Genetic Determinants of Atherogenic Indexes.

Atherogenesis and dyslipidemia increase the risk of cardiovascular disease, which is the leading cause of death in developed countries. While blood lipid levels have been studied as disease predictors, their accuracy in predicting cardiovascular risk is limited due to their high interindividual and interpopulation variability. The lipid ratios, atherogenic index of plasma (AIP = log TG/HDL-C) and the Castelli risk index 2 (CI2 = LDL-C/HDL-C), have been proposed as better predictors of cardiovascular risk, but the genetic variability associated with these ratios has not been investigated. This study aimed to identify genetic associations with these indexes. The study population (n = 426) included males (40%) and females (60%) aged 18-52 years (mean 39 years); the Infinium GSA array was used for genotyping. Regression models were developed using R and PLINK. AIP was associated with variation on APOC3, KCND3, CYBA, CCDC141/TTN, and ARRB1 (p-value < 2.1 × 10-6). The three former were previously associated with blood lipids, while CI2 was associated with variants on DIPK2B, LIPC, and 10q21.3 rs11251177 (p-value 1.1 × 10-7). The latter was previously linked to coronary atherosclerosis and hypertension. KCND3 rs6703437 was associated with both indexes. This study is the first to characterize the potential link between genetic variation and atherogenic indexes, AIP, and CI2, highlighting the relationship between genetic variation and dyslipidemia predictors. These results also contribute to consolidating the genetics of blood lipid and lipid indexes.

Correlation between Angiotensin Serum Levels and Very-Low-Frequency Spectral Power of Heart Rate Variability during Hemodialysis.

Cardiovascular regulatory mechanisms that fail to compensate for ultrafiltration and cause hypovolemia during hemodialysis (HD) are not completely understood. This includes the interaction between the autonomic nervous system and the biochemistry that regulates blood pressure and modulates cardiac activity and vascular tone in response to hypovolemia in patients treated with HD. The objective was to evaluate the association of spectral indices of heart rate variability (HRV) with serum levels of angiotensin II, angiotensin 1-7, nitric oxide and total antioxidant capacity during HD. Electrocardiographic records were obtained from 20 patients during HD (3 h), from which HRV data and spectral power data in the very-low-frequency (VLF), low-frequency (LF) and high-frequency (HF) bands were generated. Three blood samples per patient were collected during HD (0.0, 1.5, 3.0 h) to determine the levels of biomarkers involved in the pressor response during HD. Angiotensin II had a positive correlation with VLF (r = 0.390) and with LF/HF (r = 0.359) and a negative correlation with LF (r = -0.262) and HF (r = -0.383). There were no significant correlations between HRV and the other biomarkers. These results suggest that during HD, VLF could reflect the serum levels of angiotensin II, which may be associated with the autonomic response to HD.

Adherence to the DASH dietary pattern is associated with blood pressure and anthropometric indicators in Mexican adults.

INTRODUCTION: 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, : -0.55, 95 % CI: -0.77, -0.33; WC, : -1.66, 95 % CI: -2.19, -1.13; DBP, : -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.

INTRODUCCIÓN: 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 : -0,55, IC del 95 %: -0,77, -0,33; CC : -1,66, IC del 95 %: -2,19, -1,33; PAD, : -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.

Low-Intensity Intradialytic Exercise Attenuates the Relative Blood Volume Drop Due to Intravascular Volume Loss during Hemodiafiltration.

INTRODUCTION: Patients in hemodiafiltration (HDF) eliminate volume overload by ultrafiltration. Vascular volume loss is among the main mechanisms contributing to adverse events such as intradialytic hypotension. Here, we hypothesize that the intradialytic exercise (IDEX) is an intervention that could improve the acute response of physiological mechanisms involved during vascular volume loss. To test this hypothesis, we evaluated the hemodynamic response to mild aerobic exercise during HDF. METHODS: Nineteen end-stage renal disease (ESRD) patients (11 women: 40 ± 10.8 years old, and 8 men: 42 ± 21 years old) receiving HDF thrice a week, with 6 months of previous physical conditioning, participated in this study. Three HDF sessions were scheduled for each patient: 1 resting in supine position, 1 resting in sitting position, and 1 doing aerobic exercise. The first 2 sessions were taken as control. The ultrafiltration rate was set to 800 mL/h in each session. The hemodynamic response was monitored through the relative blood volume (RBV), and cardiovascular variables measured noninvasively by photoplethysmography. Adequacy variables such as Kt/V and percentage reduction of urate, urea, creatinine (Cr), and phosphate were also monitored. FINDINGS: The decrease rate of the RBV was smaller in the session with IDEX compared to the sessions with no exercise. No differences were found neither in the cardiovascular variables nor in the adequacy variables among the 3 sessions. There were no hypotension events during the session with exercise, and 8 events during the sessions without exercise (p = 0.002). DISCUSSION: Mild exercise during HDF decreased the RBV drop and was associated with less hypotension events. The lack of differences in the hemodynamic variables suggests an adequate acute response of cardiovascular compensation variables to intradialytic hypovolemia.

