Body-mass index, blood pressure, diabetes and cardiovascular mortality in Cuba: prospective study of 146,556 participants.

BACKGROUND: Cardiovascular disease accounts for about one-third of all premature deaths (ie, age < 70) in Cuba. Yet, the relevance of major risk factors, including systolic blood pressure (SBP), diabetes, and body-mass index (BMI), to cardiovascular mortality in this population remains unclear. METHODS: In 1996-2002, 146,556 adults were recruited from the general population in five areas of Cuba. Participants were interviewed, measured (height, weight and blood pressure) and followed up by electronic linkage to national death registries until Jan 1, 2017; in 2006-08, 24,345 participants were resurveyed. After excluding all with missing data, cardiovascular disease at recruitment, and those who died in the first 5 years, Cox regression (adjusted for age, sex, education, smoking, alcohol and, where appropriate, BMI) was used to relate cardiovascular mortality rate ratios (RRs) at ages 35-79 years to SBP, diabetes and BMI; RR were corrected for regression dilution to give associations with long-term average (ie, 'usual') levels of SBP and BMI. RESULTS: After exclusions, there were 125,939 participants (mean age 53 [SD12]; 55% women). Mean SBP was 124 mmHg (SD15), 5% had diabetes, and mean BMI was 24.2 kg/m2 (SD3.6); mean SBP and diabetes prevalence at recruitment were both strongly related to BMI. During follow-up, there were 4112 cardiovascular deaths (2032 ischaemic heart disease, 832 stroke, and 1248 other). Cardiovascular mortality was positively associated with SBP (>=120 mmHg), diabetes, and BMI (>=22.5 kg/m2): 20 mmHg higher usual SBP about doubled cardiovascular mortality (RR 2.02, 95%CI 1.88-2.18]), as did diabetes (2.15, 1.95-2.37), and 10 kg/m2 higher usual BMI (1.92, 1.64-2.25). RR were similar in men and in women. The association with BMI and cardiovascular mortality was almost completely attenuated following adjustment for the mediating effect of SBP. Elevated SBP (>=120 mmHg), diabetes and raised BMI (>=22.5 kg/m2) accounted for 27%, 14%, and 16% of cardiovascular deaths, respectively. CONCLUSIONS: This large prospective study provides direct evidence for the effects of these major risk factors on cardiovascular mortality in Cuba. Despite comparatively low levels of these risk factors by international standards, the strength of their association with cardiovascular death means they nevertheless exert a substantial impact on premature mortality in Cuba.

Validation of Owenia vieitezi Díaz-Díaz, Parapar amp; Moreira, a polychaete from the coast of Venezuela (Annelida: Oweniidae).

Díaz-Díaz et al. (2018) described a new species of oweniid polychaete, Owenia vieitezi, from the north-western coast of the Gulf of Venezuela, Caribbean Sea. Although the description and figures presented by Díaz-Díaz et al. (2018) fully characterize the new species, the journal issue in which the description appeared was published online only and the article in which the new name appeared did not include a ZooBank registration number (LSID), required for validation of new species names in electronic-only publications (ICZN 2012). As a result, the name Owenia vieitezi Díaz-Díaz, Parapar Moreira, 2018, as published in Cahiers de Biologie Marine 59: 589-597, is not available according the International Code of Zoological Nomenclature (ICZN 1999, 2012). Therefore, the present note serves to validate the name Owenia vieitezi by fulfilling the ICZN conditions for nomenclatural availability.

A new species of Eunice Cuvier, 1817 (Polychaeta: Eunicidae) from the slope of the Desventuradas Islands and seamounts of the Nazca Ridge, southeastern Pacific Ocean.

A new species of Eunicidae, Eunice decolorhami sp. n., from the southeastern Pacific Ocean, is described. The species was collected at the slope of the Desventuradas Islands (San Félix and San Ambrosio) and in three nearby seamounts of the Nazca Ridge, in dead coral rubble bottoms from 180 to 340 m depth and inhabiting inside parchment-like branched tubes. Eunice decolorhami sp. n. can be distinguished from other species of the genus, mainly by the coloration pattern of the subacicular hooded hooks along the body segments, the beginning of the subacicular hooded hooks, the beginning of the branchiae, the maximum number of branchial filaments, and the maxillary formula. A key for the seven Eunice species recorded off the coast of Chile and Peru, including the new species described herein, is provided.

Two new species of spionids from the genera Dispio and Prionospio (Polychaeta: Spionidae) from the Iberian Peninsula with redescription and notes on Prionospio (Minuspio) multibranchiata Berkeley, 1927.

A re-assessment of spionid specimens collected from coasts around the Iberian Peninsula and initially assigned to Dispio uncinata Hartman, 1951 and Prionospio multibranchiata Berkeley, 1927 resulted in the recognition of two new species from the genera Dispio and Prionospio: Dispio glandulosa sp. nov. and Prionospio (Minuspio) sanmartini sp. nov. In addition, the examination of specimens collected near the type locality of P. multibranchiata led to a re-description of this species. The specimens examined do not correspond to the material collected from the Iberian Peninsula and it is unlikely that P. multibranchiata is found in northern European waters.

