Inadequate diabetes knowledge is associated with poor glycemia control in patients with type 2 diabetes.

OBJECTIVE: To identify the association between glycemia control with level of diabetes knowledge, diabetes education, and lifestyle variables in patients with type 2 diabetes. DESIGN: Cross-sectional analytical study. SITE: Clinics of the Mexican Institute of Social Security (IMSS), Mexico. PARTICIPANTS: Patients with type 2 diabetes. MAIN MEASUREMENTS: Glycated hemoglobin (HbA1c), glucose, and lipid profile levels were measured from fasting venous blood samples. Assessment of disease knowledge was performed using the Diabetes Knowledge Questionnaire (DKQ-24). Systolic and diastolic blood pressure was measured. Weight and abdominal circumference were measured, as well as body composition using bioimpedance. Sociodemographic, clinical, and lifestyle variables were obtained. RESULTS: A total of 297 patients were included, sixty-seven percent (67%) were women with a median of six years since the diagnosis of diabetes. Only 7% of patients had adequate diabetes knowledge, and 56% had regular knowledge. Patients with adequate diabetes knowledge had a lower body mass index (p=0.016), lower percentage of fat (p=0.008), and lower fat mass (p=0.018); followed a diet (p=0.004) and had received diabetes education (p=0.002), and to obtain information about their illness (p=0.001). Patients with low levels of diabetes knowledge had a higher risk of HbA1c≥7% (OR: 4.68; 95% CI: 1.48,14.86; p=0.009), as well as those who did not receive diabetes education (OR: 2.17; 95% CI: 1.21-3.90; p=0.009) and those who did not follow a diet (OR: 2.37; 95% CI: 1.01,5.55; p=0.046). CONCLUSION: Inadequate knowledge of diabetes, lack of diabetes education, and dietary adherence are associated with poor glycemia control in patients with diabetes.

[Inequalities in diabetes mortality in Mexico: 2010-2019]. / Desigualdades en la mortalidad por diabetes en México: 2010-2019.

Background: The impact of diabetes mellitus has been shown to be differentially expressed between social groups. Objective: To estimate inequality gaps in diabetes mellitus mortality through absolute and relative measures according to geographic distribution and social conditions. Material and methods: Diabetes mellitus-related deaths recorded in Mexico between 2010 and 2019 were analyzed, and inequality measurements at the state level were calculated by gender. Results: National age-adjusted diabetes mellitus mortality rate showed an increase during the study period. Conclusion: The inequalities present in diabetes mortality should be considered for the design of health strategies.

Antecedentes: Se ha demostrado que el impacto de la diabetes mellitus se expresa de manera diferenciada entre los grupos sociales. Objetivo: Estimar las brechas en la desigualdad en la mortalidad por diabetes mellitus a través de medidas absolutas y relativas según distribución geográfica y condiciones sociales. Material y métodos: Se analizaron las muertes registradas en México por diabetes mellitus entre 2010 y 2019 y se calcularon las mediciones de desigualdad a nivel estatal por sexo. Resultados: La tasa de mortalidad nacional por diabetes mellitus ajustada por edad mostró un incremento durante el periodo estudiado. Conclusión: Las desigualdades presentes en la mortalidad por diabetes deben considerarse para el diseño de estrategias de salud.

Positive health beliefs are associated with improvement of glycated hemoglobin and lipid profiles in Mexican patients with type 2 diabetes mellitus: a cross-sectional study.

