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1.
Diabet Med ; 29(11): 1390-4, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22681498

RESUMO

AIMS: We evaluated the relations between surrogate indices of insulin resistance and waist circumference, metabolic syndrome and coronary heart disease risk across Hispanic and non-Hispanic white populations. METHODS: The study was a cross-sectional analysis of participants without diabetes in the San Antonio Heart Study, Mexico City Diabetes Study and Spanish Insulin Resistance Study. We evaluated commonly used indices of insulin resistance, including homeostasis model assessment, McAuley's index, Gutt's insulin sensitivity index, Avignon's insulin sensitivity index and the Stumvoll index with and without demographics, the modified Matsuda index and the product of the triglycerides and glucose index. The metabolic syndrome was defined by American Heart Association/National Heart, Lung, and Blood Institute criteria and coronary heart disease risk by Framingham risk scores. RESULTS: The Stumvoll index with demographics and the Avignon's insulin sensitivity index had the strongest correlations with waist circumference across populations. The triglycerides and glucose and McAuley's indices had the most robust correlations with Framingham risk score. The triglycerides and glucose index had the greatest ability to detect individuals with the metabolic syndrome and ≥ 10% coronary heart disease risk. Some indices display significant variability in the strength of the relationship with adiposity and coronary heart disease risk across populations. CONCLUSIONS: There are significant differences between insulin resistance indices regarding the ability to detect the metabolic syndrome and coronary heart disease risk across populations. Studies may need to consider the index of insulin resistance that best suits the objectives.


Assuntos
Glicemia/metabolismo , Doenças Cardiovasculares/sangue , Hispânico ou Latino/estatística & dados numéricos , Resistência à Insulina , Síndrome Metabólica/sangue , Triglicerídeos/sangue , Circunferência da Cintura , População Branca/estatística & dados numéricos , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Jejum/sangue , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Sensibilidade e Especificidade
2.
Diabetes Metab ; 46(4): 304-310, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-31525457

RESUMO

AIMS: In Mexico City, the mortality rate among patients with diabetes appears to be four times that of people without diabetes. Our study aimed to refine analyses of the impact of diabetes on mortality in a large cohort of women from different areas in Mexico with healthcare insurance. METHODS: Our study followed 111,299 women with comprehensive healthcare coverage from the Mexican Teachers' Cohort. After a median follow-up of 7.8years, 5514 (5%) prevalent self-reported diabetes cases and 4023 incident cases were identified, while deaths were identified through employers' databases and next-of-kin reports, with dates and causes of death for 1121 women obtained from mortality databases. Hazard ratios (HRs) for total and cause-specific mortality were estimated by Cox regression models, using follow-up time as the time scale and allowing for time-variable diabetes status after adjusting for age, socioeconomic status, use of health services, and anthropometric and lifestyle variables. RESULTS: In multivariable-adjusted models, the HR for all-cause mortality was 3.28 (95% CI: 2.86-3.75) in women with vs. without diabetes. The impact of diabetes on mortality was higher in rural vs. urban areas (HR: 4.72 vs. 2.98, respectively). HRs were 1.57 and 23.44 for cancer and renal disease mortality, respectively. CONCLUSION: In women with healthcare coverage in Mexico, the magnitude of the association between diabetes and all-cause mortality was higher than that observed in high-income countries, but less than what has previously been reported for Mexico. Such elevated mortality suggests a lack of adequate access to quality diabetes care in the population despite comprehensive healthcare coverage.


Assuntos
Diabetes Mellitus/epidemiologia , Mortalidade , Adulto , Doenças Cardiovasculares/mortalidade , Causas de Morte , Estudos de Coortes , Feminino , Humanos , Infecções/mortalidade , Nefropatias/mortalidade , México/epidemiologia , Pessoa de Meia-Idade , Neoplasias/mortalidade , Modelos de Riscos Proporcionais , População Rural , População Urbana , Ferimentos e Lesões/mortalidade
3.
Diabetes Care ; 24(12): 2059-64, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11723083

