Diabetic Ketoacidosis in Type 1 Diabetes Onset in Latin American Children.

OBJECTIVE: To describe the patterns of diabetic ketoacidosis (DKA) occurrence in children newly diagnosed with type 1 diabetes (T1DM) across several Latin American pediatric diabetes centers from 2018 to 2022. METHODS: A retrospective chart review included children under 18 with new-onset T1DM from 30 Latin American pediatric diabetes centers (Argentina, Chile, and Peru) between 30 December 2018 and 30 December 2022. Multiple logistic regression models examined the relationships between age, gender, medical insurance, BMI, and DKA at new-onset T1DM. As far as we know, there are no large studies in Latin American countries exploring the patterns of DKA in new-onset T1DM. RESULTS: A total of 2,026 (983 females) children, median age 9.12 (5.8 -11.7) years with new-onset-T1DM were included. Approximately 50% had no medical insurance. Mean glucose values were 467 mg/dL, pH 7.21, bicarbonate 13 mEq/L, HbA1c 11.3%, and BMI 18. The frequency of DKA was 1,229 (60.7%), out of which only 447 (36%) were severe. There was a significant decrease in the frequency of DKA as age increased: 373 (70.2%) in children under 6, 639 (61.6%) in those between 6 and 12, 217 and (47.5%) in those over 12. Children with medical insurance (58.8%) had a significantly lower frequency of DKA than those without (62.7%). The multiple logistic regression models showed that DKA was significantly and inversely associated with age [OR, 0.72 (95% CI 0.60-0.86)], BMI [OR, 0.95 (95% CI 0.92-0.99)], and medical insurance [OR, 0.75 (95% CI 0.60-0.94)] adjusted for sex. CONCLUSION: Latin American children with new-onset T1DM exhibited a substantial occurrence of DKA. Younger ages and the lack of medical insurance were significantly associated with DKA in new-onset T1DM.

Association between hepcidin and type 2 diabetes markers in indigenous Argentinean children living at high altitude.

BACKGROUND: Hepcidin is a protein that regulates the metabolism of iron. In addition, a high iron load can cause insulin resistance and subsequent diabetes. OBJECTIVE: To investigate the association between hepcidin levels and glucose, insulin, lipids, HOMA-IR, and inflammatory markers, C reactive protein (CRP), ferritin, Lp (a), and leucocytes, in indigenous school children living at 4000 m above sea level. Data were collected cross-sectionally from the four schools in San Antonio de los Cobres (SAC). BMI, glucose, insulin, lipids, CRP, hemoglobin, leucocytes, iron, ferritin, transferrin, and hepcidin levels were obtained. RESULTS: Three hundred and seventy-six children (170 males) aged 9.6 ± 2.3 y were included. Fifty-five(15.2 %) children were underweight, 28 (7.4 %) overweight and 10 (2.7 %) obese. Univariate analysis showed a significant inverse correlation between hepcidin and glucose (r = -0.14) and HOMA-IR (r = -0.30). Furthermore, hepcidin was found to be directly and significantly correlated with Lp(a) (r = 0.18), leucocytes (r = 0.24,) CRP (r = 0.32), and ferritin (r = 0.32). Multiple linear regression analysis indicated that hepcidin was significantly and inversely associated with glucose and BMI and directly with Lp(a), CRP, leucocytes, and ferritin; adjusted for age and gender (R2 0.26). CONCLUSION: In this study, which included indigenous children living at high altitudes (4000 m), hepcidin was significantly and inversely associated with glucose and BMI and directly associated with inflammatory markers such as CRP, Lp(a), leucocytes, and ferritin, suggesting that hepcidin could be a reliable marker of future type 2 diabetes.

Ability of TyG Index as a Marker of Insulin Resistance in Argentinean School Children.

