Prevalence of the metabolic syndrome, insulin resistance index, leptin and thyroid hormone levels in the general population of Merida (Venezuela).

The metabolic syndrome (MetSyn) is a significant risk factor for cardiovascular events, but scarce information exists about its frequency in Venezuela. In this cross-sectional study, we quantified the prevalence of the MetSyn in a probabilistic, stratified sample of 274 subjects aged > or =18 years from the Libertador district in Merida, Venezuela. Secondary outcomes were the measurement of thyroid hormones (free T4 and TSH), leptin levels, and insulin resistance index (HOMA2-IR). The frequency of MetSyn (percentage +/- 95% confidence interval) according to several diagnostic criteria was as follows: National Cholesterol Education Panel (NCEP, original): 27.4% (22.1-32.7); modified NCEP: 31.8% (26.3-37.3); International Diabetes Federation: 40.9% (35.1-46.7); Latin American Diabetes Association: 27% (21.7-32.3), and Venezuelan criteria: 31.8% (26.3-37.3). The MetSyn was more frequent in males than in females with most diagnostic criteria. The estimated prevalence of type 2 diabetes mellitus was 2.9% either according to the patients' self reports or to fasting glucose level found to be above 126 mg/dL. Abnormal HOMA2-IR index, free T4 and TSH (above the 95th percentile) were detected in 4.5%, 4.4% and 5.1% of the sample, respectively. Free T4 and TSH levels below the 5th percentile were detected in 4.4% and 4.7% of subjects respectively. These values are presented for comparisons with forthcoming studies in specific clinical populations. While studies are being conducted about the different definitions of the MetSyn in Venezuela, we recommend analyzing and publishing local research data with all the available criteria so as to allow comparisons with the results already reported in the literature.

Prevalencia del síndrome metabólico, índice de insulino resistencia y niveles de leptina y hormona tiroidea en la población general de Mérida (Venezuela) / Prevalence of the metabolic syndrome, insulin resistance index, leptin and thyroid hormone levels in the general population of Mérida (Venezuela)

The metabolic syndrome (MetSyn) is a significant risk factor for cardiovascular events, but scarce information exists about its frequency in Venezuela. In this cross-sectional study, we quantified the prevalence of the MetSyn in a probabilistic, stratified sample of 274 subjects aged ³18 years from the Libertador district in Mérida, Venezuela. Secondary outcomes were the measurement of thyroid hormones (free T4 and TSH), leptin levels, and insulin resistance index (HOMA2-IR). The frequency of MetSyn (percentage ± 95% confidence interval) according to several diagnostic criteria was as follows: National Cholesterol Education Panel (NCEP, original): 27.4% (22.1-32.7); modified NCEP: 31.8% (26.3-37.3); International Diabetes Federation: 40.9% (35.1-46.7); Latin American Diabetes Association: 27% (21.7-32.3), and Venezuelan criteria: 31.8% (26.3-37.3). The MetSyn was more frequent in males than in females with most diagnostic criteria. The estimated prevalence of type 2 diabetes mellitus was 2.9% either according to the patients’ self reports or to fasting glucose level found to be above 126 mg/dL. Abnormal HOMA2-IR index, free T4 and TSH (above the 95th percentile) were detected in 4.5%, 4.4% and 5.1% of the sample, respectively. Free T4 and TSH levels below the 5th percentile were detected in 4.4% and 4.7% of subjects respectively. These values are presented for comparisons with forthcoming studies in specific clinical populations. While studies are being conducted about the different definitions of the MetSyn in Venezuela, we recommend analyzing and publishing local research data with all the available criteria so as to allow comparisons with the results already reported in the literature.

