Does food biodiversity protect against malnutrition and favour the resilience to climate change-related events in Amazon Indigenous communities? A protocol for a mixed methods study.

Background : Undernutrition is projected to be a major consequence of climate change. Biodiversity could enhance climate change resilience by improving nutritional outcomes and providing healthy food resources during and/or after climate-related events. For Indigenous populations who currently base their diet on local biodiversity, rapid climate changes may affect their ability to produce, access or gather food and consequently impact their nutritional status. There is a knowledge gap regarding whether nutritional status among Indigenous populations is better among those who consume a diet with greater biodiversity than those who have a diet with low biodiversity. Objective : This study aims to investigate the role of food biodiversity (FBD) in nutritional resilience to extreme flooding events of Shawi Amazon Indigenous adults living in Peruvian communities that have experienced extreme floods in the past five years. Methods : This study will use a mixed-method sequential explanatory design. The quantitative component includes a cross-sectional survey to assess the association between food biodiversity (FBD) and the prevalence of anaemia in adults aged 15 to 60 years old (n=365). Anaemia will be evaluated using blood hemoglobin and serum ferritin. FBD will be measured with a food frequency questionnaire and a 24-hour dietary recall. Soil-transmitted helminth infections, malaria, and inflammatory biomarkers will also be evaluated. The qualitative component will include a community-based participatory approach to investigate the role of FBD in the responses to extreme floods. Male (n=14) and female (n=14) participants, previously identified in the quantitative phase with high and low levels of FBD, will be invited to participate in a Photovoice activity and semi-structured interviews. A analytical framework for climate change resilience will be used to integrate the data. Discussion : Findings will be integrated to identify nutritional resilience indicators that can inform adaptative interventions to changing climatic conditions in the Amazon and that respect Indigenous worldviews.

Beta-cell function and insulin resistance among Peruvian adolescents with type 2 diabetes.

OBJECTIVE: To characterize and compare the beta-cell function and insulin resistance among Peruvian adolescents with type 2 diabetes (T2D) and their non-diabetic, overweight and lean peers. METHODS: Cross-sectional study of 54 adolescents aged 10-19 years, distributed in three sex- and age-matched groups (n = 18): (i) adolescents with T2D; (ii) overweight adolescents without T2D; and (iii) lean adolescents without T2D, at the Diabetes, Obesity and Nutrition Research Center in Lima, Peru. Fasting glucose, insulin, C-peptide, and glycated hemoglobin were measured for all participants. In addition, a two-hour oral glucose tolerance test (OGTT, 1.75 mg of glucose/kg body weight) was performed, during which glucose and C-peptide were quantified. The homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-B) were derived for all participants, and beta-cell function was further examined by the area under the curve (AUC) of C-peptide. RESULTS: The median HOMA-IR score was higher in adolescents with T2D compared to lean adolescents (6.1 vs. 2.1; p = 0.002), but was not different from that of overweight adolescents (6.1 vs. 4.0; p = 0.322). The median HOMA-B was higher in overweight adolescents than in lean adolescents (256.9 vs. 134.2; p = 0.015), and adolescents with T2D (256.9 vs. 119.8; p = 0.011). The mean AUC of glucose in adolescents with T2D was 1.8-fold higher than that of overweight adolescents, and 1.9-fold higher than that of lean adolescents (p < 0.001). Although the median AUC of C-peptide in adolescents with T2D was lower than that of overweight and lean adolescents, this difference was not statistically significant (230.7 vs. 336.6 vs. 267.3 nmol/l120 min, respectively; p = 0.215). CONCLUSION: Among Peruvian adolescents with T2D, insulin resistance is the most prominent characteristic, rather than beta-cell dysfunction.