Objective: To determine if the triglycerides and glucose index (TyG) can be used as a marker for insulin resistance (IR) in Argentinean schoolchildren according to age and sex. Methods: Anthropometric data, blood glucose levels, lipid profiles, and insulin levels were measured. The TyG index was defined by Ln [fasting triglyceride (mg/dL)* fasting glucose (mg/dL)/2]. A comparison of the ability of TyG to identify children with IR was performed using receiver operating characteristic (ROC) curves and the area under the ROC (AUROC) curve. IR was defined as HOMA-IR > III quartile. Results: A total of 915 (528, 57.7% males) apparently healthy schoolchildren, aged 9.3 ± 2.2, were evaluated. The AUROC using the HOMA-IR > III quartile as the dichotomous variable showed that TyG was a fair marker to identify IR (0.65, 95% CI, 0.61-0.69; p < 0.01). There was a significantly higher TyG AUROC in males (0.69, 95% CI, 0.63-0.75; p < 001) than in females (0.60, 95% CI, 0.54-0.66; p < 0.01). When children were divided according to age into two groups (5.0-9.9 and 10.0-14.9-year-olds); younger children (0.64, 95% CI, 0.58-0.69; p < 0.011) and older children (0.62, 95% CI, 0.55-0.68; p = 0.01) had a similar and fair AUROC. However, when children were divided by age and sex, females older than ten had a non-significant AUROC (0.53, 95% CI, 0.42-0.63; p = 0.61). The TyG index compared with HOMA-IR had low sensitivity and specificity, ranging from 0.62 to 0.56. Conclusion: The TyG index had a fair AUROC with low sensitivity and specificity, indicating poor discrimination in identifying IR in apparently healthy Argentinean children. The ability to use TyG for screening purposes seems limited in Argentinean schoolchildren.

Cardiometabolic markers among Argentinean normal weight and overweight children with and without central obesity.

BACKGROUND: The association between central obesity and cardiometabolic complications justifies exploring its association in normal-weight and overweight/obese (OW/OB) schoolchildren. OBJECTIVE: To describe cardiometabolic markers in four groups according to BMI/WC categories: (i) normal weight with central OB; (ii) normal weight without central OB; (iii) OW/OB with central OB and (iv) OW/OB without central OB, in a sample of Argentinean schoolchildren. METHODS: A cross-sectional study of 1264 Argentinean schoolchildren (624 F), aged 9.5 ± 2.2 years was performed between November 2013 and 2015. Children's anthropometric measures, blood pressure (BP), glucose, lipids, and insulin were measured. Children were divided into four groups: (i) normal weight with central OB; (ii) normal weight without central OB; (iii) OW/OB with central OB and (iv) OW/OB without central OB. RESULTS: The prevalence of normal-weight children without central OB was 64.3% (796), normal weight with central OB 5% (66), OW/OB without central OB 11% (137), and OW/OB with central OB 21% (265). Normal weight with central OB had significantly higher triglycerides than normal-weight children without central OB (86 vs 70 mg/dL, respectively) and OW/OB children without central OB (81 vs 77 mg/dL). Multiple linear regression analyses showed that age, systolic BP, HDL-C, triglycerides, and maternal WC were significantly associated with children's WC; R2 = 0.50 as well as children's BMI; R2 = 0.37. CONCLUSION: This study found that children with central OB might be at future higher cardiometabolic risk than those without central OB independently of the presence of OW/OB. However, future longitudinal studies should be performed to confirm these findings.

Influence of Telemedicine on the Number of Visits and HbA1c Determinations in Latin American Children with Type 1 Diabetes.

Objective: To measure the changes in the number of medical visits and the number of hemoglobin A1c (HbA1c) determinations according to telemedicine access in children with type 1 diabetes (T1DM) during the pandemic 2020 compared with 2019 and 2018. Methods: This is a multinational study of children with T1DM from four Latin American countries. The number of medical visits, the number of HbA1c determinations, and access to telemedicine during 2020 were extracted from their records. Results: Two hundred twenty-seven children (59% females) aged 12.7 ± 3.2 years with a duration of 5.4 ± 2.7 years of T1DM in 2018 were evaluated. There was a higher prevalence of children with telemedicine access in the pandemic 2020 versus those without [145 (63.9%) vs. 82 (36.1%); P < 0.01]. There was a higher number of medical visits during 2020 in children with telemedicine access versus those without (6.9 vs. 2.6; P < 0.01). Children with telemedicine access had a higher number of visits in 2020 versus 2018 (6.87 vs. 5.04, P < 0.01), but similar to 2019. Children without access had a lower number of visits in 2020 versus 2019 (2.6 vs. 5.5; P < 0.01) and versus 2018 (2.6 vs. 5.1; P < 0.01). In 2020, the number of HbA1c determinations in children with telemedicine access was higher versus those without (1.8 vs. 0.9; P < 0.01). Children with telemedicine access had a lower number of HbA1c determinations in 2020 versus 2019 (1.8 vs. 2.4; P < 0.01), but similar to 2018. Furthermore, children without access had a lower number of HbA1c determinations in 2020 versus 2019 (0.9 vs. 1.9; P < 0.01) and versus 2018 (0.9 vs. 2.0; P < 0.01). Conclusions: We found that children with T1DM with telemedicine access had a significantly higher number of medical visits and HbA1c determinations during lockdown than those without access in different Latin American centers.

