The diabetes education material on diabetes for website: Results of a validation process.

OBJECTIVE: To validate an educational material on diabetes through an expert consensus for its implementation into a web site. MATERIAL AND METHODS: An observational study was carried out in a group of health professionals, for which an educational material was developed for patients with diabetes. Topics included nutrition, physical exercise, control indicators, complications, pharmacological treatment, among others. The language, text and figures were focused on easy comprehension, additionally, a section of didactic activities to be answered by the patient with diabetes at the end of each module was included. To evaluate the educational material by health professionals, an instrument was designed and validated. Once all the educational material was available, each of the modules was sent by e-mail to at least three clinical experts in the assigned topic, as well as the instrument for the evaluation of the module. RESULTS: Thirty-seven experts were included in the study, 76% rated the educational modules evaluated as highly adequate, while only 24% rated them as adequate. The instrument used obtained a good level of internal consistency, with a Cronbach's alpha coefficient of 0.92. In the dimensions of the instrument, the lowest Cronbach's alpha score was that of "call-to-action", with a value of 0.71. CONCLUSION: The diabetes educational material was rated as highly appropriate by the clinical experts. The developed instrument has an adequate content validity, as well as a good level of internal consistency.

A dietary pattern high in full-fat dairy and sweetened beverages is associated with glycated hemoglobin and weight in Mexican patients with type-2 diabetes / Un patrón dietético con alto contenido de lácteos enteros y bebidas azucaradas se asocia con la hemoglobina glicosilada y el peso en pacientes mexicanos con diabetes de tipo 2

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

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

Adherence to the DASH dietary pattern is associated with blood pressure and anthropometric indicators in Mexican adults / La adherencia al patrón alimentario DASH se relaciona con la presión arterial y los indicadores antropométricos en adultos mexicanos

Background: adherence to Dietary Approach to Stop Hypertension (DASH) has demonstrated to be effective in lowering blood pressure and other cardiovascular risk markers in different populations, but has never been evaluated in the Mexican population. Objective: to assess adherence to the DASH dietary pattern by using an adapted DASH adequacy index (DASH-AI), and to evaluate its association with cardiovascular risk markers in an adult Mexican population. Methods: we conducted a cross-sectional analysis of data of 1,490 adults aged 20-50 years. Diet was assessed with a Food Frequency Questionnaire and sodium intake by 24-hour urinary sodium excretion; the DASH-AI score was calculated based on the DASH nutrient targets. Multivariable linear and logistic regression analyses were performed to estimate the association between the DASH-AI score and cardiovascular risk markers (body mass index [BMI], waist circumferences, systolic (SBP) and diastolic blood pressure (DBP), glucose, triglycerides, total cholesterol, and high- and low-density lipoproteins). Results: we observed an association of the DASH-AI score with BMI, WC and DBP in the linear (BMI, β: -0.55, 95 % CI: -0.77, -0.33; WC, β: -1.66, 95 % CI: -2.19, -1.13; DBP, β: -0.65, 95 % CI: -1.07, -0.24), and logistic (BMI > 25 kg/m2, OR: 0.82, 95 % CI: 0.74, 0.93; elevated WC, OR: 0.72, 95 % CI: 0.64, 0.81; DBP, OR: 0.83, 95 % CI: 0.72, 0 .95) models. Conclusion: compliance to the DASH-style diet was inversely associated with BMI, WC and DBP in this Mexican population. Promoting adherence to this dietary pattern in the context of Mexican diet is needed to improve cardiovascular health in this population (AU)

