Evaluación del desempeño cognitivo en escolares y adolescentes con diabetes mellitus tipo 1 / Evaluation of cognitive performance in children and adolescents with type 1 diabetes mellitus

Resumen El objetivo del trabajo fue evaluar el funcionamiento cognitivo de niños y adolescentes con diabetes mellitus tipo 1 (DM1) de la consulta de Endocrinología del IAHULA, y compararlo al de niños no diabéticos, así como investigar la posible influencia de factores relacionados con la enfermedad sobre la cognición. Se realizó un estudio observacional analítico, transversal, que incluyó un grupo de 30 pacientes con DM1 de 8 a 16 años de edad (16 varones) y un grupo control de 30 individuos pareados por edad, género, escolaridad y condición socioeconómica. Se realizó interrogatorio y revisión de historias clínicas para obtener datos sobre las características clínicas y el tratamiento de la DM1. Se les aplicó el test WISC IV para evaluar cognición y cociente intelectual (CI). La edad promedio de los pacientes fue de 13,27 ± 2,31 años, la mitad de ellos masculinos. Se encontraron puntajes menores en los distintos dominios del WISC IV en el grupo con DM1 al compararlos con los del grupo control (p<0,01). El CI fue menor en los niños con DM1 que en los controles (75,47 ± 13,87 frente a 88,57±11,06; p=0,0001); así mismo, se observó con mayor frecuencia un puntaje del CI inferior al percentil 10 en los pacientes con DM1 en comparación con los controles (63,3% frente a 33,3%; p=0,02; Odds ratio: 3,45; IC95%: 1,19-9,99). Se concluyó que la DM1 impacta negativamente el desempeño cognitivo de niños y adolescentes. Se recomienda la evaluación cognitiva de estos pacientes, ya que podría repercutir en su vida diaria.

Abstract The study aimed to evaluate the cognitive functioning of children and adolescents with type 1 diabetes mellitus (T1DM) recruited from the IAHULA Endocrinology Outpatient Unit and to compare it to that of non-diabetics as to investigate the influence on cognition of factors related to the disease. An analytical, cross-sectional observational study was carried out on a group of 30 patients with T1DM between 8 and 16 years of age and on a control group of 30 individuals matched by age, gender, education, and socioeconomic status. Interrogation and review of medical records to obtain data on the clinical characteristics and treatment of T1DM were conducted. The WISC IV test was then applied to evaluate cognition and intellectual coefficient (IQ). The average age of the diabetic patients was 13.27±2.31 years, and half of them were male. Lower scores were found in the different domains of the WISC IV in the group with T1DM (p<0.01). The IQ was found to be lower in children with T1DM than in controls (75.47±13.87 vs. 88.57±11.06; p=0.0001). Likewise, a higher frequency of IQ scores below the 10th percentile was observed in the diabetic children (63.3% vs. 33.3%; p=0.02; Odds ratio: 3.45; 95%CI: 1.19-9.99). It was concluded that T1DM negatively impacts the cognitive performance of children and adolescents. Cognitive evaluation of these patients is recommended, as it could affect their daily life.

FINDRISC Modified for Latin America as a Screening Tool for Persons with Impaired Glucose Metabolism in Ciudad Bolívar, Venezuela.

OBJECTIVE: The Finnish Diabetes Risk Score (FINDRISC) includes anthropometric, metabolic, and lifestyle factors that predict type 2 diabetes mellitus. The objective of this study was to evaluate the FINDRISC modified for Latin America (LA-FINDRISC) as a screening tool for persons with impaired glucose metabolism in Ciudad Bolívar, Venezuela. METHODS: Subjects aged between 18 and 70 years of both sexes without known diabetes were invited to participate. After informed consent, they were screened with the LA-FINDRISC questionnaire and then given an oral glucose tolerance test, using the American Diabetes Association criteria for diagnosis. To obtain the cutoff point of LA-FINDRISC for predicting impaired glucose regulation, a receiver operating characteristic curve was constructed. RESULTS: A total of 200 subjects were evaluated, 64.5% female, with a mean age of 35.20 ± 13.84 years. Of these, 158 (79%) did not present with carbohydrate metabolism disorder, while 42 (21%) did. Age (p = 0.0001), body mass index (p = 0.011), and waist circumference (p = 0.031) were significantly higher in subjects with impaired glucose regulation when compared to those without it. There were a significantly greater number of sedentary (p = 0.039) and hypertensive subjects (p = 0.0001), as well as those with a history of glucose >100 mg/dL (p = 0.0001), in the impaired glucose metabolism group. A cutoff LA-FINDRISC of 14 points predicted a high risk of impaired glucose regulation with a sensitivity of 45.2% and a specificity of 89.9%. CONCLUSION: A LA-FINDRISC >14 points had low sensitivity but high specificity for predicting carbohydrate metabolism disorders in this group of patients from Ciudad Bolívar.

Epicardial adipose tissue thickness and type 2 diabetes risk according to the FINDRISC modified for Latin America / Espesor del tejido adiposo epicárdico y riesgo de diabetes tipo 2 de acuerdo al FINDRISC modificado para Latinoamérica

Background: The Finnish Diabetes Risk Score (FINDRISC) is a tool to predict 10-year risk of type 2 diabetes mellitus (T2DM), and visceral adiposity is associated with higher cardio-metabolic risk. The objective of the study was to assess the relationship of epicardial adipose tissue (EAT) thickness with T2DM risk according to the FINDRISC tool. Methods: The study was conducted in Ciudad Bolívar, Venezuela, and included 55 subjects of whom 37 (67.3%) were women and 18 (32.7%) men with ages between 18 and 75 years. A record was made of weight, height, body mass index (BMI), waist circumference (WC), fasting glucose, baseline insulin, plasma lipids, Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), and EAT thickness. The FINDRISC tool, with WC cut-off points modified for Latin America (LA-FINDRISC) was used. Results: BMI, WC, plasma insulin concentration, HOMA-IR index, and EAT thickness were higher (P < 0.0001) in the high-risk group compared to subjects in the low-moderate risk group according to the LA-FINDRISC. LA-FINDRISC was positively correlated with BMI (r = 0.513; P = 0.0001), WC (r = 0.524; P = 0.0001), fasting blood glucose (r = 0.396; P = 0.003); baseline plasma insulin (r = 0.483; P = 0.0001); HOMA-IR index (r = 0.545; P = .0.0001); and EAT thickness ( r = 0.702; P = 0.0001). The multivariate regression analysis showed that fasting blood glucose (P = 0.023) and EAT thickness (P = 0.007) remained independently associated with high T2DM risk. Conclusions: LA-FINDRISC was associated with EAT thickness and insulin resistance markers. Both were independently and directly associated with high risk for diabetes in the LA-FINDRISC category