Association Between High Birth Weight and Later Central Obesity in 9-Year-Old Schoolchildren.

Background and Objective: Studies have suggested that birth weight (BW) is associated with body mass index (BMI), but its association with waist circumference (WC) in children should be further explored. To determine the association between central obesity (OB) in 9-year-old Argentinean schoolchildren and high BW. Methods: Schoolchildren (n = 2567, 1157 males) aged 8.7 ± 2.1 years from 10 elementary schools in 5 states in Argentina were examined between April 2017 and September 2019. Mothers submitted children's BW information. Pediatricians assessed anthropometric measures and blood pressure (BP). Central OB was defined for children as WC ≥90th percentile for age and gender. Results: The prevalence of overweight (OW) and OB (OW/OB) was 42.7% (1095) and that of central OB was 34.8% (856) in 9-year-old children. The prevalence of low BW (<2500 grams) and high BW (>4000 grams) was 6.6% (n = 169) and 7.4% (n = 190), respectively. BW (3.25 vs. 3.36 kg), weight (31.38 vs. 42.88 kg), BMI (17.29 vs. 22.25 kg/m2), BMI z-scores (z-BMI; 0.25 vs. 1.63), systolic BP (96 vs. 98 mmHg), and diastolic BP (59 vs. 60 mmHg) were significantly lower in 9-year-old children without central OB than in those with central OB, respectively. Multiple logistic regression analysis using central OB as the dependent variable showed that high BW [odds ratio, 1.98 (95% confidence interval 1.44-2.73)] was associated with central OB, adjusted for age, gender, and systolic and diastolic BP. Conclusion: This study shows that central OB in 9-year-old children was associated with high BW. Future longitudinal studies should be performed to confirm this finding. Clinical Registration number, IATIMET-08102019.

Presencia de COVID-19 en Argentinos menores de 65 años / Presence of COVID-19 in Argentines under 65 years of age

Antecedentes: la presencia del virus COVID-19 se ha asociado con adultos de 65 años o más. Sin embargo, poco se ha destacado en los jóvenes. Objetivos: determinar la asociación de COVID-19 positivo y edad, sexo, índice de masa corporal (IMC), condiciones de salud subyacentes, hospitalización y muerte.Materiales y métodos: se realizó un estudio transversal en individuos de 18 a 65 años que fueron evaluados para COVID-19 en el Hospital de Agudos Carlos G. Durand de la Ciudad Autónoma de Buenos Aires, en julio de 2020, durante 15 días. Se calcularon datos sobre sexo, edad, tabaquismo, asma e hipertensión. Se utilizó reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR, del inglés reverse transcription polymerase chain reaction) para la detección del ácido ribonucleico ARN de SARS-CoV-2 (en inglés, severe acute respiratory syndrome coronavirus 2). Resultados: se incluyó en el estudio un total de 407 (225 femenino, 55,3%) individuos de 37,5±11,4 años. El 48,6% (189) fue confirmado COVID-19. El IMC promedio fue 27,5±5,2. El 37,1% (151) tenía sobrepeso y el 26,8% (109) era obeso. Hubo una prevalencia significativamente mayor de COVID-19 confirmada en personas con asma (7,9% vs 2,5%; p=0,01). El resultado COVID-19 confirmado se asoció con el sexo masculino (r=-0,12; p=0,02) y la presencia de asma (r=0,11; p=0,02). Los análisis de regresión logística múltiple mostraron que la COVID-19 confirmada se asoció con el sexo masculino (OR 0,62; IC del 95%: 0,42-0,93; p 0,02) y el asma (OR3,30; IC del 95%: 1,17-9,34; p 0,02) ajustado por variables de confusión. Hubo una mayor prevalencia de hipertensión (21,1% vs 5,4%; p=0,024) entre quienes fueron hospitalizados. La hospitalización se asoció con hipertensión (OR5,71 IC del 95%: 1,43-22,75; p 0,014) ajustada por variables de confusión. Conclusiones: la COVID-19 se diagnosticó en individuos menores de 65 años, que es un grupo de edad diferente al reportado habitualmente. La COVID-19 confirmada se asoció con el sexo masculino y el asma. La tasa de individuos hospitalizados fue del 4,4% y se asoció con hipertensión. La tasa de mortalidad de los examinados fue del 0%. Deben realizarse estudios longitudinales futuros para confirmar estos hallazgo

