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We hypothesized that higher scores on the dietary inflammatory index (DII) would be associated with a lower glomerular filtration rate (GFR). This cross-sectional study included 2098 participants from Mexican Teachers Cohort Study, the Health Workers Cohort Study, and the Comitán Study belonging to the RenMex consortium. Energy-adjusted DII scores were estimated using a semi-quantitative food frequency questionnaire (FFQ). eGFR was estimated by the CKD Epidemiology Collaboration equation. Quantile regression models and ordered regression models were estimated to assess the associations of interest. Median age of study participants was 47 years, median eGFR was 102.9 mL/min/1.73m2, and the median energy-adjusted DII was 0.89 (range, -2.25, +4.86). The median eGFR was lower in participants in the highest percentile of DII compared to those in the lowest percentile (103.8 vs 101.4). We found that continuous and categorical energy-adjusted DII scores were associated with lower eGFR, especially at the lower percentiles. In adjusted ordered logistic regression, we found that the highest DII category was associated with 1.80 times the odds of belonging to the mildly decreased eGFR category or moderately decreased eGFR category compared lowest DII category (OR: 1.80, 95%CI 1.35, 2.40). A high DII score was associated with a lower eGFR among the Mexican population. Additional studies are crucial to validate these findings and explore potential strategies to reduce the consumption of pro-inflammatory foods as a preventive approach for chronic kidney disease (CKD).
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Dieta , Taxa de Filtração Glomerular , Inflamação , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , México/epidemiologia , Estudos Transversais , Adulto , Insuficiência Renal Crônica/epidemiologia , Estudos de Coortes , Fatores de RiscoRESUMO
Plasmatic uric acid (UA) has been inconsistently associated with diabetic retinopathy (DR). Specific sight-threatening stages of DR have not been studied for their association with UA. Cross-sectional, comparative study. Between 2014 and 2018 we recruited 210 Mexican individuals > 18 years-old with type 2 diabetes (T2D). Clinical, ophthalmological and biochemical assessment was performed with standardized funduscopic examination. Certified readers classified DR stages. The association between DR and UA was assessed by multiple logistic regression analysis, calculating odds ratios (OR) and 95% CI, after adjustment for covariates. Two hundred and ten patients were included, 41 (19.5%) had referable DR. Subjects with referable (severe or worse) DR had longer diabetes duration, 22 (15-28) vs 15 (8-20) years (P < 0.01); higher levels of UA, 6.5 (5.8-8.1) vs 5.4 (4.5-6.6) mg/dL (P < 0.01); higher systolic blood pressure, 130 (120-140) vs 120 (110-130) mmHg (P < 0.01); higher diastolic blood pressure, 78.4 ± 9.7 vs 75.4 ± 9.2 mmHg (P = 0.03); and lower glomerular filtration rate , 54.1 (41.5-69.6) vs 87.3 (66.8-108.3) mL/min/1.73m2 (P < 0.01) compared with those without referable DR. With multiple logistic regression, after adjustment, per each unit of change (mg/dL) in UA the probability of having referable DR increased 45% (OR = 1.45, 95% CI 1.12-1.87, P < 0.01). When UA was evaluated as dichotomous variable, those with levels ≥ 7.8 mg/dL had almost two times (OR = 2.81, 95% CI 1.00-7.9., P = 0.049) the probability of having referable DR compared with those with levels < 7.8 mg/dL. UA may contribute to the microvascular damage in retinal vessels and therefore hyperuricemia could be a therapeutic target to prevent DR progression.
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Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Ácido Úrico , Humanos , Retinopatia Diabética/sangue , Retinopatia Diabética/etiologia , Ácido Úrico/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/sangue , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Idoso , Adulto , Fatores de RiscoRESUMO
OBJECTIVE: Periodontitis ranks sixth as a type 2 diabetes (T2D) complication. According to its severity, it may cause pain, discomfort and tooth loss. The aim of this study was to evaluate the impact of self-reported periodontal status on the Oral Health Related Quality of Life (OHRQoL) of people with T2D. METHODS: A cross-sectional study was conducted involving seventy-nine adults with T2D who visited the Metabolic Syndrome clinic at the Cosío Villegas National Institute of Respiratory Diseases in Mexico City between August and November 2010. The OHRQoL was evaluated with the shortened Oral Health Impact Profile (OHIP-EE14). Periodontitis was measured by self-report, probing depth (PD), and clinical attachment loss (CAL). The association between self-reported periodontal status and OHRQoL was evaluated with binomial regression models. RESULTS: Mean age of the participants was 60,4 years (SD=9,6); diabetes duration was 10,1 years (SD=6,6). The OHRQoL was associated with self-perception of bad breath (RR=1,58; p=0,025), self-perception of poor gum health (RR=1,66; p=0,016), dissatisfaction with chewing ability (RR=2,22; p≤0,001), tooth loss due to mobility (RR=1,74; p=0,019), and presence of 20 teeth or less (RR=1,57; p=0,045). CONCLUSIONS: OHRQoL is associated with self-report of bad breath, poor gum health and dissatisfaction with chewing ability in people with T2D, which suggests that self-perceived oral conditions represent signs and symptoms of functional and psychological impairment related to severe periodontitis.
