Papel objetivo de las bebidas azucaradas embotelladas en la etiofisiopatología y la epidemiología de la obesidad y la diabetes mellitus tipo 2 en México / Objective role of bottled sugar-sweetened beverages in the pathophysiology and epidemiology of obesity and type 2 diabetes mellitus in Mexico

En México son altas las prevalencias de obesidad y de diabetes mellitus tipo 2 (DM2), y es alto también el consumo de bebidas azucaradas embotelladas (BAE) y también de bebidas azucaradas de venta libre en las calles. Partiendo de la premisa en la que el consumo regular de BAE podría contribuir con la prevalencia de obesidad y de DM2, a partir de 2014 se instituyó en México el Impuesto Especial sobre Productos y Servicios (IEPS) a alimentos y bebidas de densidad energética alta, incluidas las BAE. Sin embargo, la aplicación del IEPS no ha disminuido ni el consumo de BAE ni las prevalencias de obesidad y DM2, puesto que —además del consumo de BAE— participan en la etiofisiopatología de la obesidad y la DM2 en México factores genéticos idiosincráticos y un patrón de inestabilidad alimentaria asociado con alto consumo de alimentos de gran densidad energética, sumado a índices particularmente elevados de sedentarismo. Para frenar la obesidad y laDM2, hacen falta estrategias basadas en la educación eficaz de la población y en el abatimiento social y económico de lapobre calidad alimentaria hasta ahora prevalente. (AU)

In Mexico, the prevalence of obesity and type 2 diabetes mellitus (DM2) is high, and the consumption of bottled sugar-sweetened beverages (BSSB), as well as sugar sweetened beverages sold over the counter on the streets, is also high. Based on the premise that regular consumption of BSSB could contribute to the prevalence of obesity and DM2, as of 2014, the Special Tax on Products and Services (IEPS) was instituted in Mexico on foods and beverages with high energy density, including BSSB. However, the application of the IEPS has not reduced either the consumption of BSSB or the prevalence of obesity and DM2, since —in addition to the consumption of BSSB— idiosyncratic genetic factors and a pattern of food instability associated with high consumption of energy dense foods, coupled with particularly high rates of sedentary lifestyle. To curb obesity and DM2, strategies based on the effective education of the population and the social and economic abatement of the poor food quality that has prevailed up to now are needed. (AU)

Comorbidity burden in terms of disability in patients with osteoarthritis in Mexico. The IMPACTAR registry.

OBJECTIVE: To determine the comorbidities associated with disability in patients with OA in Mexico (2013-2015). MATERIAL AND METHODS: A cross-sectional, retrospective and multicentre IMPACTAR study (n=7703) in Mexican patients (2013-2015). Comorbidities associated with disability were identified in 4971 patients diagnosed with OA from the IMPACTAR registry (n=7073). An adjusted logistic regression analysis was carried out by demographic, economic, clinical and medical variables. RESULTS: Mean age was 63 years; and 75% of the patients were women. Subjects with OA and presence of comorbidities are 42% more likely to develop disabilities than patients without associated comorbidity, considering age, sex, family income, OA diagnosis duration, and education level. The highest rate of people with disability (28.9%) was concentrated in Region 7, which corresponds to Mexico City. There are also significant differences between median family incomes, when the income of persons with disability is under $13 000 (IQR: 9000-16 000) Mexican pesos, compared to patients without disability. Almost half of the subjects (49.6%) reported having at least one comorbidity. Arterial hypertension was the risk factor with a statistically significant difference (32.8%) among those with disability (34.7%). CONCLUSIONS: Programs and interventions for OA patients should take into consideration comorbidity factors, being female, family income, and the region of residence as variables that may increase the possibility of developing an OA-associated disability.

Comorbidity burden in terms of disability in patients with osteoarthritis in Mexico. The IMPACTAR registry.