Background: the presence of the COVID-19 virus has been associated with adults aged 65 years and older. However, little has been highlighted in younger people. Objectives: to determine the association of positive COVID-19 and age, sex, body mass index (BMI), underlying health conditions, hospitalization, and death. Materials and methods: a cross-sectional study was performed in individuals aged 18 to 65 who were tested for COVID-19 at a Hospital in Buenos Aires in July 2020 over 15 days. Data on sex, age, smoking, asthma, and hypertension were assessed. RT-PCR was used for the detection of the RNA of SARS-CoV-2. Results: a total of 407 (225 female, 55.3%) individuals aged 37.5±11.4 were included in the study. 48.6% (189) were confirmed COVID-19. The average BMI was 27.5±5.2; 37.1% (151) were overweight and 26.8% (109) obese. There was a significantly higher prevalence of confirmed COVID-19 in individuals with asthma (7.9% vs 2.5%; p=0.01). Confirmed COVID-19 was associated with the male sex (r=-0.12; p=0.02) and the presence of asthma (r=0.11; p=0.02). Multiple logistic regression analyses showed that confirmed COVID-19 was associated with male sex (OR 0.62, 95% CI 0.42-0.93; p 0.02) and asthma (OR3.30, 95% CI 1.17-9.34; p 0.02) adjusted for confounding variables. There was a higher prevalence of hypertension (21.1% vs 5.4%; p=0.024) among those who were hospitalized. Hospitalization was associated with hypertension (OR5.71 95% CI 1.43-22.75; p 0.014) adjusted for confounding variables. Conclusions: we found that COVID-19 was diagnosed in individuals younger than 65 years, which is a different age group than the usually reported. Confirmed COVID-19 was associated with male sex and asthma. The rate of hospitalized individuals was 4.4% and was associated with hypertension. The mortality rate for those tested was 0%. Future longitudinal studies should be performed to confirm these findings

Asociación del peso al nacer con adiposidad en niños escolares de distintas regiones de argentina / Association of birth weight with adiposity in school children from different regions of argentina

Introducción: diversos estudios han sugerido que el bajo y alto peso al nacer (PN) se asocian a obesidad (OB) y sobrepeso (SP) durante la infancia y la edad adulta. Objetivos: determinar la asociación entre PN y OB en escolares de 9 años de tres regiones de Argentina. Materiales y métodos: las medidas antropométricas y la presión arterial (PA) se tomaron en 1.131 escolares (505 masculinos) de 8,8±2,1 años de edad promedio, en tres regiones de Argentina durante el año 2019. Se interrogó, además, acerca del peso al nacer y el estilo de vida. Resultados: el 21,1% (239) de los niños presentaba SP (IMC>85 <95 percentilo según CDC) y el 21,8% (246) OB (IMC>95 percentilo). La prevalencia de PN bajo (<2.500 g) fue de fue de 6,2% (n=70) y de PN alto (>4.000 g) de 7,3% (n=82). El puntaje z-IMC de los niños de 9 años aumentaba significativamente con el aumento del PN: PN bajo (z-IMC=0,33), normal (z-IMC=0,72) y alto (z-IMC=1,12). En modelos de regresión logística múltiple se observó que el PN bajo se asoció inversamente a la OB (OR, 0.41 [IC del 95%: 0,19-0,92]), mientras que el PN alto se asoció directamente con la OB ajustado por edad y sexo (OR, 2.48 [95% IC 1,53-4,02]). Conclusiones: nuestros datos indican que el alto PN, pero no el bajo PN, se asocia con OB en niños en edad escolar de 9 años, mientras que el bajo PN está inversamente asociado con OB.