BACKGROUND: Health beliefs are relevant to consider in patients with type 2 diabetes since disease control depends mainly on the patient's behaviour. The aim of this study was to assess the association between health beliefs and glycated hemoglobin levels in Mexican patients with type 2 diabetes. METHODS: An analytical cross-sectional study was conducted, and 336 patients were included. Fasting blood levels of glycated hemoglobin, glucose, cholesterol; triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) were measured. Body fat percentage, weight, height; waist circumference, and systolic and diastolic blood pressures were also obtained. A previously validated self-administered questionnaire was used to assess the health beliefs with regards to non-pharmacological treatment. Health beliefs were classified as positive, neutral, and negative. RESULTS: The average age of patients was 54.7 ± 8.5 years, with a higher proportion of females (69%). The questionnaire had a good internal consistency with a Cronbach's alpha score of 0.83. More than 90% of patients attributed a health benefit to diet and exercise, 30 to 40% experienced barriers, and more than 80% had a perception of complications associated to uncontrolled diabetes. Patients with positive health beliefs had lower HbA1c levels (8.2 ± 1.7%) compared to those with neutral (9.0 ± 2.3%), or negative (8.8 ± 1.8%; p = 0.042). The LDL-c levels were lower (p = 0.03), and HDL-c levels were higher (0.002) in patients with positive heath beliefs. CONCLUSIONS: Positive health beliefs are associated with better metabolic control indicators in patients with type 2 diabetes.

[Prevalence of dyslipidemias in Mexico city and Its relation to other cardiovascular risk factors. Results from the CARMELA study]. / Prevalencia de dislipidemias en la ciudad de México y su asociación con otros factores de riesgo cardiovascular. Resultados del estudio CARMELA.

OBJECTIVE: To estimate the prevalence of dyslipidemias in Mexico city and its relation to other cardiovascular risk factors. METHODS: A cross sectional study was conducted to measure cardiovascular risk factors in Mexico City. All subjects were interviewed and anthropometric measures performed, as well as cholesterol, high-density lipoproteins (HDL-C) and triglycerides. Low-density lipoprotein (LDL-C) values were calculated. Means- as well as dyslipidemia-weighted prevalence were measured, with 95% confidence intervals. RESULTS: 833 males and 889 females were studied. The prevalence of cholesterol ≥ 240 mg/dl was 16.4% (95% CI: 14.2-18.7), and 34.1% (95% CI: 31.6-36.5) had values between 200 and 240 mg/dl. Very high values of triglycerides were seen in 2.6% of studied subjects and 29.9% (95% CI: 26.9-32.8) had high values. The prevalence of hypertriglyceridemia was higher in males (43.3%) than females (23%). Mean values of assessed parameters were in general higher in those with other cardiovascular risk factors. CONCLUSIONS: Lipid values in the population of Mexico City are high and so is the prevalence of dyslipidemias. There is an urgent need to implement health policies directed to diminish cardiovascular risk factors, mainly dyslipidemias.

SOD2 gene Val16Ala polymorphism is associated with macroalbuminuria in Mexican type 2 diabetes patients: a comparative study and meta-analysis.

BACKGROUND: Several studies in type 2 diabetes patients have shown significant associations between the SOD2 gene Val16Ala polymorphism and albuminuria, but this association has not been explored in the Mexican population. METHODS: We evaluated the association between the SOD2 gene Val16Ala polymorphism (rs4880) and macroalbuminuria in a sample of 994 unrelated Mexican type 2 diabetes patients. The study included 119 subjects with urinary albumin >300 mg/dL and 875 subjects with urinary albumin ≤ 30 mg/dL. Genotyping of the SOD2 gene Val16Ala SNP was carried out with Real-Time Polymerase Chain Reaction (RT-PCR). RESULTS: The frequency of the TT genotype was 6.7% higher in participants with macroalbuminuria than in the normoalbuminuria group (16.8% vs. 10.1%). Using a logistic regression analysis, we observed that individuals with the CC genotype had significantly lower risks of macroalbuminuria than those with the TT genotype (OR=0.42, p=0.034). We carried out a meta-analysis combining our data with data from four previous studies and estimated an odds ratio (95% CI) for the C allele (with respect to the reference T allele) of 0.65 (0.52-0.80, p<0.001). CONCLUSIONS: A significant association was found between the SOD2 Val16Ala polymorphism and macroalbuminuria in a sample of Mexican type 2 diabetes patients.

Impact of social marginalization on oral health-related quality of life in older adults.