OBJECTIVE: To determine the comorbidities associated with disability in patients with OA in Mexico (2013-2015). MATERIAL AND METHODS: A cross-sectional, retrospective and multicentre IMPACTAR study (n=7703) in Mexican patients (2013-2015). Comorbidities associated with disability were identified in 4971 patients diagnosed with OA from the IMPACTAR registry (n=7073). An adjusted logistic regression analysis was carried out by demographic, economic, clinical and medical variables. RESULTS: Mean age was 63 years; and 75% of the patients were women. Subjects with OA and presence of comorbidities are 42% more likely to develop disabilities than patients without associated comorbidity, considering age, sex, family income, OA diagnosis duration, and education level. The highest rate of people with disability (28.9%) was concentrated in Region 7, which corresponds to Mexico City. There are also significant differences between median family incomes, when the income of persons with disability is under $13 000 (IQR: 9000-16 000) Mexican pesos, compared to patients without disability. Almost half of the subjects (49.6%) reported having at least one comorbidity. Arterial hypertension was the risk factor with a statistically significant difference (32.8%) among those with disability (34.7%). CONCLUSIONS: Programs and interventions for OA patients should take into consideration comorbidity factors, being female, family income, and the region of residence as variables that may increase the possibility of developing an OA-associated disability.

Envejecimiento exitoso. Una visión entre médicos / Successful aging. A view among physicians

Resumen: ANTECEDENTES: Los factores ambientales, educativos, sociales y de salud deben ser óptimos para que se logre un envejecimiento exitoso. OBJETIVO: Determinar las características involucradas en el proceso de envejecimiento exitoso en un grupo de internistas. MATERIAL Y MÉTODO: Estudio transversal comparativo a través de una encuesta a médicos internistas en el Congreso Nacional del Colegio de Medicina Interna 2016. Se aplicó un cuestionario de 33 preguntas que evaluó factores sociodemográficos, de salud, alimentación, convivencia, economía y espiritualidad. El análisis descriptivo incluyó frecuencias y porcentajes, el análisis bivariado se realizó con X2, un valor de p < 0.05 se consideró estadísticamente significativo. RESULTADOS: Se analizaron 282 cuestionarios, la edad media de los participantes fue de 42.7 ± 12.8 años, 161 (57%) fueron hombres. El autorreporte de regular estado de salud fue de 38%, con enfermedades crónico-degenerativas (61%), tabaquismo (8%), consumo de alcohol (24%), sedentarismo (64%). En el aspecto nutricional el consumo en buena proporción de frutas y verduras fue de 41%, de proteínas 68% y de líquidos cercana a 50%. CONCLUSIONES: Es necesaria la capacitación en áreas preventivas de la salud, económicas y sociales, así como investigar factores relevantes que pueden repercutir en un futuro en el envejecimiento del grupo poblacional de este estudio.

Abstract: BACKGROUND: The environmental, educational, social and health factors must be optimal for successful aging. OBJECTIVE: To determine the characteristics involved in the process of successful aging in a group of medical specialists in Internal Medicine. MATERIAL AND METHOD: A comparative cross-sectional study was carried out through a survey of internists in the National Congress of the College of Internal Medicine 2016. A questionnaire was applied of 33 questions to evaluate socio-demographic factors, health, nutrition, coexistence, economy and spirituality. The descriptive analysis included frequencies and percentages; the bivariate analysis was performed with X2, considering a value of p < 0.05 statistically significant. RESULTS: We analyzed 282 questionnaires, the average age of the participants was 42.7 ± 12.8 years, 161 (57%) were men. The self-report of regular health status was 38%, with chronic-degenerative diseases 61%, smoking in 8% and alcohol consumption 24% and sedentary lifestyle in 64%. Concerning the nutritional aspects the consumption in adequate proportion of fruits and vegetables was 41%, protein 68% and close to 50% in the case of water. CONCLUSIONS: There is a need for training in preventive health, economic and social areas, as well as for investigating relevant factors that may impact in the future on the aging of the population group of this study.

Ibero⁻American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages.

International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2⁻4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.

Metabolic Surgery for the Treatment of Diabetes Mellitus Positioning of Leading Medical Associations in Mexico.