Introduction: several studies have suggested that low and high birth weight are associated with obesity (OB) and overweight (OW) during childhood and adulthood. Objectives: to determine the association between birth weight and OB in 9-year-old schoolchildren from three areas of Argentina. Materials and methods: anthropometric measurements and blood pressure (BP) were taken in 1.131 schoolchildren (505 males) of an average age of 8.8±2.1 years in three areas of Argentina during 2019. Mothers were asked about their children's birth weight and lifestyle. Results: 21.1% (239) of the children had OW (BMI>85 <95 percentile according to the CDC) and 21.8% (246) OB (BMI>95 percentile). The prevalence of low birth weight (<2.500 g) was 6.2% (n=70) and of high birth weight (>4.000 g) was 7.3% (n=82). The 9-year-old z-BMI score increased significantly with increasing birth weight: low birth weight (z-BMI=0.33), normal (z-BMI=0.72) and high (z-BMI=1.12). In multiple logistic regression models, it was found that low birth weight was inversely associated with OB (OR, 0.41 [95% CI: 0.19-0.92]), while high birth weight was directly associated with OB adjusted for age and sex (OR, 2.48 [95% CI 1.53-4.02]). Conclusions: our data indicate that high birth weight, but not low birth weight, is associated with OB in 9-year-old schoolchildren, while low birth weight is inversely associated with OB

Adiposity, lifestyle behaviors, and cardiometabolic markers in Argentinean schoolchildren.

BACKGROUND: We determined the association between schoolchildren's OW/OB with age, sex, lifestyle behaviors, and cardiometabolic markers. METHODS: Age, sex, anthropometric measures, and BP (blood pressure) were recorded in 1249 (554 M) schoolchildren. OW/OB was defined as BMI > 85%ile and BMI > 95%ile respectively. A validated questionnaire for lifestyle behaviors was performed. We offered free laboratory testing to a subgroup of 168 children. RESULTS: Schoolchildren aged 8.8 ± 2.1 y from 9 elementary schools in 4 areas of Argentina were examined between April and September 2019. 265 (21.2%) of the children were OW, 265 (21.2%) were OB, and 425 (35%) had central OB. OW/OB was associated with low milk intake (OR = 1.92; 95% CI, 1.1-3.3), skipping breakfast (OR = 2.00; 95% CI, 1.2-3.4), a family history of hypertension (OR = 1.74; 95% CI, 1.1-2.9), and systolic BP (OR = 1.03; 95% CI, 1.01-1.05); adjusted for confounding variables. The subgroup analysis showed that OW/OB children had lower iron (83 vs. 94 ug/dl, respectively) and HDL-C (43 vs. 47 mg/dl) levels, but higher non-HDL-C (107 vs. 99 mg/dl) levels than normal-weight children. Multiple logistic regression analysis showed that OW/OB was inversely associated with iron (OR = 0.99; 95% CI, 0.98-0.998) and HDL-C (OR = 0.94; 95% CI, 0.91-0.97) levels; adjusted for confounding variables. CONCLUSION: Adiposity in schoolchildren was associated with unhealthy lifestyle behaviors, higher atherogenic risk, and lower iron concentrations, suggesting that OW/OB children are at increased risk for anemia and cardiometabolic disease.

Activity of Lipoprotein-Associated Enzymes in Indigenous Children Living at Different Altitudes.