RESUMO

OBJECTIVE: Mexican-American populations in San Antonio, Texas (SA-MA) and Mexico have a higher prevalence of type 2 diabetes than non-Hispanic whites in San Antonio (SA-NHW). However, the higher prevalence of type 2 diabetes in Mexican-origin populations might be related, in part, not to Native American genetic admixture but to Spanish genetic admixture. RESEARCH DESIGN AND METHODS: Four population-based epidemiological surveys conducted with Mexican-origin and European-origin samples provided data relevant to this question. In all four surveys, type 2 diabetes was defined as fasting plasma glucose > or =7.0 mmol/l or 2-h glucose > or =11.1 mmol/l or use of antidiabetic agents. RESULTS: A comparison of the two Mexican-origin populations showed that the age- and sex-adjusted prevalence of type 2 diabetes was lower in Mexico than in SA-MA (15.1 vs. 17.9%, P = 0.032). Between the two European-origin populations, the prevalence of type 2 diabetes was lower in SA-NHW than in Spain (6.2 vs. 9.1%, P < 0.0001), but differences were attenuated by adjustment for BMI or after stratification by education. In logistic regression analyses, type 2 diabetes was associated with Mexican ethnic origin after adjusting for age, education, BMI, and waist-to-hip ratio. CONCLUSIONS: The prevalence of type 2 diabetes in Spain was intermediate between that in Mexican-origin populations and SA-NHW. Although the higher degree of Native American admixture is a major contributor to the higher rates of type 2 diabetes, we cannot completely rule out a partial contribution of Spanish admixture to diabetes susceptibility among Mexican- origin populations.


Assuntos
Diabetes Mellitus Tipo 2/genética , Hispânico ou Latino , Fatores Etários , Constituição Corporal , Índice de Massa Corporal , Escolaridade , Resistência à Insulina , Modelos Logísticos , México/epidemiologia , México/etnologia , Razão de Chances , Espanha/epidemiologia , Texas/epidemiologia
4.
Diabetes Care ; 20(5): 773-7, 1997 May.
Artigo em Inglês | MEDLINE | ID: mdl-9135941

RESUMO

OBJECTIVE: To compare the prevalence of diabetic retinopathy (DR) between low-income Mexicans from Mexico City and Mexican-Americans from San Antonio, Texas. RESEARCH DESIGN AND METHODS: We designed a cross-sectional population-based study in low-income neighborhoods of Mexico City and San Antonio. The men and non-pregnant women included in the study had NIDDM and were between 35 and 64 years of age. Ophthalmologic evaluation was performed in 414 patients, 204 in San Antonio and 210 in Mexico City. Seven field standard stereophotographs of each eye were obtained, adapting the Early Treatment Diabetic Retinopathy Study protocol, and graded at the Fundus Photograph Reading Center of the University of Wisconsin. RESULTS: Early nonproliferative DR occurred in 37 (17.6%) and 39 (19.1%) patients in Mexico City and San Antonio, respectively. Moderate-to-severe nonproliferative DR occurred in 55 (26.2%) and 37 (18.1%) patients in Mexico City and San Antonio, respectively, and proliferative DR occurred in 12 (5.7%) and 7 (3.4%) patients in Mexico City and San Antonio, respectively. Using univariate and multivariate logistic regression analysis with DR as the dependent variable, age, duration of disease, and fasting glucose concentration were positively and significantly associated with retinopathy, whereas city, systolic blood pressure, and other selected metabolic variables were not. We defined moderate-to-severe DR to include the categories of moderate-to-severe nonproliferative and proliferative DR. For this combined category, Mexico City patients with diabetes had a significantly higher prevalence (P < 0.01) than those from San Antonio when analyzed by multiple logistic regression analysis (odds ratio for Mexico City/San Antonio, 1.72; 95% CI 1.10-2.70). CONCLUSIONS: Overall prevalence of DR is similar in both cities. However, moderate-to-severe DR is significantly higher in Mexico City.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/fisiopatologia , Adulto , Fatores Etários , Análise de Variância , Glicemia/análise , Pressão Sanguínea , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Jejum , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Análise de Regressão , Índice de Gravidade de Doença , Fatores Socioeconômicos , Texas/epidemiologia , Triglicerídeos/sangue , População Urbana
5.
Arch Med Res ; 26(4): 409-13, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-8555736