New species of Dispio Hartman, 1951 and Streblospio Webster, 1879 (Polychaeta, Spionidae) from the coast of the Iberian Peninsula.

Re-assessment of spionid specimens from Iberian Peninsula initially assigned to Dispio uncinata Hartman, 1951 and Streblospio benedicti Webster, 1879 led to the recognition of two new species from the spionid genera Dispio and Streblospio from coasts around the Iberian Peninsula. Dispio elegans sp. nov. is characterised by having an oblanceolate-shaped prostomium. In addition, the first two notopodial postchaetal lamellae are serrated with digitiform papillae, the anterior neuropodial lamellae are smooth; all branchiae are almost completely fused to the notopodial lamellae, but with the tips free; the notochaetae on chaetiger 1 are smooth, alimbate capillaries; the ventral chaetae located in the position of the sabre chaetae on chaetigers 1-2 are smooth, alimbate capillaries, but becoming granulated on chaetiger 3; and the middle and posterior chaetigers are granulated and reticulated. Streblospio padventralis sp. nov. is characterized by lacking dorsal papillae between the branchiae of chaetiger 1; the hooks have 4-5 pairs of small teeth; sabre chaetae are present from chaetiger 3; the pygidium has two ventral lappets; and brooding structures are present in the coelomic cavities. We suggest raising the status of Streblospio benedicti japonica Imajima, 1990 to full species level as S. japonica Imajima, 1990. A key for Streblospio species is provided.

Sternaspis chilensis n. sp., a new species from austral Chilean channels and fjords (Annelida, Sternaspidae).

Sternaspis chilensis n. sp. is described based on specimens collected in channels and fjords of southern Chile and previously identified as Sternaspis scutata (Ranzani, 1817), originally described from the Meditarrean Sea. Sternaspis chilensis n. sp. is described based on the features of the shield with anterior margins rounded and anterior depression shallow; marginal shield chaetal fascicles arranged with an inverted C-shaped pattern; and distribution of the integument papillae. Sternaspis chilensis is widely distributed in the Magellan Province from Estero Reloncaví (41°32'54"S, 72°19'48"W) to Strait of Magellan (53°34'S, 70°04'W), between 50 and 515 m depth.

Años de vida saludable perdidos por diabetes mellitus en Cuba / Years of Healthy Life Lost Due to Diabetes Mellitus in Cuba

Introducción: El reciente incremento de la prevalencia de la diabetes mellitus en Cuba sucedió con mayor celeridad, y las políticas encaminadas a su control requieren de su cuantificación sistemática. Objetivo: Identificar las diferencias en Cuba, según provincia y sexo, de los años de vida saludable perdidos por la diabetes mellitus en el 2015. Métodos: En el estudio de extensión nacional se obtuvieron los años de vida saludable perdidos como resultado de la suma de los años perdidos de vida potencial por mortalidad prematura y los años de vida perdidos por morbilidad y otros indicadores para identificar la mortalidad temprana en el año 2015. Resultados: En todas las provincias los índices de años de vida saludable perdidos por morbilidad superaron los de mortalidad prematura con predominio del sexo femenino, mientras en la mayoría de las provincias, las edades de las defunciones fueron más tempranas en el masculino. Las diferencias halladas permitieron agrupar a Artemisa, La Habana, Mayabeque, Matanzas, Villa Clara, Cienfuegos, Santi Spíritus y Camagüey, con los mayores promedios de años perdidos por morbilidad y fallecimientos más tardíos, y al resto de las provincias cubanas, con los menores años perdidos por morbilidad, pero con defunciones en edades más tempranas. Conclusiones: Las pérdidas de años de vida saludable difieren según el sexo y la provincia. Este conocimiento permite la identificación de diferentes patrones de morbimortalidad útiles para orientar las acciones de prevención y control de la enfermedad para cada territorio(AU)

Introduction: The recent increase in the prevalence of diabetes mellitus in Cuba occurred more rapidly, and policies aimed at its control require systematic quantification. Objective: To identify the differences in Cuba, according to province and sex, of the years of healthy life lost due to diabetes mellitus in 2015. Methods: The national extension study collected data on the healthy years of life lost as a result of the sum of years lost from potential life due to premature mortality and years of life lost due to morbidity and other indicators to identify early mortality in 2015. Results: In all provinces, the rates of years of healthy life lost due to morbidity exceeded those of premature mortality with a predominance of women, while in most provinces, the ages of death were earlier in the male sex. The differences found allowed to group Artemisa, Havana, Mayabeque, Matanzas, Villa Clara, Cienfuegos, Santi Spíritus and Camagüey provincesn with the highest averages of years lost due to morbidity and later deaths, and the rest of the Cuban provinces, with the lowest years lost due to morbidity, but with deaths at younger ages. Conclusions: Losses of years of healthy life differ by sex and province. This knowledge allows the identification of different patterns of morbidity and mortality useful to guide the prevention and control actions of the disease for each territory(AU)

Effects of Obex in Overweight and Obese Subjects With or Without Impaired Fasting Glucose: A Pilot Study.