Diabetes tipo 2 en niños: Serie de casos / Type 2 diabetes in children: Case series

Objetivos: Describir las características clínicas y bioquímicas de un grupo de niños y adolescentes con diagnóstico reciente de diabetes tipo 2. Material y métodos: Estudio descriptivo, retrospectivo, tipo de serie de casos. Se definió caso al niño o adolescente con glucosa plasmática en ayunas mayor a 126 mg/dl, ausencia de antiGAD y péptido C mayor a 1,5 ng/dl. Se excluyeron a los pacientes con diagnóstico previo de diabetes mellitus tipo 1, diabetes tipo MODY o diabetes secundaria a uso de fármacos. Resultados: La edad media fue 14,3 años, 59% fueron mujeres y 43% tenía por lo menos un padre con diabetes tipo 2. Al momento del diagnóstico, el índice de masa corporal fue 32,8 kg/m2, 85% tenía acantosis nigricans y 68% estaba en estadio Tanner IV y V. El tratamiento inicial incluyó el uso de hipoglicemiantes orales en 75% de los casos, siendo más frecuente el uso de metformina (64,3%). Solamente el 41% de los pacientes recibía algún tipo de insulina. Conclusiones: Los niños y adolescentes con diabetes tipo 2, tienen una frecuencia aumentada de obesidad/sobrepeso, acantosis nigricans y antecedente familiar de DM2. En general, tienen mal control metabólico y reciben metformina como tratamiento inicial. (AU)

Objectives: To describe clinical and biochemical features of children and adolescents with recent onset type 2 diabetes mellitus. Methods: Retrospective study that included children or adolescents with fasting glucose above 126 mg/dl, absence of antiGAD and C peptide above 1.5 ng/dl. Patients with previous diagnosis of type 1 diabetes, diabetes type MODY or drug associated diabetes were excluded. Results: Mean age was 14.3 years; 59% were females, and 43% had at least one parent with type 2 diabetes. At the time of diagnosis, the body mass index was 32.8 kg/m2; 85% had acanthosis nigricans and 68% had Tanner stage IV or V. Initial treatment included oral hypoglycemic drugs in 75% , metformin was the most common drug used (64.3%). Only 41% of cases received insulin. Conclusions: Children and adolescents with type 2 diabetes in this setting have a high frequency of obesity, acanthosis nigricans and family history of type 2 diabetes. In general, these patients have poorly metabolic control and receive metformin as initial treatment. (AU)

Asociación de concentraciones elevadas de ácido úrico y síndrome metabólico en adolescentes obesos / Association of elevated concentrations of uric acid and metabolic syndrome in obese adolescents

Objetivo. Determinar la asociación entre elevación de concentraciones de ácido úrico y síndrome metabólico (SM) en una población de adolescentes obesos. Material y Métodos. Se realizó un estudio caso-control, prospectivo. Se evaluó una población de 308 obesos de 10 a 17 años que acudieron al Servicio de Endocrinología del Hospital Nacional Arzobispo Loayza de Lima. Los casos fueron quienes presentaron SM según los criterios de Cook y quienes no fueron los controles. Se incluyó 70 casos y 70 controles. Se definió elevación de ácido úrico a valores mayores de 5,5 mg/dL. La asociación entre elevación de concentraciones de ácido úrico y síndrome metabólico se calculó mediante la determinación del odds ratio (OR). resultados. El 60% de adolescentes que presentó SM tuvo valores de ácido úrico mayor a 5,5 mg/dL, con promedio de 5,95 mg/dL (4,52-6,65 mg/dL). El OR para elevación de concentraciones de ácido úrico y SM fue 5,06 (95% IC 2,2-11,3). El OR para elevación de ácido úrico y perímetro de cintura (percentil > 90) fue 7,02 (0,91-313), con presión arterial elevada (percentil > 90) fue 3,09 (1,04-9,8), con glicemia (≥ 110 mg/dL) fue 1,8 (0,37-9,6), y triglicéridos elevados (≥ 110 mg/dL) fue 4,4 (1,7-12,09) y con HDL-c (< 40 mg/dL) fue 2,7 (1,2-5,8). Conclusión. El síndrome metabólico está asociado a valores elevados de ácido úrico en adolescentes obesos.

