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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Blood pressure levels among Indigenous children living at different altitudes.

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

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

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

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

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

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

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

Association between Apo B Levels in Mothers and in their Pre-school Age Offspring.

OBJECTIVE: The study aims to determine the association between apo B levels in mothers and their pre-school offspring. METHODS: Anthropometric measurement (e.g. BMI), lipids, lipoproteins, and apolipoproteins (e.g. apo B) levels in mothers and their children were obtained in November 2015 in Buenos Aires. RESULTS: Eighty-four children (42M) aged 5.3±1.6 years and their mothers aged 33.8±7.2 years were examined. The prevalence of overweight was 39.2 % (33) in mothers and 22.6 % (19) in children, and the prevalence of obesity was 38.1% (32) in mothers and 10.7% (9) in children. Multiple linear regression analysis showed that maternal apo B levels were associated with apo B levels in their offspring, adjusted for confounding variables (Beta=0.29; p=0.03; R2=0.25). Furthermore, offspring born to mothers with high apo B levels were six times likelier to have high apo B levels (OR), 5.7; (95% CI 1.3-25.5). CONCLUSION: This study suggests that maternal apo B levels were significantly associated with apo B concentration in their pre-school age children.

Association between blood pressure and magnesium and uric acid levels in indigenous Argentinean children at high altitude.

OBJECTIVE: To determine the association between nontraditional risk factors such as magnesium and uric acid with blood pressure (BP) in Indigenous children. METHODS: A total of 263 school-aged indigenous children living at high altitude were enrolled in a cross-sectional study in November 2011. Prehypertension (preHTN) and hypertension (HTN) were defined by systolic and/or diastolic BP ≥ 90th to <95th percentile or ≥95th percentile respectively, according to age, sex, and height. RESULTS: The prevalence of preHTN and HTN was 13.7 and 8.3%, respectively. Low magnesium levels were identified in 21.7% (57/263): 28.1% (16/57) of the children with low magnesium levels had preHTN versus 9.7% (20/206) with normal magnesium values. Furthermore, 21.8% (12/57) of the children with low magnesium levels had HTN versus 4.5% (20/206) with normal magnesium values. There was a significant association between mean arterial pressure and magnesium (r = -026), uric acid (r = 0.20), phosphorus (r = -0.17), z-BMI (r = 0.22), potassium (r = -0.10), HOMA-IR (r = 0.17), calcium (r = -0.10), and sodium (r = -0.13). Multiple linear regression analysis showed that mean arterial pressure was associated significantly and directly with BMI, age, gender, and uric acid; and inversely with magnesium, adjusted for sodium, calcium, phosphorus, potassium, and HOMA-IR (R2 = 0.43). Furthermore, multiple logistic regression analyses showed that magnesium (OR = 0.015) and uric acid (OR = 2.95) were significantly associated with preHTN. Similar results were obtained when preHTN was replaced by HTN. CONCLUSION: Our results indicate that HTN was associated inversely with magnesium and positively with uric acid in indigenous school children.

Comparison Between HDL-C Levels in Argentine Indigenous Children Living at High Altitudes and U.S. Children.