Obex is a dietary supplement to help weight loss. The purpose of this study was to evaluate the effect of Obex in overweight/obese participants with or without impaired fasting glucose. This was an open-label pilot study conducted with 40 overweight and obese subjects, 23-60 years old with a body mass index of 25-44 kg/m2 (20 participants with impaired fasting glucose [IFG] and 20 with normal glucose levels). Participants received Obex at a dose of one sachet before the two main meals of each day for 3 months. In addition to anthropometric measures and blood pressure (BP), fasting plasma glucose, lipid profile, insulin, creatinine, and uric acid were determined. Insulin resistance (HOMA-IR) and beta-cell function (HOMA-B) were assessed. Three indirect indices were used to calculate insulin sensitivity. Compared to baseline, Obex significantly reduced body weight, body mass index, waist circumference, waist/hip ratio, and waist/height ratio in both groups of participants (p <.05). In individuals without IFG, Obex improved HDL-c (high-density lipoprotein cholesterol) (p <.0001) and lowered BP (p <.05). After 3 months of Obex, subjects with IFG showed a reduction in fasting glucose concentrations (p <.0001). Compared to baseline, this group also showed improved insulin sensitivity and HDL-c (p <.05). In conclusion, the consumption of Obex contributed to weight reduction, improved glucose tolerance and insulin sensitivity, as well as HDL-c, and appears to be safe in overweight/obese adults with impaired fasting glucose. Obex may be beneficial for weight loss, indicating that further studies are required.

Effect of standard nicotinamide in the prevention of type 1 diabetes in first degree relatives of persons with type 1 diabetes.

BACKGROUND: Nicotinamide has been used with success to prevent type 1 diabetes in animal models and humans. This vitamin B3 derivative has attracting effects on beta-cell protection and regeneration. AIM/HYPOTHESIS: To evaluate the effect of standard nicotinamide administration on type 1 diabetes prevention in first degree relatives of persons with type 1 diabetes as well as on the concentrations of islet-cell-related autoantibodies, insulin secretion and peripheral sensitivity. SUBJECTS AND METHODS: A randomized double-blind placebo controlled intervention trial was conducted in 40 first degree relatives of type 1 diabetic patients. Persistence of ICA ( >or= 10 JDF units) was among inclusion criteria. Participants were randomly allocated oral standard nicotinamide (1.2 g/m2) or placebo for 5 years. Groups were also stratified by age. Islet associated antibodies, fasting blood glucose, fasting plasma insulin concentrations, OGTT, IVGTT and HLA-DR genotyping were performed in all participants. The main criterion to stop treatment was type 1 diabetes development as defined by WHO. RESULTS: Type 1 diabetes development frequencies were similar between the treatment groups. ICA frequencies at the end of the study, first phase insulin release, and insulin sensitivity did not differ between groups as well. None of the participants suffered from any adverse events described for nicotinamide. CONCLUSIONS: Type 1 diabetes prevention trial using standard nicotinamide is feasible but fails to prevent or delay the disease onset at the dose we used.

[Polychaetes (Annelida: Polychaeta) epibiont on Spondylus americanus (Bivalvia: Spondylidae) from Mochima National Park, Venezuela]. / Poliquetos (Annelida: Polychaeta) epibiontes de Spondylus americanus (Bivalvia: Spondylidae) en el Parque Nacional Mochima, Venezuela.

The polychaetes epibiontic on the mollusk Spondylus americanus Hermann, 1781 were extracted from mollusks hand-collected at a depth of 10-30 m in Mochima National Park, Venezuela (10 degrees 21'00" N-63 degrees 23'36" W), using scuba diving gear. Forty-three polychaete species were identified on the 32 bivalve specimens analyzed. The Serpulidae included 17 especies, Eunicidae six and Terebellidae four species. The most abundant species were Hydroides dirampha Mörch, 1863, Pileolaria militaris Claparède, 1868 (Serpulidae), and Notaulax nudicollis Krøyer, 1856 (Sabellidae). Their geographic affinitie were: 51.3% Atlantic, 28.2% widely distributed, 17.9% Amphiamericans, and 2.6% have a disjunct distribution.

Polychaeta (Annelida) associated with Thalassia testudinum in the northeastern coastal waters of Venezuela.