BACKGROUND: High altitude is associated with hypobaric hypoxia, and metabolic modifications. In particular, alterations to lipoprotein-associated enzymes have been reported under hypoxia. OBJECTIVE: To determine the association between paraoxonase 1 (PON-1) and Cholesteryl-ester transfer protein (CETP) activities and altitude in two groups of Argentinean Indigenous schoolchildren living at different altitudes. METHODS: A cross-sectional study compared 151 schoolchildren from San Antonio de los Cobres (SAC), 3,750 m, with 175 schoolchildren from Chicoana (CH), 1,400 m. Anthropometric data, lipids, apolipoprotein (apo) A-I, apo B, plus PON-1 and CETP activities were determined. RESULTS: The prevalence of overweight/obesity was significantly lower in SAC than in CH. Z- BMI (0.3 vs 0.7), Apo A-I/Apo B (1.67 vs. 1.85) and PON-1 (170 vs. 243 nmol/mL.min) were significantly lower in SAC than in CH, respectively. Total cholesterol (156 vs 144 mg/dL), triglycerides (TG) (119 vs. 94 mg/dL), apo A-I (133 vs. 128 mg/dL), apo B (84 vs. 73 mg/dL), hematocrit (48 vs. 41%), transferrin (295 vs. 260 mg/dL) and CETP (181 vs. 150%/mL.h) were significantly higher in SAC than in CH. There was a significant univariate association between altitude and transferrin (r0.38), hematocrit (r0.75), TG (r0.24), apo B (r0.29), PON-1 (r-0.40), and CETP (r0.37). Multiple linear regression analyses showed that altitude was significantly associated with children's TG (ß = 0.28, R2 = 0.14), HDL-C (ß = â€’0.27; R2 = 0.23), apo B (ß = 0.32; R2 = 0.14), CETP (ß = 0.38; R2 = 0.15) and PON-1 (ß = â€’0.36; R2 = 0.16), adjusted for age, gender and BMI. CONCLUSION: SAC children presented a more atherogenic lipid profile, plus lower PON1 and higher CETP activities, than CH children.

Non-high-density lipoprotein cholesterol curves in Argentinean indigenous children living at high altitude and US children.

OBJECTIVE: To describe the non-high-density lipoprotein cholesterol (non-HDL-C) as mean and percentiles by age and sex in Argentinean indigenous schoolchildren living at 3750 m, contrasting these estimates with those reported in the 2011-2012 National Center for Health Statistics reference population (NHANES). METHODS: Non-HDL-C was calculated as total cholesterol-HDL-C. Analyses incorporated sampling weights for age and sex to obtain unbiased estimates. Sex- and age-specific smoothed percentile curves were performed with Cole's LMS method. RESULTS: A total of 236 (49% males) children from San Antonio de los Cobres (SAC) were evaluated twice and compared with 1409 NHANES children. Non-HDL-C values were 4 mg/dL higher in SAC than in NHANES (109 vs 105 mg/dL, respectively). Trends in non-HDL-C 50th percentile in females differed between ages 6 to 7 and 8 years; in SAC non-HDL-C decreased from 111 to 104 mg/dL, NHANES levels remained stable from103 to 104 mg/dL. Among children aged 9 to10 years, non-HDL-C increased from 114 mg/dL to 117 mg/dL in SAC, but decreased from 113 to 107 mg/dL in NHANES. Between ages 12 and 13 years, non-HDL-C increased from 108 to 120 mg/dL in SAC, and remained steady from105 to 106 mg/dL in NHANES. The 50th percentile of non-HDL-C in males showed similar trends except for ages 6 to 7 to age 8 when non-HDL-C remained stable from 106 to 107 mg/dL in SAC, and increased from 98 mg/dL to 104 mg/dL in NHANES. CONCLUSIONS: Non-HDL-C levels in children vary with age, sex, ethnicity, and altitude. Different patterns in non-HDL-C were observed for girls in SAC compared with NHANES. However, more stable patterns were observed in boys in both groups.

Regulation of Serum Sphingolipids in Andean Children Born and Living at High Altitude (3775 m).

Recent studies on Andean children indicate a prevalence of dyslipidemia and hypertension compared to dwellers at lower altitudes, suggesting that despite similar food intake and daily activities, they undergo different metabolic adaptations. In the present study, the sphingolipid pattern was investigated in serum of 7 underweight (UW), 30 normal weight (NW), 13 overweight (OW), and 9 obese (O) Andean children by liquid chromatography-mass spectrometry (LC-MS). Results indicate that levels of Ceramides (Cers) and sphingomyelins (SMs) correlate positively with biochemical parameters (except for Cers and Vitamin D, which correlate negatively), whereas sphingosine-1-phosphate (S1P) correlates negatively. Correlation results and LC-MS data identify the axis high density lipoprotein-cholesterol (HDL-C), Cers, and S1P as related to hypoxia adaptation. Specifically UW children are characterized by increased levels of S1P compared to O and lower levels of Cers compared to NW children. Furthermore, O children show lower levels of S1P and similar levels of Cers and SMs as NW. In conclusion, our results indicate that S1P is the primary target of hypoxia adaptation in Andean children, and its levels are associated with hypoxia tolerance. Furthermore, S1P can act as marker of increased risk of metabolic syndrome and cardiac dysfunction in young Andeans living at altitude.

