Detection of markers of cardiovascular and renal risk in Cuba: Isle of Youth Study (ISYS).

UNLABELLED: Chronic vascular diseases constitute a growing global health problem. OBJECTIVES: To (a) determine marker positivity for renovascular damage in the total adult population of the Isle of Youth, Cuba; (b) describe marker association with common risk factors for renal and related chronic vascular conditions, and (c) identify best predictors of renovascular damage. METHODS: Previous informed consent was obtained, the population studied was 55,646, and subjects were aged ≥20 years. Blood pressure, weight and height were measured and a questionnaire applied. Urine markers for renovascular damage (hematuria, proteinuria and microalbuminuria) were also determined. RESULTS: Positive markers were detected in 21.3%: hematuria (12.6%), microalbuminuria (6.8%), proteinuria (0.9%), and proteinuria + hematuria (0.9%). Risk factors were highly prevalent: 15.1% were aged ≥60 years; 32.3% overweight, 13.9% obese, and 25.1% smokers. Prevalence of high blood pressure (30%), diabetes mellitus (5.4%) and cardiovascular disease (5%) was also high, while cerebrovascular disease registered 0.9%. Markers were more prevalent in older people and in those suffering from diabetes mellitus, high blood pressure, cardiovascular and cerebrovascular disease, overweight or obesity. Risk factor regression tree analysis identified hypertension as the best predictor of renovascular damage. CONCLUSIONS: Adult population-wide screening revealed hidden morbidity and permitted better risk stratification. Results serve to inform community-based multidisciplinary and intersectoral disease prevention and management.

Pregnancy outcomes and the use of two standards to assess adequacy of maternal body mass index in early gestation.

The maternal weight gain chart proposed by Rosso and Mardones (RM) was subsequently modified by Atalah et al. (AEA). Both charts are widely used in Latin America. The purpose of this study was to compare birth length (BL) and birth weight (BW) outcomes of both charts. A prospective study of pregnant women and their offspring's was performed in Santiago, Chile. From a total sample of 27,613 pregnant women a sub-sample of 11,465 term healthy singleton pregnant women was selected for additional analyses. κ statistics was used to study the degree of agreement of both charts in the diagnosis of maternal nutritional status. Obese and underweight women were classified using both standards at the beginning of pregnancy and compared in terms of BL4250 g proportions. Sensitivity and specificity values of at risk newborns, whose categories were considered as gold standard, were obtained for obese and underweight women of each chart. There was a moderate agreement in the nutritional classification of these charts. Proportions of BL4250 g were similar at each nutritional category; however, absolute figures for at risk newborns were much higher in the RM underweight and obese women. The RM chart showed higher sensitivity values than the AEA chart. The higher sensitivity of the RM chart would support its use for prevention purposes. This chart is advisable for Latin American countries and also for most developing countries.

Trends in infant mortality inequalities in the Americas: 1955-1995.

STUDY OBJECTIVE: s: To describe overall and income related trends in infant mortality inequalities in the Region of the Americas from 1955 to 1995. DESIGN: Infant mortality rates (IMRs) were computed and their trends assessed by ordinary least squares. Overall trends in IMR inequalities among countries were analysed by comparing 10 year period IMRs, Gini coefficients, and Lorenz curves. Income related trends in IMR inequalities were assessed using 10 year period IMR ratios between the highest and the lowest quintiles of the per capita gross national product (GNP) distributions (adjusted for purchasing power). SETTING: Aggregated country data were used for all countries with over 200 thousand inhabitants (33 geopolitical units). The 10 year period midpoint IMR estimates used for the 1955-1995 time series were those published by the United Nations in 1997. MAIN RESULTS: IMRs decreased from 90.34 to 31.31 per 1000 live births between 1955 and 1995 at an average of 15.3 every 10 years. In contrast, Lorenz curves and Gini coefficients were similar for the five 10 year periods. After grouping by adjusted GNP distribution, a similar decreasing trend of IMR was observed in all groups. The rate ratio between the group at the lowest quintile and that at the highest quintile ranged from 4 to 5. The analysis of variance for repeated observations showed that there is a significant reduction in the IMR (F=130.18; p<0.01), that trends did not differ significantly among groups (F=1.16; p=0.32), and that they were approximately linear (F=155.83; p<0.01). CONCLUSIONS: Despite a sizable reduction in the infant mortality, whether or not income related, levels of IMR inequality among countries have remained almost constant between 1955 and 1995 in the Region of the Americas. Further analysis and focused interventions are needed to tackle the challenges of reducing these persistent mortality inequalities.