OBJECTIVE: La periodontitis es la sexta complicación de la diabetes tipo 2 (DT2); dependiendo de su severidad puede causar dolor, incomodidad o hasta pérdida dental. El objetivo del estudio fue evaluar el impacto del estado periodontal autorreportado en la Calidad de Vida Relacionada con la Salud Oral (CVRSO) en personas con DT2. METHODS: Se realizó un estudio transversal que incluyó a setenta y nueve adultos con DT2 atendidos en la Clínica de Síndrome Metabólico del Instituto Nacional de Enfermedades Respiratorias Cosío Villegas en la Ciudad de México, entre agosto y noviembre de 2010. La CVRSO se evaluó con el cuestionario Perfil de Impacto en la Salud Bucal acortado (OHIP-EE14). La periodontitis se evaluó por autorreporte, profundidad al sondeo (PS) y pérdida de inserción clínica (PIC). La asociación entre estado periodontal autorreportado y CVRSO se evaluó con modelos de regresión binomial negativa. RESULTS: La edad promedio fue de 60,4 años (DE=9,6); la duración de diabetes de 10,1 años (DE=6,6). La CVRSO se asoció con la autopercepción de mal aliento (RR=1,58, p=0,025), autopercepción de mala salud de las encías (RR=1,66, p=0,016), insatisfacción de la habilidad para masticar (RR=2,22, p≤0,001), pérdida de algún diente con movilidad previa (RR=1,74, p=0,019) y 20 dientes presentes o menos (RR=1,57, p=0,045). CONCLUSIONS: La CVRSO se asocia con el autorreporte de mal aliento, mala salud de las encías e insatisfacción de la habilidad para masticar en personas con DT2; esto sugiere que las condiciones bucales autopercibidas representan signos y síntomas de deterioro funcional y psicológico relacionados con la periodontitis severa.
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Diabetes Mellitus Tipo 2 , Periodontite , Perda de Dente , Adulto , Humanos , Qualidade de Vida/psicologia , Diabetes Mellitus Tipo 2/complicações , Autorrelato , Perda de Dente/epidemiologia , Estudos Transversais , México/epidemiologia , Saúde Bucal , Espanha , Periodontite/complicações , Periodontite/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND & AIMS: To evaluate the association between soft drinks (SDs) consumption and estimated glomerular filtration rate (eGFR) in a Mexican adult population. METHODS: We used data from the RenMex consortium (n = 2095) that included the Mexican Teachers Cohort Study (34-65 years), the Health Workers Cohort Study (18-90 years), and the Comitán Study (19-91 years). In this cross-sectional study, we assessed SDs consumption (cola and flavored soda) using a food frequency questionnaire (FFQ) and estimated eGFR using the CKD Epidemiology Collaboration equation. Quantile regression was used to assess the association between SDs consumption and eGFR with eGFR as a continuous variable. Multinomial logistic regression models were used for eGFR categories derived from quantile regression (mildly decreased eGFR, ≥72.9-87.9 mL/min/1.73 m2 and moderately decreased eGFR, <72.9 mL/min/1.73 m2). RESULTS: Mean age of study participants was 47.2 years, 67.5% were women, and 12.2% had diabetes. eGFR was <60 mL/min/1.73 m2 in 3.7% of study participants. Mildly decreased eGFR was present in 14.8%, and moderately decreased eGFR was present in 10.1% of study participants. Quantile regression results showed that SDs consumption was associated with lower eGFR at the 10th, 25th, 50th and 75th percentile. Based on the final adjusted multinomial model, ≥7 servings/week was positively associated with moderately decreased eGFR relative to <1 serving/week (Relative Risk Ratio = 1.95; 95% CI: 1.07-3.57). CONCLUSION: Our results suggest that higher SDs consumption is associated with lower eGFR. Encouraging healthy dietary choices should be part of the management and prevention of CKD.
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Insuficiência Renal Crônica , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Taxa de Filtração Glomerular , Estudos de Coortes , Estudos Transversais , Insuficiência Renal Crônica/epidemiologia , Bebidas Gaseificadas , Fatores de RiscoRESUMO
Purpose: To evaluate the risk factors associated with diabetic macular edema (DME) in patients with a recent type 2 diabetes mellitus (T2DM) diagnosis. Patients and Methods: We conducted a case-control study at a third-level hospital in Mexico City. We enrolled patients ≥18 years old, with T2DM less than five years of diagnosis, without disabling complications, and non-smokers. The control group was patients with diabetic retinopathy and without macular edema (DR-DME). Cases were patients with DR+DME. We measured fasting glucose, creatinine, lipid profile, urinary albumin/creatinine ratio (ACR), and HbA1c. An ophthalmological examination consisted of visual acuity measurement, digital three-field fundus photography with an automatic non-mydriatic camera, slit lamp, and Optical coherence tomography (OCT) examination. Results: 183 and 61 patients with DR-DME and DR+DME, respectively, were included in the analysis. The prevalence of mild DR was higher in the DR-DME group, but the frequencies of moderate and severe retinopathy were higher in the DR+DME group. Patients in the DR-DME group had better vision than those in the DR+DME group. Logistic regression analysis revealed that age (OR, 1.07), HbA1c (OR, 1.19), and Albumin-to-Creatinine Ratio (ACR) > 30 mg/g (OR, 3.37) were associated with an increased possibility of DME compared to DR-DME. Conclusion: Our study provides insights into the association between risk factors and DME. We found a statistically strong association between HbA1c levels, age, and ACR. Patients with poor metabolic control should undergo an extensive medical examination to screen for DME, which may be related to the chronicity of DM and renal damage.
