Prevalence, severity and management of hypertriglyceridemia-associated pancreatitis; A 7-year retrospective cohort study at Canadian quaternary care hospitals.

BACKGROUND: Hypertriglyceridemia (HTG) is known as the third most common cause of acute pancreatitis (AP). OBJECTIVE: To study the prevalence and outcomes of HTG-AP as well as the quality of the follow-up post HTG-AP hospitalization in Canada. METHODS: This retrospective multicenter study was performed in patients admitted with AP (ICD 10 code K85) in quaternary care hospitals between 2012 and 2018. For every case of HTG-AP (TG ≥ 5.6 mmol/L on admission), two controls of biliary-AP were selected and matched for sex and age at the time of admission. RESULTS: Out of 1490 admitted AP patients, 40 (3%) had HTG-AP. The average TG concentration was higher in patients admitted to the ICU compared to those who were not (27.34 mmol/L vs 13.02 mmol/L). Compared to biliary-AP group, the HTG-AP patients had more frequent severe Balthazar grade (45% vs 25%) with longer duration of hospitalisation (nine versus five days) and more frequent ICU admission (38% vs 8%). Furthermore, only 35% of HTG-AP patients were referred to specialized clinics and 42.5% were left with no follow-up. Only 17% of newly discovered HTG-AP patients were started on fibrate at discharge. CONCLUSION: In comparison to biliary-AP, HTG-AP patients had a worse clinical course of pancreatitis. Furthermore, the quality of the follow-up post HTG-AP hospitalization was suboptimal. This could be explained by of the lack of knowledge of health care providers concerning the proper diagnosis and management of chylomicronemia syndromes, leading to this condition to be frequently missed or underdiagnosed.

Cumulative non-HDL-cholesterol burden in patients with hypertriglyceridemia receiving long-term fibrate therapy: Real life data from a lipid clinic cohort.

OBJECTIVE: Though epidemiological data suggest that an elevated triglyceride (TG) level may be a risk factor for coronary artery disease (CAD), there is still insufficient clinical evidence. This study was designed to evaluate the real-life efficacy and side effects of fibrate treatment for hypertriglyceridemia seen in a lipid clinic, as well as cardiovascular and diabetic outcomes. METHODS: This retrospective study evaluated patients who were followed-up for a diagnosis of hypertriglyceridemia at the lipid outpatient clinic of the Ege University Cardiology Department between 1997 and 2018. Data of demographic and clinical characteristics were obtained from hospital records. All patients (n=240) with at least 1 year of follow-up were included in the analysis. During follow-up, patients were treated with fenofibrate, and less frequently, gemfibrozile (14 patients), at different doses according to the TG level and disease severity. RESULTS: Of the study population, 23% had CAD, 21% were diabetic, and 52% were obese. On admission, 20% were using fibrates and 17% were on statins. The mean admission lipid levels were TG: 281±194 mg/dL, low-density lipoprotein cholesterol: 115±37 mg/dL, high-density lipoprotein (HDL) cholesterol: 43±13 mg/dL, and non-HDL cholesterol: 166±42 mg/dL. The mean length of follow-up was 5.3±4.7 years (range: 1-16 years). A total of 8 (4.3%) patients had adverse effects during follow-up (1 on statin combination and 7 on fibrates alone). The side effects observed were an elevation of liver enzymes in 3, myalgia in 2, insomnia in 1, malaise in 1, and a skin rash in 1 patient. No rhabdomyolysis or myopathy was seen. During follow-up, diabetes developed in 14 and cardiovascular disease (CVD) in 14 patients. The cumulative non-HDL cholesterol level was significantly high in patients who developed diabetes or CVD. Receiver operating curve analysis indicated that a cumulative non-HDL cholesterol value of 1016 mg/dL was predictive of the development of diabetes mellitus or CVD with 85% sensitivity and 70% specificity. CONCLUSION: In real life, long-term fibrate use is effective and safe. The cumulative non-HDL cholesterol burden can be used to assess the efficacy of treatment as a simple and easily calculated method. Large studies are needed to further clarify the value of this parameter in predicting the development of both diabetes and CVD.

Association of Elevated Triglycerides With Increased Cardiovascular Risk and Direct Costs in Statin-Treated Patients.