Adiposity and growth: relationship of stature at fourteen years with relative body weight at different ages and several measures of adiposity and body bulk.

A non-probabilistic sample of 354 healthy adolescents (182 boys and 172 girls) with ages ranging from 13.6 to 14.5 years was studied. Measurements of mid-arm muscle, thigh and leg circumferences, triceps and subscapular skinfolds, and records of body weight and height at one, four, six and twelve years of age were available. The sexual maturation stage of all subjects was also determined. Height at fourteen years was found to be significantly associated with relative body weight at different ages in both sexes, and particularly with the relative weight at twelve months. Height is more strongly related with indicators of lean body mass than with indicators of adiposity, especially in boys. The stage of sexual development is also an important determinant of stature at fourteen years of age. The results seem to support the hypothesis that the same factors which increase fat deposition, contribute to increase lean tissues and linear growth.

The relationship of birthweight with height at 14 and with the growing process.

The association of birthweight with length at 12 mo and with height at different ages was assessed in a sample of 260 healthy adolescents (130 boys and 130 girls). The longitudinal study included measures on body weight and height at 4, 6, 12, and 14 yr of age. Birthweight is highly correlated with stature at 14 years, particularly in male adolescents. Longitudinal principal components analysis (LPCA) showed that it is also correlated with the growing process. There is also strong evidence that birthweight can be a good predictor of the onset of the pubertal maturation process.

Body mass index at different ages and its association with height at age 14 and with the whole growing process.

The relevance of the association of the body mass index (BMI) at 1,4,6, and 12 years of age with the growing process and its capacity for predicting height at age 14 was investigated in a sample of 354 adolescents (182 boys and 172 girls). Regression analysis showed that body bulk at various ages, as expressed by the BMI is closely related with the height attained at age 14, and longitudinal principal components analysis suggested that it is also associated with the whole growing process. The way in which BMI affects height could be related with the stage of sexual development, which seems to play an intermediate role in the pathway linking body bulk and height.

Multivariate allometry as a model of morphometric harmony of four skinfolds in the newborn.

The concept of harmony in a set of anthropometric dimensions is identified with the notion of minimum variance associated with a function of several variables in those dimensions. When the chosen function is linear in the natural logarithms of the variables, the resulting model is the well-known multivariate allometry and the notion of minimum variance corresponds to the eigenvector associated with the smallest eigenvalue of the covariance matrix. This multivariate allometry model was fitted to four skinfolds in a sample of 250 newborns. The existence of a harmonic relationship among the skinfolds which is independent of weight, total body fat, body mass index, and several other maternal variables is indicated. There is, however, some evidence suggesting a possible correlation with the nutritional condition of the mother. © 1992 Wiley-Liss, Inc.

[Influence of breast feeding on nutritional development of infants with persistent diarrhea]. / Influencia de la lactancia materna en la evolución nutricional del lactante con diarrea persistente.

The evolution of some nutritional anthropometric indicators was studied in a 115 breast-feeding infants (52 received breast-feeding during the first four months of life (120 days) exclusively and 63 mixed feeding). Breast feeding infants showed sustained weight increment during the four weeks of evolution. The multivariate repeated measures analysis performed, proved significant changes during evolution's time in all studied indicator in lineal form, as well as interaction between type of feeding and indicators evolution except the subescapular fat fold. Author concluded that it should be reinforced the breast-feeding practice promotion as an effective way for the nutritional recovery of breast-feeding infants with persistent diarrhoea.