RESUMO

We present the results of a population based survey designed to estimate the prevalence and clinical characteristics of carotid artery atherosclerosis (CAS) diagnosed using vascular ultrasonography (VUS) in a low income area of Mexico City encompassing six neighborhoods that we previously studied. We attempted to locate all the non-diabetic participants of the first two neighborhoods (n = 834) and all diabetics from the six neighborhoods (n = 304). We located 1078 (94.7%) participants and examined 770 (71.4%). All study subjects were men and non-pregnant women between 35-64 years of age and had standardized VUS protocol. In men, the prevalence of CAS was 16.29%, in women the prevalence was 12.3%. CAS was significantly associated in both sexes to age (p < 0.001) and systolic blood pressure (p < 0.001). The ratio of the subscapular to triceps skinfolds was significantly higher in men with CAS (p < 0.04). In women, fasting glucose was higher in subjects with CAS (p < 0.04). The lipid profile was similar in men with and without CAS. However, women with CAS had significantly higher total cholesterol (p < 0.001), LDL cholesterol (p < 0.002), VLDL cholesterol (p < 0.092) and mean TG (p < 0.033). The percent of patients with hypertension, tobacco use, myocardial infarction and diabetic retinopathy of any degree was significantly higher in the subjects with CAS. CAS of any degree was observed in 12.4% of the non-diabetic population and 18.13% of the diabetics.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Arteriosclerose/epidemiologia , Doenças das Artérias Carótidas/epidemiologia , Carboidratos da Dieta/efeitos adversos , Adulto , Arteriosclerose/etiologia , Doenças das Artérias Carótidas/etiologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência
6.
Arch Med Res ; 32(3): 208-13, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11395186

RESUMO

BACKGROUND: It is known that insulinemia is the result of the interaction among several factors, such as weight, body fat pattern distribution, and physical activity as well as ethnicity. There is little information regarding this question among Mexican adolescents. The association among fasting insulin levels, weight, fat distribution, physical activity, and cigarette smoking was studied in Mexican adolescents. METHODS: Cross-sectional data were collected from 352 Mexican adolescents aged 14-19 years (response rate 41.5%). Fasting insulin levels were measured by microparticle enzyme immunoassay; body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC) were determined using standardized techniques, while physical activity was determined by 7-day Stanford physical activity inventory. Cigarette smoking was defined as number of cigarettes/year. RESULTS: Increased BMI and waist circumference, low physical activity, younger age, and non-smoking were associated with high insulin levels. Non-smokers had higher fasting insulin levels compared to smokers (57.8 pmol +/- 1.84 vs. 49.7 pmol/L +/- 2.8; p = 0.034). However, adjusted odds ratio (OR) between insulin and smoking status was not significant. Multivariate analysis showed the following: insulin increased 1.06 pmol/L for each unit of change in BMI; increased 1.02 pmol/L for each unit of change in waist circumference; increased 1.16 pmol/L for non-smoking, and decreased 1.07 pmol/L for each 250 kcal/day of energy expenditure. CONCLUSIONS: Our results support the concept that Mexican adolescents who are overweight have abdominal fat distribution and physical inactivity, and significant hyperinsulinemia. The relationship between smoking and lower insulinemia found in this research warrants further study.


Assuntos
Peso Corporal , Exercício Físico , Insulina/sangue , Fumar/sangue , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , México
7.
Arch Med Res ; 25(3): 347-53, 1994.
Artigo em Inglês | MEDLINE | ID: mdl-7803987

RESUMO

The aim of this study was to characterize the prevalence and detection of systemic hypertension in a low income urban area of Mexico City. The population of the studied area was 15,532 inhabitants, of whom 3505 (22.6%) were eligible for study (men aged 35-64 years and non-pregnant women). Home interviews were obtained on 2810 (80.2%) and physical and laboratory examination was performed on 2282 individuals (941 men, 1341 women, 81.2% of those interviewed and 65.1% of all the eligibles). Blood pressure (BP) was measured using a random zero sphygmomanometer (Hawksley, London). Three measurements were made on the right arm after a 5 min rest, with the patient seated. The average of the last two determinations was taken as the patient's BP. High blood pressure (HBP) was defined as systolic BP > or = 160 and/or diastolic BP > or = 95 mmHg, or if the patient was taking antihypertensive therapy regardless of the blood pressure value. A total of 216 subjects (77 men, 139 women) met criteria for HBP. In the 35-44 age group, prevalence for men was 4.16% and for women 3.06%. In the 44-55 age groups the prevalence for men was 7.81% and for women 12.55%. In the 55-64 year group the prevalence for men was 16.51% and for women 22.2%. Obesity was associated with HBP (body mass index in men with HBP was 28.9 kg/m2 vs. without 26.9 kg/m2, p < 0.001; women with HBP, 30.8 kg/m2 vs. without 28.5 kg/m2, p < 0.001.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Hipertensão/epidemiologia , Adulto , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência
8.
Arch Med Res ; 25(3): 355-60, 1994.
Artigo em Inglês | MEDLINE | ID: mdl-7803988