OBJECTIVE: To retrospectively investigate the real-world impact of elevated triglyceride (TG) levels on cardiovascular (CV) outcomes, medical resource utilization, and medical costs using observational administrative claims data from the Optum Research Database. METHODS: Patients with one or more claims for statin therapy between January 1, 2010, and December 31, 2010, and 6 months or more of baseline data prior to the index date were eligible for inclusion in the study. Patients aged 45 years or older with diabetes and/or atherosclerotic CV disease were included and analyzed in an elevated TG cohort (≥150 mg/dL) vs a comparator cohort with TG levels less than 150 mg/dL and high-density lipoprotein cholesterol (HDL-C) levels greater than 40 mg/dL. RESULTS: In the elevated TG vs propensity-matched comparator cohorts (both N=23,181 patients), the mean age was 62.2 vs 62.6 years, mean follow-up was 41.4 vs 42.5 months, 49.7% (11,518) vs 49.5% (11,467) were female, 83.7% (19,392) vs 84.0% (19,478) had diabetes, and 29.8% (6915) vs 29.3% (6800) had atherosclerotic CV disease. In the elevated TG (N=27,471 patients) vs comparator (N=32,506 patients) cohorts, multivariate analysis revealed significantly greater risk of composite major CV events (hazard ratio [HR], 1.26; 95% CI, 1.19-1.34; P<.001), nonfatal myocardial infarction (HR, 1.32; 95% CI, 1.20-1.45; P<.001), nonfatal stroke (HR, 1.14; 95% CI, 1.04-1.24; P=.004), and need for coronary revascularization (HR, 1.46; 95% CI, 1.33-1.61; P<.001) but not unstable angina (P=.53) or CV death (P=.23). Increased CV risk was maintained with the addition of non-HDL-C to the multivariate model and with high and low HDL-C subgroup analysis. Total direct health care costs (cost ratio, 1.12; 95% CI, 1.08-1.16; P<.001) and inpatient hospital stays (HR, 1.13; 95% CI, 1.10-1.17; P<.001) were significantly higher in the elevated TG cohort vs the comparator cohort. CONCLUSION: Statin-treated patients with TG levels of 150 mg/dL or greater had worse CV and health economic outcomes than those with well-managed TG (<150 mg/dL) and HDL-C (>40 mg/dL) levels.

Comparison of the energy and metabolic nutritional profile of women with central obesity of socioeconomic classes A/B vs C/D/E.

INTRODUCTION: Objective: to describe the characteristics of food consumption and energy intake of women with central obesity of socioeconomic classes A/B vs C/D/E. Methodology: a cross-sectional study in which a structured questionnaire was answered containing data on socioeconomics and physical activities. Weight and waist circumference (WC) were measured and the 24-hour recall was assessed (24hR) in relation to food consumption. Biochemical exams were analyzed. The dietary analysis was performed on the Nutwin software and statistical analysis on the SPSS 23.0. Results: there were 89 women assessed in each group and no significant differences were observed in relation to age, with averages of 51.2 ± 12.2 years vs 49 ± 14.4 years for classes C/D/E vs A/B, respectively. A sedentary lifestyle was predominant for class C/D/E 82 (92.13%) vs 22 (24.71%) (p < 0.001).Significant differences were observed between the groups for variables of hypertriglyceridemia (p < 0.001), predominant in the C/D/E socioeconomic group, and HDL-C (p < 0.001), predominant in the A/B socioeconomic group. Total energy consumption of women from class C/D/E vs A/B presented mean values of 1,528.72 kcal (1,128.8-1,697.3) vs 2,267.48 kcal (1,670.3-2,625.84), respectively. Significant differences were observed in the consumption of fiber between groups C/D/E vs A/B (p < 0.001), with less consumption in class C/D/E. With reference to income and schooling levels, we observed heterogeneity in the results and emphasize the marked contrast between low and high income that could influence the choice of food, contributing in the lower income to monotonous diets, less energy consumption and, furthermore, low quality in the ingested food. Conclusion: in this study, all of the women presented metabolic profiles in different manners among the groups and, also, women of class C/D/E, who presented insufficient fiber consumption, directly contributing to this condition of obesity, also presented worse lipid (total cholesterol and triglycerides) and glycemic profiles.

INTRODUCCIÓN: Objetivo: describir las características del consumo alimentario e ingestión energética de mujeres con obesidad central de clase socioeconómica A/B vs C/D/E. Metodología: estudio transversal en el que respondieron a un cuestionario estructurado que contenía datos socioeconómicos y actividad física. Se evaluaron el peso, circunferencia de la cintura (CC), y se hizo un recordatorio de 24 horas (R24h) en relación al consumo alimentario y los exámenes bioquímicos. Los análisis dietéticos se realizaron en el software Nutwin y los análisis estadísticos en el SPSS 23.0. Resultados: se valoraron 89 mujeres en cada grupo y no se observó diferencia significativa para la edad, con una media de 51,2 ± 12,2 años frente a 49 ± 14,4 años clase C/D/E vs A/B, respectivamente. El sedentarismo fue predominante en la clase C/D/E 82 (92,13%) vs 22 (24,71%), (p < 0,001). Se observaron diferencias significativas entre los grupos para las variables de hipertrigliceridemia (p < 0,001), predominantes en el grupo de clase socioeconómico C/D/E y HDL-C (p < 0,001), predominante en el grupo de clase socioeconómico A/B. El consumo energético total de las mujeres de clase C/D/E vs A / B, presentó medianas de 1528,72 kcal (1128,8-1697,3) frente a 2267,48 kcal (1670,3-2625,84), respectivamente. Se observó una diferencia significativa del consumo de fibra entre los grupos C/D/E vs A/B (p < 0,001), siendo el consumo menor en la clase C / D / E. En lo que se refiere a la renta y escolaridad, observamos la heterogeneidad de los resultados y destacamos el marcado contraste entre la baja y elevada renta lo que podría influir en la elección de los alimentos, contribuyendo en la menor renta para la monotonía alimentaria, menor consumo energético y, además, baja calidad de los alimentos ingeridos. Conclusión: en este estudio, todas las mujeres presentaron perfiles metabólicos de maneras distintas entre los grupos. Las mujeres de la clase C/D/E presentaron consumo insuficiente de fibra, lo que ciertamente contribuyó al cuadro de obesidad encontrado y paralelamente presentan peor perfil lipídico (colesterol total y triglicéridos) y glucémico.