[Subscapular/triceps index: percentile values in Cuban children and adolescents]. / Indice subescapular/tricipital: valores percentilares en niños y adolescentes cubanos.

The percentiles (3,10,25,50,75,90 and 97) of the subscapular/triceps Index (SS/TR), obtained in a sample of 7286 subjects (3721 males and 3765 females) aged 5 to 20 years, were calculated. Median values of SS/TR are generally higher in females up to the age of 13 years approximately, and show a pattern of peripheral distribution of fat during all the period of study. In males, a pattern of central distribution of fat develops starting from age fourteen and becomes more central as age increases. Values obtained were higher than those reported in the literature at all ages and in both sexes. The results reported in this paper show that SS/TR is useful for assessing changes in the pattern of fat distribution during childhood and adolescence.

[Anthropometric characteristics of obese women before and after weight reduction]. / Características antropométricas de mujeres obesas antes y después de un tratamiento reductor.

Anthropometric changes in 53 premenopausal obese women, 25-45 year-old, after an obesity treatment, were analyzed. Before and immediately after treatment, midarm, abdomen, waist, hip, midthigh and midcalf circumferences, as well as tricipital, bicipital, suprailiac, subscapular, abdominal and calf skinfold thickness were measured. The later averaged over percentil 75th. All final measurements, except midcalf circumference, abdomen/waist and hip/midthigh indexes, were significantly lowers as compared with the initial values. Body weight decreased on average 8.9 kg, and skinfold thickness mean fell below the 75th percentile. Percentage body fat decreased 18.3%, and body mass index 11%. Initial principal component analysis results, exhibited three chief characteristics of obesity: general adiposity; trunk vs. extremity fatness, and upper vs. lower fatness. Body fat distribution pattern and body composition were modified as a result of the treatment. Therefore, the morbidity risk associated with them, was substantially reduced.

[Energy/protein ratio: new validation of its applicability to nutritional evaluation]. / Indice energía/proteína: nueva validación de su aplicabilidad en evaluación nutricional.

A new anthropometric rate called energy/protein ratio (E/P) which results from the division of the logarithmic transformation of tricipital skin fold (F) by the logarithm of branchial muscle circumference (BMC) is described. In a study of a sample of healthy preschool children from 97 day-care centers of the Havana City it was proved a relationship between adiposity and the muscular mass of the arm middle third which depends on age, sex and race and is normally distributed. Percentiles for each age and sex were obtained and it was confirmed the dependence of age and differences in each sex. It was also proved the quality of E/P in assessing variations of the muscular mass as well as a relationship between energy and protein storages. The E/P ratio is a new contribution to nutritional evaluation since it offers a new approach for the use of arm measurements, specially the tricipital fold, and demonstrates the easiness for its obtention and its reliability. The ratio may be applied either to individual assessment or to field studies. Measurements may be performed by well trained personnel, which may record the primary data and screen initially according to the percentile distribution of the values obtained. The E/P ratio may be obtained by a computerized program or a nomogram designed to that purpose.

Dermatoglyphics in Cuban mongols.

Finger and palm prints of 220 Cuban mongols, all trisomic 21, were statistically compared with those of a group of 400 normal Cuban individuals. The most important dermatoglyphic findings in the patients were: an excess of ulnar loops on the 2nd and 3rd fingers, and radial loops on the 4th and 5th fingers; a paucity of patterns in the thenar/I area; more hypothenar true patterns, specially ulnar loops, higher percentages of patterns in the II and III interdigital spaces with less true patterns in the IV interdigital space; distal position t" of the axial triradius and large atd angles of more than 70 degrees; high values of the main-line index; predominance of radial type of the C line and higher frequencies of type 11 of the D line. The simian crease, especially the complete variety, had more diagnostic value than the Sydney line. Parathenar patterns which did not seem to have been described previously in mongols, were significantly more frequent in the patients than in controls. The results are very similar to those observed in other countries and it seems that the peculiar dermatoglyphic pattern of patients with Down syndrome is not affected by ethnic influences.