Development of an online tool for sodium intake assessment in Mexico

[ABSTRACT]. Excess sodium intake is associated with adverse health effects, and reducing its intake is a strategy that improves population health. However, estimating sodium intake is challenging and new options for assessment are needed. This review describes the design and development of a web-based, publicly-accessible, dietary sodium intake screening tool (Calculadora de Sodio) for individuals in Mexico. Sodium data from 2017 – 2018 for 3 429 packaged foods, 655 restaurant and cafeteria foods, and 320 home-style meals and street foods (determined by chemical analysis) comprised the 71-question tool. It was piloted with 10 nutrition experts for feedback on content and face validity; and with 30 potential users to test its usability and interface. Improvements were made to content, language, and formatting following the pilot. Its predictive validity will be established in the future. The Calculadora de Sodio provides instant feedback on an individual’s average daily sodium intake, computed by frequency of intake, average number of servings, and sodium content per serving of each sodium-focused food category. This is the first web-based dietary sodium screening tool developed for the general population of Mexico. It is an efficient and practical way to assess sodium intake and can serve as a model for similar tools for other countries and regions.

[RESUMEN]. La ingesta excesiva de sodio se asocia a efectos nocivos para la salud y su reducción constituye una estrategia para mejorar la salud de la población. Sin embargo, es complicado estimar la ingesta de sodio y se necesitan nuevas alternativas para evaluarla. En este examen se describe el diseño y la creación de una herramienta en línea y de acceso público con el fin de establecer la ingesta de sodio en la alimentación (denominada la “calculadora de sodio”) para la población de México. La herramienta, consistente en 71 preguntas, incluye los datos de sodio correspondientes al 2017-2018 de 3 429 alimentos envasados, 655 alimentos de restaurantes y cafeterías y 320 comidas caseras y alimentos de puestos de venta de la calle (determinados mediante análisis químicos). Se hizo una prueba piloto con diez nutricionistas que aportaron su opinión experta en materia de validez del contenido y diseño, además de 30 usuarios potenciales que probaron la facilidad de uso y su interfaz. Tras la prueba piloto, se incluyeron mejoras de contenido, idioma y formato. En el futuro se podrá determinar su valor predictivo. La calculadora de sodio ofrece una evaluación instantánea sobre la ingesta de sodio promedio diaria de una persona, calculada según la frecuencia de la ingesta, la cantidad promedio de raciones y el contenido de sodio por ración de cada categoría de alimentos con sodio. Esta es la primera herramienta en línea de detección de sodio en los alimentos creada para la población general de México. Es una manera eficaz y práctica de evaluar la ingesta de sodio, y puede servir de modelo para herramientas similares en otros países y regiones.

[RESUMO]. A ingestão de sódio em excesso está associada a efeitos adversos à saúde, e a redução do consumo alimentar de sódio é uma estratégia que contribui para a melhoria da saúde das pessoas. Porém, como é difícil estimar a ingestão de sódio, são necessários novos métodos de avaliação. Neste estudo são apresentados o projeto e o desenvolvimento de um instrumento on-line e aberto ao público (denominado ‘’calculadora de sódio’’) para a triagem da ingestão alimentar de sódio por indivíduos no México. O instrumento contém 71 perguntas preparadas com base em dados do teor de sódio, coletados no período de 2017 a 2018, de 3.429 alimentos embalados, 655 alimentos comercializados em restaurantes e lanchonetes e 320 refeições do tipo caseiro e comidas de rua (medidos com análises químicas). Um testepiloto foi realizado com 10 especialistas em nutrição, que fizeram observações sobre a validade de conteúdo e a validade aparente do instrumento, e 30 possíveis usuários que avaliaram sua usabilidade e interface. O conteúdo, os enunciados e o formato foram aperfeiçoados após o teste-piloto. A validade preditiva do instrumento será determinada futuramente. A ‘’calculadora de sódio’’ proporciona uma avaliação imediata da ingestão alimentar média de sódio de uma pessoa, calculada pela frequência de consumo, número médio de porções e teor de sódio por porção de cada categoria de alimento que contém sódio. Este é o primeiro instrumento on-line para a triagem de sódio alimentar desenvolvido para a população do México. É um recurso eficiente e prático para avaliar a ingestão de sódio e pode servir de modelo para o desenvolvimento de instrumentos semelhantes em outros países e regiões.