The aim of this study was to determine the association between oral health-related quality of life (OHRQoL) and social marginalization in people aged 60 years and older enrolled in social security in Mexico. A cross-sectional and analytical study was carried out in older adults. To assess the OHRQoL, the OHIP-14 instrument was applied, and the degree of social marginalization and sociodemographic characteristics were analyzed. Measures of central tendency and dispersion, simple frequencies and proportions were estimated. Student's t-test was used for comparison of means, and prevalence ratio (PR) and logistic regression were used to assess associations, all with a significance value of 0.05 and 95% confidence intervals. Perceived OHRQoL in the population measured through the OHIP-14 reached an average value of 9.84 ± 8.91, with the highest value in the dimension of physical pain (2.06 ± 1.91). Perceived treatment need was higher among people with social marginality (p = 0.011). The multivariate analysis shows that marginalized people have a lower OHRQoL. Socially marginalized older adults showed a low a better perception of OHRQoL, independent of demographic and clinical factors.

Economic burden of hypercholesterolemia in high risk of cardiovascular disease population in Mexico.

OBJECTIVE: To estimate the direct and indirect economic burden of hypercholesterolemia in patients with high risk of a cardiovascular event, specifically there were defined 5 groups of patients: 1) familial hypercholesterolemia; 2, 3 and 4) patients with hypercholesterolemia and background of diabetes, myocardial infarction or stroke; 5) diabetes, myocardial infarction and hypercholesterolemia (very high-risk patients) from the Mexican public healthcare institutions. METHODS: For the estimation of the direct costs the items included correspond to: outpatient care, pharmacological treatment, inpatient hospital care, and surgical procedures. For indirect economic burden, death certificates, before the end of the productive age due to hypercholesterolemia were calculated (premature mortality). RESULTS: The direct economic burden for the 5 groups of patients at risk is MXN $39,601,464,154 (USD $1,987,526,432), while the indirect economic burden amounts to MXN $121,646,689 (USD $6,105,229). CONCLUSIONS: The economic impact of hypercholesterolemia in patients with high cardiovascular risk is $39,723,110,843 (equivalent to USD $1,993,631,661) and corresponds to the 0.16% of GDP.

OBJETIVO: Se estimó la carga económica directa e indirecta de la hipercolesterolemia en población con alto riesgo de presentar un evento cardiovascular. Para ello se definieron específicamente cinco grupos de pacientes: 1) aquellos con hipercolesterolemia familiar; 2, 3 y 4) personas con hipercolesterolemia más el antecedente de diabetes, infarto o evento vascular cerebral; 5) pacientes con hipercolesterolemia más diabetes y antecedente de infarto agudo de miocardio (definidos como pacientes de muy alto riesgo cardiovascular). Los cálculos se hicieron desde la perspectiva de las instituciones de salud pública en México. MÉTODO: Para la estimación de los costos directos se incluyó la atención ambulatoria, el tratamiento farmacológico, la atención hospitalaria y las intervenciones quirúrgicas relacionadas con las enfermedades cardiovasculares. Para la carga económica indirecta, se consideraron las muertes reportadas específicamente por causa de hipercolesterolemia, en un momento anterior al final de la edad productiva (muerte prematura). RESULTADOS: La carga económica directa de las cinco categorías de pacientes en riesgo consideradas es de MXN $39,601,464,154 (USD $1,987,526,432), mientras que la carga económica indirecta asciende a MXN $121,646,689 (USD $6,105,229). CONCLUSIONES: El impacto económico de la hipercolesterolemia en población con alto riesgo cardiovascular correspondía a $39,723,110,843 en 2020 (equivalente a USD $1,993,631,661), equivalente al 0.16% del PIB nacional.

A dietary pattern high in full-fat dairy and sweetened beverages is associated with glycated hemoglobin and weight in Mexican patients with type-2 diabetes.