Introducción: La escala Finlandesa de riesgo de diabetes (FINDRISC) es una herramienta para predecir el riesgo a 10 años de diabetes tipo 2 (DMT2). La adiposidad visceral se asocia con un alto riesgo cardiometabólico. El objetivo fue evaluar la relación del espesor del tejido adiposo epicárdico (TAE) y el riesgo de DMT2 calculado según FINDRISC. Métodos: Este estudio fue realizado en Ciudad Bolívar, Venezuela. Cincuenta y cinco sujetos; 37 mujeres (67,3%) y 18 hombres (32,7%) con edades entre 18 y 75 años fueron incluidos. Peso, talla, índice de masa corporal (IMC), circunferencia abdominal (CA), glucemia, insulina basal, lípidos plasmáticos, Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) y espesor del TAE fueron medidos. Se aplicó el FINDRISC con puntos de corte de CA modificados para Latinoamérica (LA-FINDRISC). Resultados: El IMC, CA, insulina, HOMA-IR y espesor del TAE fueron mayores (p < 0,0001) en el grupo de alto riesgo comparado con el grupo de bajo-moderado riesgo según LA-FINDRISC. Esta escala se correlacionó positivamente con el IMC (r = 0,513; p = 0,0001), CA (r = 0,524; p = 0,0001), glucemia en ayuna (r = 0,396; p = 0,003); insulina (r = 0,483; p = 0,0001); HOMA-IR (r = 0,545; p = 0,0001); y espesor del TAE (r = 0,702; p = 0,0001). El análisis de regresión multivariante mostró que la glucemia en ayuna (p = 0,023) y el espesor del TAE (p = 0.007) se asociaron independientemente con alto riesgo de DMT2. Conclusiones: LA-FINDRISC se asocia tanto con el espesor del TAE como con marcadores de resistencia a la insulina. Ambos se asociaron directa e independientemente con la categoría de alto riesgo de DMT2 según LA-FINDRISC

Epicardial adipose tissue thickness and type 2 diabetes risk according to the FINDRISC modified for Latin America.

BACKGROUND: The Finnish Diabetes Risk Score (FINDRISC) is a tool to predict 10-year risk of type 2 diabetes mellitus (T2DM), and visceral adiposity is associated with higher cardio-metabolic risk. The objective of the study was to assess the relationship of epicardial adipose tissue (EAT) thickness with T2DM risk according to the FINDRISC tool. METHODS: The study was conducted in Ciudad Bolívar, Venezuela, and included 55 subjects of whom 37 (67.3%) were women and 18 (32.7%) men with ages between 18 and 75 years. A record was made of weight, height, body mass index (BMI), waist circumference (WC), fasting glucose, baseline insulin, plasma lipids, Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), and EAT thickness. The FINDRISC tool, with WC cut-off points modified for Latin America (LA-FINDRISC) was used. RESULTS: BMI, WC, plasma insulin concentration, HOMA-IR index, and EAT thickness were higher (P<0.0001) in the high-risk group compared to subjects in the low-moderate risk group according to the LA-FINDRISC. LA-FINDRISC was positively correlated with BMI (r=0.513; P=0.0001), WC (r=0.524; P=0.0001), fasting blood glucose (r=0.396; P=0.003); baseline plasma insulin (r=0.483; P=0.0001); HOMA-IR index (r=0.545; P=.0.0001); and EAT thickness (r=0.702; P=0.0001). The multivariate regression analysis showed that fasting blood glucose (P=0.023) and EAT thickness (P=0.007) remained independently associated with high T2DM risk. CONCLUSIONS: LA-FINDRISC was associated with EAT thickness and insulin resistance markers. Both were independently and directly associated with high risk for diabetes in the LA-FINDRISC category.

Factores de riesgo cardiometabólico en niños y adolescentes con síndrome de Down y su relación con indicadores de composición corporal / Cardiometabolic risk factors in children and adolescents with Down syndrome and its relationship with indicators of body composition

Determinar la frecuencia de factores de riesgo cardiometabólico (FRC) en niños y adolescentes con síndrome de Down y establecer su relación con indicadores de composición corporal. Este estudio de tipo transversal descriptivo, desarrollado entre 2015-2016, en la ciudad Mérida, Venezuela, incluyó a 54 individuos con síndrome de Down menores de 18 años, Los FRC investigados fueron, sobrepeso-obesidad, hipertensión arterial (HTA), sedentarismo, dislipidemia e hiperglucemia; los indicadores de composición corporal, circunferencia de cintura, área grasa, pliegues tricipital, suprailíaco y subescapular, y los índices de cintura/talla, SESTRI, conicidad y centripetalidad. Presentaron uno o más FRC 75,9%, y entre los más frecuentes fueron dislipidemia 59,3%, sedentarismo 45,2% y Pre-HTA/HTA 24,1%. Hubo una elevada frecuencia de circunferencia de cintura alta 75,9%, índice cintura/talla alto 74%, área grasa alta 92,6% e índice de conicidad alto 46,3%. Se observaron correlaciones positivas significativas de la presión arterial sistólica, diastólica y negativas del CHDL, con la circunferencia de cintura (r=0,710; r=0,657; r=-0,423, respectivamente; p=0,0001), con el pliegue tricipital (r=0,346, r=0,380; r=-0,362, respectivamente, p<0,01) y con el índice de conicidad (r=0,333, r=0,616, r=-0412, respectivamente p<0,01). El CHDL bajo fue más frecuente en sujetos del área urbana en comparación con la rural (60 % vs 31,6 %; p=0,046).La prevalencia de FRC en niños y adolescentes con síndrome de Down es mayor que la reportada en la población sin esta entidad genética, y los indicadores de adiposidad se correlacionaron con los FRC. Estos deben ser detectados a temprana edad para disminuir enfermedades crónicas degenerativas en edad adulta(AU)