El síndrome metabólico (SM) es un factor de riesgo significativo en la ocurrencia de eventos cardiovasculares. Sin embargo, existe poca información sobre su frecuencia en Venezuela. En la presente investigación transversal, cuantificamos la prevalencia del SM es una muestra probabilística de 274 sujetos con edad mayor o igual a 18 años provenientes del municipio Libertador de la cuidad de Mérida, Venezuela. Como resultados secundarios, se cuantificaron los niveles de leptina, hormonas tiroideas (T4 libre y TSH), y el índice de resistencia a la insulina (HOMA2-RI). La frecuencia de SM (porcentaje ± intervalo de confianza del 95%) de acuerdo a varios criterios diagnósticos fue la siguiente: Panel para el Colesterol (original): 27,4% (22,1-32,7); Panel para el Colesterol (modificado): 31,8% (26,3-37,3); Federación Internacional de Diabetes: 40,9% (35,1-46,7); Asociación Latino-Americana de Diabetes: 27% (21,7- 32,3) y criterios Venezolanos: 31,8% (26,3-37,3). Al utilizar la mayoría de los criterios, el SM fue más frecuente en hombres que en mujeres. La prevalencia estimada de diabetes mellitus tipo 2 fue 2,9% tanto mediante el auto-reporte como mediante la detección de glicemia en ayunas > 126 mg/dL. Se detectaron niveles anormales (por encima del percentil 95) del índice HOMA2-IR, T4 libre y TSH en el 4,5%, 4,4% y 5,1% de la muestra respectivamente. Niveles de T4 y TSH por debajo del percentil 5 se detectaron en el 4,4% y 4,7% de sujetos respectivamente. Los valores del HOMA2-RI y hormonas tiroideas también se presentan con el fin de permitir comparaciones con futuros estudios en poblaciones clínicas específicas. Mientras se realizan estudios adicionales en Venezuela sobre las diversas definiciones del SM, recomendamos analizar y publicar los resultados científicos locales con todos los criterios disponibles con el fin de permitir la comparación con los estudios que ya están disponibles.

The metabolic syndrome and its constituting variables in atypical antipsychotic-treated subjects: comparison with other drug treatments, drug-free psychiatric patients, first-degree relatives and the general population in Venezuela.

BACKGROUND: Few studies on the association between atypical antipsychotic drug (AAP) administration and metabolic dysfunction have concurrently evaluated the general population (GP), other psychotropic drug treatments and drug-free psychiatric patients. METHODS: We assessed the frequency of the metabolic syndrome (MS) according to the National Cholesterol Education Program criteria (NCEP) and its constituting variables in a GP sample (n=271) and in patients receiving, for at least three consecutive months, antiepileptic drugs (n=93), olanzapine (n=162), clozapine (n=105), typical antipsychotics (n=117), other AAP (n=58), other psychotropic drugs (n=185), and drug-free individuals (n=636). Subjects were clinically classified as schizophrenia, bipolar or other axis I disorders (DSM-IV-RT), and as first-degree relatives of each diagnostic group. RESULTS: The MS was detected in 26.6% of the GP (95% confidence interval: 21.5-31.8). No diagnostic or treatment group had a significantly higher age-adjusted frequency than the GP (p>0.05). Treatment duration did not significantly affect the results. However, significant differences were observed in the frequency of abnormal MS constituting variables in comparison to the GP. For example, schizophrenia patients and their relatives, bipolar subjects and olanzapine- and clozapine-treated patients had higher abnormal waist circumference values. In addition, bipolar patients and their relatives and subjects treated with olanzapine and other AAPs had higher frequencies of abnormal glucose levels. Neither schizophrenia nor bipolar patients in the diagnostic categories nor the olanzapine or the clozapine groups displayed higher proportions of abnormal triglycerides, high density cholesterol or blood pressure levels than the GP. CONCLUSIONS: While we did not demonstrate an increased frequency of the MS in AAP-treated subjects, our results confirm that specific metabolic variables must be monitored in psychiatric patients. Besides they stress the importance, in epidemiological studies, of concurrently comparing the figures recorded in AAP-treated patients with those obtained in the local GP, other drug treatment groups and drug-free subjects when referring to the magnitude of the metabolic effects of specific antipsychotic agents.

Prevalencia del síndrome metabólico en la población urbana de Mucuchíes, Mérida-Venezuela

Objetivos: evaluar la prevalencia del síndrome metabólico (SM) en una muestra representativa de la población urbana de Mucuchíes, Estado Mérida. Métodos: Se estudiaron 109 sujetos mestizos, de ambos sexos, con edad entre 20 y 65 años. La prevalencia de SM fue definida de acuerdo a los criterios del National Cholesterol Education Program (NECP)/Adult Treatment Panel III (ATP III) y de la International Diabetes Federation (IDF). Resultados: la prevalencia del SM fue del 38% y 43% según los criterios ATP III e IDF respectivamente. El 80% de la población mostró anormalidad en el peso corporal y más del 50% tenía valores anormales de la circunferencia abdominal (CA). La dislipidemia fue muy frecuente, con una alta frecuencia de hipertrigliceridemia (56%) y valores bajos de cHDL (76%). La hipertensión arterial fue significativamente más alta (p<0,05) en los hombres y la glucosa alterada en ayunas sólo se observó en el 6% de la población sin variaciones significativas entre el sexo. La frecuencia del SM fue del 24% en los individuos con normopeso y aumentó significativamente en función del IMC, con una frecuencia máxima de 73% en los sujetos obesos. La circunferencia abdominal, la presión arterial sistólica y el índice TG/c-HDL fueron los factores de riesgo que se asociaron mas fuertemente con el diagnóstico de SM. Conclusiones: La prevalencia del SM en la población urbana de Mucuchíes-Venezuela, es de 38% y 43%, según criterios NCEP-ATPIII e IDF respectivamente. El patrón de SM predominante se caracterizó por dislipidemia, obesidad visceral y baja frecuencia de glucosa en ayunas alterada.