Vitamin D Levels and Cardiometabolic Markers in Indigenous Argentinean Children Living at Different Altitudes.

The objective of this study was to assess the association between vitamin D and cardiometabolic markers in 2 indigenous communities from similar ethnic backgrounds, but living at different altitudes. A cross-sectional study compared 152 (72 females) indigenous schoolchildren from San Antonio de los Cobres (SAC), 3750 m above sea level, with 175 (86 females) from Chicoana (CH), 1400 m above sea level, mean age 9 years. Anthropometry, blood pressure, lipids, glucose, insulin, and vitamin D were assessed in spring season. The prevalence of children's overweight/obesity was significantly lower in SAC, 9.2% (13), than in CH, 41.5% (71). There was a significantly higher prevalence of vitamin D deficiency (<20 ng/mL) in SAC (n = 103, 67.7%) than in CH (n = 62, 36.3%). SAC showed an inverse correlation between vitamin D and insulinemia (r = -0.17, P < .05), whereas CH showed an inverse correlation between vitamin D and systolic blood pressure (r = -0.19, P < .05), z-BMI (body mass index; r = -0.25, P < .01), triglycerides (r = -0.15, P < .05), glucose (r = -0.35, P < .05), and insulinemia (r = -0.24, P < .01). Multiple linear regression analysis showed that vitamin D (ß = -.47; R 2 = .21) was significantly associated with SAC location, adjusted for confounding variables. Vitamin D levels were significantly and directly associated with altitude and inversely with metabolic markers, suggesting that populations living at high altitudes are at higher risk for future cardiovascular diseases.

Blood pressure levels among Indigenous children living at different altitudes.

The objective was to compare blood pressure (BP) levels in 2 groups of Indigenous Argentine school children from similar ethnic backgrounds but living at different altitudes. One hundred and fifty-two (46.3%) children (age, 4-14 years) from San Antonio de los Cobres (SAC), at 3750 m above sea level, and 176 children (53.7%) from Chicoana (CH), at 1400 m above sea level, participated in this cross-sectional study. Data for children's anthropometry, BP, glucose, lipids, vitamin D, and insulin, as well as mothers' height and weight were assessed. Hypertension was defined as BP ≥ 95th percentile. The prevalence of overweight/obesity among children was significantly lower in SAC (n = 17, 11.2%) than in CH (n = 74, 42%) (body mass index (BMI) > 85th percentile per US Centers for Disease Control and Prevention norms). However, the prevalence of hypertension was significantly higher among children in SAC (n = 15, 9.9%) than among those in CH (n = 2, 1.1%). Children were divided into 4 groups by mean arterial BP quartiles for comparison by ANOVA. As mean arterial BP increased, age, BMI, glucose, triglycerides, triglycerides/high-density lipoprotein cholesterol, and insulin levels increased significantly. Multiple linear regression analyses showed that children's mean arterial BP was significantly associated with altitude adjusted for confounding variables (R2 = 0.42). Furthermore, when mean arterial BP was replaced by systolic BP (R2 = 0.51) or diastolic BP (R2 = 0.33), similar results were obtained. Our results suggest that Indigenous children who live permanently at high altitude have higher levels of BP, adjusted for confounding variables. Routine BP measurements conducted in the SAC community could be essential for the prevention of cardiovascular disease.

Blood pressure level increase with altitude in three argentinean indigenous communities.

OBJECTIVE: To compare blood pressure (BP) levels in three groups of Argentinean Indigenous schoolchildren from similar ethnic backgrounds but living at three different altitudes. METHODS: A cross-sectional study compared 185 (83 females) children aged 5-14 years from San Antonio de los Cobres (SAC), 3750 m above sea level; 46 (23 females) from Cobres, 3450 m; and 167 (83 females) from Chicoana (CH), 1400 m. Anthropometric and BP measurements were performed. RESULTS: The prevalence of overweight/obesity was lower in SAC (6.5% [12]) and Cobres (4.3% [2]) than in CH (24% [24]) (BMI > 85 percentile per CDC norms). Systolic BP increased significantly with altitude: (SAC 86 mm Hg, Cobres 77 mm Hg, and CH 69 mm Hg). Similar results were obtained with diastolic BP (SAC 57 mm Hg, Cobres 51 mm Hg, and CH 47 mm Hg) and with median arterial pressure (MAP) (SAC 67 mm Hg, Cobres 60 mm Hg, and CH 55 mm Hg). Multiple linear regression analyses showed that altitude was significantly and independently associated with children's systolic BP (beta 10.56; R2 = 0.40), diastolic BP (beta 6.27; R2 = 0.25) and MAP (beta 7.69; R2 = 0.32); adjusted for age, sex, and BMI. CONCLUSIONS: We found that as altitude increased, BP levels increased significantly in indigenous children from similar backgrounds living permanently at different altitudes.