To determine the frequency of cardiometabolic risk factors (CRF) in children and adolescents with Down syndrome and establish their relationship with body composition indicators. A descriptive cross-sectional investigation was carried out between 2015-2016 in Mérida, Venezuela, with 54 individuals with Down syndrome. The CRF investigated were overweight-obesity, hypertension, sedentary lifestyle, dyslipidemia and hyperglycemia. Body composition indicators investigated were waist circumference, fat area, triceps, suprailiac and subscapular folds, and waist/height, SESTRI, conicity and centripetality indices. The 75.9% presented one or more CRF, the most frequent were dyslipidemia 59.3%, sedentary lifestyle 45.2% and pre-hypertension and hypertension 24.1%. There was a high frequency of high waist circumference 75.9%, high waist/height index 74%, high fat area 92.6% and high conicity index 46.3%. Significant positive correlations of systolic, diastolic and negative of HDL-C were observed, with waist circumference (r = 0.710, r = 0.657, r = -0.423 respectively, p = 0.0001), with the triceps fold (r = 0.346, r = 0.380, r = -0.362 respectively, p <0.01) and with the conicity index (r = 0.333, r = 0.616, r = -0412 respectively p <0.01). Low HDL-C was more frequent in urban subjects compared to rural subjects (60% vs 31.6%, p = 0.046).The prevalence of CRF in children and adolescents with Down syndrome is higher than that reported in the population without this genetic entity, and the indicators of adiposity were correlated with CRF. These must be detected at an early age to reduce chronic degenerative diseases in adulthood(AU)

Relación triglicéridos/colesterol de la lipoproteína de alta densidad como indicador de riesgo cardiometabólico en niños y adolescentes de la ciudad de Mérida, Venezuela / Triglycerides/High density lipoprotein cholesterol ratio as a cardiometabolic risk marker in children and adolescents from Mérida city, Venezuela

Objetivo: Determinar el comportamiento de la relación triglicéridos/colesterol HDL (TG/cHDL) como indicador de riesgo cardiometabólico en niños y adolescentes escolarizados de la ciudad de Mérida. Métodos: Se estudió a 1.292 niños y adolescentes entre 7 y 18 años de edad, de instituciones educativas del Municipio Libertador. Se registraron medidas antropométricas y la presión arterial. Se determinaron glucemia, insulina y lípidos en ayunas. Se calcularon la relación TG/cHDL y los índices HOMA-IR y QUICKI. Se realizó la clasificación de individuos con riesgo y sin riesgo cardiometabólico a partir de la presencia o no de 2 o más factores de riesgo. Se determinaron puntos de corte de la relación TG/cHDL a través de la construcción de curvas operador receptor (COR). Resultados: La relación TG/cHDL presentó medias significativamente superiores en individuos púberes (2,2 ± 1,7) en comparación con prepúberes (1,8 ± 1,5; p = 0,001), sin diferencias según el género. El 14,7% (n = 192) de los participantes presentaba 2 o más factores de riesgo y los valores de la relación TG/cHDL fueron significativamente mayores en comparación con aquellos sin riesgo (3,5 ± 2,9 frente a 1,6 ± 0,8 en prepúberes y 4,1 ± 3,5 frente a 1,8 ± 0,9 en púberes; p = 0,0001). De acuerdo con el riesgo cardiometabólico, se obtuvieron puntos de corte para la relación TG/cHDL de 1,8 y 2,5 en prepúberes y púberes, respectivamente. Estos puntos de corte muestran riesgos (odds ratios) superiores a 2,5 para alteraciones como síndrome metabólico, colesterol no HDL elevado, obesidad abdominal y HOMA-IR elevado. Conclusión: En esta muestra de niños y adolescentes, la relación TG/cHDL elevada demostró ser un buen marcador para predecir riesgo cardiometabólico (AU)

Objective: To determine the behavior of the triglycerides/HDL-cholesterol ratio (TG/HDL) as a cardiometabolic risk marker in children and adolescents from Mérida, Venezuela. Methods: A total of 1292 children and adolescents aged 7-18 years who attended educational institutions in the Libertador Municipality were enrolled into this study. Anthropometric measurements and blood pressure values were recorded. Fasting blood glucose, insulin and lipid levels were measured. The TG/HDL ratio, HOMA-IR, and QUICKI indexes were calculated. Subjects were categorized as with and without cardiometabolic risk based on the presence or absence of 2or more risk factors. Cut-off points for the TG/HDL ratio were determined by constructing ROC curves. Results: Significantly higher mean TG/HDL ratios were found in pubertal (2.2 ± 1.7) as compared to prepubertal subjects (1.8 ± 1.5; P=.001), with no sex differences. Two or more risk factors were found in 14.7% (n=192) of the participants, in whom TG/HDL ratios were significantly higher as compared to those with no risk (3.5±2.9 versus 1.6±0.8 in prepubertal and 4.1 ± 3.5 versus 1.8 ± 0.9 in pubertal subjects; P=.0001). According to cardiometabolic risk, cut-off points for the TG/HDL ratio of 1.8 and 2.5 were found for prepubertal and pubertal children respectively. These cut-off points showed risks (odds ratio) higher than 2.5 for conditions such as metabolic syndrome, elevated non-HDL-C, abdominal obesity, and elevated HOMA-IR. Conclusion: In this sample of children and adolescents, an elevated TG/HDLc ratio was found to be a good marker for predicting cardiometabolic risk (AU)

Triglycerides/High density lipoprotein cholesterol ratio as a cardiometabolic risk marker in children and adolescents from Mérida city, Venezuela. / Relación triglicéridos/colesterol de la lipoproteína de alta densidad como indicador de riesgo cardiometabólico en niños y adolescentes de la ciudad de Mérida, Venezuela.

OBJECTIVE: To determine the behavior of the triglycerides/HDL-cholesterol ratio (TG/HDL) as a cardiometabolic risk marker in children and adolescents from Mérida, Venezuela. METHODS: A total of 1292 children and adolescents aged 7-18 years who attended educational institutions in the Libertador Municipality were enrolled into this study. Anthropometric measurements and blood pressure values were recorded. Fasting blood glucose, insulin and lipid levels were measured. The TG/HDL ratio, HOMA-IR, and QUICKI indexes were calculated. Subjects were categorized as with and without cardiometabolic risk based on the presence or absence of 2or more risk factors. Cut-off points for the TG/HDL ratio were determined by constructing ROC curves. RESULTS: Significantly higher mean TG/HDL ratios were found in pubertal (2.2 ± 1.7) as compared to prepubertal subjects (1.8 ± 1.5; P=.001), with no sex differences. Two or more risk factors were found in 14.7% (n=192) of the participants, in whom TG/HDL ratios were significantly higher as compared to those with no risk (3.5±2.9 versus 1.6±0.8 in prepubertal and 4.1 ± 3.5 versus 1.8 ± 0.9 in pubertal subjects; P=.0001). According to cardiometabolic risk, cut-off points for the TG/HDL ratio of 1.8 and 2.5 were found for prepubertal and pubertal children respectively. These cut-off points showed risks (odds ratio) higher than 2.5 for conditions such as metabolic syndrome, elevated non-HDL-C, abdominal obesity, and elevated HOMA-IR. CONCLUSION: In this sample of children and adolescents, an elevated TG/HDLc ratio was found to be a good marker for predicting cardiometabolic risk.