Objective. To determine the association between elevated concentrations of uric acid and the metabolic syndrome in a population of obese adolescents. Material and Methods. It was carried out a case-control and prospective study. We evaluated a population of 308 obese adolescents from 10-17 years old who were followed up in the Endocrinology Service of the Arzobispo Loayza National Hospital, Lima. They were diagnosed as a case of metabolic syndrome according to the CookÆs criteria and those who were not were considered as the controls. We included 70 cases and 70 controls. An elevated concentration of acid uric was defined as uric acid values > 5,5 mg/dL. The association between elevated concentrations of acid uric and metabolic syndrome was determined by odds ratio (OR). results. Sixty per cent of adolescents had metabolic syndrome had uric acid values greater than 5,5 mg/dL, with an average value of 5,95 mg/dL (4,52-6,65). Elevated concentrations of acid uric and metabolic syndrome odds ratio was 5,06 (95% IC 2,2-11,3). The odds ratio (95% CI) for elevated of uric acid and waist circumference (percentile > 90) 7,02 (0,91 to 313) and high blood pressure (percentile > 90) 3,09 (1,04-9,8), and glucose (≥ 110 mg/dL) 1,8 (0,37-9,6) and elevated triglycerides (≥ 110 mg/dL) 4,4 (1,7-12,09) and HDL (< 40 mg/dL) 2,7 (1,2-5,8). Conclusion. The metabolic syndrome is associated with an elevated concentrations of uric acid in obese adolescents.

Diabetes tipo 2, obesidad y cetoacidosis diabética en niños. Reporte de caso / Type 2 diabetes, obesity and diabetic ketoacidosis in children. Case report

Se reporta el caso de una niña con obesidad que acudió a nuestro hospital por presentar cetoacidosis diabética. El manejo inicial incluyó hidratación enérgica e insulina endovenosa. El análisis de anticuerpos anti-GAD fue negativo y el péptido C fue normal. El control metabólico a largo plazo fue con metformina, dieta y ejercicio. Tradicionalmente, la diabetes tipo 2 ha sido considerada una enfermedad de adultos. Sin embargo, a medida que aumenta la prevalencia de obesidad en niños, aumenta el número de casos de diabetes tipo 2 en este grupo etáreo. La hiperglicemia sostenida puede deteriorar la secreción de insulina por parte de las células beta del páncreas. Este fenómeno, llamado glucotoxicidad, puede explicar porque algunos pacientes con diabetes tipo 2 presentan cetoacidosis diabética. No todos los niños que debutan con cetoacidosis diabética tienen diabetes tipo 1.

A 14-year-old woman presented with recent history of type 2 diabetes and diabetic ketoacidosis. Initial treatment included hydration and IV insulin. The anti-GAD was negative, and C-peptide was normal. Clinical evolution was good. Long-term treatment included metformin, diet and exercise. Type 2 diabetes has traditionally been viewed as a disorder of adults. However, as the prevalence of obesity in youth is increasing, type 2 diabetes is now occurringin children and adolescents. Sustained hyperglycemia can impair the secretion of insulin by the beta-cells of the pancreas. Glucose toxicity explains why some patients newly diagnosed with type 2 diabetes have weight loss, diabetic ketoacidosis, and low measured insulin and C-peptide. Diabetic ketoacidosis in obese adolescents with new-onset diabetes does not imply the diagnosis of type 1 diabetes.