INTRODUCTION: Objective: the aim of this study was to identify dietary patterns in a sample of patients with type-2 diabetes, and to evaluate their association with markers of metabolic control. Methods: a cross-sectional study in 395 patients with type-2 diabetes in primary care was conducted. Fasting blood levels of glycated hemoglobin (A1c), glucose, total cholesterol, low- (LDL-c) and high-density lipoprotein cholesterol (HDL-c), and triglycerides were measured. Waist circumference, body mass index (BMI), and blood pressure were evaluated. Dietary intake was assessed by a food frequency questionnaire, and dietary patterns were derived by cluster analysis. Three dietary patterns were identified: 'fruits and vegetables', 'dairy and sweetened beverages', and 'diverse with alcohol'. Results: an association between the 'dairy and sweetened beverages' dietary pattern and A1c levels was identified (ß = 0.61; 95 % CI: 0.09, 1.12, p = 0.021), considering the 'fruits and vegetables' dietary pattern as the reference group. We also observed a trend towards an adjusted increased risk of A1c ≥ 7 % (odds ratio [OR]: 1.56; 95 % CI: 0.92, 2.64; p = 0.099) and an increased risk of BMI ≥ 25 kg/m2 (OR: 2.62, 95 % CI: 1.20, 5.71, p = 0.015) among patients in the 'dairy and sweetened beverages' dietary pattern as compared to the reference group. Conclusions: a dietary pattern characterized by a high intake of full-fat dairy and sweetened beverages was associated with higher A1c levels and increased risk of high glucose and BMI when compared to a dietary pattern with a higher consumption of fruits and vegetables.

INTRODUCCIÓN: Objetivo: el objetivo de este estudio fue identificar los patrones dietéticos de una muestra de pacientes con diabetes de tipo 2 y evaluar su asociación con los marcadores de control metabólico. Métodos: se realizó un estudio transversal de 395 pacientes con diabetes de tipo 2 en atención primaria. Se estimaron los niveles de hemoglobina glicosilada (A1c), glucosa, colesterol total, colesterol de lipoproteínas de baja (LDL-c) y alta densidad (HDL-c), y triglicéridos en ayunas. Se evaluaron el perímetro de la cintura, el índice de masa corporal (IMC) y la presión arterial. La ingesta dietética se evaluó mediante un cuestionario de frecuencia de alimentos y los patrones dietéticos se obtuvieron mediante un análisis de conglomerados. Se identificaron tres patrones dietéticos: "frutas y verduras", "lácteos y bebidas azucaradas" y "diversos con alcohol". Resultados: se identificó una asociación entre el patrón dietético de "productos lácteos y bebidas azucaradas" y los niveles de A1c (ß = 0,61; IC del 95 %: 0,09, 1,12, p = 0,021), considerando el patrón dietético de "frutas y verduras" como grupo de referencia. También se observó una tendencia a un mayor riesgo ajustado de A1c ≥ 7 % (odds ratio [OR]: 1,56; IC del 95 %: 0,92, 2,64; p = 0,099) y un mayor riesgo de IMC ≥ 25 kg/m2 (OR: 2,62; IC del 95 %: 1,20, 5,71, p = 0,015) entre los pacientes del patrón "lácteos y bebidas azucaradas" en comparación con el grupo de referencia. Conclusiones: el patrón dietético caracterizado por un alto consumo de lácteos y bebidas azucaradas se asoció con niveles más altos de A1c y un mayor riesgo de elevación de la glucosa y el IMC, en comparación con un patrón dietético con mayor consumo de frutas y verduras.

Adherence to non-pharmacological treatment is associated with the goals of cardiovascular control and better eating habits in Mexican patients with type 2 diabetes mellitus. / La adherencia al tratamiento no farmacológico se asocia con metas de control cardiovascular y mejores hábitos dietéticos en pacientes mexicanos con diabetes mellitus tipo 2.