RESUMO

We present the results of a population based study designed to estimate the prevalence of diabetic retinopathy in a series of 284 type 2 diabetics residing in low income areas of Mexico City. These patients were identified in a survey performed between February 1990 and October 1992 (The Mexico City Diabetes Study). We located 214 (75.35%) of the original 284 patients and invited them to attend a clinic where they were interviewed and had a complete ophthalmologic examination. All participants had, in addition to the retinal examination by a certified ophthalmologist, seven fields stereo fundus photographs taken with a Topcon 50X retinal camera. Photos were taken using ASA 100 Kodak film and processed in their laboratory. All photographs were read and graded for quality and level of diabetic retinopathy (DR) in the Reading Center of the Department of Ophthalmology of the University of Wisconsin. A total of 37 (43.5%) men and 69 (53.5%) women had no evidence of DR. In 16 (18.8%) men and 21 (16.3%) women there was background DR. In 25 (29.4%) men and 30 (23.3%) women there was preproliferative DR. In 5 (5.9%) men and in 7 (5.4%) women there was proliferative DR. Macular edema was diagnosed in 7 (8.2%) men and 6 (4.7%) women, of these in 3 (3.5%) men and in 5 (3.9%) women the macular edema was central. This complication is associated with duration of diabetes, chronic poor metabolic control and microalbuminuria. A very significant proportion of cases with sight threatening DR remains undiagnosed and untreated. Consequently there is a significant number of cases developing into blindness that could have been prevented.


Assuntos
Retinopatia Diabética/epidemiologia , Adulto , Retinopatia Diabética/diagnóstico , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência
9.
Arch Med Res ; 25(4): 387-92, 1994.
Artigo em Inglês | MEDLINE | ID: mdl-7858396

RESUMO

The importance of good metabolic control in the treatment of diabetes mellitus (DM) is unquestionable. Measurements of the level of control (LC) are available such as glycohemoglobin (GH) and fructosamine (FA). The aims of this study are: to estimate LC in a population based case series of type II DM patients, to assess the effect of clinical, metabolic and sociodemographic variables usually associated with the LC and to estimate the clinical impact of the LC on vascular complications of DM. A low income area of Mexico City was enumerated. All males and non-pregnant females between 35-64 years of age were considered eligible. Home interview was obtained in 2813 and a medical exam including an oral glucose tolerance test was performed in 2282 (65.1%). Three hundred and four subjects met the criteria (WHO) for DM. Three years later, 213 (70.1%) were located for GH and FA measurements. Cases were divided according to the level of GH: Group I, good LC (GH < or = 8.6%, n = 66); and group II poor LC (GH > or = 8.7%, n = 147). A significant difference was observed in the mean value of FA between groups (Group I 255 +/- 52.3 mumol/dl. Group II 306.4 +/- 51.1; p < 0.001). In comparison with subjects with good LC, patients with poor LC had higher values of duration of DM (p < 0.01), waist/hip ratio (p < 0.04), fasting glucose (p < 0.001) and lower values of fasting insulin (p < 0.07), LDL cholesterol (p < 0.006) and VLDL cholesterol (p < 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Pobreza , Adulto , Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Dieta , Escolaridade , Exercício Físico , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Vigilância da População
10.
Arch Med Res ; 26(2): 133-40, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-7620278

RESUMO

The epidemiologic data supporting an association between physical activity and lipoprotein profile is controversial. We hypothesized that physical activity is positively associated with triglyceride levels and negatively associated with high density lipoprotein (HDL) cholesterol levels, and that these associations are mediated by insulin activity. We tested these hypotheses in 819 male and 1159 female healthy non-diabetic Mexicans, aged 35-64 years, residing in Mexico City. Physical activity was assessed using a modified Stanford 7-day Physical Activity Recall. Serum glucose and insulin were evaluated in the fasting state and 2 h following a glucose challenge. Crude analysis indicated that physical activity was not associated with HDL cholesterol in males, but was associated with HDL cholesterol in females (r = 0.06; p = 0.025). Physical activity was not associated with triglyceride concentration in males or females. Multivariate results showed that the positive association between HDL cholesterol and physical activity in women remained after controlling for age, estrogen status, body mass index, and smoking. Furthermore, there was a significant interaction between physical activity, HDL cholesterol and an index of insulin sensitivity. Women with higher levels of insulin sensitivity had higher levels of HDL cholesterol. However, among women at lower levels of insulin sensitivity, those with greater physical activity were significantly more likely to have higher HDL cholesterol values.