Diabetes mellitus tipo 2 en adolescentes: reporte de tres casos / Type 2 diabetes mellitus in adolescents: Three cases report

Se reporta tres casos de pacientes adolescentes con diagnóstico de diabetes mellitus tipo 2 (DM2), un varón y dos mujeres, con características clínicas en común como obesidad, acantosis nigricans y malos hábitos alimentarios. El primero de ellos debutó con cetoacidosis diabética por lo que fue tratado con insulina; luego de un mes se suspendió la insulina y se indicó dieta y metformina, disminuyendo de peso y con glicemias normales. El segundo caso es una mujer que debutó con polidipsia, poliuria y polifagia, tratada con dieta y metformina la cual no fue tolerada por lo se cambió a glibenclamida y ya no presentó eventos adversos, cursa con Hb1Ac 6,3 por ciento y disminución de peso. El tercer caso es una mujer con síntomas de hiperglicemia, recibió insulina y educación, luego de tres meses se suspendió la insulina y se continuó sólo con dieta y ejercicios manteniendo niveles estables de glucosa. Este tipo de presentaciones que se observan con cierta frecuencia en adultos con debut de DM2 hay que tenerlo en cuenta en nuestros adolescentes con sobrepeso y obesidad ya que lo más probable es que se presenten otros casos similares a estos, porque la incidencia y prevalencia de obesidad se seguirá incrementando, y es donde hay que hacer prevención.

We report three cases of adolescent patients diagnosed with DM2, one male and two female, with clinical features in common as obesity, acanthosis nigricans and bad eating habits. The first one starts with diabetic ketoacidosis and was treated with insulin; one month later insulin was stopped and diet plus metformin were indicated, reaching decreased glycemia and a normal body weight. The second case was a female patient that debuts with polydipsia, polyphagia and polyuria, being treated with diet and metformin, and because of intolerance the latter was switched to glybenclamide, then reaching Hb1Ac 6,3 percent and a decreased body weight. The third case was a woman with symptoms of hyperglycemia, received insulin and education, and three months later insulin was stopped following up with only diet and exercise and normal glycemia. Such clinical presentations are seen with some frequency in debut of with adults diabetes mellitus type 2 and must be taken into account in the overweight and obese adolescents because it is likely that similar new cases will be presenting due to the increasing incidence and prevalence of obesity so prevention measures are needed.

Prevalencia de neuropatía diabética dolorosa en los pacientes ambulatorios con diabetes mellitus tipo 2 en un hospital general / Prevalence of painful diabetic neuropathy in type-2 diabetic outpatients in a general hospital

OBJETIVO. Determinar la frecuencia de neuropatía diabética dolorosa (NDD) en pacientes con diabetes mellitus tipo 2 y sus características. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo, descriptivo y transversal en 258 pacientes diabéticos ambulatorios. Se les aplicó el cuestionario DN4 (dolor neuropático 4 preguntas). RESULTADOS. La frecuencia de NDD fue de 31 por ciento y la localización del dolor más frecuente fue en miembros inferiores, 94 por ciento. Los opioides y AINE fueron los fármacos más usados entre los pacientes con dolor neuropático, 10 por ciento y 9 por ciento respectivamente. Se encontró una asociación estadísticamente significativa (p menor que 0,05) entre la NDD con la edad y tiempo de duración de la diabetes. CONCLUSIONES: La neuropatía diabética dolorosa es una complicación muy frecuente y existe una asociación significativa con la edad y tiempo de enfermedad. La localización más frecuente fue en los miembros inferiores.

OBJECTlVE. To find the frequency and characteristics of painful diabetic neuropathy (PDN) in patients with diabetes mellitus type 2. MATERIALS AND METHODS. A prospective, transversal, descriptive study was carried out in 258 type 2 diabetic outpatients. The DN4 questionnaire (neuropathic painfour questions) was applied. RESULTS. The frequency of painful diabetic neuropathy was 31 per cent. The pain was mainly localized in the lower limbs, in 94 per cent. Opioids and NSAlDs were the most used drugs, 10 per cent and 9 per cent, respectively. A statistic significant association was found between PDN and the age and the time of diagnosis of diabetes mellitus type 2. CONCLUSIONS. PDN is a high frequent complication of diabetes and there is an association with the age and diabetes duration. The most frequent localization of the PDN was in the lower limbs.