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Abstract Objective: To determine the prevalence of HIV in individuals by analyzing the influence of social determinants and sexual risk behaviors, in order to estimate the crude and adjusted risks of being HIV positive in the municipality of Solidaridad, state of Quintana Roo, Mexico. Method and Materials: A cross-sectional study was conducted in the municipality of Solidaridad, Quintana Roo, Mexico. Third and fourth generation HIV rapid tests were performed. Descriptive statistics, measures of association (OR and 95 % CI) and p value were calculated for each stratum. Logistic regression models were performed to determine the risk factors associated with being HIV positive in the tests. Results: The sample consisted of 4,800 people, of whom 3,030 were men (63.12%); the mean age was 32.6 years (SD 14.96). The variables included in the multivariate model for being HIV positive are: men who have sex with men with OR=61.20, age 30-39 years OR=1.72, having anal sex OR=2.21, and as a protective factor having health service OR =0.42. Conclusions: This study confirms already known social determinants such as being male and being in economically active age and sexual practices such as: having anal sex and men with men. Being entitled to health services was shown to be the only protective factor.
Resumen Objetivo: Determinar la prevalencia de VIH en personas analizando la influencia de los determinantes sociales y las conductas sexuales de riesgo, para estimar los riesgos crudos y ajustados para ser VIH positivo en el municipio Solidaridad, estado de Quintana Roo, México. Método y Materiales: Se realizó un estudio transversal en el municipio de Solidaridad, Quintana Roo, México. Se realizaron pruebas rápidas de VIH de tercera y cuarta generación. Se calcularon las estadísticas descriptivas, las medidas de asociación (OR e IC del 95 %) y el valor de p para cada estrato. Se realizaron modelos de regresión logística para determinar los factores de riesgo asociados con ser VIH positivo en las pruebas. Resultados: La muestra estuvo compuesta por 4,800 personas de las cuales; 3,030 hombres (63.12%); la edad promedio fue de 32.6 años (D.E. 14.96). Las variables incluidas en el modelo multivariado para ser VIH positivo son: hombres que tienen sexo con hombres con OR=61.20, edad 30-39 años OR=1.72, tener sexo anal OR=2.21, y como factor protector contar con servicio de salud OR =0.42. Conclusiones: Este estudio confirma determinantes sociales ya conocidos como el ser hombre y estar en edad económicamente activa y prácticas sexuales como: el tener sexo anal y hombres con hombres. Contar con derechohabiencia se muestra como único factor protector.
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Resumen Antecedentes: Los datos sobre discapacidad visual (DV) en pacientes con diabetes son necesarios para orientar los recursos económicos y humanos que disminuyan su prevalencia. Objetivo: Estimar la prevalencia de DV relacionada con retinopatía diabética en pacientes con diabetes tipo 2 en un entorno hospitalario. Material y métodos: Estudio transversal realizado de 2014 a 2019 en una consulta externa de oftalmología. Cualquier DV se definió como agudeza visual corregida con agujero estenopeico en el ojo con mejor visión (≥ 0.24 logMAR). Se evaluó la presencia de retinopatía diabética, edema macular diabético (EMD) y cataratas. Resultados: Se incluyeron 840 pacientes; la mediana de duración de la diabetes fue de 15 años. La prevalencia de DV fue de 30 %. Se encontró retinopatía diabética en 62 % (30 % tenía retinopatía diabética que amenazaba la visión [RDAV]); 17 %, EMD y 3 %, cataratas. La razón de momios para DV moderada o de mayor gravedad fue de 9.02 para RDAV (p < 0.001), 5.89 para EMD referible (p = 0.001) y 2.51 para catarata (p = 0.006). Conclusión: Treinta por ciento de los participantes tenía algún grado de DV. La DV moderada o de mayor gravedad mostró una fuerte asociación con RDAV y EMD referible.
Abstract Background: Data on visual impairment (VI) in patients with diabetes are necessary in order to guide economic and human resources for reducing its prevalence. Objective: To estimate the prevalence of diabetic retinopathy-related VI in patients with type 2 diabetes in a hospital-based setting. Material and methods: Cross-sectional study carried out from 2014 to 2019 in an ophthalmology outpatient clinic. Any VI was defined as corrected pin-hole visual acuity in the better eye of ≥ 0.24 logMAR. The presence of diabetic retinopathy (DR), diabetic macular edema (DME) and cataract was evaluated. Results: A total of 840 patients were included; median diabetes duration was 15 years. The prevalence of VI was 30 %. DR was found in 62 % of patients (30 % had sight-threatening DR [STDR]), 17 % had referable DME, and 3 %, cataracts. The odds ratio for moderate or worse VI was 9.02 for STDR (p < 0.001), 5.89 for referable DME (p = 0.001), and 2.51 for cataract (p = 0.006). Conclusion: Thirty percent of participants had some degree of VI. Moderate or worse VI showed a strong association with STDR and referable DME.