BACKGROUND: Studies have shown low levels of high-density lipoprotein cholesterol (HDL-C) in indigenous children versus urban children from Argentina. We hypothesized that indigenous children living at high altitudes might have lower HDL-C levels compared with U.S. children, probably due to ambient hypoxia, lifestyle conditions, or ethnicity. This study was designed (1) to compare HDL-C levels in Argentinean indigenous children with those reported in the 2011-2012 National Health and Nutrition Examination Survey (NHANES) for U.S. children and (2) to determine the association between HDL-C and adiposity in both groups. SUBJECTS AND METHODS: A cross-sectional study of 1,232 (631 females) Argentinean indigenous schoolchildren (4-14 years old) from San Antonio de los Cobres (SAC) was performed between November 2011 and November 2014. Anthropometric measures were performed in the whole group and compared with those of 2,151 U.S. children (1,034 females). However, HDL-C concentrations were measured in 905 SAC children and compared with those of 1,451 U.S. children. Analyses were done incorporating sampling weights for age in both samples to obtain unbiased estimates. In the case of NHANES the weights provided by each individual in the 2011-2012 NHANES demographic file were used, whereas in the SAC sample the weights were obtained using the census data provided by the 2010 National Statistics and Censuses Institute of Argentina. RESULTS: The prevalence of overweight/obesity was significantly lower in SAC (135/1,232; 11%) than in the United States (759/2,151; 35%). However, the prevalence of low levels of HDL-C was significantly higher in SAC (298/905; 33%) than in the United States (142/1,451; 10%). The prevalence of low levels of HDL-C increased significantly in both groups as body mass index categories increased. Multiple logistic regression analysis showed that SAC children had nine and a half times the odds of having low levels of HDL-C compared with U.S. children, adjusted for confounding variables (odds ratio = 9.55; 95% confidence interval, 7.18-12.71). CONCLUSIONS: This study shows a high prevalence of low levels of HDL-C in indigenous Argentinean children 4-14 years of age living at high altitudes compared with U.S. children.

Waist Circumference Percentiles in Indigenous Argentinean School Children Living at High Altitudes.

BACKGROUND: Central obesity is associated with increased risk of type 2 diabetes. OBJECTIVES: The study objectives were to develop waist circumference (WC) percentiles, to determine if WC is associated with metabolic risk, and to compare our WC percentiles with those reported in the 2007-2010 National Health and Nutrition Examination Survey (NHANES). METHODS: A cross-sectional study of 1232 children (606 boys ) 5-14 years was performed from 2011 to 2014 in indigenous Koya children from northwestern Argentina. Anthropometric characteristics, glucose, lipids, and insulin levels were measured. Sex-specific reference percentiles were computed using the Lambda-Mu-Sigma (LMS) method. We obtained 2007-2010 NHANES data for comparison with our results. RESULTS: Compared with the NHANES 90th percentile, WC values for children in this study were lower by an average of 11.05 cm for girls and 12.66 cm for boys. The prevalence of low high-density lipoprotein cholesterol (HDL-C) was 11.8% in children with WC ≤50th percentile, 10.3% in children with WC >50th-70th percentile, 17.5% in children with WC >70th-90th percentile, and 21.3% in children with WC >90th percentile. The prevalence of high triglycerides (TG) was 19.5% in children with WC ≤50th percentile, 19.9% in children with WC >50th-70th percentile, 28.8% in children with WC >70th-90th percentile, and 39.7% in children with WC >90th percentile. Multiple logistic regression analyses showed that high TG values (>150 mg/dL) were significantly associated with WC [odds ratio (OR)] 1.05; 95% confidence interval (CI) 1.03-1.08; and low HDL-C values (<35 mg/dL) were significantly associated with WC (OR 1.04; 95% CI 1.01-1.06), adjusted for age and gender. CONCLUSION: We present for the first time WC reference data for indigenous Koya children ages 5-14 years. There was a significant association between WC and dyslipidemia in this community. Compared with the NHANES WC percentiles, our WC values were lower. These differences possibly reflect ethnicity or the lower prevalence of obesity.

Healthier Lipid Profiles with Vitamin D Supplementation in a Pilot Study in Argentinean Children of Two Ethnicities.