Frecuencia, aspectos clínicos y moleculares de la hipercolesterolemia familiar en una unidad de endocrinología de Ciudad Bolívar, Venezuela / Frequency and clinical and molecular aspects of familial hypercholesterolemia in an endocrinology unit in Ciudad Bolívar, Venezuela

Objetivo: Describir la frecuencia, los aspectos clínicos, bioquímicos y moleculares de la hipercolesterolemia familiar (HF) en sujetos que acuden a una unidad de endocrinología. Métodos: Estudio observacional, descriptivo en el que se evaluaron 3.140 sujetos que fueron atendidos en la Unidad de Endocrinología del Centro Médico Orinoco en Ciudad Bolívar, Venezuela, desde el 7 de enero del 2013 al 9 de diciembre del 2016. Los casos índice fueron seleccionados de acuerdo con los criterios de la Red de Clínicas de Lípidos de Holanda. Se midieron lípidos plasmáticos. El análisis molecular se realizó por medio de secuenciación de ADN de los genes LDLR y APOB. Resultados: De los 3.140 sujetos evaluados, 10 (0,32%) tuvieron características clínicas y bioquímicas compatibles con HF. Todos, excepto uno, eran de sexo femenino. Tres pacientes tuvieron antecedente familiar en primer grado de enfermedad coronaria prematura y ninguno antecedente personal de esta patología. Tres pacientes tuvieron obesidad, 3 hipertensión arterial y ninguno tuvo diabetes. Tres pacientes presentaban xantomas tendinosos y solo uno arco corneal. Los valores de c-LDL oscilaron entre 191 y 486mg/dl. Solo 2 recibían tratamiento con estatinas. En 4 pacientes se identificó la causa genética de la HF: 3 de ellos por mutaciones en el gen LDLR y uno por mutación en el exón 26 del gen APOB. Conclusión: Aproximadamente una de cada 300 personas que acuden a consulta en esta unidad de endocrinología presentan HF. Las mutaciones en el gen LDLR son las principales causantes de HF en este grupo de pacientes (AU)

Objective: To assess the frequency and the clinical, biochemical, and molecular aspects of familial hypercholesterolemia (FH) in subjects attending an endocrinology unit. Methods: An observational, descriptive study evaluating 3,140 subjects attending the endocrinology unit of Centro Médico Orinoco in Ciudad Bolívar, Venezuela, from 7 January 2013 to 9 December 2016. The index cases were selected using the Dutch Lipid Clinic Network criteria. Plasma lipid levels were measured, and a molecular analysis was performed by DNA sequencing of the LDLR and APOB genes. Results: Ten (0.32%) of the 3,140 study patients had clinical and biochemical characteristics consistent with FH. All but one were female. Three had first-degree relatives with prior premature coronary artery; and none had a personal history of this condition. Three patients were obese; three had high blood pressure; and no one suffered from diabetes. Three patients had a history of tendon xanthomas, and one of corneal arcus. LDL-C levels ranged from 191 to 486mg/dL. Two patients were on statin therapy. The genetic causes of FH were identified in four patients, and were LDLR gene mutations in three of them and an APOB gene mutation in exon 26 in the other. Conclusion: Approximately, one out of every 300 people attending this endocrinology unit in those four years had FH, and LDLR gene mutations were the most prevalent cause (AU)

Frequency and clinical and molecular aspects of familial hypercholesterolemia in an endocrinology unit in Ciudad Bolívar, Venezuela. / Frecuencia, aspectos clínicos y moleculares de la hipercolesterolemia familiar en una unidad de endocrinología de Ciudad Bolívar, Venezuela.

OBJECTIVE: To assess the frequency and the clinical, biochemical, and molecular aspects of familial hypercholesterolemia (FH) in subjects attending an endocrinology unit. METHODS: An observational, descriptive study evaluating 3,140 subjects attending the endocrinology unit of Centro Médico Orinoco in Ciudad Bolívar, Venezuela, from 7 January 2013 to 9 December 2016. The index cases were selected using the Dutch Lipid Clinic Network criteria. Plasma lipid levels were measured, and a molecular analysis was performed by DNA sequencing of the LDLR and APOB genes. RESULTS: Ten (0.32%) of the 3,140 study patients had clinical and biochemical characteristics consistent with FH. All but one were female. Three had first-degree relatives with prior premature coronary artery; and none had a personal history of this condition. Three patients were obese; three had high blood pressure; and no one suffered from diabetes. Three patients had a history of tendon xanthomas, and one of corneal arcus. LDL-C levels ranged from 191 to 486mg/dL. Two patients were on statin therapy. The genetic causes of FH were identified in four patients, and were LDLR gene mutations in three of them and an APOB gene mutation in exon 26 in the other. CONCLUSION: Approximately, one out of every 300 people attending this endocrinology unit in those four years had FH, and LDLR gene mutations were the most prevalent cause.

Adiposidad visceral, patogenia y medición / Visceral adiposity, pathogenesis and measurement

El reconocimiento del tejido adiposo como un órgano endocrino sumamente complejo, capaz de secretar una serie de biomoléculas conocidas como adipocitoquinas (o adipoquinas) con un impacto en diversos procesos como, regulación de mecanismos de hambre y saciedad (y por ende balance energético), sensibilidad a la insulina, respuesta inmune, metabolismo lipídico, entre otros, sitúan en el tejido adiposo un papel protagónico en la génesis de las complicaciones metabólicas y cardiovasculares de la obesidad. Se ha planteado como principal responsable la disfunción del tejido adiposo visceral, fenómeno conocido como adipocitopatía. Entre los mecanismos propuestos de disfunción adipocitaria se señalan: alteración en la adipogénesis que limita la capacidad expansora del tejido adiposo subcutáneo, favoreciendo la hipertrofia de depósitos viscerales con expresión subsiguiente de su potencial proinflamatorio, hipoxia por angiogénesis limitada y acumulación intraorganelar de productos intermediarios del metabolismo lipídico (lipotoxicidad), con la consecuente resistencia a la insulina y sus efectos deletéreos. En este artículo se revisan los mecanismos implicados en este fenómeno, así como los métodos directos e indirectos de medición de los diferentes depósitos de grasa visceral, con especial énfasis en aquellos de más fácil aplicación en la práctica clínica diaria.