Seasonal variations of polychaetes in a Thalassia testudinum bed were studied from June 2000 to April 2001 in Chacopata, northeastern Venezuela. Eight replicate samples were taken monthly with a 15 cm diameter core and the sediment was passed through a 0.5 mm mesh sieve. A total of 1,013 specimens, belonging to 35 species, was collected. The monthly density ranged from 387 ind/m2 (September) to 1,735 ind/m2 in May (x = 989+/-449 ind/m2). Species richness was lowest in August and September (8) and highest (25) in April (x = 18.00+/-5.29). The shoot density of Thalassia showed an average of 284+/-77.60 shoots/m2, with extreme values in February (164) and May (422). Species diversity ranged from 1.25 in August and 3.33 bits/ind in December (x = 2.47+/-0.64). Significant positive correlations were detected among the number of Thalassia shoots, polychaete abundance and species richness, as well as among species richness, polychaete abundance and species diversity. Species number and average density were found within the intervals of mean values reported in similar studies. The higher number of species and organisms obtained in March-April and June-July can be attributed to the recruitment correlated with the regional up-welling.

Redescription of two species and five new species of Dispio Hartman, 1951 (Spionidae: Polychaeta) from the eastern Pacific Coast and Caribbean Sea, with a review of the genus.

Available type material of Dispio uncinata Hartman, 1951 and D. mororoi Gibbs, 1971, as well as newly collected material from Venezuela and material deposited in the Los Angeles County Museum of Natural History, was examined. Several important differences were found between D. uncinata, D. mororoi, the new material deposited in the museum and the newly collected material from Venezuela, Panama and California. Dispio uncinata and D. mororoi are redescribed and five new species are also identified and described: D. anauncinata sp. nov., D. lenislamellata sp. nov., and D. longibranchiata sp. nov. are from Southern California, D. panamensis sp. nov. from Panama, and D. bescanzae sp. nov. from Venezuela. Morphological differences between species were recorded, particularly in reference to the shape of prostomium, and caruncle, size of peristomium, shape of notopodial and neuropodial postchaetal lamellae, branchiae from anterior chaetigers fused completely or partially to the notopodial lamellae, presence or abscent of accessory branchial pairs, structure of notopodial and neuropodial chaetae, notopodial and neuropodial lamellae overlapping or touching and other consistent characters. Results of the review of the material from Southern California indicates that D. uncinata is not found in this area of the Pacific, and we recommend that the wide distribution of this species should be taken with caution especially for those distant records from the type locality. A key to all species of Dispio is provided.

Tasa de mortalidad de personas con pie diabético en La Habana durante el periodo 2010-2015 / Mortality for Diabetic Foot in People with Diabetes Mellitus in Havana during the 2010-2015 Period

Introducción: Se define como pie diabético toda infección, úlcera o destrucción tisular del pie asociada a neuropatía y/o enfermedad vascular periférica de miembros inferiores en personas con diabetes. Objetivo: Determinar la tasa de mortalidad en personas con pie diabético en La Habana durante el período 2010-2015, así como las causas y las variables sociodemográficas de los fallecidos. Método: Estudio observacional, descriptivo y retrospectivo. Se revisó el registro de fallecidos por diabetes mellitus en La Habana como causa básica de muerte de los años comprendidos del 2010 al 2015, Se analizaron las variables edad, sexo, causa básica de muerte, amputaciones y municipio de procedencia. Los resultados se expresaron en frecuencias absolutas, relativas y tasas por 100 000 habitantes. Resultados: La tasa de mortalidad en personas con pie diabético fue de 3,07/105 habitantes. El año de mayor mortalidad fue el 2010 (10,41 por ciento) y el de menor fue el 2011 (7,34 por ciento). Predominaron las mujeres (56 por ciento) y los mayores de 70 años (66,5 por ciento). En el 48,5 por ciento de los casos se reportaron amputaciones. Las causas directas de muerte más frecuente fueron: la sepsis (34,5 por ciento), el tromboembolismo pulmonar (32,2 por ciento) y la bronconeumonía (21,1 por ciento). Los municipios con menores tasas de fallecidos fueron La Habana Vieja y Arroyo Naranjo. Conclusiones: La tasa de mortalidad en personas con pie diabético en el período 2010-2015 tuvieron una tendencia a la disminución. Las cifras más elevadas se observaron en la edad y en el sexo femenino. Las infecciones, el tromboembolismo pulmonar y la bronconeumonía fueron las causas de muerte directa más importantes(AU)

Introduction: Mortality due to diabetes mellitus may rise due to an increase in its prevalence and the risk of chronic complications. Objective: To determine the mortality rate in people with diabetic foot in Havana during the 2010-2015 period, as well as the causes and sociodemographic variables of the deceased. Methods: Observational, descriptive and retrospective study. The registry of deaths from diabetes mellitus as the basic cause of death from 2010 to 2015 was reviewed. The variables age, sex, basic cause of death, amputations and municipality of origin were analyzed. The results were expressed in absolute and relative frequencies, as well as in rates per hundred thousand inhabitants. Results: The mortality rate in people with diabetic foot was 3.07/105 inhabitants. The year with the highest mortality was 2010 (10.41 percent) and the year with the lowest value was 2011 (7.34 percent). Women (56 percent) and those aged over seventy years (66.5 percent) predominated. In 48.5 percent of the cases accounted for amputations. The most frequent direct causes of death were sepsis (34.5 percent), pulmonary thromboembolism (32.2 percent) and bronchopneumonia (21.1 percent). The municipalities with the lowest death rates were La Habana Vieja and Arroyo Naranjo. Conclusions: Mortality rates in people with diabetic foot in the 2010-2015 period tended to decrease. The highest figures were observed in geriatric ages and among women. Infections, pulmonary embolism and bronchopneumonia were the most important direct causes of death(AU)