Assuntos
HDL-Colesterol/sangue , Insulina/sangue , Esforço Físico , Triglicerídeos/sangue , Adulto , Consumo de Bebidas Alcoólicas/sangue , Glicemia/análise , Índice de Massa Corporal , Estrogênios , Feminino , Humanos , Resistência à Insulina , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Pobreza , Valores de Referência , Fumar/sangue , População Urbana
11.
Arch Med Res ; 27(1): 19-23, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-8867362

RESUMO

In this report we present the results of a population based survey designed to characterize the prevalence of hypercholesterolemia (HCL: total cholesterol > or = 240 mg/dl) in a low income urban area of Mexico City (The Mexico City Diabetes Study). In an area of 15,532 inhabitants, 3505 (22.57%) were found to be study eligible (all 35-64 year-old men and nonpregnant women residing in the area permanently). A home interview was obtained in 2813 (80.26%) subjects. A physical exam and oral glucose tolerance test was performed on 2282 (81.2% of the individuals that gave the interview and 65.1% of all study eligibles, 941 men and 1341 women). The crude prevalence of HCL for men in this group was 12.3% and for women 12.5%. Severe HCL (total cholesterol > or = 260 mg/dl) was found in 6.6% of men and 6.5% of women. In the older age group (55-64 years) prevalence in women reached 21.1%. Of the individuals with HCL this abnormality was previously diagnosed in only 15.9% of men and in 7.8% of women. Despite having been diagnosed, the abnormality remained untreated in all cases. HCL was associated with higher mean systolic blood pressure (in women), higher mean diastolic blood pressure (in men) and higher mean fasting and 2 h post-glucose load glycemia as well as post-challenge insulinemia in both sexes. Mean TG was found high in both groups (with and without HCL), but in subjects with HCL the values were significantly higher. We conclude that HCL is very common in this population. The majority of the cases remained undiagnosed and of the small fraction of subjects that have been diagnosed, virtually none is under medical care. It is necessary to design and implement a national program to reduce the impact of this serious health problem.


Assuntos
Hipercolesterolemia/epidemiologia , Adulto , Fatores Etários , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/metabolismo , Feminino , Humanos , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/metabolismo , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais
12.
Arch Med Res ; 26 Spec No: S9-15, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-8845665

RESUMO

The insulin resistance syndrome (IRS) is recognized as a harbinger of serious morbidity and high mortality. No published data on the prevalence of the IRS in the Mexican population exist. We estimated the prevalence of the IRS in an area that had 15,532 inhabitants, 3505 (22.6%) of whom were eligible (35-64 years of age, men and non-pregnant women). Interviews were obtained on 2810 (80.2%), a physical and laboratory examination with oral glucose tolerance test, insulin determinations and lipid profile was performed on 2282 individuals, 81.2% of those interviewed, 65.1% of eligibles. The IRS was defined as the coexistence of the triad: hypertension, glucose intolerance (diabetes or impaired glucose tolerance) and dyslipidemia (triglycerides > or = 200 mg/dl and HDL < 35 mg/dl). Using this diagnostic criteria the prevalence of IRS in the general population was 2.97% for men and 3.21% for women. In subjects with impaired glucose tolerance (IGT), the IRS was identified in 11.7%. In diabetics, IRS occurred in 13.7%. Subjects with IRS (IGT and diabetics) were significantly more obese (BMI 30 +/- 4.3 vs. 28.4 +/- 4.2 kg/m2 p < 0.001), had central upper body fat pattern distribution (sub/tri skinfolds 1.66 +/- 1.1 vs. 1.5 +/- 0.7 p < 0.02), (waist/hip circumferences 1 +/- 0.07 vs. 0.97 +/- 0.07 p < 0.001) and hyperinsulinemia fasting and post glucose load (25 +/- 17 vs. 15 +/- 13 p < 0.001, 157 +/- 92 vs. 85 +/- 72 p < 0.001, respectively). We conclude that the prevalence of IRS is high, individuals with IRS in Mexico have an anthropometric profile characterized by central, upper body obesity. A significant proportion of the patients with IGT and DM are at the highest cardiovascular risk.