Objective: to estimate the prevalence of metabolic syndrome (MS) in the urban population of Mucuchíes, Estado Mérida, Venezuela. Methods: a representative sample of 109 Hispanic men and women subjects, aged 20-65 yr was studied. MS was defined according to National Cholesterol Education Program (NECP)/Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria. Results: the prevalence of MS was 38% and 43% according to ATPIII and IDF criteria respectively. Eighty percent of population had abnormal body mass index and more than 50% showed abnormal waist circumference (WC). Dyslipidemia showed a high frequency of hypertriglyceridemia (56%) and low levels of HDL-C (76%). Hypertension was significantly higher in men (p<0,05). Impaired fasting glucose was observed in 6% of population, no significant difference related to gender was observed. Metabolic syndrome frequency in nonobese subjects was 24% and increased significantly as a function of body mass index showing a maximal frequency of 73% in obese subjects. Waist circumference, systolic blood pressure and triglyceride/HDL-C ratio were the main risk factors related with MS diagnosis. Conclusions: the prevalence of MS in the urban population of Mucuchíes, Estado Mérida, Venezuela is 38% y 43% according to NCEP-ATPIII and IDF criteria respectively. The predominant pattern of MS was characterized by dyslipidemia, abdominal obesity and a low frequency of impaired fasting glucose.

Frequency of abnormal correlation between leptin and the body mass index during first and second generation antipsychotic drug treatment.

BACKGROUND: Leptin dysregulation has been implicated in the body weight gain and metabolic dysfunction observed with the second generation antipsychotic drugs (SGAD) olanzapine and clozapine. METHODS: This study quantified the frequency of subjects with abnormal correlation between leptin and the body mass index controlling for gender (defined as being out of the upper or lower 95% confidence interval in the regression line when combining each group with the drug-free subjects) after prolonged treatment with olanzapine (n=126), clozapine (n=62), first generation antiypsychotics (n=91), other SGAD (n=22), other psychotropic drugs (n=65) and drug-free subjects (n=229). RESULTS: None of the analysis was significant (p>0.05). In fact, in 17 out of 20 comparisons, the drug-free group had numerically higher frequencies of outliers than the corresponding treatment group. There were 28 outliers (4.7% of the total sample). In agreement with previous studies, cross-sectional analysis did not report gross alterations in serum leptin levels during olanzapine or clozapine administration. CONCLUSIONS: Longitudinal studies should focus on leptin regulation early on treatment, on the frequency of abnormal leptin receptor sensitivity and/or specific polymorphisms in the leptin allele and on several confounding factors in order to design personalized preventive and therapeutic measures.

Síndrome metabólico como factor de riesgo para enfermedad cardiovascular / Cardiovascular disease and the metabolic syndrome

Investigar la asociación entre enfermedad cardiovascular y síndrome metabólico, definido este por los criterios del NCEP/ATP III en pacientes del Servicio de Medicina Interna del Hospital Universitario de Los Andes, en el período comprendido entre el 15 de marzo al 30 de junio de 2004. Se incluyeron 82 pacientes hospitalizados por enfermedad cardiovascular (caso) y 82 pacientes ambulatorios sin enfermedad cardiovascular (controles). Se recopiló y analizó la información relacionada con los datos demográficos, criterios para identificar síndrome metabólico, y variables relacionadas. El promedio de edad fue de 54,76 años. Un 59,8 por ciento correspondió al sexo femenino y 40,2 por ciento masculino. La frecuencia de síndrome metabólico fue de 72(43,9 por ciento), 56,09 por ciento en el grupo de casos y 31,7 por ciento en el grupo control. Se encontró asociación estadística y epidemiológica entre la presencia de enfermedad cardiovascular y síndrome metabólico con (P=0,003) y OR=2,75 (IC 95 por ciento = 1,39-5,49). No se encontró asociación con género, diabetes y obesidad. Hubo diferencia significativa en los valores de C-HDL(P<0,001), glicemia basal (P<0,001), y tensión arterial diastólica (p=0,02) en relación con la presencia de enfermedad cardiovascular.