Development of an online tool for sodium intake assessment in Mexico.

Excess sodium intake is associated with adverse health effects, and reducing its intake is a strategy that improves population health. However, estimating sodium intake is challenging and new options for assessment are needed. This review describes the design and development of a web-based, publicly-accessible, dietary sodium intake screening tool (Calculadora de Sodio) for individuals in Mexico. Sodium data from 2017 - 2018 for 3 429 packaged foods, 655 restaurant and cafeteria foods, and 320 home-style meals and street foods (determined by chemical analysis) comprised the 71-question tool. It was piloted with 10 nutrition experts for feedback on content and face validity; and with 30 potential users to test its usability and interface. Improvements were made to content, language, and formatting following the pilot. Its predictive validity will be established in the future. The Calculadora de Sodio provides instant feedback on an individual's average daily sodium intake, computed by frequency of intake, average number of servings, and sodium content per serving of each sodium-focused food category. This is the first web-based dietary sodium screening tool developed for the general population of Mexico. It is an efficient and practical way to assess sodium intake and can serve as a model for similar tools for other countries and regions.

La ingesta excesiva de sodio se asocia a efectos nocivos para la salud y su reducción constituye una estrategia para mejorar la salud de la población. Sin embargo, es complicado estimar la ingesta de sodio y se necesitan nuevas alternativas para evaluarla. En este examen se describe el diseño y la creación de una herramienta en línea y de acceso público con el fin de establecer la ingesta de sodio en la alimentación (denominada la "calculadora de sodio") para la población de México. La herramienta, consistente en 71 preguntas, incluye los datos de sodio correspondientes al 2017-2018 de 3 429 alimentos envasados, 655 alimentos de restaurantes y cafeterías y 320 comidas caseras y alimentos de puestos de venta de la calle (determinados mediante análisis químicos). Se hizo una prueba piloto con diez nutricionistas que aportaron su opinión experta en materia de validez del contenido y diseño, además de 30 usuarios potenciales que probaron la facilidad de uso y su interfaz. Tras la prueba piloto, se incluyeron mejoras de contenido, idioma y formato. En el futuro se podrá determinar su valor predictivo. La calculadora de sodio ofrece una evaluación instantánea sobre la ingesta de sodio promedio diaria de una persona, calculada según la frecuencia de la ingesta, la cantidad promedio de raciones y el contenido de sodio por ración de cada categoría de alimentos con sodio. Esta es la primera herramienta en línea de detección de sodio en los alimentos creada para la población general de México. Es una manera eficaz y práctica de evaluar la ingesta de sodio, y puede servir de modelo para herramientas similares en otros países y regiones.

A ingestão de sódio em excesso está associada a efeitos adversos à saúde, e a redução do consumo alimentar de sódio é uma estratégia que contribui para a melhoria da saúde das pessoas. Porém, como é difícil estimar a ingestão de sódio, são necessários novos métodos de avaliação. Neste estudo são apresentados o projeto e o desenvolvimento de um instrumento on-line e aberto ao público (denominado ''calculadora de sódio'') para a triagem da ingestão alimentar de sódio por indivíduos no México. O instrumento contém 71 perguntas preparadas com base em dados do teor de sódio, coletados no período de 2017 a 2018, de 3.429 alimentos embalados, 655 alimentos comercializados em restaurantes e lanchonetes e 320 refeições do tipo caseiro e comidas de rua (medidos com análises químicas). Um teste-piloto foi realizado com 10 especialistas em nutrição, que fizeram observações sobre a validade de conteúdo e a validade aparente do instrumento, e 30 possíveis usuários que avaliaram sua usabilidade e interface. O conteúdo, os enunciados e o formato foram aperfeiçoados após o teste-piloto. A validade preditiva do instrumento será determinada futuramente. A ''calculadora de sódio'' proporciona uma avaliação imediata da ingestão alimentar média de sódio de uma pessoa, calculada pela frequência de consumo, número médio de porções e teor de sódio por porção de cada categoria de alimento que contém sódio. Este é o primeiro instrumento on-line para a triagem de sódio alimentar desenvolvido para a população do México. É um recurso eficiente e prático para avaliar a ingestão de sódio e pode servir de modelo para o desenvolvimento de instrumentos semelhantes em outros países e regiões.

Bread Consumption Is Associated with Elevated Blood Pressure among Adults Living in Mexico City⁻A Sub-Analysis of the Tlalpan 2020 Study.