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Abstract Objective: We assessed the prevalence of overweight and obesity and its association with some social determinants in a highly marginalized population in Mexico. Materials and methods: Cross-sectional study conducted in Comitán, Chiapas, from 2010 to 2012, comprising 1 858 subjects aged ≥20 years. We evaluated proximal, intermediate, and structural social determinants. Results: The prevalence of overweight and obesity was 37.9 and 16.5%, respectively. The probability of overweight and obesity was higher in participants with ≥primary school, self-reported non-indigenous origin, and medium level of marginalization compared with those with <primary school, self-reported indigenous origin, and high/very high level of marginalization. Conclusion: The probability of overweight and obesity was higher in population with more favorable social conditions, which may be partially explained by changes in the traditional lifestyle with greater access to high energy foods and physical inactivity.
Resumen Objetivo: Estimar la prevalencia de sobrepeso y obesidad y su asociación con determinantes sociales en población con alto grado de marginación. Material y métodos: Estudio transversal realizado en Comitán, Chiapas, de 2010 a 2012, que incluyó 1 858 sujetos ≥20 años de edad. Se evaluaron determinantes sociales proximales, intermedios y estructurales. Resultados: La prevalencia de sobrepeso y obesidad fue de 37.9 y 16.5%, respectivamente. La probabilidad de sobrepeso y obesidad fue mayor en sujetos con escolaridad ≥primaria, en sujetos que se autodefinieron como no indígenas y en sujetos con un grado de marginación medio comparado con individuos con escolaridad <primaria, con autodefinirse como indígena y tener un grado de marginación alto/muy alto. Conclusión: La probabilidad de sobrepeso y obesidad fue mayor en población con condiciones sociales más favorables, parcialmente explicada por cambios en el estilo de vida con mayor acceso a alimentos con alta energía e inactividad física.
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Humanos , Sobrepeso , Determinantes Sociais da Saúde , Obesidade , Prevalência , Estudos Transversais , Populações Vulneráveis , Sobrepeso/epidemiologia , México/epidemiologia , Obesidade/epidemiologiaRESUMO
Abstract: Objective: To determinate the prevalence of hearing loss (HL) and visual impairment (VI) among adult population from Tlaxcala, Mexico. Materials and methods: A population-based cross-sectional study comprising persons 50 years and older was conducted in 2013. Self-reported HL was measured using the Hearing Impairment Inventory for the Elderly (SHIIE) questionnaire; VI was determined using the Snellen tumbling E chart. Results: 900 women and 611 men (mean age 66.1 years) were included. 481(31.8%) individuals had HL (415 alone and 66 combined with VI). Prevalence of HL alone and together with VI was associated with age (per two years, OR=1.03 and OR=1.18, respectively) and self-reported poor health status (OR=1.90 and OR=3.69, respectively). Conclusion: The high prevalence of these disabilities calls for the implementation of public health interventions that help to reduce its impact in the population.
Resumen: Objetivo: Determinar la prevalencia de discapacidad auditiva (DA) y visual (DV) en adultos del estado de Tlaxcala, México. Material y métodos: Estudio transversal de base poblacional realizado en 2013 que incluye sujetos ≥50 años de edad. La DA se evaluó por autorreporte con el cuestionario Hearing Impairment Inventory for the Elderly (SHIIE); la DV se midió usando la cartilla E rotatoria de Snellen. Resultados: Se evaluaron 900 mujeres y 611 hombres (media=66.1 años). El 31.8% (481) tenía DA (415 sola y 66 con DV). La prevalencia de DA sola o con DV se asoció con edad (por cada dos años, RM=1.03 y RM=1.18, respectivamente) y con autorreporte del estado de salud deficiente (RM=1.90 y RM=3.69, respectivamente). Conclusiones: Se requiere la implementación de intervenciones en salud pública que reduzcan el impacto de estas dos condiciones en la población.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Transtornos da Visão/epidemiologia , Autorrelato/estatística & dados numéricos , Perda Auditiva/epidemiologia , Acuidade Visual , Razão de Chances , Nível de Saúde , Prevalência , Estudos Transversais , Fatores de Risco , Inquéritos Epidemiológicos , Fatores Etários , Perda Auditiva/complicações , Testes Auditivos , México/epidemiologiaRESUMO
Abstract: Objective: To determine the prevalence of dry eye symptoms (DES) and associated risk factors among adults in Tlaxcala, Mexico. Materials and methods: A cross-sectional population-based study that included 1 508 individuals aged ≥50 years who answered the Dry Eye Questionnaire (DEQ-5), with a score ranging between 0 and 22; the following categories were defined: no DES (<6); mild-moderate DES (6 to 11) and severe DES (≥12). Results: The prevalence of DES was 41.1% (95%CI 38.6-43.6), and was higher in women (OR=2.26, 95%IC 1.70-3.00), in individuals with smoking index of <10 (OR=1.40, 95%CI 1.05-1.87) and ≥10 pack-years (OR=2.29, 95%CI 1.44-3.63), subjects with history of ever consuming alcohol (OR=1.31, 95%CI 1.02-1.70), and those receiving antihypertensive treatment (OR=1.29, 95%CI 1.00-1.65). Conclusion: Dry eye symptoms were highly prevalent in the study population and were associated with sex, smoking, alcohol consumption, and antihypertensive medications.