The triad of diabetes ketoacidosis, hypertriglyceridemia and acute pancreatitis. How does it affect mortality and morbidity?: A 10-year analysis of the National Inpatient Sample.

The triad of acute pancreatitis (AP) coexisting with diabetes ketoacidosis (DKA) and hypertriglyceridemia (HTG) has been reported, but no impact on mortality has been found to date. We aim to assess if patients with this triad are at a higher inpatient mortality compared to patients with acute pancreatitis only.Retrospective cohort. The National Inpatient Sample (NIS) database from 2003 to 2013 was queried for patients with a discharge diagnosis of AP and presence of DKA and HTG was ascertained based on International Classification of Diseases, 9th revision (ICD9) codes. Adjusted for age, gender, race, Charlson comorbidity index (CCI), median income quartile, and hospital characteristics.Over 2.8 million AP patients were analyzed. When compared with patients with AP-only, patients with the triad of AP + DKA + HTG had higher inpatient mortality (aOR 2.8, P < .001; CI: 1.9 - 4.2), Acute Kidney Injury (AKI) (aOR 4.1, P < .001; CI: 3.6-4.6), Systemic Inflammatory Response Syndrome (SIRS) (aOR 4.9, P < .001), Shock (aOR 4.3, P < .001), Acute Respiratory Distress Syndrome (ARDS) (aOR 3.0, P < .001), sepsis (aOR 2.6, P < .001), ileus (aOR 2.1, P < .001), parenteral nutrition requirement (aOR 1.8, P < .001), inflation-adjusted hospital charges (US$ 17,704.1), and had longer length of stay (LOS) (aOR 2.0, P < .001; CI 1.8-2.3). Furthermore, when compared to AP-only, patients with AP + HTG had lower mortality, which is different from the current AP knowledge. Finally, it appears that the driving force for the increased in mortality of patients with the triad (AP, DKA, HTG) is the DKA rather than the HTG.Patients with the triad of AP, DKA, and HTG constitute a unique subgroup of patients that has higher inpatient mortality, multi-organ failure, hospital charges, and longer hospital length of stay. Therefore, hospital protocols targeting this subgroup of AP patients could improve mortality and outcomes.

High Triglycerides Are Associated With Increased Cardiovascular Events, Medical Costs, and Resource Use: A Real-World Administrative Claims Analysis of Statin-Treated Patients With High Residual Cardiovascular Risk.

Background The American Heart Association recognizes high triglycerides as a cardiovascular risk factor. Methods and Results This retrospective observational administrative claims analysis (Optum Research Database) included statin-treated patients ≥45 years old with diabetes mellitus and/or atherosclerotic cardiovascular disease, triglycerides 2.26 to 5.64 mmol/L, and a propensity-matched comparator cohort with triglycerides <1.69 mmol/L and high-density lipoprotein cholesterol >1.04 mmol/L. In the high-triglycerides cohort versus comparators (both n=10 990, 49% women), mean age was 61.7 versus 62.2 years and follow-up was 41.3 versus 42.1 months, respectively. Multivariate analysis of composite major cardiovascular events demonstrated significantly increased risk in the high-triglycerides (n=13 411 patients) versus comparator (n=32 506 patients) cohorts (hazard ratio [ HR ], 1.35; 95% confidence interval [ CI ], 1.225-1.485; P<0.001), with significantly higher risk for nonfatal myocardial infarction ( HR , 1.35; 95% CI , 1.19-1.52; P<0.001), nonfatal stroke ( HR , 1.27; 95% CI , 1.14-1.42; P<0.001), and need for coronary revascularization ( HR , 1.51; 95% CI , 1.34-1.69; P<0.001), but not unstable angina or cardiovascular death. Increased cardiovascular risk in the high-triglycerides versus comparator cohort was maintained, even with addition of non-high-density lipoprotein cholesterol to the multivariate model and when analyzing high and low high-density lipoprotein cholesterol subgroups. Average total healthcare cost per patient per month (cost ratio, 1.15; 95% CI , 1.084-1.210; P<0.001) and rate of occurrence of inpatient hospital stay ( HR , 1.17; 95% CI , 1.113-1.223; P<0.001) were also significantly greater in the high-triglycerides cohort. Conclusions In this real-world analysis, patients with high cardiovascular risk and high triglycerides had worse composite cardiovascular and health economic outcomes than patients with well-managed triglycerides and high-density lipoprotein cholesterol >1.04 mmol/L.