Excessive dietary sodium is associated with elevated blood pressure (EBP). Bread products are identified as one of the main sources of daily sodium intake. The objective of this cross-sectional study was to evaluate the association between bread and others cereal products consumption with EBP. Frequency intake of a standard serving of bread and other cereal products was recorded and categorized as: ≤3 times/month or never (reference category group) and ≥ once/week. EBP was defined as systolic blood pressure (SBP) ≥120 mmHg and/or diastolic blood pressure (DBP) ≥80 mmHg. Raw and adjusted odds ratios (OR) for the association between consumption of the studied food products and blood pressure status were estimated. Overall, 2011 participants aged 37.3 ± 9.1 years old were included. In the models adjusted for relevant covariates, consumption of one piece of bolillo or telera (OR = 1.39; 95% CI = 1.01⁻1.89) ≥ once/week was associated with an increased risk of EBP, compared to the reference category. Also, participants consuming one bowl of high-fiber breakfast cereal once/week were less likely to have EBP (OR = 0.73; 95% CI = 0.53⁻0.98). Initiatives to reduce sodium levels in bread products such as bolillo and telera are needed in Mexico to help manage the cardiovascular risk at the population level.

Activity of Antioxidant Enzymes and Their Association with Lipid Profile in Mexican People without Cardiovascular Disease: An Analysis of Interactions.

Dyslipidemia and oxidative stress are both considered to be factors involved in cardiovascular disease; however, the relationship between them has been little explored. In this work, we studied the association between the lipid profile and the activity of antioxidant enzymes such as paraoxonase-1 (PON1), superoxide dismutase 1 (SOD1), ceruloplasmin, and catalase, as well as total antioxidant capacity (the ferric-reducing ability of plasma (FRAP)), in 626 volunteers without cardiovascular disease. Their lipid profile was evaluated, and they were classified as having or not having high triglycerides (↑TG), high low-density cholesterol (↑LDLC), and low high-density cholesterol (↓HDLC), resulting in eight groups: Without dyslipidemia, ↑TG, ↑LDLC, ↓HDLC, ↑TG↑LDLC, ↑TG↓HDLC, ↑LDLC↓HDLC, and ↑TG↑LDLC↓HDLC. When comparisons by group were made, no significant differences in the activity of antioxidant enzymes were obtained. However, the linear regression analysis considering the potential interactions between ↑TG, ↑LDLC, and ↓HDLC suggested a triple interaction between the three lipid profile alterations on the activity of PON1 and a double interaction between ↑TG and ↑LDLC on ferroxidase-ceruloplasmin activity. The analysis presented in this work showed an association between the lipid profile and antioxidant-enzyme activity and highlighted the importance of considering the interactions between the components of a phenomenon instead of studying them individually. Longitudinal studies are needed to elucidate the nature of these associations.

[Development of a screening tool for a high sodium intake in an adult Mexican population]. / Desarrollo de una herramienta de tamizaje para consumo elevado de sodio en una población adulta mexicana.

BACKGROUND: twenty-four-hour urinary sodium excretion is the reference method to assess sodium intake; however, tools that can be more easily applied in the clinical and population setting are needed. OBJECTIVES: to develop and evaluate a self-administered high-sodium food frequency questionnaire (abbreviated to CFCA-S in Spanish) as a screening tool for high sodium intake in an adult Mexico City population. METHODS: a CFCA-S including 28 sodium-rich food categories and a scoring system were developed. The 75 percentile for the total score was tested as cut-off point to classify high sodium consumers at two different levels (≥ 2,000 and ≥ 3,000 mg/day) against 24-h urinary sodium excretion as reference method. RESULTS: ninety-five participants were included (median age: 39 [25th-75th percentiles: 26-46] years; men: 39 [41.1%]). A total score of 51.2 in the CFCA-S showed a sensitivity of 31.6% (95% confidence interval [CI]: 19.1-47.5), specificity of 78.9 (95% CI: 66.7-87.5), positive predictive value of 50% (95% CI: 31.4-68.6) and negative predictive value of 63.4% (95% CI: 51.8-73.6) to classify high-sodium consumers at a level of intake ≥ 3,000 mg/day. A total score ≥ 51.2 was significantly associated with a sodium intake ≥ 3,000 mg/day, observing an odds ratio of 3.12 (CI 95%: 1.03-9.44, p = 0.04), after adjusting by sex, age, and body mass index. CONCLUSIONS: the sodium CFCA-S developed in this study is a practical, feasible and useful tool to identify individuals at greater risk of having a high sodium intake.