Resumen: Objetivo: Determinar la prevalencia de síntomas de ojo seco y factores de riesgo asociados en población adulta de Tlaxcala, México. Material y métodos: Se realizó un estudio de base poblacional con 1 508 individuos ≥50 años que respondieron el Dry Eye Questionnaire (DEQ-5) y se definieron las siguientes categorías: sin síntomas (<6); síntomas leve-moderado (6 a11) y síntomas severos (≥12). Resultados: La prevalencia de síntomas de ojo seco fue de 41.1% (IC95% 38.6-43.6); fue mayor en mujeres (OR=2.26, IC95% 1.70-3.00), en individuos con índice de tabaquismo <10 (OR=1.40, IC95% 1.05-1.87) y ≥10 paquetes-año (OR=2.29, IC95% 1.44-3.63), en sujetos con historia de consumo de alcohol (OR=1.31, IC95%1.02-1.70) y en aquellos con tratamiento antihipertensivo (OR=1.29, IC95% 1.00-1.65). Conclusión: La frecuencia de síntomas de ojo seco fue altamente prevalente en la población de estudio y se asoció con sexo, tabaquismo, consumo de alcohol y medicamentos antihipertensivos.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/epidemiologia , Prevalência , Estudos Transversais , Fatores de Risco , Avaliação de Sintomas , México/epidemiologiaRESUMO
Objetivo. Presentar los resultados de la carga de enfermedad en México de 1990 a 2010 para las principales enfermedades, lesiones y factores de riesgo, por sexo. Materiales y métodos. Se realizó un análisis secundario del estudio de la carga mundial de la enfermedad 2010. Resultados. En 2010 se perdieron 26.2 millones de años de vida saludable (AVISA), 56% en hombres y 44% en mujeres. Las principales causas de AVISA en hombres fueron violencia, cardiopatía isquémica y los accidentes de tránsito. En las mujeres fueron la diabetes, la enfermedad renal crónica y la cardiopatía isquémica. Los trastornos mentales y musculoesqueléticos concentran 18% de la carga. Los factores de riesgo que más afectan a los hombres son sobrepeso/obesidad; niveles de glucosa en sangre y de presión arterial elevados; y el consumo de alcohol y tabaco (35.6% de AVISA perdidos). En las mujeres, el sobrepeso y la obesidad; glucosa elevada; hipertensión arterial; baja actividad física; y el consumo de alcohol y tabaco fueron responsables de 40% de los AVISA perdidos; en ambos sexos, la dieta contribuye con 12% de la carga. Conclusiones. El panorama epidemiológico en México demanda una urgente adecuación y modernización del sistema de salud.
Objective. To present the results of the burden of disease, injuries and risk factors in Mexico from 1990 to 2010 for the principal illnesses, injuries and risk factors by sex. Materials and methods. A secondary analysis of the study results published by the Global Burden of Disease 2010 for Mexico performed by IHME. Results. In 2010, Mexico lost 26.2 million of Disability adjusted live years (DALYs), 56 % were in male and 44 % in women. The main causes of DALYs in men are violence, ischemic heart disease and road traffic injuries. In the case of women the leading causes are diabetes, chronic kidney disease and ischemic heart diseases. The mental disorders and musculoskeletal conditions concentrate 18% of health lost. The risk factors that most affect men in Mexico are: alcohol consumption, overweight/obesity, high blood glucose levels and blood pressure and tobacco consumption (35.6 % of DALYs lost). In women, overweight and obesity, high blood sugar and blood pressure, lack of physical activity and consumption of alcohol are responsible for 40 % of DALYs lost. In both sexes the problems with diet contribute 12% of the burden. Conclusions. The epidemiological situation in Mexico, demands an urgent adaptation and modernization of the health system.
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Feminino , Humanos , Masculino , Efeitos Psicossociais da Doença , Atenção à Saúde , Ferimentos e Lesões/epidemiologia , Causas de Morte , Pessoas com Deficiência , Expectativa de Vida , México/epidemiologia , Fatores de RiscoRESUMO
Objetivo. Estimar la frecuencia de medidas de prevención y control para diabetes tipo 2 en población mexicana. Material y métodos. La ENSANUT 2012 es una encuesta con representatividad nacional, con diseño de muestreo probabilístico, multietápico, estratificado y por conglomerados. En este análisis se utilizó la información de 46 277 adultos mayores de 20 años. El análisis se efectuó utilizando Stata 12. Resultados. La prevalencia de diabetes por diagnóstico previo fue de 9.2% (6.4 millones) en la ENSANUT 2012, 7.3% (3.7 millones) en 2006 y 4.6% (2.1 millones) en 2000. En 2012, la media del número de consultas en el último año para control de la diabetes fue de 7.3; no obstante, el porcentaje de revisión de pies (14.6%), oftalmológica (8.6%) y la determinación de HbA1c (9.6%) fue bajo. Conclusiones. Los casos diagnosticados tienen acceso frecuente a la atención médica. Sin embargo, las intervenciones preventivas se aplican en forma insuficiente en cantidad y calidad.