OBJECTIVE: To identify the association of diabetes education or medical nutrition therapy with the goals of control of cardiovascular risk indicators and dietary habits in patients with type 2 diabetes mellitus. METHODS: Analytical cross-sectional study in 395 primary care patients. HbA1c, fasting glucose and lipid profile, blood pressure, weight, waist circumference, and body composition were measured. Dietary habits were measured using the «Instrument for measuring lifestyle in patients with type 2 diabetes mellitus¼ (IMEVID), in the nutrition dimension. Medical nutrition therapy (MNT) and diabetes education (DE) were considered as received by the patient when provided in their healthcare clinic. RESULTS: Women comprised 68% of the patients, with a median of 6 years from diabetes diagnosis. Of the patients, 21% received DE and MNT, 28% DE or MNT, and 51% received neither. The HbA1c was lower in the patients with DE and MNT (7.7% ± 1.9% vs. 8.7% ± 2.3%, 8.4% ± 2.2%; p = .003) respectively. In the patients with DE and MNT, a higher proportion took physical exercise, consumed less tobacco, and had better dietary habits (p < .05). Patients who received DE and MNT achieved HbA1c and HDL-c control levels. A greater risk of HbA1c > 7% was identified when they only received DE or MNT or neither, a longer time since diagnosis of the disease and less frequent adherence to a diet to control the disease (p < .05). CONCLUSION: Diabetes education and medical nutritional therapy favour the goal of cardiovascular risk control and better dietary habits in the patient with type 2 diabetes.

Prevalence of Dementia and Main Subtypes in Mexico: The Study on Aging and Dementia in Mexico (SADEM).

BACKGROUND: Dementia is a priority public health issue due to its high prevalence worldwide and its economic, social, and health impact. However, there are few reports in Mexico based on formal tests and with a clinical approach based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). OBJECTIVE: This study estimates the prevalence of the main types of dementia among elderly people living in the community in Mexico City. METHODS: A population-based, two-step study was conducted, including 6,204 elderly individuals aged 60 or above with in-home assessment. All participants were screened for cognitive impairment; those who presented some cognitive problem underwent a standardized neurological examination. Each diagnosis was based on the criteria for dementia in the DSM-5, and the final consensus diagnosis of dementia was determined by an expert panel. RESULTS: The global estimated prevalence of dementia in the Mexican population was 7.8% met the criteria for Alzheimer's disease, 4.3% for vascular dementia, and 2.1% for mixed dementia. The prevalence of dementia was higher in women than in men (15.3% versus 12.5%, respectively). CONCLUSION: These results provide evidence to propose strategies for Latin American countries where dementia represents a challenge due to the heterogeneity of the populations and socioeconomic disparities, requiring early diagnosis and at the first levels of care.

Reduction of inappropriate prescriptions in older adults through the support of Asynchronous Geriatric Counseling Online (AGAlink): Implemented in primary care.

BACKGROUND/AIM: Medication prescription is a fundamental component in the care of the elderly. Several characteristics of aging and geriatric medicine affect prescriptions for these people and make the selection of drug therapy a difficult and complex process. The objective of this study is to develop a geriatric portal for asynchronous online counseling (AGAlink) for use by physicians specializing in family medicine to reduce medication problems among older adult patients in the first level of care. METHOD: A qualitative study was carried out in the first level of care at the Mexican Institute of Social Security (IMSS), 31 family doctors were interviewed to identify attitudes, preferences about the use of the AGAlink geriatric portal, as well as their recommendations for the implementation of this tool in their daily practice. For the analysis of the data obtained, a qualitative thematic content analysis was used. RESULTS: 90% of the physicians used the geriatric portal outside office hours without the need for the patient to be present. The perception of the physician towards the use of the AGAlink geriatric portal was favorable, provided relevant information and had several positive effects on the process of care for medical prescription. The barriers identified to accept the change in medication were not having the proposed therapeutic option, lack of any laboratory analysis, continuing to consider their experience for the prescription of the medication. CONCLUSIONS: The AGAlink geriatric portal was a tool that was well received by physicians who expressed a positive attitude, considered an investment of a short time that allowed them to update and learn about strategies to reduce the prescription problems presented among the elderly population. However, the main barrier was the use of technology, especially in the doctors with more seniority in the service.

Relationship Between Genetic Variants of ACAT1 and APOE with the Susceptibility to Dementia (SADEM Study).