INTRODUCCIÓN: la excreción de sodio en orina de 24 horas es el método de referencia para evaluar la ingesta de sodio; sin embargo, se  requieren herramientas que puedan aplicarse de manera más práctica tanto en el ámbito clínico como en el poblacional. OBJETIVOS: desarrollar y evaluar un cuestionario autoadministrable de frecuencia de consumo de alimentos ricos en sodio (CFCA-S) como herramienta de tamizaje para consumo elevado de sodio en una población adulta de la Ciudad de México. MÉTODOS: se desarrolló un CFCA-S con 28 categorías de alimentos ricos en sodio y su sistema de puntuación respectivo. El percentil 75 del puntaje total del CFCA-S se probó como punto de corte para clasificar a las personas con alto consumo de sodio a dos niveles (≥ 2.000 y ≥ 3.000 mg/día), considerando la excreción urinaria de sodio en 24 horas como método de referencia. RESULTADOS: se incluyeron 95 participantes (mediana de edad: 39 [percentiles 25-75: 26-46] años; hombres: 39 [41,1%]). Un puntaje total de 51,2 en el CFCA-S mostró una sensibilidad del 31,6% (intervalo de confianza [IC] 95%: 19,1-47,5), una especificidad del 78,9% (IC 95%: 66,7-87,5), valor predictivo positivo del 50% (IC 95%: 31,4-68,6) y valor predictivo negativo del 63,4% (IC 95%: 51,8-73,6), para clasificar a las personas con consumo de sodio ≥ 3.000 mg/día. Un puntaje ≥ 51,2 se asoció significativamente con una ingesta de sodio ≥ 3.000 mg/día, resultando en una razón de momios de 3,12 (IC 95%: 1,03-9,44, p = 0,04), después de ajustar por sexo, edad e índice de masa corporal (IMC). CONCLUSIONES: el CFCA-S es una herramienta práctica, factible de aplicarse y útil para identificar a personas en riesgo de tener un consumo elevado de sodio.

Desarrollo de una herramienta de tamizaje para consumo elevado de sodio en una población adulta mexicana / Development of a screening tool for a high sodium intake in an adult Mexican population

Introducción: la excreción de sodio en orina de 24 horas es el método de referencia para evaluar la ingesta de sodio; sin embargo, se requieren herramientas que puedan aplicarse de manera más práctica tanto en el ámbito clínico como en el poblacional. Objetivos: desarrollar y evaluar un cuestionario autoadministrable de frecuencia de consumo de alimentos ricos en sodio (CFCA-S) como herramienta de tamizaje para consumo elevado de sodio en una población adulta de la Ciudad de México. Métodos: se desarrolló un CFCA-S con 28 categorías de alimentos ricos en sodio y su sistema de puntuación respectivo. El percentil 75 del puntaje total del CFCA-S se probó como punto de corte para clasificar a las personas con alto consumo de sodio a dos niveles (≥ 2.000 y ≥ 3.000 mg/día), considerando la excreción urinaria de sodio en 24 horas como método de referencia. Resultados: se incluyeron 95 participantes (mediana de edad: 39 [percentiles 25-75: 26-46] años; hombres: 39 [41,1%]). Un puntaje total de 51,2 en el CFCA-S mostró una sensibilidad del 31,6% (intervalo de confianza [IC] 95%: 19,1-47,5), una especificidad del 78,9% (IC 95%: 66,7-87,5), valor predictivo positivo del 50% (IC 95%: 31,4-68,6) y valor predictivo negativo del 63,4% (IC 95%: 51,8-73,6), para clasificar a las personas con consumo de sodio ≥ 3.000 mg/día. Un puntaje ≥ 51,2 se asoció significativamente con una ingesta de sodio ≥ 3.000 mg/día, resultando en una razón de momios de 3,12 (IC 95%: 1,03-9,44, p = 0,04), después de ajustar por sexo, edad e índice de masa corporal (IMC). Conclusiones: el CFCA-S es una herramienta práctica, factible de aplicarse y útil para identificar a personas en riesgo de tener un consumo elevado de sodio

Background: twenty-four-hour urinary sodium excretion is the reference method to assess sodium intake; however, tools that can be more easily applied in the clinical and population setting are needed. Objectives: to develop and evaluate a self-administered high-sodium food frequency questionnaire (abbreviated to CFCA-S in Spanish) as a screening tool for high sodium intake in an adult Mexico City population. Methods: a CFCA-S including 28 sodium-rich food categories and a scoring system were developed. The 75 percentile for the total score was tested as cut-off point to classify high sodium consumers at two different levels (≥ 2,000 and ≥ 3,000 mg/day) against 24-h urinary sodium excretion as reference method. Results: ninety-five participants were included (median age: 39 [25th-75th percentiles: 26-46] years; men: 39 [41.1%]). A total score of 51.2 in the CFCA-S showed a sensitivity of 31.6% (95% confidence interval [CI]: 19.1-47.5), specificity of 78.9 (95% CI: 66.7-87.5), positive predictive value of 50% (95% CI: 31.4-68.6) and negative predictive value of 63.4% (95% CI: 51.8-73.6) to classify high-sodium consumers at a level of intake ≥ 3,000 mg/day. A total score ≥ 51.2 was significantly associated with a sodium intake ≥ 3,000 mg/day, observing an odds ratio of 3.12 (CI 95%: 1.03-9.44, p = 0.04), after adjusting by sex, age, and body mass index. Conclusions: the sodium CFCA-S developed in this study is a practical, feasible and useful tool to identify individuals at greater risk of having a high sodium intake