Objective. To determine the frequency of application of prevention and control measures for type 2 diabetes in Mexican population. Materials and methods. ENSANUT 2012 is a nationally and by-state representative survey. Sample design was probabilistic, multistage, stratified and clustered. The information of 46 277 adults≥20 was used for this analysis. A weighted analysis was performed using Stata 12. Results. Prevalence of diabetes by previous diagnosis was 9.2% (6.4 millions) in ENSANUT 2012, 7.3% (3.7 millions) in 2006 and 4.6% (2.1 millions) in 2000. In 2012, the mean of medical examinations in the previous year related to diabetes control was 7.3. However, the percentage of cases in which preventive actions for chronic complications were performed (such as foot care [14.6%], ophthalmology [8.6%] and determination of HbA1c [9.6%]) was low. Conclusions. Patients with diabetes have frequent access to medical services. However, preventive actions are applied insufficiently both in quality and quantity.
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , /epidemiologia , /prevenção & controle , México , Prevalência , Prevenção PrimáriaRESUMO
OBJECTIVE: To describe the number of Mexican adults with undiagnosed diabetes and arterial hypertension and their association with obesity. MATERIAL AND METHODS: The study included a sub-sample of 6 613 subjects aged 20 years or more who participated in the 2006 National Health and Nutrition Survey (ENSANUT 2006). Subjects with a previous diagnosis of diabetes or hypertension (n=1 861) were excluded. Prevalences and standard errors were estimated, taking into account the complex sample design. RESULTS: 6.4 million adults have obesity and undiagnosed impaired fasting glucose. Almost two million more have fasting glucose levels diagnostic for diabetes. As for arterial blood pressure, 5.4 million adults had prehypertension. Another 5.4 million adults had blood pressure levels suggestive of probable hypertension. A total of 21.4 million Mexican adults with obesity had at least one further component of the metabolic syndrome. CONCLUSIONS: A large proportion of adults with obesity-related metabolic comorbidities remains undiagnosed in Mexico.
OBJETIVO: Estimar el número de adultos mexicanos que tienen diabetes o hipertensión arterial no diagnosticadas y el riesgo de tales condiciones asociado a la obesidad. MATERIAL Y MÉTODOS: Se analiza una submuestra de 6 613 sujetos mayores de 20 años que participaron en la Encuesta Nacional de Salud y Nutrición 2006. Los sujetos con diagnóstico previo de diabetes o hipertensión arterial fueron excluidos (n=1 861). Las prevalencias y errores estándar fueron estimados considerando el diseño complejo de la muestra. RESULTADOS: 6.4 millones de adultos tienen obesidad y glucemia anormal de ayuno. Casi dos millones más tienen una glucemia de ayuno diagnóstica de diabetes En cuanto a la presión arterial, 5.4 millones tienen prehipertensión. El mismo número de casos tienen valores diagnósticos de hipertensión. Un total de 21.4 millones de adultos con obesidad tienen al menos un componente del síndrome metabólico. CONCLUSIONES: Un alto porcentaje de los adultos que tienen comorbilidades metabólicas de la obesidad permanecen sin ser diagnosticados en México.
Assuntos
Adulto , Feminino , Humanos , Masculino , Adulto Jovem , /complicações , Hipertensão/complicações , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , PrevalênciaRESUMO
OBJECTIVE: To compare the waist circumference cutoff points established by the American Heart Association and the National Heart, Lung and Blood Institute (AHA/NHLBI) with those of the International Diabetes Federation (IDF) for the screening of diabetes, hypertension, and metabolic syndrome in Mexican adults. MATERIAL AND METHODS: This study comprised a subsample of the ENSANUT 2006. Subjects without diabetes and hypertension and non-pregnant women were included. Sensitivity, specificity, and predictive values were compared using AUC and the positive likelihood ratio test [LR(+)]. RESULTS: In subjects aged ≥40 years, sensitivity for detection of diabetes and hypertension was higher for the IDF thresholds (85.34 and 86.87 percent, respectively) compared with those of the AHA/NHLBI (59.49 and 52.41 percent, respectively). LR(+) were higher for IDF thresholds compared with AHA/NHLBI. Similar results in subjects aged ≥65 years were observed. CONCLUSIONS: The measurement of abdominal obesity defined by the IDF was a better screening tool for diabetes and hypertension, considering that initially a high sensitivity and low cost tool at population level is required.
OBJETIVO: Comparar los puntos de corte de circunferencia de cintura de la American Heart Association and the National Heart, Lung and Blood Institute (AHA/NHLBI) y la International Diabetes Federation (IDF) para escrutinio de diabetes, hipertensión arterial y síndrome metabólico en adultos mexicanos. MATERIAL Y MÉTODOS: Se analizó una submuestra de la ENSANUT 2006 incluyendo sujetos sin diabetes o hipertensión y mujeres no embarazadas. Se comparó la sensibilidad, especificidad y valores predictivos mediante AUC y la razón de verosimilitudes positiva [LR(+)]. RESULTADOS: En personas ≥40 años, la sensibilidad para detección de diabetes e hipertensión usando el criterio de la IDF fue de 85.34 por ciento (LR(+)=1.1) y 86.87 por ciento (LR(+)=1.1); mientras que para el criterio de la AHA/NHLBI fue de 59.49 por ciento (LR(+)=1.34) y 52.41 por ciento (LR(+)=1.21). Los resultados fueron similares en personas ≥65 años. CONCLUSIONES: La obesidad abdominal según la IDF fue superior como procedimiento de tamizaje de diabetes e hipertensión, considerando que se requiere de una prueba inicial más sensible y de bajo costo para ser aplicada a nivel poblacional.