Assessment of omega-3 carboxylic acids in statin-treated patients with high levels of triglycerides and low levels of high-density lipoprotein cholesterol: Rationale and design of the STRENGTH trial.

It is uncertain whether omega-3 fatty acids are beneficial in statin-treated patients. Epanova is a mix of omega-3 free fatty acids, not requiring co-ingestion with food, which can lower triglycerides by up to 31%. STRENGTH will examine whether Epanova 4 g daily reduces the rate of cardiovascular events in statin-treated patients with hypertriglyceridemia and low levels of HDL-C at high risk for developing cardiovascular events. STRENGTH is a randomized, double-blind, placebo-controlled trial. Patients had a triglyceride level ≥ 180 to <500 mg/dL and HDL-C < 42 mg/dL (men) or < 47 mg/dL (women) in the presence of either (1) established atherosclerotic cardiovascular disease, (2) diabetes with one additional risk factor, or (3) were other high-risk primary prevention patients, based on age and risk factor assessment. Patients should be treated with a statin, for >4 weeks, and have LDL-C < 100 mg/dL, but were also eligible if LDL-C was ≥100 mg/dL while on maximum tolerated statin therapy. The study will extend from October 30, 2014 to October 30, 2019. 13 086 patients were randomized to Epanova 4 g or placebo daily in addition to standard medical therapy. The primary efficacy outcome is time to first event of cardiovascular death, myocardial infarction, stroke, coronary revascularization or hospitalization for unstable angina. The trial will continue until 1600 patients reach the primary endpoint, with a median duration of therapy of 3 years. STRENGTH will determine whether Epanova 4 g daily will reduce cardiovascular events in statin-treated high-risk patients with hypertriglyceridemia and low HDL-C levels.

Multicenter study of parenteral nutrition in non-critically ill elderly patients compared to younger patients - Study IAIOS-PN (Incidence and Assessment of Iatrogenesis in Older Subjects receiving Parenteral Nutrition).

OBJECTIVE: this study assessed the incidence of hyperglycemia, hypertriglyceridemia, and liver function test (LFT) alterations among patients older and younger than 65 years receiving parenteral nutrition (PN). A secondary objective was to compare the incidence of any of these three events. MATERIAL AND METHODS: inclusion criteria were non-critically ill adult inpatients receiving PN for ≥ 7 days in 15 hospitals in Spain. Exclusion criteria were hyperglycemia, hypertriglyceridemia, LFT alterations, sepsis, shock, pancreatic/hepatobiliary surgery, renal failure, diabetes mellitus (DM) type 1, insulin-treated DM type 2, acute DM complications, or obesity prior to PN. Patients were classified into groups YOUNG (aged 35-64) and OLD (aged 65-95). RESULTS: this study recruited 200 patients. Group YOUNG included 63 (31.5%) patients and OLD, 137 (68.5%). Hyperglycemia appeared in 37 (18.5%) patients, eight (12.7%) in group YOUNG and 29 (21.2%) in group OLD (p = 0.174). Hypertriglyceridemia appeared in only one (0.7%) patient. LFT alterations appeared in 141 (70.5%) patients, 44 (69.8%) in group YOUNG and 97 (70.8%) in group OLD (p = 1.000). The model for hyperglycemia included DM type 2, previous surgical procedure, and use of hyperglycemia-inducing medications. The model for LFT alteration included previous surgical procedure, amount of lipids and amino acids, medications causing LFT alterations and a trend for age group. The model for any event included surgical procedure, DM type 2, and medications causing alterations. CONCLUSION: patients of ≥ 65 years receiving PN had similar incidences of hyperglycemia, hypertriglyceridemia, and LFT alterations as younger patients. Additionally, older patients had trends toward lower LFT alterations.

An assessment of platelet parameters in different ethnic groups with hypertension subtypes and associated risk factors in Xinjiang, China.

The goal of this study was to investigate platelet parameters in populations with hypertension subtypes among the Han, Uygur, and Kazakh ethnic groups and their associated risk factors in Xinjiang, northwestern China. In total, 9816 adult participants were recruited from a multiethnic, cross-sectional cardiovascular risk survey. Our results indicated that the platelet counts in Han, Uygur, and Kazakh participants with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic diastolic hypertension (SDH) varied significantly (P < 0.001). Additionally, the mean platelet volume (MPV) in Han, Uygur, and Kazakh participants with ISH was significantly different (P < 0.05). Furthermore, the individual platelet parameters had different associated risk factors. For example, the risk factors for platelet counts were Uygur ethnicity, Kazakh ethnicity, drinking, ISH, diabetes, and high triglycerides (TGs). The risk factors for MPV were Uygur ethnicity, smoking, overweight, obesity, ISH, IDH, diabetes, and high TGs. Gender was a risk factor for abnormal plateletcrit (PCT) values. Only a low high-density lipoprotein cholesterol level was found to be a risk factor for platelet distribution width (PDW). We suggest that more attention should be paid to platelet parameters and the associated risk factors to reinforce the effect of antiplatelet therapy and to provide a clinical basis for preventing the occurrence of thrombosis complications and cerebro- and cardiovascular diseases effectively.