Indicators of accumulated fat are stronger associated with prehypertension compared with indicators of circulating fat: A cross-sectional study.

Recently, prehypertension has been considered as a risk factor for cardiovascular disease because it can progress to hypertension. The association between obesity and dyslipidemia with raised blood pressure has been reported in some studies; however, the ability of indicators of such conditions to predict prehypertension has been scarcely explored. In this cross-sectional study, we compared the ability of indicators of accumulated and circulating fat to discriminate between prehypertensive and normotensive Mexico City residents (n = 1377). The indicators were classified based on the parameters needed for their calculation: including only circulating fat (IOCFi) (e.g., Castelli risk indexes), including only accumulated fat (IOAFi) (e.g., waist circumference [WC]), and mixed (e.g., lipid accumulation product [LAP]). We compared the areas under the receiving operating characteristic curves (AURCs) and estimated the cutoff points for each indicator and their associated risk of prehypertension. The IOAFi had the greatest AURCs, followed by mixed and IOCFi; the AURCs for WC were the highest (AURC = 0.688 and 0.666 for women and men, respectively). The highest odds ratios for prehypertension were those associated with the cutoff points for IOAFi and LAP (e.g., OR = 2.8 for women with WC > 83.5 cm and OR = 2.6 for men with WC > 87.5 cm). Early detecting people at risk of cardiovascular disease is a necessity and given that WC had a better performance than the other indexes and it is relatively easy to measure, it has the potential of being used as a complementary measure in routine clinical examinations and by the general population as an auto-screening measurement to detect prehypertension.

Dyslipidemia and tobacco smoking synergistically increase serum manganese / La dislipidemia y el tabaquismo aumentan de manera sinérgica el manganeso sérico

Manganese is a trace metal involved in both physiology and toxicity. The association between manganese and dyslipidemia has been scarcely revised, and results from studies in both animals and humans are inconsistent. The aim of this study was to evaluate the association between serum manganese levels and dyslipidemia, considering some manganese sources and factors that could affect its concentration, especially tobacco smoking. Serum manganese concentration in 63 volunteers was determined and their smoking habits were recorded. Dietary manganese, iron, fat and alcohol consumption was also estimated by a food-frequency questionnaire. A bivariate analysis was carried out to identify those factors affecting manganese concentration. Only dyslipidemia and smoking resulted statistically significant and thus were considered for the subsequent two-way analysis of variance, to test a possible interaction between dyslipidemia and smoking. Marginal means for serum manganese were as follows: 8.32 ± 2.14 nmol/L for nonsmokers without dyslipidemia, 9.21 ± 2.22 nmol/L for smokers without dyslipidemia, 10.21 ± 2.53 nmol/L for nonsmokers with dyslipidemia, and 14.21 ± 3.44 nmol/L for smokers with dyslipidemia. Dyslipidemia and tobacco smoking were synergistically associated with increased serum manganese. To maintain adequate manganese levels in the organism, other factors in addition to its dietary intake should be considered, for instance, lipid status and smoking habits, particularly in those conditions in which manganese accumulation is an issue.