The recognition of adipose tissue as a highly complex endocrine organ, capable of secreting a series of biomolecules known as adipocytokines (or adipokines) with an impact on various processes such as regulation of hunger and satiety mechanisms (and therefore energy balance), insulin sensitivity, immune response, lipid metabolism, among others, place in adipose tissue a leading role in the genesis of the metabolic and cardiovascular complications of obesity. The dysfunction of visceral adipose tissue, a phenomenon known as adiposopathy, has been the main culprit. Among the proposed mechanisms of adipocyte dysfunction are: alteration in adipogenesis that limits the capacity of the subcutaneous adipose tissue to expand, favoring the hypertrophy of visceral deposits with subsequent expression of its proinflammatory potential, hypoxia due to limited angiogenesis and intraorganellar accumulation of intermediate products of lipid metabolism (lipotoxicity), with the consequent resistance to insulin and its deleterious effects. In this article we review the mechanisms involved in this phenomenon, as well as the direct and indirect methods of measurement of the different visceral fat deposits, with special emphasis on those that are easier to apply in daily clinical practice.

Dislipidemia en Diabetes Mellitus Tipo 1: Características y factores de riesgo asociados en pacientes del Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela / Dyslipidemia and Type 1 Diabetes Mellitus: Characteristics and risk factors associated with patients of the Autonomous Institute of the Hospital Universitario de Los Andes, Mérida, Venezuela

Objetivo: Conocer las características clínicas, de laboratorio y los factores de riesgo asociados para la presentación de dislipidemia, de los pacientes con Diabetes Mellitus tipo 1 (DM1) de la Unidad de Endocrinología del IAHULA. Métodos: Estudio observacional, retrospectivo y descriptivo, basado en la data de 63 pacientes con DM1. Se recolectaron de su última consulta, edad, sexo, examen físico, tratamiento y datos de laboratorio para establecer el control metabólico. Resultados: El 56% de los pacientes era del sexo masculino y 44% del femenino, la edad promedio fue 17,43±8,89 años con rango de 3 a 44 años, la mayoría entre 11 y 18 años. El normopeso predominó (69,8%), seguido por sobrepeso-obesidad (27,9%), siendo éste más frecuente en el sexo femenino (50% vs 11,5%; p=0,008). El 73% presentó mal control metabólico, sin diferencias por sexo, edad y estado nutricional. El 60,3% presentó dislipidemia, principalmente hipercolesterolemia (cTotal alto 42,9% y cLDL alto 27%), seguida por elevación de triglicéridos (17,5%) y en menor frecuencia cHDL bajo (14,3%). La dislipidemia se asoció de manera significativa con sexo femenino, sobrepeso-obesidad y mal control metabólico (p<0,03). El mal control metabólico fue el factor más influyente en la presentación de dislipidemia y representó un riesgo 6 veces mayor de padecerla. Conclusión: En este grupo de pacientes con DM1 se observó una alta frecuencia de dislipidemia, principalmente hipercolesterolemia, en asociación con el mal control metabólico, el sexo femenino y el sobrepeso-obesidad. Son necesarias diferentes estrategias terapéuticas para evitar el exceso de peso y mejorar el control metabólico.

Objective: To know the clinical and laboratory characteristics and the associated risk factors for the presentation of dyslipidemia of the patients with type 1 Diabetes Mellitus (T1D) from the Endocrinology Unit of the IAHULA. Methods: Observational, retrospective and descriptive study, based on the data from 63 patients with T1D. Age, sex, physical examination, treatment, and laboratory data to establish metabolic control, were collected from the last visit. Results: Fifty-six percent of patients were male and 44% female, mean age was 17.43 ± 8.89 years with a range of 3 to 44 years. Most were in the range of 11-18 years. The normal weight predominated in 69.8%, followed by overweight-obesity in 27.9%, this being significantly more frequent in females (50% vs 11.5%; p=0.008). Seventy-three percent had poor metabolic control, with no differences by sex, age and nutritional status. The 60.3% had dyslipidemia, mainly hypercholesterolemia (high Total-c 42.9% and high LDL-c 27%), followed by elevated triglycerides (17.5%) and less frequently low HDL-c (14.3%). Dyslipidemia was significantly associated with female sex, overweight-obesity and poor metabolic control (p <0.03). Poor metabolic control was the most influential factor in the presentation of dyslipidemia and represents a 6-fold increased risk of developing it. Conclusion: In this group of patients with DM1 a high frequency of dyslipidemia, mainly hypercholesterolemia was observed, in association with poor metabolic control, female sex and overweight-obesity. Different therapeutic strategies are needed to prevent excess weight and improve metabolic control.

Tumores pardos mimetizando enfermedad metastásica ósea como presentación inicial de un carcinoma paratiroideo: A propósito de un caso / Brown tumors mimetizing bone metastasic disease as an initial presentation of a parathyroid carcinoma: About a case

Objetivo: Describir caso inusual de paciente con tumor pardo, manifestación poco frecuente del hiperparatiroidismo, como presentación inicial de carcinoma de paratiroides. Caso Clínico: Paciente masculino de 25 años, inicia enfermedad actual en el 2011, caracterizada por dolor en encía inferior de hemiarcada izquierda, acompañada de tumoración en región maxilar inferior ipsilateral. Se evidencia progresión de dicha lesión y aparición de nueva tumoración en maxilar superior derecho, además de dolores óseos, limitación a la movilización y fracturas patológicas en húmeros. En abril de 2015 presenta disartria, dificultad en la alimentación por progresión de la tumoración en la cavidad oral, además de sangrado en el sitio de la lesión, por lo que es hospitalizado. Examen físico: lesión tumoral en maxilar superior e inferior que deforma la arcada dentaria, con sangrado activo que imposibilita la oclusión completa de boca, con asimetría facial. Extremidades: asimetría en ambos húmeros. Paraclínicos: PTH: 990 pg/mL, calcio: 13 mg/dL, fosfatasa alcalina: 300 UI/L. Se realiza paratiroidectomía y lobectomía tiroidea izquierda. Biopsia: carcinoma paratiroideo. A los meses se evidencia mejoría del dolor óseo y del tamaño de las lesiones. Conclusión: El carcinoma de paratiroides es una neoplasia rara, la prevalencia es menos de 1% de los casos de hiperparatiroidismo, y la incidencia es de 0.015 por 10000 casos. El tumor pardo es una forma infrecuente de manifestación de un hiperparatiroidismo, reflejando un desafío en el diagnóstico diferencial de una enfermedad metastásica ósea, y más aún cuando el carcinoma paratiroideo generalmente al momento del diagnóstico ya presenta metástasis a distancia.