Assuntos
Resistência à Insulina/fisiologia , Adulto , Antropometria , Estudos de Casos e Controles , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Pobreza , Prevalência , Síndrome , População Urbana
13.
Arch Med Res ; 27(3): 367-72, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-8854397

RESUMO

Among the most serious complications associated with diabetes mellitus (DM) is nephropathy (DN). In Mexico, there is little information on the frequency and clinical characteristics of DN in the Mexican population. We present results of a population-based survey designed to estimate the prevalence of DN. The low income population consisted of 15,532 inhabitants. All 35- to 64-year-old males and non-pregnant women residing in the survey area were identified as eligible for the study (3505; 22.6%). A home interview was obtained in 2810 (80.2%). A physical exam with oral glucose tolerance test was obtained in 2282 (81.2% of those interviewed). DM was diagnosed in 304 (crude rate 13.3%). Mean age for men and women with DM was 51.6 +/- 8.4 and 52.2 +/- 7.5, respectively. Duration of DM in men was 9.2 +/- 8.1 and in women, 7.3 +/- 6.7 years. Hypertension was diagnosed in 19.8% of men and 18.1% of women. Diabetic retinopathy of any level was found in 55.4% of men and 45.7% of women. Mean glycohemoglobin in men was 9.6 +/- 2.1 and in women 9.5 +/- 2.2% (normal 4-8%). At baseline, proteinuria (1+ or more, by dipstick) was found in 24.7% of men and 9.6% of women, microalbuminuria (MA) in 84.4% of men and 63.8% of women. Quantitative albuminuria was abnormally high in 54.7% of men and 40.3% of women. In the 203 diabetics studied with 24 h urine collection for creatinine clearance, normal renal function was found in 69.1% of men and 47.5% of women, reduced renal function was found in 26% of men and 50% of women, renal insufficiency was diagnosed in 4.9% of men and 1.6% of women. One patient was on dialysis and in a subsequent follow up, we found that 2.3% of the patients had died of renal failure, six men (46-63 years) and a woman of 62 years. We conclude that DN is a very serious threat to this population. The high case fatality rate associated with this condition maintains a low prevalence. It is important to develop a program to diminish the frequency of this condition.


Assuntos
Nefropatias Diabéticas/epidemiologia , Adulto , Comorbidade , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/metabolismo , Retinopatia Diabética/epidemiologia , Feminino , Teste de Tolerância a Glucose , Humanos , Hipertensão/epidemiologia , Testes de Função Renal , Masculino , Programas de Rastreamento , México/epidemiologia , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Obesidade/epidemiologia , Exame Físico , Pobreza , Prevalência , Proteinúria/epidemiologia , Proteinúria/etiologia , Fumar/epidemiologia , Análise de Sobrevida
14.
Arch Med Res ; 28(4): 543-7, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9428581

RESUMO

The authors present the results of a population-based survey of cholelithiasis carried out in a low-income area of Mexico City using high-resolution gallbladder ultrasound. The purpose of the study was to estimate the prevalence and selected associated risk factors of cholelithiasis (CL). The population of the studied area was 15,532 subjects, of whom 3,505 (22.6%) were eligible for the baseline survey (men and non-pregnant women between 35-64 years of age). Of this group, 1,735 (76.03%, 702 men and 1,033 women) were located for a follow-up study. Ultrasonography was performed on all except for 100 subjects who had undergone previous cholecystectomy. Crude prevalence of CL was 14.1% (95% CI 12.5-15.5). The prevalence was 5.8% (95% CI 4.1-7.5) in men and 19.7% (95% CI 17.3-22.1) in women. Presence of gallstones was associated with age, sex (men p<0.006, women p<0.001), and multiparity (p<0.002). Centrality index in men and body mass index in women were positive and significantly associated with CL when compared with subjects without CL. High levels of fasting and post-glucose load insulin in women and men respectively were associated with CL. The authors conclude that the population of this study has a high prevalence of CL and confirm some known risk factors such as age, sex, BMI and multiparity. Proper assessment of the magnitude problem and characterization of potentially modifiable risk factors will play a major role in preventing this pathology.


Assuntos
Colelitíase/diagnóstico por imagem , Colelitíase/epidemiologia , Pobreza , Adulto , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Ultrassonografia
15.
Arch Med Res ; 28(1): 129-35, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9078600

RESUMO

The most frequent cause of preventable blindness in adults, in the developed world, is diabetic retinopathy (DR). The early treatable phase of this complication is clinically silent. In order to institute effective laser photocoagulation and prevention of blindness, timely detection is crucial. Consequently there is a need for periodic funduscopic examinations of all diabetics. Due to the high prevalence of DM in Mexico most of the primary care facilities are limited. We present the results of a DR screening program (DRSP) using a mobile unit equipped with a fundus photography camera, parked outside of a clinic. We report the prevalence of the various stages of DR and clinical characteristics observed in this population as well as our experience working in such an environment. The study period was from September 1 to December 22, 1995. All the diabetics that presented for care to the clinic were identified and all other persons were invited to participate. A total of 231 participants were invited (112 men, 119 women). Non-stereo fundus photos of two retinal fields (macula and optic disk centered) were taken with technique and classification according to international standards. Response rate to the invitation was 95.3%. Mean age was 62.4 +/- 13 years and 63.5 +/- 10 years and duration of diabetes was 12.3 +/- 10.1 years and 11.0 +/- 7.5 years for men and women, respectively. DR was detected in 38% of the cases, of these only 5.6% have received treatment. DR was uncovered in 84.5% of the cases and was associated with duration of diabetes (p < 0.001 in men and p = 0.04 in women) and hyperglycemia (in men p < 0.005, only). DR has a high prevalence in this population and can be detected through a screening program which reveals undiagnosed high risk DR in an efficient, and standardized manner.