Assuntos
Adulto , Feminino , Humanos , Masculino , Adulto Jovem , /diagnóstico , Hipertensão/diagnóstico , Síndrome Metabólica/diagnóstico , Circunferência da Cintura , MéxicoRESUMO
OBJECTIVE: To examine the prevalence of metabolic syndrome (MS) and its associated risk factors in Mexican adults aged 20 years or older, using data derived from the National Health and Nutrition Survey 2006 (ENSANUT 2006). MATERIAL AND METHODS: The ENSANUT 2006 was conducted between October 2005 and May 2006. Questionnaires were administered to 45 446 adult subjects aged 20 years or older who were residents from urban and rural areas. Anthropometric and blood pressure measurements were obtained from all subjects and fasting blood specimens were provided by 30 percent of participants. We randomly selected a sub-sample of 6 613 from which laboratory measurements were carried out for glucose, insulin, triglycerides, total cholesterol and HDL-cholesterol. For this analysis, we included only results from eight or more hours of fasting samples (n=6 021). We used individual weighted factors in the statistical analysis and considered the survey's complex sampling design to obtain variances and confidence intervals. All analyses were done using SPSS 15.0. RESULTS: In accordance with definitions by the National Cholesterol Education Program Adult Treatment Panel III (ATP III), the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI), and the International Diabetes Federation (IDF), the prevalence of MS in Mexican adults aged 20 years or older was 36.8, 41.6 and 49.8 percent, respectively. Women were more affected than men due to the higher prevalence of central obesity among females. Prevalence of MS increased with age and was higher among populations living in metropolitan areas, in the west-central region, and those with lower education. DISCUSSION: Regardless of the MS definition, a large proportion of Mexican adults has the condition, so preventive measures are needed to decrease the prevalence of the MS components in this population. MS can predict type 2 diabetes and cardiovascular disease, two of the main causes ...
OBJETIVO: Describir la prevalencia de síndrome metabólico (SM) y los factores asociados en población mexicana de 20 años y más de edad a partir de datos de la Encuesta Nacional de Salud y Nutrición 2006 (ENSANUT 2006). MATERIAL Y MÉTODOS: La ENSANut 2006 se realizó entre octubre de 2005 y mayo de 2006. Se entrevistó a 45446 adultos de 20 años y más residentes de localidades rurales y urbanas. A todos ellos se les tomaron medidas antropométricas y de tensión arterial. Al 30 por ciento de los adultos entrevistados se les tomó una muestra de sangre, preferentemente en ayunas. Se seleccionó al azar una submuestra de 6613 individuos para la determinación de glucosa, insulina, triglicéridos, colesterol total y colesterol HDL. Para el análisis de laboratorio sólo se incluyeron las muestras obtenidas en ayuno de 8 horas o más (n=6021). Se utilizaron las definiciones de SM publicadas por el ATP III, modificada por la American Heart Association; National Heart, Lung and Blood Institute (AHA/NHLBI) y la International Diabetes Federation (IDF). Para el análisis estadístico se utilizaron los factores de expansión individuales y para el cálculo de las varianzas e intervalos de confianza se tomó en consideración el diseño complejo de la encuesta usando SPSS 15.0. RESULTADOS: La prevalencia nacional de SM en adultos de 20 años de edad y más, de acuerdo con el ATP III, AHA/NHLBI e IDF fue de 36.8, 41.6 y 49.8 por ciento, respectivamente. Con las tres definiciones, la prevalencia fue mayor en las mujeres que en los hombres, debido principalmente al mayor porcentaje de obesidad en las mujeres. La prevalencia de SM aumentó conforme a la edad y fue ligeramente mayor en la población residente de las áreas metropolitanas, en la región centro-occidente y con el menor nivel de escolaridad. DISCUSIÓN: Independientemente de la definición utilizada, una gran proporción de mexicanos presenta SM, el cual es considerado como predictor de diabetes tipo 2 y enfermedad ...
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Inquéritos Epidemiológicos , Síndrome Metabólica/epidemiologia , Inquéritos Nutricionais , Antropometria , Glicemia/análise , Jejum/sangue , Hipertensão/epidemiologia , Síndrome Metabólica/sangue , México/epidemiologia , Obesidade Abdominal/epidemiologia , Prevalência , Fatores de Risco , Estudos de Amostragem , Fatores Sexuais , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: To describe the characteristics of patients with type 2 diabetes diagnosed before age 40 (early-onset type 2 diabetes) identified in a nation-wide, population-based study. MATERIALS AND METHODS: The survey was done in Mexico during 2006. Medical history, anthropometric and biochemical measurements were obtained in every subject. RESULTS: Cases diagnosed before (n=181) and after age 40 (n=659) were included. Early-onset type 2 diabetes was present in 13.1 percent of the previously diagnosed, 30.3 percent of the cases identified during the survey and 21.5 percent of the whole population with diabetes. These individuals had a greater prevalence of obesity and hypertriglyceridemia compared to the cases diagnosed after age 40. CONCLUSIONS: Early-onset type 2 diabetes was present in 21.5 percent of patients with type 2 diabetes in Mexico. Close to 70 percent of them were obese or overweight and had the clinical profile of the metabolic syndrome.