Objective: To describe the unusual case of a patient with brown tumor, rare manifestation of hyperparathyroidism, as initial presentation of a parathyroid carcinoma. Case Report: Two years later evidence progression of the lesion, also appearance of new tumor in the right upper jaw, in addition to bone pain, limitation mobilization and pathological fractures in the humerus. In April 2015 the patient presents dysarthria and difficulty in feeding due to progression of the tumor in the oral cavity, in addition to bleeding at the site of injury, so it is hospitalized. Physical examination: tumor lesion in upper and lower jaw, which deforms the dental arch, with active bleeding that precludes complete occlusion of the mouth, with facial asymmetry. Limbs: asymmetry in both humerus. Paraclinical: PTH: 990 pg/mL, calcium: 13 mg/dL, alkaline phosphatase: 300 IU/L. Parathyroidectomy and left thyroid lobectomy was performed. Biopsy: parathyroid carcinoma. Months later, improvement in bone pain and lesion size was evident. Conclusions: Parathyroid carcinoma is a rare neoplasm, the prevalence is less than 1% of cases of hyperparathyroidism, and the incidence is 0.015 per 10,000 cases. The brown tumor is a rare form of manifestation of hyperparathyroidism, reflecting a challenge in the differential diagnosis of a metastatic bone disease, and even more when the parathyroid carcinoma usually at the time of diagnosis already presents distant metastases.

Relationship between the Finnish Diabetes Risk Score (FINDRISC), vitamin D levels, and insulin resistance in obese subjects.

AIM: To assess the relationship between 25-hydroxyvitamin D [25(OH)D] blood concentrations in subjects with obesity and type 2 diabetes mellitus (T2D) risk according to the Finnish Diabetes Risk Score (FINDRISC) modified for Latin America (LA-FINDRISC). METHODS: This study was conducted in Ciudad Bolívar, Venezuela. Eighty two women and 20 men (53 obese and 49 nonobese), with an average age of 42.6±12.30 years were enrolled. Weight, height, body mass index (BMI), waist circumference (WC), fasting glucose, basal insulin, plasma lipids, Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), and 25(OH)D levels were measured. FINDRISC with WC cutoff points modified for Latin America was applied. RESULTS: No difference in 25(OH)D levels between obese and nonobese subjects was found. When anthropometric, clinical, and biochemical variables according to the 25(OH)D status were compared, the only difference detected was higher LA-FINDRISC in the insufficient/low 25(OH)D group compared to normal 25(OH)D levels group (12.75±6.62; vs 10.15±5.21; p=0.031). LA-FINDRISC was negatively correlated with plasma 25(OH)D levels (r=-0.302; p=0.002) and positively correlated with the HOMA-IR index (r=0.637; p=0.0001). CONCLUSIONS: The LA-FINDRISC significantly correlated with both 25(OH)D levels and insulin resistance markers in this group of patients.

Factores asociados a pubertad precoz central en pacientes pediátricos portadores de parálisis cerebral infantil / Associated factors with central precocious puberty in pediatric patients with cerebral palsy

Objetivo: Determinar los factores asociados a la aparición de pubertad precoz central (PPC) en niños con parálisis cerebral infantil (PCI). Métodos: Estudio observacional analítico, tipo caso-control, incluyó 45 niños de ambos géneros con PCI, 20 casos con PPC y 25 controles sin PPC que asistieron a las consultas externas de Neuropediatría y Endocrinología Pediátrica del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA), entre Junio 2014 y Mayo 2015. Se determinaron variables clínicas y paraclínicas para diagnóstico de PPC, así como variables demográficas, antropométricas, nutricionales, características clínicas de la PCI, patología endocrinológica asociada, y uso pro-longado de medicamentos. Resultados: La PPC fue más frecuente en el género femenino (15 de 20 casos; p=0,009), con un riesgo (odds ratio) de 5,33 (IC95%: 1,45-19,57). No se comprobó asociación entre edad, estrato socio-económico, antropometría, etiología o características clínicas de la PCI y la aparición de PPC. La enfermedad endocrinológica concomitante más frecuente fue el hipotiroidismo y no endocrinológica, la epilepsia y los trastornos gastrointestinales. Hubo una asociación significativa entre el uso de medicamentos anticonvulsivantes y la presencia de PPC (85% frente a 48% en aquellos sin PPC; p=0,01), con un odds ratio de 6,14 (IC95%: 1,43-26,34). Conclusión: En este grupo de pacientes con PCI, el género femenino y el uso de medicamentos anticonvulsivantes, fueron los factores que se encontraron asociados a la presencia de PPC.

Objective: To determine the factors associated with the development of Central Precocious Puberty (CPP) in children with Cerebral Palsy (CP). Methods: An analytical observational, case-control study was conducted, including 45 children with CP, 20 with CPP and 25 without it. All attended at pediatric neurology and pediatric endocrinology departments at the Autonomuos Institute University Hospital of Los Andes between June 2014 and May 2015. Clinical and laboratory variables for the diagnosis of CPP were determined, as well as demographic, anthropometric, nutritional variables, clinical characteristics of the CP, endocrine pathology associated, and prolonged use of drugs. Results: The PPC was more frequent in females (15 of 20 cases; p = 0.009) with a risk (odds ratio) of 5,33 (95CI%: 1,45-19,57). There was not association between demographic characteristics, age, socioeconomic status, anthropometry, etiology or clinical features of CP and the occurrence of CPP. The concomitant most common endocrine disorder was hypothyroidism, and non-endocrine disorder, epilepsy and gastrointestinal disorders. There was a significant association between the use of anticonvulsant drugs and the presence of PPC (85% versus 48% in those without PPC; p=0.01), with a odds ratio of 6,14 (IC95%: 1,43-26,34). Conclusion: In this group of patients with CP, female gender and use of anticonvulsant drugs were the factors that were associated with the presence of PPC.