Assessment of Lean Patients with Non-alcoholic Fatty Liver Disease in a Middle Income Country; Prevalence and Its Association with Metabolic Disorders: A Cross-sectional Study.

BACKGROUND: Recent data has proven that the WHO (world health organization) cut-off for obesity is not applicable to the Asian population. This study aims to estimate the prevalence of lean NAFLD (non-alcoholic fatty liver disease) in the capital of Iran and extract probable predictors for this growing health issue in this population. METHODS: This is a population-based cross-sectional study on apparently healthy subjects over 18 years of age. The participants were interviewed for baseline demographic and clinical information. They were subsequently referred for physical examination and blood sampling. NAFLD was diagnosed using abdominal ultrasonography by a single expert radiologist. RESULTS: Of 927 eligible participants who entered the study, 314 were lean; BMI (body mass index) <25 kg/m2. The prevalence of NAFLD was 17.52% (95% Exact CI: 13.48%-22.18%). BMI, SBP (systolic blood pressure), DBP (diastolic blood pressure), total cholesterol, HDL (high-density lipoprotein), LDL (low-density lipoprotein) and triglyceride were significantly different in patients with NAFLD. In the final multiple analysis, higher levels of triglyceride, upper SBP and higher BMI even in the range of less than 25 kg/m2 were independent predictors of NAFLD in lean participants. In lean participants with more components of metabolic syndrome, the prevalence of NAFLD increased significantly (all P < 0.01). BMI cut-offs in men and women along with waist circumference cut-off in men could significantly predict the presence of NAFLD in lean patients. After comparing these values, McNemar test showed that BMI cut-offs are more robust than waist circumference cut-offs for predicting the presence of NAFLD in lean subjects (P < 0.01). CONCLUSION: The prevalence of NAFLD in lean subjects in a sample of Iranian population is 17.52%. Hypertriglyceridemia, higher SBP, and higher BMI especially over 23.2 are independent factors associated with the presence of NAFLD in lean subjects.

The Relationship Between Socioeconomic Status and CV Risk Factors: The CRONICAS Cohort Study of Peruvian Adults.

BACKGROUND: Variations in the distribution of cardiovascular disease and risk factors by socioeconomic status (SES) have been described in affluent societies, yet a better understanding of these patterns is needed for most low- and middle-income countries. OBJECTIVE: This study sought to describe the relationship between cardiovascular risk factors and SES using monthly family income, educational attainment, and assets index, in 4 Peruvian sites. METHODS: Baseline data from an age- and sex-stratified random sample of participants, ages ≥35 years, from 4 Peruvian sites (CRONICAS Cohort Study, 2010) were used. The SES indicators considered were monthly family income (n = 3,220), educational attainment (n = 3,598), and assets index (n = 3,601). Behavioral risk factors included current tobacco use, alcohol drinking, physical activity, daily intake of fruits and vegetables, and no control of salt intake. Cardiometabolic risk factors included obesity, elevated waist circumference, hypertension, insulin resistance, diabetes mellitus, low high-density lipoprotein cholesterol, and high triglyceride levels. RESULTS: In the overall population, 41.6% reported a monthly family income

Sugar-Sweetened Beverage Intake Is Positively Associated with Baseline Triglyceride Concentrations, and Changes in Intake Are Inversely Associated with Changes in HDL Cholesterol over 12 Months in a Multi-Ethnic Sample of Children.

BACKGROUND: Intake of sugar-sweetened beverages (SSBs) is linked to greater cardiometabolic risk in adults. Although longitudinal evidence is sparse among children, SSB intake reduction is targeted to reduce cardiometabolic risk factors in this group. OBJECTIVE: We investigated characteristics associated with consumption of SSBs in a multi-ethnic sample of children/adolescents and measured cross-sectional and longitudinal associations between SSB intake and plasma HDL cholesterol and triglycerides (TGs) over 12 mo. METHODS: In a diverse cohort of children aged 8-15 y, cross-sectional associations (n = 613) between baseline SSB intake and blood lipid concentrations and longitudinal associations (n = 380) between mean SSB intake, changes in SSB intake, and lipid changes over 12 mo were assessed with multivariable linear regression. RESULTS: Greater SSB intake was associated with lower socioeconomic status, higher total energy intake, lower fruit/vegetable intake, and more sedentary time. In cross-sectional analysis, greater SSB intake was associated with higher plasma TG concentrations among consumers (62.4, 65.3, and 71.6 mg/dL in children who consumed >0 but <2, ≥2 but <7, and ≥7 servings/wk, respectively; P-trend: 0.03); plasma HDL cholesterol showed no cross-sectional association. In the longitudinal analysis, mean SSB intake over 12 mo was not associated with lipid changes; however, the 12-mo increase in plasma HDL-cholesterol concentration was greater among children who decreased their intake by ≥1 serving/wk (4.6 ± 0.8 mg/dL) compared with children whose intake stayed the same (2.0 ± 0.8 mg/dL) or increased (1.5 ± 0.8 mg/dL; P = 0.02). CONCLUSIONS: In a multi-ethnic sample of children, intake of SSBs was positively associated with TG concentrations among consumers, and changes in SSB intake were inversely associated with HDL cholesterol concentration changes over 12 mo. Further research in large diverse samples of children is needed to study the public health implications of reducing SSB intake among children of different racial/ethnic groups. The Daily D Health Study was registered at clinicaltrials.gov as NCT01537809.