Utilidad del fenotipo hipertensión-obesidad abdominal para identificar personas con riesgo cardiovascular global moderado y alto / Use of the hypertension- abdominal obesity phenotype to identify people with moderate and high overall cardiovascular risk

Introducción: La obesidad está relacionada con un riesgo elevado de enfermedades no transmisibles. Una tendencia creciente en la prevalencia de la obesidad desde principios de la década de 1980 ha planteado una importante carga de salud de la población en todo el mundo. Objetivos: Determinar la utilidad del fenotipo hipertensión-obesidad abdominal para identificar personas con riesgo cardiovascular global moderado o alto en adultos con exceso de peso corporal y si esta es superior a la de otros binomios fenotípicos descritos y al síndrome metabólico. Métodos: Estudio observacional, descriptivo y transversal que incluyó 257 personas de 35 a 70 años. Variables estudiadas: edad, sexo, peso, talla, índice de masa corporal, circunferencia de la cintura, presión arterial, colesterol, triglicéridos, colesterol-HDL y glucemia en ayunas. Se determinó la presencia del síndrome metabólico según los criterios de la declaración provisional conjunta [Joint Interim Statement (JIS), siglas en inglés], además se estudiaron los fenotipos hipertensión-obesidad abdominal, hipertrigliceridemia-obesidad abdominal e hiperglucemia-obesidad abdominal. El riesgo cardiovascular global fue evaluado mediante las tablas de Gaziano. Resultados: El 81,7 por ciento (210/257) de los sujetos presentó el fenotipo hipertensión-obesidad abdominal y la frecuencia de riesgo cardiovascular moderado-alto fue de 28,0 por ciento (72/257). El fenotipo hipertensión-obesidad abdominal detectó la mayor proporción de sujetos con riesgo cardiovascular moderado-alto (64 de los 72); el riesgo cardiovascular moderado-alto estaba presente en la mayoría con este fenotipo (88,8 por ciento), diferente de aquellos sin el fenotipo (11,1 por ciento). La sensibilidad (88,9 por ciento) y el valor predictivo negativo (83,0 por ciento) muestran que el fenotipo hipertensión-obesidad abdominal es un binomio útil para detectar individuos con riesgo cardiovascular moderado-alto. Conclusiones: La utilidad del fenotipo hipertensión-obesidad abdominal es superior a la de otros binomios fenotípicos y al síndrome metabólico para identificar personas con riesgo cardiovascular moderado-alto. La elevada sensibilidad y el alto valor predictivo negativo del fenotipo hipertensión-obesidad abdominal, así como la simplicidad de su determinación, lo convierten en una buena opción para pesquisar sujetos con este riesgo(AU)

Introduction: Obesity is linked to a high risk of non-communicable diseases. A growing trend in the prevalence of obesity since the early 1980s has posed a significant population´s health burden worldwide. Objectives: Determine the usefulness of the hypertension- abdominal obesity´s phenotype to identify cases with moderate or high overall cardiovascular risk in adults with excess body weight and whether it is superior to that of other phenotypic binomials described and to the metabolic syndrome. Methods: Observational, descriptive and cross-sectional study that included 257 people from 35 to 70 years old. Variables studied: age, sex, weight, size, body mass index, waist circumference, blood pressure, cholesterol, triglycerides, HDL cholesterol and fasting blood glucose. The presence of metabolic syndrome was determined according to the criteria of the Joint Interim Statement (JIS), and hypertension- abdominal obesity phenotypes, abdominal hypertriglyceridemia-obesity and hyperglycemia- abdominal obesity were also studied. The overall cardiovascular risk was assessed using Gaziano's tables. Results: 81.7 percent (210/257) of subjects had the hypertension-abdominal obesity´s phenotype and the frequency of moderate-high cardiovascular risk was 28.0 percent (72/257).The hypertension- abdominal obesity´s phenotype detected the highest proportion of subjects at moderate-high cardiovascular risk (64 of the 72); moderate-high cardiovascular risk was present in most of the subjects with this phenotype (88.8 percent), different from those without the phenotype (11.1 percent).Sensitivity (88.9 percent) and the negative predictive value (83.0 percent) show that the hypertension- abdominal obesity´s phenotype is a useful binomial for detecting individuals with moderate-high cardiovascular risk. Conclusions: The usefulness of the hypertension- abdominal obesity phenotype is superior to that of other phenotypic binomials and to the metabolic syndrome in order to identify people with moderate-high cardiovascular risk. The high sensitivity and high negative predictive value of the hypertension- abdominal obesity phenotype, as well as the simplicity of its determination, make it a good option for researching subjects with this risk(AU)