One of the hypotheses that have emerged to explain the origin of dementia relates the disease with altered lipid metabolism, particularly cholesterol. To maintain cholesterol homeostasis, the ACAT1 enzyme has an important function to regulate the production of Aß. Moreover, APOE is the main cholesterol carrier in the brain, and it has been reported as a risk factor for this disease. This study evaluates the relationship between ACAT1 and APOE genetic variants with susceptibility for the development of Alzheimer's disease and other dementias. We examined four ACAT1 polymorphisms (rs2247071, rs2862616, rs3753526, rs1044925) and two in the APOE gene (rs7412, rs429358) in a group of 204 controls and 196 cases of dementia. Our results show one protective haplotype: CGCA (OR = 0.34, 95% CI = 0.23-0.46; p < 0.001) and one risk haplotype: CGGA (OR = 1.87, 95% CI = 1.34-2.60; p < 0.001) for the development of dementia. Subjects identified as APOE-ε4 allele carriers had a higher risk of developing dementia compared with non-carriers, OR = 13.33 (95% CI = 3.14-56.31). The results support the hypothesis that the ACAT1 gene, together with the APOE gene, plays an important role in susceptibility to the development of dementia and shows genetic characteristics of the Mexican population that can be used to identify the population at risk.

High burden of cardiovascular disease risk factors in Mexico: An epidemic of ischemic heart disease that may be on its way?

BACKGROUND: Whereas developed nations have witnessed a drop in the occurrence and mortality of ischemic heart disease, developing nations have recorded a constant rise. The burden of cardiovascular disease risk factors may explain this increase. METHODS: We conducted a population-based cross-sectional survey to estimate the prevalence of cardiovascular risk factors in the population protected by the Mexican Social Security Institute. A total of 20,062 Mexicans, aged >or=20 years, 43.5% (8,727) male and 56.5% (11,335) female, randomly selected in a 4-stage stratified population-based sampling process were included. RESULTS: The most prevalent cardiovascular risk factor in men was smoking (31.9%), whereas in women, it was obesity (26.6%) and central obesity (49.7%). A similar high age-adjusted prevalence was observed in women and men for hypertension (29.7% and 28.8%), diabetes (12.94% and 12.66%), and hypercholesterolemia (13.81% and 12.36%). There was a clear age effect on the prevalence of diabetes, hypertension, and hypercholesterolemia, with increasing prevalence with aging. Smoking also had an age effect, but its prevalence increases as age diminishes. More than half of the subjects in reproductive age (20-44 years old) have at least 1 cardiovascular risk factor, mainly smoking. CONCLUSIONS: Cardiovascular risk factors are highly prevalent in the Mexican population, which seems to be between the second and third stages of the tobacco epidemic. The increased prevalence of risk factors clustering indicates the need for comprehensive integrated management of cardiovascular risk factors in Mexicans, with special emphasis on individuals at younger ages.

Association of polymorphisms within the transforming growth factor-ß1 gene with diabetic nephropathy and serum cholesterol and triglyceride concentrations.

AIM: The TGF-ß gene participates in the development of chronic kidney disease. We investigated whether the 869 T > C, 915 G > C and -800 G > A polymorphisms of TGF-ß1 are associated with diabetic nephropathy (DN). METHODS: Polymorphisms were genotyped in 439 type 2 diabetes mellitus patients, 233 with diabetic nephropathy (DN+) and 206 without (DN-). The sample was characterized for relevant clinical and biochemical parameters. RESULTS: The 869 T > C (P = 0.016; odds ratio (OR) = 1.818, 95% confidence interval (CI) = 1.128-2.930) and the 915 G > C polymorphisms (P = 0.008, OR = 4.073, 95% CI = 1.355-12.249) were associated with diabetic nephropathy. The 869 T > C variant was associated with total cholesterol levels: CC + CT genotypes had a mean cholesterol concentration of 5.62 ± 1.40 mmol/L vs a mean concentration of 5.15 ± 1.40 mmol/L for the TT genotype (P = 0.011). Triglycerides were also higher in CC + CT genotypes (2.49 ± 1.56 mmol/L) in comparison with TT homozygotes (2.1 ± 1.22 mmol/L, P = 0.042). Multivariate logistic regression showed that the polymorphisms 869 T > C and 915 G > C were independent predictors for DN (P = 0.049 and 0.046, respectively). CONCLUSION: The 869 T > C and 915 G > C polymorphisms within the TGF-ß1 gene were associated with DN+. Lower cholesterol and triglycerides levels were observed in TT homozygotes for the 869 T > C polymorphism. The TGF-ß1 869 T allele seems to confer protection against DN+.