Assuntos
Cegueira/prevenção & controle , Retinopatia Diabética/diagnóstico , Programas de Rastreamento , Idoso , Algoritmos , Antropometria , Cegueira/etiologia , Glicemia/análise , Centros Comunitários de Saúde , Comorbidade , Retinopatia Diabética/sangue , Retinopatia Diabética/complicações , Retinopatia Diabética/psicologia , Estudos de Viabilidade , Feminino , Angiofluoresceinografia , Humanos , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Masculino , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , México/epidemiologia , Pessoa de Meia-Idade , Unidades Móveis de Saúde , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Fumar/epidemiologia , Inquéritos e Questionários
16.
Arch Med Res ; 27(2): 237-41, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-8696071

RESUMO

We present the results of a population-based survey carried out in a low income area of Mexico City. The aim of this study is to characterize the prevalence of clinically significant gallbladder disease (CSGD) using the self-reported history of cholecystectomy (CG) or cholelithiasis (CL) demonstrated by cholecystography and/or ultrasonography. The population of the studied area was 15,532 inhabitants, of whom 3505 (22.6%) were age eligible (35-64 year-old men and non-pregnant women). Home interviews were obtained in 2810 (80.2%). A physical and laboratory examination was performed in 2282 individuals (65.1%; 941 men and 1341 women). The prevalence of CSGD in men was 2.0% (95% confidence intervals 1.1-2.9%) and 9.2% in women (95% confidence intervals 7.7-10.7%). Patients with CSGD were older, men (p < 0.003) and women (p < 0.001). Women with CSGD had higher waist to hip circumference ratio (p < 0.06), higher fasting glucose (p < 0.03) as well as 2 h post challenge glycemia (p < 0.04) and insulinemia (p < 0.03). In the multiple logistic regression model only age (p < 0.001) and sex (p < 0.001) remained significantly associated. We conclude that CSGD is quite prevalent in this population. It is associated with age in both genders and in women, higher glucose and insulin levels. The prospective follow-up of this cohort is important since it could generate the information needed to implement a preventive program to diminish the impact of this condition.


Assuntos
Doenças da Vesícula Biliar/epidemiologia , Adulto , Idoso , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos
17.
Rev Invest Clin ; 51(3): 141-50, 1999.
Artigo em Espanhol | MEDLINE | ID: mdl-10466004

RESUMO

Diabetic retinopathy is one of the leading causes of preventable blindness in working age population. Diabetes mellitus and this microvascular complication affects frequently Mexican population and presents itself in severe clinical forms. There are no incidence studies of diabetic retinopathy in Mexico. The four year incidence and progression of diabetic retinopathy were investigated in low income diabetic patients of Mexico City. In the follow up phase we studied 164 patients, 76.6% of the patients studied at baseline, 63 were men and 101 women. All participants had a complete ophthalmological exam and seven field stereo photographs. All photographs were graded using internationally accepted criteria in the reading center of our institution. The four year incidence of any level of retinopathy was 22.5%. Worsening of retinopathy occurred in 20.6% and the proliferative diabetic retinopathy stage was reached in 4.5%. Incidence of diabetic retinopathy was associated to age at diagnosis of diabetes mellitus of less than 45 years and progression was associated to duration of disease of more than ten years. The four year incidence of macular edema was 8.8%. These data are important to plan strategies for prevention of blindness and the implementation of optimal care of diabetic patients in our country.