Valor de corte del índice cintura/cadera como predictor independiente de disglucemias / Cutoff value of the waist-hip ratio as an independent predictor of dysglycemia

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)

Valor de corte del índice de conicidad como predictor independiente de disglucemias / Cut-off value of the conicity index as an independent predictor of dysglycemia

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)

Evaluación de tres metodologías para la predicción del riesgo de alteraciones del metabolismo de la glucosa en sujetos con sobrepeso y obesidad / Evaluation of three methodologies for risk prediction of impaired glucose metabolism in overweighed and obese subjects

Introducción: en la actualidad, en Cuba no existe una estrategia establecida para la pesquisa de las alteraciones del metabolismo de la glucosa. Objetivo: evaluar la capacidad diagnóstica de tres metodologías para predecir el riesgo de alteraciones del metabolismo de la glucosa en sujetos con sobrepeso y obesidad. Métodos: se realizó un estudio de evaluación diagnóstica longitudinal, con los datos de 90 sujetos con edades comprendidas entre 25 y 70 años, analizados 2,5 años después de la evaluación inicial. Se obtuvo la edad, el sexo, los antecedentes patológicos personales, los medicamentos empleados, el peso, la talla, el perímetro de cintura y la tensión arterial, así como las concentraciones de glucosa al inicio y a los 2,5 años ulteriores, la insulina y los triglicéridos, además de calcular la resistencia a la insulina en la evaluación inicial. Se utilizó un modelo de puntaje-riesgo para la diabetes tipo 2. Resultados: la frecuencia de alteraciones del metabolismo de la glucosa (glucemia alterada en ayuna y diabetes tipo 2) a los 2,5 años ulteriores, de acuerdo con la presencia previa o no en los sujetos de glucemia alterada en ayunas, resistencia a la insulina y riesgo moderado/alto de diabetes tipo 2, fue superior en los sujetos con glucemia alterada en ayuna previa (72,4 por ciento [21/29]), con resistencia a la insulina al inicio (65,6 por ciento [40/61]) y con riesgo moderado/alto (54,4 por ciento [43/79]), en relación con aquellos sin glucemia alterada en ayuna, sin resistencia a la insulina y con riesgo bajo de diabetes (41,0 por ciento [25/61], p= 0,005; 20,7 por ciento [6/29], p= 0,006 y 27,3 por ciento [3/11], p< 0,0001 respectivamente). La resistencia a la insulina y el riesgo de diabetes tipo 2 moderado/alto mostraron una elevada sensibilidad para identificar sujetos con alteraciones del metabolismo de la glucosa (87,0 y 93,5 por ciento respectivamente), por el contrario de la glucemia alterada en ayunas, que mostró una baja sensibilidad (45,7 por ciento). De los 19 sujetos que desarrollaron diabetes tipo 2 a los 2,5 años, el 100 por ciento presentó riesgo de diabetes tipo 2 moderado/alto y 94,7 por ciento resistencia a la insulina al inicio. Conclusiones: la resistencia a la insulina y el riesgo de diabetes tipo 2 podrían ser de gran utilidad en la identificación de individuos con alto riesgo para padecer diabetes(AU)

Introduction: at present, there is no set strategy in Cuba for the screening of impaired glucose metabolism. Objective: to evaluate the diagnostic capacity of three methodologies to predict the risk of impaired glucose metabolism in overweighed and obese individuals. Methods: a longitudinal diagnostic evaluation study was carried out using data from 90 subjects aged 25 to 70 years, which were analyzed two and a half years after the initial assessment. Information about age, sex, personal pathological history, used medication, weight, height, waist circumference and blood pressure as well the glucose concentrations at the beginning and two and a half years later, insulin and triglyceride indexes was collected in addition to estimating the insulin-resistance index in the initial evaluation. A risk-score model for type 2 diabetes was also used. Results: the frequency of impaired glucose metabolism (impaired fasting glycemia and type 2 diabetes) after two and a half years, according to the previous existence or not of impaired fasting glycemia, insulin resistance and moderate/high risk of type 2 diabetes, was higher in subjects with previous impaired fasting glycemia (72,4 percent [21/29]), with insulin resistance at the beginning (65.6 percent [40/61]) and with moderate/high risk (54,4 percent [43/79]) than in those individuals without impaired fasting glycemia, insulin resistance and with low diabetes risk (41.0 percent [25/61], p= 0,005; 20.7 percent [6/29], p= 0.006 and 27.3 percent [3/11], p< 0.0001, respectively). Insulin resistance index and moderate/high risk of type 2 diabetes showed high sensitivity to identify subjects with impaired glucose metabolism (87.0 and 93.5 percent, respectively), in contrast to impaired fasting glucose whose sensitivity was low (45.7 percent). Of 19 individuals who developed type 2 diabetes two and a half years later, 100 percent had moderate/high risk of type 2 diabetes and 94.7 percent had insulin resistance at the beginning. Conclusions: insulin resistance and risk of type 2 diabetes could be very useful in detecting individuals with high risk of developing diabetes(AU)