Body Fat Percentage Rather than Body Mass Index Related to the High Occurrence of Type 2 Diabetes.

BACKGROUND: Diabetes prevalence estimation and reduction of its risk factors remain the major goals of health services. While obesity is the major risk factor for diabetes, body fat distribution may be a better predictor. AIMS: To estimate the prevalence of diabetes in an adult working population in Mexico City, and to evaluate the strength of association with different risk factors. METHODS: A cross-sectional survey was conducted in two city halls of Mexico City. Anthropometrics, blood pressure, physical activity, diet, and biochemical parameters were assessed. Diabetes was defined as a fasting plasma glucose level ≥7.0 mmol/l or referred diabetes. The bioelectrical impedance analysis of body components was performed and weight, soft lean mass, body fat percentage and abdominal fat were obtained. Prevalence with 95% confidence intervals was estimated, as well as odds ratios derived from a logistic regression model. RESULTS: The prevalence of type 2 diabetes was 11.0% (95% CI 9.6-12.4%). The proportion of individuals with diabetes who were unaware of having the disease was higher in women (42.5 vs. 36.9%), and the degree of metabolic control was better in women (39.1 vs. 25.0%). Age, blood pressure, triglycerides and the percentage of body fat, were major risk factors related to the occurrence of type 2 diabetes. No relation was observed with physical activity and diet. CONCLUSIONS: The prevalence of type 2 diabetes in Mexico continues to be high and obesity measured by body fat percentage seems to be a better predictor of its occurrence than body mass index.

Fibrinogen is associated with silent myocardial ischaemia in type 2 diabetes mellitus.

OBJECTIVE: Because traditional risk factors only partially explain coronary events, it is necessary to search for new ones like fibrinogen which has been related with coronary disease in healthy middle-aged adults. We attempted to determine the impact of fibrinogen on silent myocardial ischaemia (SMI) in diabetic patients. METHODS AND RESULTS: In a cross-sectional study, 134 type 2 diabetes patients with no history of cardiovascular disease were assessed for SMI. A personal history and physical evaluation of each patient was conducted as well as evaluation of cholesterol, glucose, fibrinogen, blood cell counts, glycated haemoglobin, urine albumin quantification, and urinalysis. A modified Bruce test was performed on all study participants to evaluate the presence of SMI. RESULTS: Eleven patients had SMI (8.2%) that was associated with systolic, diastolic and mean blood pressure, hypertension, and fibrinogen. The correlation coefficient was obtained for quintiles of fibrinogen with the percentage of patients with SMI in that quintile (r = 0.97; 95% = 0.66-0.99). Fibrinogen levels were associated with SMI. A receiver-operator curve analysis showed that the cutoff value for fibrinogen to predict SMI was 400 mg/dL (82% sensitivity, 81% specificity). A cutoff value of 306 mg/dL of fibrinogen would rule in the diagnosis of SMI (100% sensitivity, 17% specificity), while fibrinogen cutoff of 682 mg/dL would rule out SMI (100% specificity, 9% sensitivity). CONCLUSIONS: Fibrinogen strongly predicts SMI in diabetic patients and may identify individuals with high cardiovascular risk. Fibrinogen should be evaluated in diabetic patients for a more accurate cardiovascular evaluation.

[The impact of nutritional education on metabolic disorders in obese children and adolescents]. / Impacto de la educación nutricional sobre alteraciones metabólicas en niños y adolescentes con obesidad.