Antecedentes: la adherencia al patrón de alimentación DASH ha mostrado ser eficaz para reducir la presión arterial y los marcadores de riesgo cardiovascular en diferentes poblaciones, pero nunca en la mexicana. Objetivo: evaluar la adherencia al patrón de alimentación DASH mediante un índice adapatado a los lineamientos DASH (DASH-AI) y evaluar su asociación con marcadores de riesgo. Métodos: análisis transversal de datos de 1490 adultos de entre 20 y 50 años de edad. La ingesta dietética se evaluó utilizando un cuestionario de frecuencia de consumo de alimentos y el sodio a través de la excresión urinaria en 24 horas; la puntuación DASH-AI se calculó de acuerdo con la adherencia a las recomendaciones DASH. Se realizaron modelos logísticos y lineales para estimar la asociación entre el puntaje DASH-AI y los marcadores de riesgo cardiovascular (índice de masa corporal [IMC], circunferencia de cintura (CC), presión arterial sistólica (PAS) y diastólica (PAD), glucosa, triglicéridos, colesterol total, lipoproteínas de alta y baja densidad). Resultados: observamos una asociación del DASH-AI con el IMC, la CC y la PAD en los modelos lineales (IMC β: -0,55, IC del 95 %: -0,77, -0,33; CC β: -1,66, IC del 95 %: -2,19, -1,33; PAD, β: -0,65, IC del 95 %: -1,07, -0,24) y logístico (IMC > 25 kg/m2, OR: 0,82, IC del 95 %: 0,74, 0,93; CC elevado, OR: 0,72; IC del 95 %: 0,64, 0,81; PAD, OR: 0,83, IC del 95 %: 0,72, 0,95). Conclusión: la adherencia a la dieta DASH se asoció inversamente con el IMC, la CC y la PAD en la población estudiada. Es necesario promover la adherencia a este patrón dietético para mejorar la salud cardiovascular (AU)

Comparison of nutritional and hydration status in patients undergoing twice and thrice-weekly hemodialysis: a silent drama in developing countries.

PURPOSE: In low and middle- income countries, due to lack of financial resources, the number of patients receiving one or two hemodialysis (HD) sessions a week has increased, leading to a large number of complications. Protein-energy wasting (PEW) and overhydration (OH) are common complications; nevertheless, the evidence regarding the nutritional status of patients receiving 2 and 3 weekly dialysis sessions is scarce. Thus, our objective was to compare the nutritional and hydration status of patients with two and three HD sessions. Secondarily, we aimed to compare hospitalizations, infectious complications and mortality within the following 6 months after the initial assessment. METHODS: Forty-four patients in a 3 weekly session scheme and 44 dialyzed twice a week were included. Anthropometrical, biochemical, dietary and impedance measurements were performed. Malnutrition Inflammation Score (MIS) and PEW score were applied. Number of hospitalizations, infectious complications and mortality during the 6 months following the evaluation were recorded. RESULTS: Prevalence of moderate/severe undernutrition (63.6% vs 36.4%, p < 0.006) and prevalence of OH (90.9% vs 77.3%, p < 0.001) were significantly higher in the twice-weekly sessions group compared to the 3 weekly sessions. The twice a week session group showed a 3.7-fold (OR 3.7, 95% CI 1.3-10.5, p = 0.01), a 2.5-fold (OR 2.4, 95% CI 0.9-6.6, p = 0.01), a 4.5-fold (OR 4.5, 95% CI 1.0-20.2, p < 0.05), a 8.3-fold (HR 8.3, 95% CI 2.4-28.2, p = 0.001) and a 11.6-fold (HR 11.6, 95% CI 2.4-54.0, p = 0.002) increased odds of developing undernutrition, PEW, OH, being hospitalized or death, respectively, compared to those who received three sessions per week. CONCLUSIONS: Twice weekly hemodialysis scheme is associated with higher odds of moderate or severe undernutrition, PEW, OH status, hospitalization and mortality compared to a thrice-weekly hemodialysis scheme.

Outcomes of a school-based intervention (RESCATE) to improve physical activity patterns in Mexican children aged 8-10 years.

The aim of this study was to evaluate the impact of an intervention program on the patterns of physical activity in 8- to 10-year-old Mexican children from lower socioeconomic status. This study performed a randomized controlled field trial in 498 children aged 8-10 years from 10 public schools of low socioeconomic status in Mexico City. Schools were randomly assigned to intervention (n = 5) or control (n = 5) groups and followed up during 12 months. Physical and sedentary activities were assessed at the beginning of the program and after 6 and 12 months. At the end of follow-up, there was a significant increase in the performance of moderate physical activity (MPA) among children in intervention group who had not performed MPA at baseline any day of the week (40%, P = 0.04) but not in the control group (8%, P = not significant). The intervention group also showed a significant reduction in the proportion of children who spent more than 3 hours a day playing video games (from 23 to 13%, P = 0.01), while control group did not show significant changes. Given these findings, we conclude that intervention was able to modify positively physical activity and reduce time spent on such sedentary activities as video games among those at highest risk studied children.