Dislipidemia mixta severa en población pediátrica: enfoque diagnóstico y terapéutico. A propósito de un caso / Severe mixed dyslipidemia in pediatric population: Diagnosis and treatment. About a case

Objetivo: Dar a conocer una presentación atípica de dislipidemia mixta severa en población pediátrica y su abordaje diagnóstico y terapéutico. Caso Clínico: Escolar femenina de 7 años de edad, quien es referida por presentar suero lactescente, evidenciado al realizarle pruebas de laboratorio. Examen físico: talla, peso e índice de masa corporal en percentil 50, hepatomegalia palpable no dolorosa. Paraclínicos de ingreso: glucemia 114 mg/dl, colesterol: 166 mg/dl y triglicéridos: 1200 mg/ dl. Electroforesis: se evidencia VLDL y quilomicrones. Se hace diagnóstico de hiperlipoproteinemia tipo V, se inicia tratamiento con modificación de estilo de vida y ácidos omega 3, 1500 mg/día. Persisten niveles elevados de triglicéridos y aumenta el colesterol, por lo que se omite el omega 3 y se indica tratamiento con ezetimiba 10 mg y ciprofibrato 50 mg diarios. El estudio genético evidenció una variante intrónica G/C en el intrón 7 para el gen de PPARα, correlacionándose con un riesgo elevado de hipertrigliceridemia y mutación del exón 4 del gen del receptor de LDL, por lo que se modifica el diagnóstico a dislipidemia mixta con elevación de VLDL, quilomicrones y LDL. La evolución actual ha sido satisfactoria. Conclusión: Las hiperlipidemias primarias son un grupo de patologías con frecuencia variables de acuerdo a los diferentes fenotipos presentes. El diagnóstico diferencial es importante para descartar una causa secundaria. La electroforesis y el estudio genético orientan al diagnóstico, y el tratamiento debe ser individualizado dependiendo de la clínica del paciente, los niveles de lípidos plasmáticos y los factores de riesgos asociados.

Objective: To present an atypical presentation of severe mixed dyslipidemia in the pediatric population and its diagnostic and therapeutic approach. Case Report: Female 7-year-old is referred because of presenting lactescent serum, evidenced by laboratory tests. Physical exam: height, weight and body mass index in the 50th percentile, painless palpable hepatomegaly. Initial paraclinical: glucose 114 mg/dl, cholesterol 166 mg/dl and triglycerides 1200 mg/dl. Electrophoresis: evidence of VLDL and chylomicrons. Hyperlipoproteinemia type V diagnosis is made; treatment is initiated with lifestyle modification and omega 3 fatty acids, 1500 mg/day. However, given the persistence of high levels of triglycerides and cholesterol, the omega 3 fatty acids is omitted and treatment with ezetimibe 10 mg and ciprofibrate 50 mg daily, is indicated. Genetic studies revealed an intronic variant G/C in intron 7 for gene PPARα, correlated with a high risk of hypertriglyceridemia, and a mutation of exon 4 of gene LDL receptor; for this reason, the diagnosis is modified to mixed dyslipidemia, with elevated VLDL, LDL and chylomicron. The current evolution has been satisfactory. Conclusions: Primary hyperlipidemia is a group of diseases with variable frequency according to the different phenotypes present. The differential diagnosis is important to exclude a secondary cause. Electrophoresis and genetic study guide the diagnosis. Treatment should be individualized depending on the clinical findings of the patient, plasma lipid levels, and associated risk factors.

Espesor del tejido adiposo epicárdico en niños y adolescentes con factores de riesgo cardiometabólico / Epicardial adipose tissue thickness in children and adolescents with cardiometabolic risk factors

Objetivo: Determinar la relación del espesor del tejido adiposo epicárdico (TAE) con factores de riesgo cardiometabólico (FRC) en niños y adolescentes. Métodos: Se seleccionaron 77 sujetos de ambos sexos entre 7 y 18 años. Se realizó anamnesis y evaluación de parámetros clínicos, determinación de glucemia, insulina y lípidos y se calculó el HOMA-IR. Se determinó el espesor del TAE mediante ecocardiografía transtorácica. Se formaron 2 grupos, participantes con menos de 2 FRC (cero o un FRC) y participantes con 2 o más FRC. Resultados: El grupo con 2 o más FRC presentó mayores valores de espesor del TAE, insulina y HOMA-IR (p < 0,05). El espesor del TAE mostró una correlación positiva estadísticamente muy significativa con el índice de masa corporal (IMC) (r = 0,561; p = 0,0001), la circunferencia abdominal (r = 0,549; p = 0,0001), la presión arterial sistólica (PAS) (r = 0,256; p = 0,028), la insulina (r = 0,408; p = 0,0001) y el HOMA-IR (r = 0,325; p = 0,005), sin embargo, estas correlaciones fueron no significativas al ajustar para el IMC. El punto de corte para el espesor del TAE como predictor de 2 o más FRC fue de 3,17 mm. El riesgo (odds ratio) de tener 2 o más FRC si presenta un espesor de TAE > 3,17 mm fue de 3,1 (IC: 1,174-8,022, p = 0,02). El IMC fue la variable independiente que más influyó sobre los valores del espesor del TAE y la presencia de 2 o más FRC (AU)

Conclusión: En este grupo de niños y adolescentes se encontró que la relación del TAE con los FRC es dependiente del IMC. Objective: To assess the relationship of epicardial adipose tissue (EAT) thickness with cardiometabolic risk factors (CRFs) in children and adolescents. Methods: Seventy-seven subjects of both sexes aged 7-18 years were selected. Medical history, clinical parameters, and glucose, insulin, and lipid levels were collected. EAT thickness was measured using transthoracic echocardiography. Study subjects were divided into two groups based on whether they had less than two or two or more CRFs. Results: The group with two or more CRFs had higher EAT thickness, insulin, and HOMA-IR values (P < .05). EAT thickness showed a statistically significant positive correlation with body mass index (BMI) (r = 0.561, P = .0001), waist circumference (r = .549, P = .0001), systolic blood pressure (SBP) (r = .256, P = .028), insulin (r = 0.408, P = .0001), and HOMA-IR (r = .325, P = .005). However, these correlations were not significant after adjustment for BMI. The cut-off point for EAT thickness as predictor of two or more CRFs was 3.17 mm. The risk (odds ratio) of having two or more CRFs if EAT thickness was > 3.17 mm was 3.1 (95% CI: 1.174-8.022). BMI was the independent variable that most affected EAT thickness and the presence of two or more CRFs. Conclusion: In this group of children and adolescents, the relationship of EAT thickness with CRFs was found to be dependent on BMI (AU)

Effect of sitagliptin on epicardial fat thickness in subjects with type 2 diabetes and obesity: a pilot study.