OBJECTIVE: to explore changes in lipid levels in two groups of children of different ethnicities who were able to access vitamin D supplementation versus those who were not. METHODS: A prospective one-year study evaluated 87 San Antonio de los Cobres (SAC) Indigenous and 36 Buenos Aires (BA) urban schoolchildren aged 9.7 + 2.1 years between October 2013 and October 2014. SAC children included 70 (80.5%) treated with 100,000 IU/year of vitamin D and 17 (19.5%) untreated; and BA children included 25 (69,5%) treated and 11(30.5%) untreated. BMI, lipids, and 25-hydroxyvitamin D (25(OH)D) concentrations were measured at baseline and after one year. RESULTS: There was a significantly lower prevalence of overweight/obesity in SAC (n = 7; 8%) versus BA (n = 7; 36.4%) children. There was a significant association between changes in (25(OH)D) and changes in HDL-C levels in SAC (r0.44;p < 0.01) and in BA (r0.34;p < 0.05). Multiple linear regression analyses showed that changes in (25(OH)D ) were significantly associated with changes in HDL-C in SAC (Beta = 0.55, p = 0.02; R20.11) and BA children (Beta = 0.42, p = 0.04; R2 0.21) adjusted for age, gender, and BMI. Furthermore, multiple logistic regression analysis showed that children in the treated group had a likelihood six times greater of having HDL-C >40 mg/dL than the untreated group, adjusted for age, gender, and BMI (OR 6.3: CI 2.0 - 19.8; p < 0.01). CONCLUSION: These results suggest that children who had received vitamin D supplementation had significantly higher vitamin D status and HDL-C, as compared with non-supplemented children in both communities.

Status of Dyslipidemia in Vitamin D Supplemented Argentinean Indigenous Children Versus A Non-supplemented Mixed Population Group.

BACKGROUND: Epidemiological studies have suggested an inverse association between circulating levels of vitamin D and cardiovascular disease risk biomarkers, including an atherogenic lipid profile. OBJECTIVE: To compare the prevalence and the distribution of lipid levels among vitamin D supplemented Argentinean indigenous San Antonio de los Cobres (SAC) children with a nonsupplemented Buenos Aires (BA) mixed population group. METHODS: A group of indigenous children from SAC with hypovitaminosis D supplemented with vitamin D; and a nonsupplemented group from a BA mixed population were compared via a cross sectional study. Anthropometric measures, glucose, lipids, vitamin D, and insulin were measured. RESULTS: The mean ages were 10.3 + 2.3 in SAC and 8.7 ± 1.8 years in BA children. There was a lower prevalence of overweight 7.9%(15/192) vs 17.8% (23/129); and of obesity 1.6% (3/192) vs 30.2% (39/129) in SAC vs. BA respectively. Approximately half of the SAC children versus 30% from BA had optimal vitamin D levels (≥30ng/mL). There was a significantly higher prevalence of high triglycerides (TG) (27.6%vs 4.6%) and low HDL-C (21.3% vs 5.4%) in SAC vs BA children, respectively. In separate linear regression models, we found that despite effective vitamin D repletion, SAC children had higher TG and TG/HDL-C values, whereas HDL-C levels were lower than those of BA children adjusted for age, gender, BMI, and insulin levels. CONCLUSION: Indigenous Argentinean children have a higher risk for dyslipidemia in comparison with BA children, even after vitamin D treatment, suggesting that dyslipidemia could be related to diet or ethnic backgrounds.

Improvement of Apolipoprotein B in Argentine Indigenous School Children after Vitamin D Supplementation.

OBJECTIVE: To determine whether vitamin D supplementation improves non-traditional cardiovascular risk factors such as Apo B levels among indigenous children. METHODS: A prospective two-year study evaluated a treated cohort of 190 children (104 males) aged 9.4+ 2.2 years. Children were divided into group A (n=104; 54.7%) and group B (n=86; 45.3%). Both groups received vitamin D supplementation with 100,000 u/year; group B was treated in 2013 and group A in 2014. All subjects were evaluated at the end of each treatment and anthropometric measures, lipids and vitamin D levels between the two groups were compared. RESULTS: Changes in vitamin D levels were significantly higher in Group A, which was supplied in 2014, than in group B, which was not supplied in 2014 (6.8 vs 0.96 ng/dL; respectively). Levels of LDL-C and Apo B were improved in group A versus B: LDL-C (-5.7 vs 6.9 mg/dL respectively) and Apo B (-0.9 vs 11. mg/dL respectively). Several multiple regression linear analyses showed that changes in vitamin D were significantly associated with lower LDL-C levels (Beta- 0.41, p<0.01; R2 0.07); and with lower Apo B levels (Beta-0.37, p<0.01; R2 0.17). CONCLUSION: Vitamin D supplementation among indigenous children could improve Apo B levels.