El manganeso es un metal traza esencial involucrado tanto en procesos fisiológicos como en toxicidad. La asociación entre el manganeso y las dislipidemias se ha estudiado poco, y los resultados de estudios en animales y en humanos son inconsistentes. El objetivo de este trabajo fue evaluar la asociación entre el manganeso sérico y las dislipidemias, considerando algunas fuentes de manganeso y factores que pudieran afectar su concentración, especialmente el tabaquismo. Se determinaron las concentraciones séricas de manganeso de 63 voluntarios y se registraron sus hábitos de consumo de tabaco. Se estimó la ingesta de manganeso, hierro, grasa y alcohol mediante un cuestionario de frecuencia de consumo. Se realizó un análisis bivariado para identificar los factores que afectaron las concentraciones de manganeso; únicamente las dislipidemias y el tabaquismo resultaron estadísticamente significativos y se consideraron enel subsecuente análisis de varianza de dos vías, para examinar una posible interacción entre las dislipidemias y el tabaquismo. Las medias marginales para el manganeso sérico fueron: 8,32 ± 2,14 nmol/L para no fumadores sin dislipidemia, 9,21 ± 2,22 nmol/L para fumadores sin dislipidemia, 10,21 ± 2,53 nmol/L para no fumadores con dislipidemia, y 14,21 ± 3,44 nmol/L para fumadores con dislipidemia. Las dislipidemias y el tabaquismo se asociaron sinérgicamente con el aumento del manganeso sérico. Para mantener niveles adecuados de manganeso en el organismo, se deben tomar en cuenta factores adicionales a su consumo dietético, como el estatus lipídico y el tabaquismo, particularmente en condiciones en las que la acumulación de manganeso sea un problema.

Protocol for a prospective longitudinal study of risk factors for hypertension incidence in a Mexico City population: the Tlalpan 2020 cohort.

INTRODUCTION: Systemic hypertension (HTN) is a common risk factor for cardiovascular disease. In Mexico, HTN prevalence has increased over time and is currently 31%. Nonetheless, information about the country's HTN incidence and its associated risk factors is scarce. Understanding this condition is a priority for identifying the scope of primary prevention. The main objective of this study is to evaluate the effect of traditional and non-traditional risk factors on the incidence of HTN in a cohort of healthy Mexico City residents under biannual follow-up for 10 years. METHODS AND ANALYSIS: A prospective longitudinal study is proposed in which clinically healthy residents of Mexico City between 20 and 50 years old will be recruited; the participants will be evaluated every 2 years over a period of 10 years or until they develop HTN. Evaluations regarding sociodemographic, clinical, anthropometric, biochemical, diet, physical activity, stress, sleep quality, alcohol and tobacco consumption factors will be performed. The participants will be recruited from the 16 municipalities of Mexico City through promotional strategies aimed at the community and will be clinically evaluated at a tertiary care institution, Instituto Nacional de Cardiología Ignacio Chávez (National Institute of Cardiology Ignacio Chavez), located in Mexico City, Mexico. Sample size estimated for this study is 3436, and the Cox proportional hazards model will be used to estimate HRs for the association between explanatory variables and HTN using both raw and adjusted data. ETHICS AND DISSEMINATION: This study was approved by the Institutional Bioethics Committee of the Instituto Nacional de Cardiología Ignacio Chávez (National Institute of Cardiology Ignacio Chavez) under number 13-802. Findings from this study will be disseminated through scientific papers and research conferences.

Assessment of Sodium and Potassium Intake by 24 h Urinary Excretion in a Healthy Mexican Cohort.

BACKGROUND AND AIMS: A high dietary sodium intake and a low potassium intake are associated with adverse cardiovascular health. Data on these nutrients consumption in Mexico is limited. The aim of this study was to assess sodium and potassium intake by 24 h urinary excretion in a clinically healthy Mexican population. We additionally explored their association with blood pressure. METHODS: 711 clinically healthy participants aged 20-50 years old recruited in the Tlalpan 2020 cohort from September 2014-December 2015, were included in this cross-sectional analysis. All participants provided a 24 h urine sample and underwent anthropometric, biochemical, and blood pressure evaluations. Univariate and multivariate linear regression analyses were used to assess the association of urinary sodium, potassium, and Na/K ratio with blood pressure. RESULTS: Mean (95% confidence interval [CI]) urinary sodium and potassium in the overall population was 3150.1 (3054.2-3246.0) mg/d and 1909.5 (1859.3-1959.6) mg/d, respectively. Overall, only 121 (17%) met the WHO recommendation for sodium intake (<2000 mg/d) and 16 (2.3%) met the goal for potassium intake (≥3510 mg/d). Urinary sodium (ß coefficient 1.3, 95% CI: 0.7, 1.8, p <0.001) and potassium (ß coefficient 2.1, 95% CI: 1.0, 3.2, p <0.001) were found to be associated with systolic blood pressure in the univariate analysis but not in the multivariate analysis. CONCLUSIONS: Sodium intake was higher and potassium intake was lower than the WHO recommendations in this healthy Mexican population. Sodium and potassium intakes were not associated with blood pressure at the mean levels of intake observed in this population, after adjusting for key variables.