[Clinical and etiological data in 21 cases of Poland's syndrome]. / Datos clínicos y etiológicos en 21 observaciones de síndrome de Poland.

Clinical and etiological data of 21 cases of Poland's syndrome are reported. The anomaly was seen especially on the right side and was significantly more frequent in males than in females (4:1). The variable expressivity of the morphology of the ipsilateral hand is analyzed. Height of the hand was obtained in 18 cases. Simian crease and Sydney line are significantly more frequent in patients than in controls. These observations confirmed that unilateral isolate absence of the pectoralis major muscle is a mild expression of the syndrome. Most of the cases were sporadic. No difference was found in the number of spontaneous abortions between the mothers of patients and controls. In one family, it seems that a mother-to-child transmissin was present which could be explain by an autosomal dominant inheritance.

Percentiles of the waist-hip ratio in Cuban scholars aged 4.5 to 20.5 years.

Values of the waist-hip ratio (WHR), expressed as percentiles and stratified by sex and age, were obtained from a simple judgment sample of 7285 schoolchildren and adolescents (3721 males and 3564 females) aged between 4.5 and 20.5 years. WHR is higher with age in males, and it changes more gradually chronologically also. The graph for males shows three relative maxima at 6, 11-12 and 15-16 years; and for females, two relative maxima at 10 and 13 years. In females, there are two sharp reductions between 10 and 13 and between 13 and 16 years of age. The changes in WHR are associated with age and sexual maturation in both sexes. We conclude that WHR might be useful in assessing body fat distribution in late childhood and adolescence.

Assessing obesity with body weight and height.

Anthropometric measurements in one hundred girls and one hundred boys from 4.6 to 5.5 years of age were carried out in order to study the correspondence between the criteria of obesity according to weight for stature (BW-HT) and according to the magnitude of fat body mass (FM calculated of two different regression equations, one developed starting from body weight (BW), height (HT) and two skinfolds, and another one, using only BW and HT. Employing the criterion of obesity based upon BW-HT above 120%, a number of heavy but not fatty subjects (mainly boys) were included as obese, and three of the girls studied were fatty but not overweight. Conversely, if we calculate FM using the regression equation based on BW and HT, and the criterion of obesity based upon body fat percent, the incidence of obesity could be underestimated. The best results were given by regression equations which include BW, HT and two skinfolds (triceps and subscapular). Though the usefulness of BW and HT in nutritional assessment is not discussed, the diagnostic limitations of these measurements used alone or in combination are evident and therefore it is necessary to include skinfold measurements if we wish to obtain a correct diagnosis of obesity.

Nutritional assessment of infants and preschool children using two different anthropometric criteria of classification.

A comparison of two criteria for assessing malnutrition in infants and children has been carried out in a sample of 184 healthy infants and children grouped according to two different anthropometric criteria: considering the quantity of body mass for linear dimension by the ratio W/H; and considering the degree of wasting according to weight for height (WH). Biochemical studies were also carried out in each child and correlated with body systems of classification. Total amino acids in serum and eryhtrocytes, the non-essential/essential amino acid ratio in serum and erythrocytes, total serum proteins and the albumin/alpha globulin ratio were investigated. The results showed that both criteria were closely related, the linear regression between them was highly significant (r = 0.931). Nevertheless, the W/H criterion classified as undernourished a higher proportion of children, because it included those of delayed biological age though not malnourished. On the contrary, WH only classified as undernourished those who probably have actual malnutrition. Biochemical studies showed significant correlations with both criteria but higher r values were found for W/H in some cases. Thus, classification on the basis of WH including the analysis of the degree of wasting and of stunting, is satisfactory for individual and community assessment, but it should include the classification of overweights. It must be stressed that both systems, being based on weight as the basis of classification, do not consider body composition and therefore can only assess whole body mass and thus only approximate the nutritional status.