OBJETIVO: Describir las características de los pacientes con diabetes diagnosticados antes de los 40 años en una encuesta representativa de la población mexicana. MATERIAL Y MÉTODOS: La encuesta fue realizada en México durante 2006. Se registró la historia médica, mediciones antropométricas y bioquímicas de los participantes. RESULTADOS: Se incluyeron casos diagnosticados antes (n=181) y después (n=659) de los 40 años. La diabetes tipo 2 de inicio temprano está presente en 13.1 por ciento de los casos previamente diagnosticados, 30.3 por ciento de los identificados durante la encuesta y en 21.5 por ciento de la población total con diabetes. En los casos diagnosticados antes de los 40 años hay una prevalencia mayor de obesidad e hipertrigliceridemia que en los diagnosticados después de los 40. CONCLUSIONES: La diabetes de aparición temprana está presente en 21.5 por ciento de los casos con diabetes en México. Setenta por ciento de ellos tenían un peso mayor al saludable y tenían el perfil clínico del síndrome metabólico.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , /epidemiologia , Inquéritos Epidemiológicos , Síndrome Metabólica/epidemiologia , Inquéritos Nutricionais , Idade de Início , Antropometria , Complicações do Diabetes/epidemiologia , /sangue , Jejum/sangue , Hemoglobinas Glicadas/análise , Hiperlipidemias/epidemiologia , Síndrome Metabólica/sangue , México/epidemiologia , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Estudos de Amostragem , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: To estimate the incidence of myocardial infarction (MI) in a low-income Mexican population. MATERIAL AND METHODS: A total of 1 696 men and women aged 35 to 64 years from a longitudinal study were included. All subjects were free of MI at baseline. Incident MI was diagnosed during follow-up by electrocardiogram or by death certificate. Multiple logistic regression was used to estimate the risk of MI. RESULTS: Median follow-up was 6.2 years. Sixty-two of the participants developed MI. Age-adjusted incidence of MI was 6.6 in men and 4.8 in women per 1 000 person-years. The risk of developing MI was associated diabetes (OR= 2.42, p= 0.003), systolic blood pressure (OR= 1.28 per10 mm Hg, p= 0.013) and serum cholesterol (OR= 1.36 per 50 mg/dL, p= 0.038). CONCLUSIONS: Incidence of MI in this population may be explained by the rising prevalence of diabetes and hypercholesterolemia. It is necessary to implement preventive measures to address those risk factors.
OBJETIVO: Estimar la incidencia de infarto al miocardio (IM) en población mexicana de nivel socioeconómico bajo. MATERIAL Y MÉTODOS.. Estudio longitudinal de 1696 hombres y mujeres de 35 a 64 años de edad y sin IM basal. IM fue definido por electrocardiograma o certificado de defunción. El riesgo de IM se evaluó con regresión logística múltiple. RESULTADOS: Durante el seguimiento (mediana de 6.2 años) 62 participantes desarrollaron IM o murieron por éste. La incidencia de IM ajustada por edad en hombres y mujeres fue de 6.6 y 4.8 por 1000 años-persona, respectivamente. El riesgo de IM estuvo asociado con diabetes (RM=2.42, p= 0.003), presión arterial sistólica (RM= 1.28 por cada 10 mm Hg, p= 0.013) y colesterol total (RM= 1.36 por cada 50 mg/dL, p=0.038). CONCLUSIONES: La incidencia de IM en esta población, puede ser debida a la alta prevalencia de diabetes y colesterol elevado. Es necesario tomar medidas preventivas para disminuir estos factores de riesgo.
RESUMO
Objective. To compare the predicted risk of coronary heart disease (CHD) and incident myocardial infarction (MI) using Framingham score equations with the observed rate of MI in Mexican subjects. Material and Methods. Longitudinal study that included 1 667 men and women aged 35 to 64 years without MI at baseline. Incident MI was defined by electrocardiogram or death certificate. The predicted risk of fatal MI, non-fatal MI, and both was calculated using Framingham score equations. Predicted to observed risk ratio of MI was estimated. Results. There were 34 incident MI cases and 24 MI deaths (median follow-up 6.2 years). The score equations overestimated the prediction of incident MI and CHD death (ratio 2.27, 95% CI, 1.19-3.34) and incident MI (ratio 2.36, 95% CI, 1.07-3.65) in men. Conclusions. The Framingham score overestimated incident MI and CHD death risk in men; however, other studies are needed to confirm our results for recalibrating the score for Mexican subjects.
Objetivo. Comparar el riesgo predicho y observado de enfermedad coronaria (EC) e infarto al miocardio (IM) usando ecuaciones del puntaje de Framingham en individuos mexicanos. Material y métodos. Estudio longitudinal de 1 667 hombres y mujeres de entre 35 a 64 años de edad y sin IM en la medición basal. IM se definió por electrocardiograma o certificado de defunción. Se estimó el riesgo predicho y la razón del riesgo predicho y observado de IM. Resultados. Durante el seguimiento (mediana de 6.2 años) hubo 34 casos y 24 defunciones por IM. El puntaje sobreestimó la predicciónde IM y muerte por EC (razón 2.27, IC 95% 1.19-3.34) e IM incidente (razón 2.36, IC 95% 1.07-3.65) en hombres. Conclusiones. En este estudio, el puntaje de Framingham sobreestimó el riesgo de IM y muerte por IM en hombres; sin embargo, estos resultados necesitan ser confirmados por otros estudios, para la posterior recalibración del puntaje en población mexicana.