INTRODUCTION: Metabolic surgery (MS) can be a useful therapeutic strategy in patients with type 2 diabetes (DM2) and obesity. OBJECTIVE: To define the place of MS within DM2 treatment in Mexico. METHODS: A committee of experts consisting of internists and surgeons representing the leading Mexican associations involved in the field was created. Each one responded to a specific question regarding mechanisms involved in controlling DM2, surgical procedures, and the indications and contraindications for MS. This document was prepared based on the presentation and discussion of such answers. RESULTS: Obesity through insulin resistance, incretins, bile salts, and intestinal microbiota plays a determining role in the appearance of DM2. MS improves glucose homeostasis by reducing weight and intake, increasing incretins, and modifying bile salts and microbiota. MS leads to remission of DM2 and reduces cardiovascular risk factors in well-selected cases. We recommend MS as a therapeutic option in DM2 and grade III obesity regardless of metabolic control and grade II and grade I obesity with poor glycemic control. MS could be considered an option in grade II obesity with good metabolic control in the presence of associated comorbidities. Gastric bypass presents the most favorable risk-benefit profile. CONCLUSIONS: Current evidence endorses the inclusion of MS in the algorithm for treatment of DM2 and obesity. The therapeutic approach must be multidisciplinary at experienced centers.

Hidratación: importancia en algunas condiciones patológicas en adultos / Hydration: Importance in some pathological conditions in adults

Resumen Estar bien hidratado se relaciona con un estado adecuado de salud y bienestar; sin embargo ¿qué pasa en los pacientes adultos que tienen algún padecimiento como obesidad, diabetes mellitus tipo 2, hipertensión arterial, cardiopatía isquémica e insuficiencia cardiaca, alteraciones nefrológicas (insuficiencia, poliquistosis y litiasis renal), enfermedad pulmonar obstructiva crónica, dislipidemia, hiperuricemia o, bien, en adultos mayores y en el periodo perioperatorio, en donde hay pérdida del estado de salud o una necesidad diferente de hidratación y que requieren consumir bebidas no alcohólicas para tener un buen estado de hidratación sin alterar la evolución natural de estas condiciones? Algunos puntos y recomendaciones son: la carbonatación de las bebidas ofrece el beneficio de aumentar la saciedad y disminuir la ingesta energética, lo que puede contribuir a la pérdida de peso; el agua simple es la mejor fuente de hidratación en los pacientes diabéticos, sin embargo, otras fuentes de hidratación pueden ser el agua mineralizada, el agua mineral, la leche (de preferencia descremada), café y té sin azúcar o con edulcorantes no calóricos o bajos en calorías, así como cualquier bebida que los contenga; en pacientes con litiasis renal se recomienda ingerir 2.5 a 4 L de agua al día; las bebidas para deportistas pueden ser consumidas por pacientes hipertensos, siempre y cuando no excedan la cantidad de sodio recomendada por la Organización Mundial de la Salud. En conclusión, la hidratación juega un papel importante en la evolución de las enfermedades mencionadas.

Abstract Being well hydrated is related to an adequate state of health and well-being; however, what happens in those adult patients having some pathological conditions such as obesity, type 2 diabetes mellitus, high blood pressure, ischemic heart disease and heart failure, kidney diseases (renal failure, polycystic renal disease and renal lithiasis), chronic obstructive pulmonary disease, dyslipidemia, hyperuricemia, or in the elderly and in the perioperative period, where there is loss of health or a different need for hydration and require the use of non-alcoholic beverages in order to have a good state of hydration without altering the natural evolution of these conditions? Some key points and recommendations are: carbonation of beverages offers the benefit of increasing satiety and decreasing energy intake, which can contribute to weight loss; simple water is the best source of hydration in diabetic patients; however, other sources of hydration may be mineralized water, mineral water, milk (preferably non-fat), coffee and tea without sugar or non-caloric sweeteners or low-calorie, as well as any beverage containing them; in patients with renal lithiasis it is recommended to take 2.5 to 4 L of water per day; sports drinks can be consumed by hypertensive patients as long as they do not exceed the amount of sodium recommended by the World Health Organization. In conclusion, hydration plays an important role in the evolution of the pathologic conditions mentioned above.