The aim of the study was to assess the effect of sitagliptin addition on the epicardial adipose tissue (EAT) thickness in subjects with type 2 diabetes mellitus inadequately controlled on metformin monotherapy. This was a 24-week interventional pilot study in 26 consecutive type 2 diabetic patients, 14 females and 12 males average age of 43.8 ± 9.0 years, with Hemoglobin A1c (HbA1c) ≥ 7% on metformin monotherapy. Subjects who met the inclusion criteria were added on sitagliptin and started on sitagliptin/metformin combination at the dosage of 50 mg/1000 mg twice daily. EAT and visceral and total body fat were measured, respectively, with echocardiography and bioelectrical impedance analysis at baseline and after 24 weeks of sitagliptin/metformin treatment in each subject. HbA1c and plasma lipids were also measured. EAT decreased significantly from 9.98 ± 2.63 to 8.10 ± 2.11 mm, p = 0.001, accounting for a percentage of reduction (∆%) of -15% after 24 weeks of sitagliptin addition, whereas total body fat percentage, visceral fat, and body mass index (BMI), decreased by 8, 12, and 7%, respectively (p = 0.001 for all). After 6 month, EAT ∆% was significantly correlated with ∆% of visceral fat (r = 0.456; p = 0.01), whereas no correlation with either BMI ∆% (r = 0.292; p = 0.147) or HbA1c ∆% was found. The addition of Sitagliptin produced a significant and rapid reduction of EAT, marker of organ-specific visceral fat, in overweight/obese individuals with type 2 diabetes inadequately controlled on metformin monotherapy. EAT as measured with ultrasound can serve as no invasive and accurate marker of visceral fat changes during pharmaceutical interventions targeting the fat.

Epicardial adipose tissue thickness in children and adolescents with cardiometabolic risk factors.

OBJECTIVE: To assess the relationship of epicardial adipose tissue (EAT) thickness with cardiometabolic risk factors (CRFs) in children and adolescents. METHODS: Seventy-seven subjects of both sexes aged 7-18 years were selected. Medical history, clinical parameters, and glucose, insulin, and lipid levels were collected. EAT thickness was measured using transthoracic echocardiography. Study subjects were divided into two groups based on whether they had less than two or two or more CRFs. RESULTS: The group with two or more CRFs had higher EAT thickness, insulin, and HOMA-IR values (P<.05). EAT thickness showed a statistically significant positive correlation with body mass index (BMI) (r=0.561, P=.0001), waist circumference (r=.549, P=.0001), systolic blood pressure (SBP) (r=.256, P=.028), insulin (r=0.408, P=.0001), and HOMA-IR (r=.325, P=.005). However, these correlations were not significant after adjustment for BMI. The cut-off point for EAT thickness as predictor of two or more CRFs was 3.17mm. The risk (odds ratio) of having two or more CRFs if EAT thickness was >3.17mm was 3.1 (95% CI: 1.174-8.022). BMI was the independent variable that most affected EAT thickness and the presence of two or more CRFs. CONCLUSION: In this group of children and adolescents, the relationship of EAT thickness with CRFs was found to be dependent on BMI.

Sobrepeso-obesidad y factores de riesgo cardiometabólico en niños y adolescentes de la ciudad de Mérida, Venezuela / Overweight-obesity and cardiometabolic risk factors in adolescents from Merida city, Venezuela

Con el objetivo de establecer la frecuencia de sobrepeso-obesidad y factores de riesgo cardiometabólico (FRC) (sedentarismo, dislipidemia, elevación de presión arterial y alteración de carbohidratos), en niños y adolescentes de la ciudad de Mérida, Venezuela, se estudiaron 922 niños y adolescentes entre 9 y 18 años de edad, procedentes de diferentes instituciones educativas. Se tomaron medidas antropométricas y presión arterial; se calculó el índice de masa corporal. En ayunas, se midieron niveles de glucemia, insulina y lípidos, y posterior a 2h de sobrecarga de glucosa, se midieron glucemia e insulina. Se calculó el índice HOMA-IR. Se observó sedentarismo en 49,3% de los participantes, dislipidemia en 28,3%, sobrepeso-obesidad en 17,4% (7,9% obesidad y 9,5% sobrepeso), pre-hipertensión e hipertensión arterial (Pre-HTA/HTA) en 8,8%, prediabetes en 4%, resistencia a la insulina en 3,9% y síndrome metabólico (SM) en 2,5%. Hubo una significativa mayor frecuencia de sedentarismo en el sexo femenino y de SM en el masculino. Los FRC estuvieron asociados al sobrepeso-obesidad, los más frecuentes fueron la dislipidemia 50,3% vs 23,7% en el grupo con IMC normal-bajo y la Pre-HTA/HTA 23,8% vs 5,7% (p=0,0001 para ambos). En el grupo sobrepeso-obesidad, el riesgo de Pre-HTA/HTA fue 5,14 veces mayor que en el de IMC normal-bajo, el riesgo de dislipidemia fue 3,26 y el de SM fue 119,56 veces mayor (p=0,0001). Se concluye que la frecuencia de sobrepeso y obesidad en Mérida ha aumentado en el tiempo, y en vista de la clara asociación con FRC, se recomienda impartir educación poblacional e individual para mejorar el estado nutricional.

To establish the prevalence of overweight-obesity and cardiometabolic risk factors (CRF) (sedentary lifestyle, dyslipidemia, hypertension and impaired carbohydrate metabolism) in children and adolescents in the city of Mérida, Venezuela, we studied 922 children and adolescents from 9 to 18 years of age, from different educational institutions. Anthropometric measurements and arterial blood pressure were recorded. Body mass index was calculated. Fasting blood glucose, insulin and lipids levels, and glucose and insulin 2 h post-load glucose were measured. HOMA-IR was calculated. In order of frequency, sedentary lifestyle was observed in 49.3% of participants, dyslipidemia in 28.3%, overweight-obesity in 17.4% (7.9% obesity and 9.5% overweight), pre-hypertension and hypertension (PreHT/HT) in 8.8%, prediabetes in 4%, insulin resistance in 3.9% and metabolic syndrome (MS) in 2.5%. CRF’s were associated with overweight-obesity, being the most common, dyslipidemia (50.3% vs 23.7% in normal weight) and PreHT/HT (23.8% vs 5.7%; p=0.0001 for both). The risk of PreHT/HT, dyslipidemia, and MS were 5.14, 3.26 and 119.56 times more in overweight-obesity, than in low-normal weight respectively (p=0.0001 for all). In conclusion, the frequency of overweight and obesity in Mérida has increased over time. Given its clear association with CRF, it is recommended to provide the appropriated education to improve nutritional status.