A Cross-sectional Assessment of Risk Factors of Non-Communicable Diseases in a Sub-Himalayan Region of West Bengal, India Using who Steps Approach.

BACKGROUND: Non-communicable diseases (NCDs), principally cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes are the leading causes of death and disability globally. The basic element of NCD prevention is the identification of the common risk factors and their prevention and control. OBJECTIVE: To determine the prevalence of risk factors for non-communicable diseases, in Siliguri city of West Bengal, India using WHO Steps approach. METHODS: Between April 2012 to July 2012, 779 adults of 18-64 years from Siliguri city were chosen by 30-cluster sampling. They were interviewed and measurements and laboratory tests were done. RESULTS: The prevalence of behavioural risk factors like tobacco use, alcohol, unhealthy diet was 57.5%, 12.5%, 50.87% and 60.4%, respectively while that of biological risk factors like overweight, abdominal obesity and hypertension was 29.8%, 20.2% and 17.8%, respectively. The prevalence of biochemical risk categories like diabetes, hypercholesterolemia, hypertriglyceridaemia, low HDL-C was 9.1%, 17.8%, 16.6% and 67.5%, respectively. CONCLUSIONS: A high prevalence of risk factors for non-communicable diseases was found in Siliguri city which emphasizes the need of interventions to reduce these risk factors.

A multicenter study on etiology of acute pancreatitis in Beijing during 5 years.

OBJECTIVES: The aim of this study was to determine the etiology tendency of acute pancreatitis (AP) in the Beijing region and the relationship with influencing factors. METHODS: This retrospective multicenter study enrolled 8 representative general hospitals from January 1, 2006 to December 31, 2010. The etiology tendency was analyzed, and the relationship was defined with sex, aging, severity, mortality, recrudesce rate, length of stay, and hospitalization cost. RESULTS: The study enrolled 2461 patients. The total number was increasing year by year. Causes included biliary (1372, 55.75%), alcoholism (246, 10%), hypertriglyceridemia (255, 10.36%), and the others (588, 23.89%). Biliary AP was the most frequent primary cause. Hypertriglyceridemic AP increased at a faster rate than alcoholic AP. There was higher proportion of alcoholic and hypertriglyceridemic AP in men than in women. There is an increase of AP patients with ages 40 to 49 years and older than 70 years. Alcoholic and hypertriglyceridemic AP were higher in patients younger than the age of 50 years, and biliary pancreatitis was higher in patients older than 70 years. Severe AP was classified among 736 patients (29.9%). Etiology distribution was different between severe AP and mild AP (P < 0.001). Mortality in the hospital was 1.54%, and there was no difference in each group. Recrudesce of hypertriglyceridemic AP was higher (P < 0.01). CONCLUSIONS: Acute pancreatitis patients increased year by year in Beijing. Gallstones were the predominant etiological factor. There were different etiology proportion of AP according age, sex, and severity.

Cholesterol screening in US adults and awareness of high cholesterol among individuals with severe hypertriglyceridemia: National Health and Nutrition Examination Surveys 2001-2008.

BACKGROUND: Cholesterol screening is an effective method for identifying individuals with elevated triglyceride levels. Individuals with severe hypertriglyceridemia (SHTG; ≥500 mg/dL) have a substantially higher risk for developing coronary heart disease and acute pancreatitis than individuals with lower triglyceride levels. OBJECTIVE: The aims of this study were to estimate the proportion of US adults who reported having their cholesterol checked, to evaluate the characteristics associated with having cholesterol checked, and to assess factors that are associated with awareness of having high cholesterol among adults with SHTG. METHODS: The sample included 7988 adults who participated in the National Health and Nutrition Examination Surveys 2001-2008. Polytomous logistic regression models were used to identify factors that were associated with time since the last cholesterol screening, categorized as never screened, screened less than 2 years ago, and screened 2 or more years ago. RESULTS: Approximately 71% of the US adults reported ever having their cholesterol checked. Only 56% of the individuals with SHTG were aware of having high cholesterol. Factors associated with awareness of high cholesterol among those with SHTG included obesity, education, having insurance, having diabetes, and having a history of cardiovascular events. CONCLUSIONS: Most adults in the United States have had their cholesterol checked; however, only half of those with SHTG were aware of having high cholesterol. Awareness is the first step in implementing strategies to attenuate the health risks associated with dyslipidemia.