Valor de corte de la circunferencia de la cintura como predictor de disglucemia / Cut-off point of the waist circumference as a predictor of dysglycemia

Introducción: la circunferencia de la cintura es un parámetro clínico útil para identificar alteraciones en el metabolismo de los carbohidratos, pero la Organización Mundial de la Salud recomienda que cada país o región debe establecer sus propios valores de corte. Objetivo: determinar el punto de corte de la circunferencia de cintura como predictor de disglucemia en una población cubana. Métodos: se realizó un estudio descriptivo transversal basado en 982 pacientes (457 hombres y 525 mujeres) que asistieron a las consultas del Instituto Nacional de Endocrinología por sospecha de diabetes mellitus tipo 2, entre abril de 2008 y abril de 2013. La metodología consistió en la realización de un interrogatorio y un examen físico, que incluyó la medición de la circunferencia de cintura y estudios de laboratorio que se completaron con una prueba de tolerancia a la glucosa oral. Se determinaron distribuciones de frecuencia de las variables cualitativas y de las cuantitativas, media y desviación estándar. Además se utilizaron el coeficiente de correlación de Pearson, regresión lineal simple, el análisis de las curvas Receiver Operator Characteristics y la prueba de chi cuadrado. Resultados: se halló una correlación positiva entre la circunferencia de cintura y los valores de glucemia, insulinemia, ácido úrico y el índice Homeostasis Model Assessment Estimate of Insulin Resistance. La circunferencia de la cintura en ambos sexos fue la variable con mayor poder predictor de disglucemia, con un punto de corte de cintura de 86,75 cm en hombres y 80,5 cm en las mujeres. Conclusiones: el punto de corte óptimo de la circunferencia de cintura como predictor de disglucemia en hombres es de 86,75 cm (87) y en mujeres de 80,5 cm (81) en una población cubana(AU)

Introduction: waist circumference is a useful clinical parameters to identify alterations in carbohydrate metabolism; however the World Health Organization recommends that each country or region should set its own cut off point values. Objective: to determine the cut-off point of the waist circumference as a predictor of dysglycemias in a Cuban population. Methods: a cross-sectional descriptive study was conducted in 982 patients (457 men and 525 females) who went to the medical offices of the National Institute of Endocrinology on suspicion of diabetes mellitus type 2 from April 2008 to April 2013. The methodology consisted of administration of questionnaires and physical examination including the measurement of waist circumference and lab studies that were completed with the oral glucose tolerance test. Frequency distributions of the qualitative and quantitative variables, the median and standard deviation were all determined. Additionally, Pearson´s correlation coefficient, the simple linear regressions, analysis of Receiver Operator Characteristic curves and the Chi-square test were also used. Results: positive correlation was found between the waist circumference and the glycemia, insulinemia, uric acid and the homeostasis model assessment estimate of insulin resistance. Waist circumference in both sexes was the variable with greatest predictive power for dysglycemia, with a cutoff point of 86.75 cm for men and 80.5 cm for women. Conclusions: the optimal cutoff point of waist circumference as a dysglycemia predictor in men is 86.75 cm (87) and in women is 80.5 (81) in a Cuban population(AU)

Discrepancia diagnóstica clínico-anatomopatológica de la diabetes mellitus como causa básica de muerte / Clinical and anatomopathological diagnostic discrepancy of diabetes mellitus as a basic cause of death

Introducción: el conocimiento acerca del grado de discrepancia del diagnóstico clínico corroborado por la necropsia, permitirá el mejoramiento del pensamiento clínico y de la calidad de la atención médica. Objetivos: determinar el nivel de discrepancia del diagnóstico de diabetes mellitus como causa básica de la muerte, según certificado médico de defunción, partiendo de las necropsias realizadas, así como determinar el nivel de contribución de las técnicas de recuperación estadística de los certificados médicos de defunción, en los que exista discrepancia clínico-anatomopatológica. Métodos: estudio observacional descriptivo, transversal en los fallecidos con diabetes mellitus, con necropsias realizadas, en hospitales de La Habana, en el año 2014 (n= 167). Resultados: el sexo y el grupo de edad más representado fueron: el femenino (106; 63,5 por ciento) y el de 60-79 años (93; 77,7 por ciento) respectivamente. Las causas directas de la muerte más frecuentes fueron el shock séptico (38; 22,7 por ciento), seguido del tromboembolismo pulmonar (27; 16,2 por ciento). La discrepancia entre el certificado médico de defunción y el resultado de la necropsia, en cuanto a la diabetes mellitus como causa básica de la muerte, fue de un 34,7 por ciento. El médico que más certificó la defunción fue el de guardia (138; 82,6 por ciento). De los 58 certificados médicos de defunción en los que no hubo discrepancia diagnóstica, el método de recuperación del diagnóstico de diabetes mellitus más frecuente fue el reparo (32; 52,6 por ciento), seguido del método de recodificación (26; 44,8 por ciento). Conclusiones: la discrepancia diagnóstica entre la causa directa de la muerte en el certificado médico de defunción y el resultado de la necropsia, de los fallecidos estudiados, presenta valores superiores al estándar propuesto(AU)