Características clínicas de un adolescente con obesidad e inicio de debut de diabetes mellitus tipo 2 con cetoacidosis: reporte de un caso / Clinical characteristics of a teenager with obesity and an early debut with type 2 diabetes mellitus ketoacidosis: a case report

Se reporta el caso de un paciente adolescente de 14 años, obeso con síntomas de poliuria, polidipsia, baja de peso y antecedente de gran consumo de dulces y alimentos azucarados, antecedente familiar de diabetes y que debuta con cetoacidosis diabética y anticuerpos antidescarboxilasa del ácido glutámico (anti GAD) negativo y que al seguimiento a los tres meses está controlado con dieta e hipoglicemiantes orales. Esta entidad clásicamente se encuentra relacionada a diabetes mellitus tipo 1, sin embargo, estudios muestran la incidencia elevada en diabetes tipo 2 (DM 2), en su mayoría adolescentes obesos afroamericanos e hispanos.

It is report the case of a teenager patient 14 years old of age, obese with symptoms of polyuria and polydipsia, loss of weight and history of great food consumption of sweets, with a family history of diabetes whose debut is diabetic ketoacidosis and anti GAD negative and that the follow-up to three months is controlled with diet and oral agents. This entity is traditionally linked to a type 1 diabetes mellitus, however studies show the high incidence in type 2 diabetes (DM 2) mostly teenagers obese of African Americans and Hispanics race.

Síndrome metabólico en los pacientes con eventos cardiovasculares agudos en la unidad de cuidados coronarios / Metabolic syndrome in patients with acute cardiovascular events in the coronary care unit

Objetivo: Evaluar la frecuencia del síndrome metabólica (SM) en los pacientes con eventos cardiovasculares agudos en una unidad de cuidados coronarios. Material y Métodos: Se hizo un estudio descriptivo, retrospectivo y transversal. Se recogió los datos de 64 pacientes hospitalizados por algún evento cardiovascular agudo en la unidad de cuidados coronarios del Hospital Nacional Arzobispo Loayza de Lima. El diagnóstico de SM se realizó utilizando los criterios de la IDF. Resultados: La frecuencia de SM en este estudio fue de 75 por ciento (IC 95 por ciento: 63,3-84,4), 65,1 por ciento para varones y 95,24 por ciento para mujeres. La frecuencia de obesidad abdominal y de HDL bajo fue significativamente mayor en las mujeres que en los varones. Se encontró diferencia estadística de una mayor frecuencia de SM en las mujeres. Los criterios de la IDF identificaron un número estadísticamente mayor de casos de SM en comparación con el ATP III/NCEP (75,0 por ciento vs. 56,25 por ciento). Conclusión: El presente estudio halló una elevada frecuencia de síndrome metabólico en los pacientes admitidos en una en la unidad de cuidados coronarios, especialmente en las mujeres.

Objetive. To asses the frecuency of metabolic (MS) in patients with acute cardiovascular events in a coronary care unit. Material and Methods. A descriptive, retrospective and cross-sectional study was done. Data were collected on 64 patients hospitalized for any acute cardiovascular event in the coronary care unit of the Hospital Nacional Arzobispo Loayza of Lima. MS was diagnosed according to the IDF criteria. Results. MS frequency was 75 per cent (CI 95 per cent 63,3-84,4 per cent), 65,1 per cent for men and 95,24 per cent for women. Abdominal obesity and low HDL was significantly higher in women than men. MS was significantly more frequent among women than among men. The IDF criteria identified a significant higher number of MS cases patients compared with the ATP III/NCEP criteria (75,0 per cent vs. 56,25 per cent). Conclusion: High metabolic syndrome frequency was found in admitted patients to the coronary care unit and it was significantly higher in women.