Prevalence of hypertension in argentinean indigenous children living at high altitudes versus US children.

BACKGROUND: Exposure to hypoxia at high altitude is increasingly being recognized as a risk factor for hypertension. OBJECTIVE: To compare the prevalence of hypertension in Indigenous Argentinean children living at high altitude with that reported in the 2011-2012 National Health and Nutrition Examination Survey (NHANES) of US children. METHODS: A cross-sectional study of 811 (400 females) Argentinean Indigenous school children (8-14 years) from San Antonio de los Cobres (SAC) was performed between 2011-2014. SAC is located in the Andean foothills 3,750 m above sea level. 98% of its population is Indigenous. Anthropometric, BP, and biochemical data were obtained from SAC and compared with those of 1279 (625 females) US children. Pre-hypertension and hypertension were defined by BP≥90th to <95th percentile or ≥95th percentile, respectively. RESULTS: The prevalence of obesity was significantly lower in SAC (22; 2.7%) than in the US (310; 24.3%). However, the prevalence of hypertension was significantly higher in SAC (129; 15.9%) than in US children (35; 2.9%). Multiple logistic regression analyses showed that SAC children had four times the odds of having pre-hypertension compared with US children (OR 4.47; 95% CI 3.29-6.08), and eight times the odds of presenting hypertension (OR 8.36; 95% CI 5.36-13.05), adjusted for age, gender, and BMI. CONCLUSIONS: This study shows a higher prevalence of hypertension in Indigenous Argentinean children living at high altitude compared with US children. Various factors such as high hemoglobin levels, lifestyle behavior, and genetics may have an influence on BP in high altitude Indigenous SAC children. ABBREVIATIONS: BP: Blood pressure; SAC: San Antonio de los Cobres; CDC: Centers for Disease Control and Prevention; NHANES: National Health and Nutrition Examination Survey.

Type 2 diabetes markers in indigenous Argentinean children living at different altitudes.

BACKGROUND: Exposure to hypoxia at high altitude is increasingly being recognized as a risk factor for metabolic diseases. OBJECTIVE: To determine the association between Type 2 diabetes (T2D) risk factors and altitude in two groups of Argentinean indigenous schoolchildren who live permanently at different altitudes. METHODS: This cross-sectional study compared 142 schoolchildren from San Antonio de los Cobres (SAC), 3750 m above sea level, with 171 from Chicoana (CH), 1400 m. Data for children's anthropometry, blood pressure and lipids, as well as mothers' height and weight were assessed. RESULTS: There was not a significant difference in age between SAC (9.0 + 2y) and CH (9.4 + 2y) children. However, mean children's weight (29 vs. 38 kg), height (130 vs. 138 cm), BMI (17 vs. 19 kg/m2), and HDL-C (46 vs. 48 mg/dL) were significantly lower in SAC than in CH, respectively. In contrast, systolic blood pressure (87 vs. 70 mmHg), cholesterol (157 vs. 148 mg/dL), and triglycerides (104 vs. 88 mg/dL) were significantly higher in SAC than in CH, respectively. There was not a significant difference in age (33.2 + 7y vs. 34.4 + 8y) and BMI (26.2 + 4y vs. 28 + 5y) between SAC and CH mothers. Multiple linear regression analyses showed that children's blood pressure (R2 = 0.38), triglycerides (R2 = 0.21), and HDL-C (R2 = 0.16) were significantly associated with altitude, adjusted for confounding variables. CONCLUSION: This study shows that indigenous Argentinean children living at 3750 meters have higher T2D risk compared with those living at 1400 meters above sea level.