Assuntos
Retinopatia Diabética/epidemiologia , Adulto , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fatores Socioeconômicos
18.
Rev Invest Clin ; 44(3): 321-8, 1992.
Artigo em Espanhol | MEDLINE | ID: mdl-1488576

RESUMO

In this report we present the results of an epidemiologic survey performed in a low income urban neighborhood. The study was designed to investigate the prevalence of type II diabetes mellitus (DM) and impaired glucose tolerance (IGT) in this socioeconomic stratum. The study was done using the standard procedure for the oral glucose tolerance test (OGT) and the recommended diagnostic criteria for defining DM and IGT according to the World Health Organization. A neighborhood corresponding to a census tract was selected and defined by a map. The 39 blocks encompassed in the neighborhood were identified and randomized using the statistical package Systat. According to the randomization, a complete household enumeration was performed. All the residents and the family relationships were identified. The individuals that were between 35-64 years of age and were not pregnant, were considered eligible and were interviewed at home and invited to have a physical examination with an OGT. The number of inhabitants in the study was 4411 of whom 931 were eligible: 452 (48.5%) men, 479 (51.5%) women. The response rate for the home interview was 91.7%; for the physical examination with the OGT it was 69.8%. The crude rate prevalence of DM for men was 10.6%, and for women it was 14.8%. The crude rate prevalence of IGT for men was 12.8% and 12.3% for women. These results show that susceptibility to DM and IGT is high in our population and are among the highest in the world.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Teste de Tolerância a Glucose , População Urbana , Adulto , Países em Desenvolvimento , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos , Saúde da População Urbana
19.
Rev Invest Clin ; 45(1): 13-21, 1993.
Artigo em Espanhol | MEDLINE | ID: mdl-8484063

RESUMO

We present the results of a population based study designed to estimate the prevalence of obesity defined as body mass index (BMI males > or = 27.7 kg/m and females > or = 27.31 kg/m) and to characterize the adipose tissue distribution pattern in our population, using subscapular and triceps skinfolds and waist and hip circumferences. In addition we assess the effect of obesity on the various metabolic indices that define cardiovascular risk, and explore the attitude of the participants towards obesity and its health consequences. The survey was performed in a low income neighborhood of Mexico City. Anthropometric measurements, laboratory determinations and protocol procedures used in the study were all performed according to international recommendations. The community had 4411 inhabitants, of whom 931 were age eligible (35-64 years): 452 (48.5%) men, 479 (51.5%) women. The response rate for the home interview was 91.7% and for the physical examination with interview and laboratory determinations it was 69.9%. The crude prevalence of obesity in men was 36.8% and in women 60.0%. Subscapular and triceps skinfold measurements were significantly higher in obese patients when compared to non obese participants. Adiposity tended to be distributed preferentially in the lower segment of the body, both in males and females. This pattern showed a tendency to reverse in the obese population. Fat distribution also showed a centrally predominant pattern, especially in obese males. In patients with obesity systemic blood pressure was higher than without obesity, though this was significant only in the first two age groups in males and the youngest age group in females.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Doenças Cardiovasculares/epidemiologia , Obesidade/epidemiologia , Adulto , Glicemia/análise , Pressão Sanguínea , Índice de Massa Corporal , Feminino , Humanos , Insulina/sangue , Lipídeos/sangue , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/psicologia , Prevalência , Fatores de Risco , Dobras Cutâneas , Fatores Socioeconômicos , População Urbana
20.
Rev Invest Clin ; 45(2): 127-32, 1993.
Artigo em Espanhol | MEDLINE | ID: mdl-8337539

RESUMO

We present the results of a population based survey in a low income area of Mexico City. The equivalent of three census tracts were identified and enumerated. The age eligible population (35-64 yrs) in the zone comprised 2253 subjects. A household interview was obtained in 94.8% and a physical exam with laboratory determinations was performed in 62.6% of the total population. The total number of cases studied was 1411 of which 565 were males and 846 were females. Age group distribution was as follows: group 1 (35-44 y) 235 men, 367 women; group 2 (45-54 y) 203 men, 289 women; and group 3 (55-64 y) 127 men, 190 women. The physical exam included the following measurements: height, weight, blood pressure measured with a random zero sphygmomanometer, subscapular and triceps skinfold measurements, and waist and hip circumferences. The body mass index (BMI) was calculated according to a standard formula; the subscapular/triceps ratio was used as centrality index and the waist/hip ratio was used to indicate upper/lower body fat distribution. In addition, the following blood lipids were measured following a 12 hr fast: total and HDL, LDL, VLDL-cholesterol as well as triglycerides. The mean BMI for women was 28.9 kg/m2, for men it was 27 kg/m2. The subscapular/triceps skinfold ratio revealed a predominantly central fat distribution pattern in both sexes. The waist/hip circumference ratio showed a predominantly lower fat distribution pattern also in both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Arteriosclerose/epidemiologia , Lipídeos/sangue , Adulto , Antropometria , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Obesidade/epidemiologia , Valores de Referência , Fatores de Risco , População Urbana
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