[Physical fitness in dependence on cardiovascular risk factors - an assessment of 20- to 30-year-old adults]. / Körperliche Leistungsfähigkeit in Abhängigkeit von kardiovaskulären Risikofaktoren - Eine Erhebung bei 20-30-jährigen jungen Erwachsenen.

OBJECTIVE: Cardiovascular and metabolic risk factors are already common in the young adult population. The prevalence of obesity increases. More and more employees are not able to stand the physical demands at the workplace. In the course of increasing the statutory retirement age ("retirement with 67") more knowledge about the prevalence of cardiovascular risk factors and their influence on the physical fitness is necessary for a wise and goal-oriented primary prevention. METHODS: A retrospective analysis of survey examinations from young German soldiers in terms of prevalence of cardiovascular risk factors and their physical fitness was undertaken. The causes for rejection were analysed. RESULTS: In the group of 646 test persons (in average 23.4 years old) there were large rates of people with overweight (37.9%) and obesity (10.8%). Smoking (55.6%), hypercholesteremia (18.6%) and hypertriglyceridemia (13.3%) were also common. Apparent diseases were rare. With an increasing number of cardiovascular risk factors, the physical fitness was significantly lower. High liver enzymes, obesity and lacking physical fitness were reasons for rejection. CONCLUSION: Already in this young adult collective cardiovascular risk factors are widely spread. This reduces the physical fitness directly or indirectly. A goal-oriented primary prevention is already necessary in this collective of young employees to avoid later limitations in ability to work.

Prevalence of the metabolic syndrome in patients presenting to the University Hospital of the West Indies: a need to adopt proactive screening and specific management policy / Prevalencia del síndrome metabólico en pacientes que acuden al Hospital Universitario de West Indies: necesidad de adoptar un tamizaje proactivo y políticas de tratamiento específico

Studies have shown that the metabolic syndrome (MetS), a major risk factor for the development of Type 2 diabetes mellitus and cardiovascular disease, is higher among psychiatric patients on antipsychotic medications than the general population. While studies on the prevalence of MetS in the Jamaican adult population have been undertaken, no such study has been done on the corresponding psychiatric population. The purpose of this study was to determine the prevalence of MetS in a Jamaican adult psychiatric inpatient population. The study group comprised thirty-eight patients with a primary DSM-IV-TR Axis 1 diagnosis. Criteria for the diagnosis of MetS were the presence of any three or more of five factors as defined by using the International Diabetes Federation (IDF) and American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) consensus agreement. The prevalence of MetS in this cohort was 28.9% and was associated with significantly higher abdominal obesity (p = 0.010), elevated blood pressure (p = 0.000), elevated triglycerides (p = 0.019) and low high density lipoprotein-cholesterol (p = 0.016) when compared with patients not diagnosed with MetS. Metabolic syndrome was common in this group of psychiatric patients and likely represents a pathway to the future development of Type 2 diabetes mellitus and cardiovascular disease. Screening and continuous monitoring will allow for early intervention and possibly prevention of increased morbidity and mortality in this vulnerable population.

Los estudios han mostrado que el síndrome metabólico (SMet) - un factor de riesgo mayor para el desarrollo de la diabetes mellitus tipo 2 y la enfermedad cardiovascular - es más alto entre los pacientes psiquiátricos bajo medicamentos antipsicóticos que entre la población general. Si bien se han llevado a cabo estudios sobre la prevalencia del SMet en la población adulta jamaicana, no se han realizado estudios de esta clase en la población psiquiátrica correspondiente. El propósito de este estudio fue determinar la prevalencia del SMet en una población jamaicana adulta de pacientes hospitalizados. El grupo de estudio comprendió treinta y ocho pacientes con diagnóstico primario DSM-IV-TR de eje I. Los criterios para el diagnóstico de SMet se basaron en la presencia de tres o más de cinco factores, los cuales fueron definidos usando el acuerdo por consenso de la Federación Internacional de la Diabetes (FID) y la Asociación Nacional de Cardiología/Instituto Nacional del Corazón, el Pulmón y la Sangre (AHA/NHLBI). La prevalencia de SMet en esta cohorte fue 28.9%, y se hallaba asociada con obesidad abdominal significativamente más alta (p = 0.010), presión sanguínea elevada (p = 0.000), triglicéridos elevados (p = 0.019), y bajos niveles de colesterol-lipoproteína de alta densidad (p = 0.016), al compararse con pacientes no diagnosticados con SMet. El síndrome metabólico fue común en este grupo de pacientes psiquiátricos y probablemente representa una vía al desarrollo futuro de la diabetes mellitus tipo 2 y la enfermedad cardiovascular. El tamizaje así como el monitoreo continuos permitirán la intervención temprana y la posible prevención del aumento de la morbosidad y la mortalidad en esta población vulnerable.