Introduction: the knowledge about the level of discrepancy of the clinical diagnosis corroborated by necropsy will allow improving the clinical thought and the quality of medical care. Objectives: to determine the level of discrepancy of the diabetes mellitus diagnosis as a basic cause of death, according to the medical death certificate, on the basis of performed necropsies, and to determine the level of contribution of statistical death certificate retrieval techniques when clinical and anatomopathological discrepancy exists. Methods: descriptive, observational and cross-sectional study of dead people with diabetes mellitus and performed necropsies in hospitals located in Havana in 2014 (n= 167). Results: the most representative sex and age group was females (106; 63.5 percent) and 50-79 y group (93; 77.7 percent), respectively. The most common direct causes of death were septic shock (38; 22.7 percent) followed by pulmonary thromboembolism (27; 16.2 percent). Discrepancy rate between the death certificate and the necropsy was 34.7 percent in terms of diabetes mellitus as the basic cause of death. The physician working in the emergency room was the one who gave the highest number of death certificates (138; 82.6 percent). In the 58 death certificates which showed no diagnostic discrepancies, the most frequent method of retrieval of diabetes mellitus diagnosis was the repair one (32; 52.6 percent), followed by the recoding method (26; 44.8 percent). Conclusions: diagnostic discrepancy between the direct cause of death written in the death certificate and the results of necropsy of the studied dead people showed some values higher than the suggested standard(AU)

Valor de corte del índice cintura/talla como predictor independiente de disglucemias / Cutoff value of the waist-to-height ratio as independent predictor of dysglycemia

Introducción: el índice cintura/talla constituye un parámetro clínico útil para identificar alteraciones del metabolismo de los carbohidratos. Objetivo: determinar el punto de corte del índice cintura/talla como predictor independiente de disglucemias, su utilidad en este sentido, así como su relación con otras variables de riesgo. Métodos: estudio descriptivo transversal con 523 mujeres y 452 hombres. Se les realizó interrogatorio, examen físico y estudios complementarios. En el procesamiento estadístico se determinaron distribuciones de frecuencia de las variables cualitativas y cuantitativas. Se aplicó el coeficiente de correlación de Pearson, el análisis de curvas Receiver Operator Characteristic, así como un análisis de regresión logística, y se utilizó la prueba chi cuadrado para evaluar la significación estadística. Resultados: se encontró en ambos sexos, una correlación directamente proporcional entre el índice cintura/talla y las variables: glucemia en ayunas y a las 2 h, insulinemia en ayunas, colesterol, triglicéridos, ácido úrico y el índice de resistencia a la insulina, con significación estadística. El índice cintura/talla fue la variable con mayor poder predictor de disglucemias, al compararlo con otras variables -colesterol e índice de resistencia a la insulina- en ambos sexos, con un punto de corte de 0,50 en mujeres y 0,49 en hombres. Conclusiones: el punto de corte óptimo del índice cintura/talla como predictor independiente de disglucemias fue de 0,50 en mujeres y 0,49 en hombres. Existió una correlación directamente proporcional entre este índice y las variables de riesgo analizadas. Fue mejor predictor de disglucemias que el colesterol y el índice de resistencia a la insulina(AU)

Introduction: the waist-to-height ratio is a useful clinical indicator to identify impaired metabolism of carbohydrates. Objective: to determine the cutoff value of the waist-to-height ratio as an independent predictor of dysglycemias, its usefulness and association with other risk variables. Methods: descriptive and cross-sectional study conducted in 523 women and in 452 men. They were questioned, physically examined and performed supplementary studies. The statistical processing determined the frequency distributions in qualitative and quantitative variables. Pearson´s correlation coefficient, analysis of Receiver Operator Characteristic curves as well as logistic regression analysis were all applied, in addition to chi-square test for evaluation of the statistical significance. Results: in both sexes, the study found a directly proportional correlation between the waist-to-height ratio and the variables called fasting glycemia and glycemia at 2 hours, fasting insulinemia, cholesterol, triglycerides, uric acid values and insulin-resistance index, with statistical significance. The waist-to-height index exhibited the highest predictive power for dysglycemia when compared to other variables such as cholesterol and insulin-resistance index in both sexes, with a cutoff value of 0.50 in women and 0.49 in men. Conclusions: the optimal cutoff value of the waist-to-height ratio, as an independent predictor of dysglycemias, was 0.50 in women and 0.49 in men. There was direct proportional correlation between this ratio and the analyzed risk variables. It was a better predictor than cholesterol and the insulin-resistance index(AU)