Aumento en la efectividad de la identificación de cimas y pies en el pulso fotopletismográfico al reconstruirlo mediante filtrado adaptativo / Increase in the effectiveness of identifying peaks and feet of the photoplethysmographic pulse to be reconstructed it using adaptive filtering

Resumen: Objetivo: Mejorar la identificación de cimas y pies en el pulso fotopletismográfico (PPG, por sus siglas en inglés), deformado por efecto del ruido miocinético, mediante la implementación de un dedal modificado y filtrado adaptativo. Método: Se obtuvo el PPG en 10 voluntarios sanos empleando 2 sistemas de fotopletismografía colocados en el dedo índice de cada mano, y registrándolos simultáneamente durante 3 min. Durante el primer minuto de registro, ambas manos estuvieron en reposo, y durante los 2 min posteriores, solo la mano izquierda realizó movimientos cuasi-periódicos para añadir ruido miocinético. Se emplearon 2 metodologías para procesar las señales fuera de línea, en una se usó un filtro con el algoritmo de mínimos cuadrados promediados (LMS, por sus siglas en inglés) y en la otra se hizo un preprocesamiento adicional al filtrado LMS. Ambas metodologías fueron comparadas y la de menor error porcentual en la señal recuperada se utilizó para valorar la mejora en la identificación de cimas y pies del PPG. Resultados: El error promedio obtenido fue del 22.94% para la primera metodología, y del 3.72% para la segunda. Los errores en la identificación de cimas y pies antes de filtrar el PPG fueron del 24.26 y 48.39%, respectivamente, una vez filtrados, disminuyeron a 2.02 y 3.77%, respectivamente. Conclusiones: El filtrado adaptativo basado en el algoritmo LMS, más una etapa de preprocesamiento, permite atenuar el ruido miocinético en el PPG, y aumentar la efectividad en la identificación de cimas y pies de pulso, que resultan de gran importancia para una valoración médica.

Abstract: Objective: To improve the identification of peaks and feet in photoplethysmographic (PPG) pulses deformed by myokinetic noise, through the implementation of a modified fingertip and applying adaptive filtering. Method: PPG signals were recordedfrom 10 healthy volunteers using two photoplethysmography systems placed on the index finger of each hand. Recordings lasted three minutes andwere done as follows: during the first minute, both handswere at rest, and for the lasting two minutes only the left hand was allowed to make quasi-periodicmovementsin order to add myokinetic noise. Two methodologies were employed to process the signals off-line. One consisted on using an adaptive filter based onthe Least Mean Square (LMS) algorithm, and the other includeda preprocessing stage in addition to the same LMS filter. Both filtering methods were compared and the one with the lowest error was chosen to assess the improvement in the identification of peaks and feet from PPG pulses. Results: Average percentage errorsobtained wereof 22.94% with the first filtering methodology, and 3.72% withthe second one. On identifying peaks and feet from PPG pulsesbefore filtering, error percentages obtained were of 24.26% and 48.39%, respectively, and once filtered error percentageslowered to 2.02% for peaks and 3.77% for feet. Conclusions: The attenuation of myokinetic noise in PPG pulses through LMS filtering, plusa preprocessing stage, allows increasingthe effectiveness onthe identification of peaks and feet from PPG pulses, which are of great importance for medical assessment.

[Increase in the effectiveness of identifying peaks and feet of the photoplethysmographic pulse to be reconstructed it using adaptive filtering]. / Aumento en la efectividad de la identificación de cimas y pies en el pulso fotopletismográfico al reconstruirlo mediante filtrado adaptativo.

OBJECTIVE: To improve the identification of peaks and feet in photoplethysmographic (PPG) pulses deformed by myokinetic noise, through the implementation of a modified fingertip and applying adaptive filtering. METHOD: PPG signals were recordedfrom 10 healthy volunteers using two photoplethysmography systems placed on the index finger of each hand. Recordings lasted three minutes andwere done as follows: during the first minute, both handswere at rest, and for the lasting two minutes only the left hand was allowed to make quasi-periodicmovementsin order to add myokinetic noise. Two methodologies were employed to process the signals off-line. One consisted on using an adaptive filter based onthe Least Mean Square (LMS) algorithm, and the other includeda preprocessing stage in addition to the same LMS filter. Both filtering methods were compared and the one with the lowest error was chosen to assess the improvement in the identification of peaks and feet from PPG pulses. RESULTS: Average percentage errorsobtained wereof 22.94% with the first filtering methodology, and 3.72% withthe second one. On identifying peaks and feet from PPG pulsesbefore filtering, error percentages obtained were of 24.26% and 48.39%, respectively, and once filtered error percentageslowered to 2.02% for peaks and 3.77% for feet. CONCLUSIONS: The attenuation of myokinetic noise in PPG pulses through LMS filtering, plusa preprocessing stage, allows increasingthe effectiveness onthe identification of peaks and feet from PPG pulses, which are of great importance for medical assessment.