Prevalence of the metabolic syndrome in patients presenting to the university hospital of the West Indies: a need to adopt proactive screening and specific management policy.

Studies have shown that the metabolic syndrome (MetS), a major risk factor for the development of Type 2 diabetes mellitus and cardiovascular disease, is higher among psychiatric patients on antipsychotic medications than the general population. While studies on the prevalence of MetS in the Jamaican adult population have been undertaken, no such study has been done on the corresponding psychiatric population. The purpose of this study was to determine the prevalence of MetS in a Jamaican adult psychiatric inpatient population. The study group comprised thirty-eight patients with a primary DSM-IV-TR Axis 1 diagnosis. Criteria for the diagnosis of MetS were the presence of any three or more of five factors as defined by using the International Diabetes Federation (IDF) and American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) consensus agreement. The prevalence of MetS in this cohort was 28.9% and was associated with significantly higher abdominal obesity (p = 0.010), elevated blood pressure (p = 0.000), elevated triglycerides (p = 0.019) and low high density lipoprotein-cholesterol (p = 0.016) when compared with patients not diagnosed with MetS. Metabolic syndrome was common in this group of psychiatric patients and likely represents a pathway to the future development of Type 2 diabetes mellitus and cardiovascular disease. Screening and continuous monitoring will allow for early intervention and possibly prevention of increased morbidity and mortality in this vulnerable population.

Methodology for the analysis of type 2 diabetes, metabolic syndrome and cardiovascular disease risk indicators in the ENSANUT 2006.

OBJECTIVE: To describe: a) the methods used to quantify biochemical indicators of Type 2 Diabetes (T2D), and other cardiovascular risk indicators in the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006) and b) compare the sub-sample with the non-selected participants in diverse socio-demographic, anthropometric and health characteristics. MATERIAL AND METHODS: A sub-sample of 6 021 fasting adult participants was randomly selected from the total fasting participants (n=39 425). We compared diverse socio-demographic, anthropometric and health parameters between this sub-sample and the rest of the participants. RESULTS: No differences were found in sociodemographics characteristics, except age, between the sub-sample and from the rest of the fasting adults. In addition no difference were found between prevalences of overweight and obesity, central obesity, and previously diagnosed high blood pressure, T2D or hypertrigliceridemia. CONCLUSIONS: The randomly selected sub-sample was not essentially different from the rest of the fasting subjects. Thus, no bias is expected in the interpretation of cardiovascular risk indicators derived from these data.

Methodology for the analysis of type 2 diabetes, metabolic syndrome and cardiovascular disease risk indicators in the ENSANUT 2006 / Metodologia para el análisis de diabetes tipo 2, síndrome metabólico e indicadores de riesgo cerdiovascular en la ENSANUT 2006

OBJECTIVE: To describe: a) the methods used to quantify biochemical indicators of Type 2 Diabetes (T2D), and other cardiovascular risk indicators in the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006) and b) compare the sub-sample with the non-selected participants in diverse socio-demographic, anthropometric and health characteristics. MATERIAL AND METHODS: A sub-sample of 6 021 fasting adult participants was randomly selected from the total fasting participants (n=39 425). We compared diverse socio-demographic, anthropometric and health parameters between this sub-sample and the rest of the participants. RESULTS: No differences were found in sociodemographics characteristics, except age, between the sub-sample and from the rest of the fasting adults. In addition no difference were found between prevalences of overweight and obesity, central obesity, and previously diagnosed high blood pressure, T2D or hypertrigliceridemia. CONCLUSIONS: The randomly selected sub-sample was not essentially different from the rest of the fasting subjects. Thus, no bias is expected in the interpretation of cardiovascular risk indicators derived from these data.

OBJETIVO: Describir: a) los métodos usados para definir Diabetes tipo 2 (T2D), y otros indicadores de riesgo cardiovascular en la submuestra de la Encuesta Nacional de Salud y Nutrición 2006 (ENSANUT 2006) y b) comparar en características sociodemográficas, antropométricas y otros determinantes de salud a los participantes de la submuestra con los no seleccionados. MATERIAL Y MÉTODOS: Una submuestra de 6 021 adultos fue seleccionada aleatoriamente de la totalidad de participantes en ayuno (n= 39 425). Se compararon parámetros sociodemográficos, antropométricos y de salud entre la submuestra y el resto de los participantes. RESULTADOS: No se encontraron diferencias en ninguna de las variables sociodemográficas, a excepción de la edad; ni en la prevalencia de sobrepeso, obesidad abdominal, diagnóstico previo de hipertensión, T2D, hipercolestrolemia e hipertrigliceridemia entre los adultos de la submuestra y los no seleccionados. CONCLUSIONES: La submuestra no fue estadísticamente diferente del resto de los sujetos no seleccionados. Por ello, no se espera un sesgo en la interpretación de los indicadores de riesgo cardiovascular derivados del análisis de estos datos.