.54; 95 percentCI = 0.05-0.78; P = 0.048), stent area (SA): <8.91 mm² (RR = 0.66; 95 percentCI = 0.24-0.85; P = 0.006), stent volume (SV): <119.75 mm³ (RR = 0.74; 95 percentCI = 0.38-0.89; P = 0.0005), HOMA-IR: >2.063 (RR = 0.44; 95 percentCI = 0.14-0.64; P = 0.027), and fasting plasma glucose (FPG): ≤108.8 mg/dL (RR = 0.53; 95 percentCI = 0.13-0.75; P = 0.046). SV was an independent predictor of restenosis by multivariable analysis. Dysglycemia is a common clinical condition in patients submitted to PCI. The degree of insulin resistance, FPG, RVD, SA, and SV were correlated with restenosis. SV was inversely correlated with an independent predictor of restenosis in patients treated with a bare-metal stent.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Angioplastia Coronária com Balão , Reestenose Coronária/etiologia , Hiperglicemia/complicações , Stents , Angioplastia Coronária com Balão/efeitos adversos , Estudos de Coortes , Reestenose Coronária/metabolismo , Reestenose Coronária , Estenose Coronária/terapia , Estenose Coronária , Homeostase , Resistência à Insulina , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Ultrassonografia de IntervençãoRESUMO
OBJETIVO: conocer la frecuencia de hiperglucemia y resistencia a la insulina en un grupo de pacientes con riesgo de padecer trastornos del metabolismo de los carbohidratos. MÉTODOS: se realizó un estudio transversal descriptivo en una población del policlínico Reina, se estudiaron 118 pacientes, a los que se les midieron glucemia de ayuno y posprandial, después de una carga oral de glucosa e insulinemia. Se aplicó el índice de HOMA-IR para el cálculo de la insulinorresistencia. RESULTADOS: se obtuvo 5,1 porciento de pacientes con diabetes, todos mayores de 60 años de edad e hipertensos; 25,4 porciento de la muestra mostró algún grado de hiperglucemia en el rango de prediabetes. Los trastornos de la glucemia se incrementaron de manera paralela al aumento de la edad (p= 0,005). La insulinorresistencia fue detectada en 21,2 porciento del total de pacientes incluidos y en 53,8 porciento de los que presentaron algún trastorno del metabolismo hidrocarbonado; resultó aún más relevante en los pacientes con diabetes, en los que afectó a 83,3 porciento (p= 0,001). CONCLUSIONES: los trastornos asociados a la hiperglucemia asintomática y la resistencia a la insulina, asociada a la hiperglucemia, son frecuentes en la práctica clínica cuando se estudian grupos de riesgo de padecer diabetes(AU)
OBJECTIVE: to know the hyperglycemia frequency and resistance to insulin in a group of patients with risk of carbohydrates metabolism disturbances. METHODS: a cross-sectional and descriptive study was conducted in a population from the Reina polyclinic. A total of 118 patients were studied to measure the fast and postprandial glycemia after an oral load of glucose e insulinemia. For insulin-resistance calculus HOMA-IR index was applied. RESULTS: there was a 5.1 percent of diabetic patients aged over 60 and hypertensive; 25.4 percent of sample showed some degree of hyperglycemia in the pre-diabetes rank. Glycemia disturbances increased in a parallel way to age increase (p= 0.005). Insulin-resistance was detected in 21,2 percent of total of included patients and in 53.8 per of those presenting with some hydrocarbon metabolism disturbance being more marked in diabetic patients affecting to 83.3 percent (p= 0.001). CONCLUSIONS: hyperglycemia-associated disturbances and insulin-resistance associated with hyperglycemia are frequent in clinical practice when risk group are studied due to diabetes(AU)