INTRODUCTION: Childhood obesity has become a serious public health problem. Nutritional therapy plays an important role in its prevention and treatment. PATIENTS AND METHODS: A nonrandomized clinical trial was conducted in 40 obese children and adolescents who underwent a complete medical history and assessment of eating habits through 24-hour food recall and a frequency of food consumption questionnaire. In all patients, body weight, height, skinfold thickness, waist and hip circumferences and fasting glucose, total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, and triglyceride levels were measured. The nutritional intervention consisted of identifying the calorie consumption and nutrient intake, and participants were given advice aimed at changing eating habits with a healthy normocaloric diet. After 4 months, biochemical, anthropometric and dietary indicators were measured again. RESULTS: Significant reductions were observed in body weight (56.0 +/- 16.5 to 54.4 +/- 16.1 kg), body mass index (26.5 +/- 3.7 to 25.1 +/- 3.1), waist circumference (86.4 +/- 11.6 to 81.4 +/- 11.4 cm) and mid-arm circumference (29.0 +/- 5.0 to 26.0 +/- 4.2 mm). Significant reductions were also observed in total cholesterol (167.1 +/- 30.0 to 156.0 +/- 26.5 mg/dl) and LDL-cholesterol (103.0 +/- 21.4 to 84.6 +/- 26.0 mg/dl). A significant increase was found in HDL values (38.0 +/- 7.8 to 43.4 +/- 9.3 mg/dl). In all comparisons, the p-value was < 0.05. CONCLUSIONS: Counseling aimed at changing eating habits is effective in reducing body weight and improves lipid profile in children and adolescents with obesity.

Interleukin 10 gene polymorphisms and frailty syndrome in elderly Mexican people: (Sadem study).

Frailty is a geriatric syndrome, characterized by a loss in functional reserve with an increase in morbidity and mortality. There are no reports that link the genetic polymorphisms between interleukin 10 (IL10) and frailty; for this reason, our objective was used to analyze the role of the polymorphisms of IL10 (rs1800896, rs1800871) in the susceptibility to frailty in a Mexican population. Our study included 984 participants divided into 368 nonfrail, 309 prefrail, and 307 frail. The models for the polymorphisms rs1800896 and rs1800871 were recessive models in association with frailty (OR = 2.3, CI 95% = 1.6-3.2; OR = 1.53, CI 95% = 1.0-2.6), respectively. Two risk haplotypes were identified: ACG and CCG (p < .0001), and three protective haplotypes were identified: ACA, ATG, and ATA (p < .05). This study evaluated the relationship between IL10 and the three subtypes of this geriatric syndrome (frail, prefrail, and nonfrail). These results support a greater susceptibility to frailty for the minor alleles of rs1800871 and rs1800896. In addition, we found two risk haplotypes supporting the participation of the IL10 in the susceptibility for frailty in the Mexican population.

[Effect of a personalized diet in the metabolic control and renal function of patients with type 2 diabetes]. / Efecto de la dieta personalizada en el control metabólico y función renal de pacientes con diabetes tipo 2.

OBJECTIVE: to evaluate a personalized diet customize for present comorbidity, on metabolic control indicators and renal function. METHODS: a non-randomized clinical trial was conducted during a three-month period in a group of patients with microalbuminuria and in a group with macroalbuminuria. The patients received personalized dietary counseling customize to their comorbidity (obesity, hypertension, and dislypidemia). The effect of the diet was measured through metabolic control variables: body mass index (BMI), waist circumference, fasting glucose levels, glycated hemoglobin (HbA(1))c and lipids profile; the renal function variables were: glomerular filtration rate (GFR) and urine albumin excretion (UAE). Statistical analysis was done with t-paired test. RESULTS: thirty-nine patients were included (21 women and 18 men). After the intervention, the weight and waist circumference had significantly decreased (p = 0.01); the fasting glucose levels and HbA(1)c were significantly lower (p = 0.001). The HDL-cholesterol increased significantly (p = 0.009); UAE decreased significantly in patients with micro and macroalbuminuria; 123.0 +/- 73.4 to 105.3 +/- 61.3 mg/24-h; p = 0.040 and 1482.7 +/- 1200.6 to 1093.5 +/- 601.8 mg/24-h; p = 0.02. The GFR increased in both groups: 68.9 +/- 35.4 to 74.7 +/- 41.6 mL/min, p = 0.04; and 62.2 +/- 26.6 to 68.5 +/- 25.3 mL/min, p = 0.02. CONCLUSIONS: the dietary intervention improved the metabolic control and renal function in type 2 diabetes patients with comorbidity.