Development and validation of a multivariable genotype-informed gestational diabetes prediction algorithm for clinical use in the Mexican population: insights into susceptibility mechanisms.

INTRODUCTION: Gestational diabetes mellitus (GDM) is underdiagnosed in Mexico. Early GDM risk stratification through prediction modeling is expected to improve preventative care. We developed a GDM risk assessment model that integrates both genetic and clinical variables. RESEARCH DESIGN AND METHODS: Data from pregnant Mexican women enrolled in the 'Cuido mi Embarazo' (CME) cohort were used for development (107 cases, 469 controls) and data from the 'Mónica Pretelini Sáenz' Maternal Perinatal Hospital (HMPMPS) cohort were used for external validation (32 cases, 199 controls). A 2-hour oral glucose tolerance test (OGTT) with 75 g glucose performed at 24-28 gestational weeks was used to diagnose GDM. A total of 114 single-nucleotide polymorphisms (SNPs) with reported predictive power were selected for evaluation. Blood samples collected during the OGTT were used for SNP analysis. The CME cohort was randomly divided into training (70% of the cohort) and testing datasets (30% of the cohort). The training dataset was divided into 10 groups, 9 to build the predictive model and 1 for validation. The model was further validated using the testing dataset and the HMPMPS cohort. RESULTS: Nineteen attributes (14 SNPs and 5 clinical variables) were significantly associated with the outcome; 11 SNPs and 4 clinical variables were included in the GDM prediction regression model and applied to the training dataset. The algorithm was highly predictive, with an area under the curve (AUC) of 0.7507, 79% sensitivity, and 71% specificity and adequately powered to discriminate between cases and controls. On further validation, the training dataset and HMPMPS cohort had AUCs of 0.8256 and 0.8001, respectively. CONCLUSIONS: We developed a predictive model using both genetic and clinical factors to identify Mexican women at risk of developing GDM. These findings may contribute to a greater understanding of metabolic functions that underlie elevated GDM risk and support personalized patient recommendations.

Emergency Use of Tocilizumab in Moderate and Severe COVID-19 Patients over the Prevaccination Stage during the Pandemic in Mexico.

Introduction: COVID-19 has been associated with the overactivation of the immune system; interleukin-6 (IL-6) seems to have a key role, which made its moderation to be proposed as a therapeutic blank. Tocilizumab has been used as part of treatments to modulate the immune response to infections caused by COVID-19. Material and Methods. An observational, descriptive, retrospective, and transversal study was carried out in patients diagnosed with moderate-severe COVID-19 who were hospitalized in the 251 General Regional Hospital from March to December 2020. Results: A review of 700 files corresponding to hospitalized patients was carried out, and a sample of 70 patients who met the inclusion criteria proposed for this protocol was obtained. Among the comorbidities associated with the disease, it was found that hypertensive patients have a higher mortality rate: 62% died and so did 59% of those who needed invasive respiratory support. As regards admission tests, statistical significance was found for the figures of leukocytes, neutrophils, glomerular filtration rate, and PCR. Conclusion: The use of this drug benefits mainly young nonhypertensive patients with a moderate disease and preserved renal functions with no need for invasive respiratory support, regardless of other comorbidities.

Association of Serum Levels of Plasticizers Compounds, Phthalates and Bisphenols, in Patients and Survivors of Breast Cancer: A Real Connection?

Phthalates and bisphenols are ubiquitous environmental pollutants with the ability to perturb different systems. Specifically, they can alter the endocrine system, and this is why they are also known as endocrine-disrupting compounds (EDCs). Interestingly, they are related to the development and progression of breast cancer (BC), but the threshold concentrations at which they trigger that are not well established. OBJECTIVES: The aim of this study was to compare the concentration measures of parent EDCs in three groups of women (without BC, with BC, and BC survivors) from two urban populations in Mexico, to establish a possible association between EDCs and this disease. We consider the measure of the parent compounds would reflect the individual's exposure. METHODS: The levels of di-ethyl-hexyl-phthalate (DEHP), butyl-benzyl-phthalate (BBP), di-n-butyl phthalate (DBP) and di-ethyl-phthalate (DEP), bisphenol A (BPA) and bisphenol S (BPS) were determined by gas chromatograph-mass spectrometry in 102 subjects, including 37 women without any pathological disease, 46 patients with BC and 19 women survivals of BC of Mexico and Toluca City. RESULTS: All phthalates were detected in 100% of women, two of them were significantly higher in patients with different BC subtypes in Mexico City. Differential increases were observed mainly in the serum concentration of phthalates in women with BC compared to women without disease between Mexico and Toluca City. In addition, when performing an analysis of the concentrations of phthalates by molecular type of BC, DEP and BBP were found mainly in aggressive and poorly differentiated types of BC. It should be noted that female BC survivors treated with anti-hormonal therapy showed lower levels of BBP than patients with BC. BPA and BPS were found in most samples from Mexico City. However, BPS was undetectable in women from Toluca City. DISCUSSION: The results of our study support the hypothesis of a positive association between exposure to phthalates and BC incidence.

Sarcopenia, neuropatía periférica y enfermedad arterial periférica en pacientes con diabetes mellitus sometidos a hemodiálisis / Sarcopenia, peripheral neuropathy, and peripheral arterial disease in patients with diabetes mellitus under hemodialysis

Resumen Introducción: La sarcopenia se caracteriza por pérdida de fuerza y masa muscular. Los pacientes con diabetes mellitus que se encuentran bajo tratamiento en hemodiálisis tienen disminución de actividad física y cambios en su ingestión alimentaria, lo que propicia también la presencia de sarcopenia; por otro lado, la neuropatía periférica y enfermedad arterial periférica aparecen comúnmente como complicaciones crónicas de la diabetes mellitus. Material y métodos: Se realizó un estudio transversal, observacional, en pacientes con diabetes mellitus y hemodiálisis. Para la evaluación de la sarcopenia se midió fuerza muscular, rendimiento físico y cantidad de masa muscular. Se midió fuerza muscular con dinamómetro, mientras que el rendimiento físico se evaluó con el tiempo en segundos de marcha con cronómetro, la cantidad de músculo de obtuvo utilizando una báscula con bioimpedancia. Se consideró sarcopenia severa cuando existía baja fuerza y cantidad muscular además de bajo rendimiento físico. La neuropatía periférica se evaluó explorando la sensibilidad a la presión y el tacto con el monofilamento de Semmes-Weinstein y sensibilidad profunda con un diapasón de 128 Hz. El índice tobillo-brazo fue la medición tomada para la clasificación de enfermedad arterial periférica. Resultados: El análisis final se realizó con 33 pacientes. Con un tiempo en hemodiálisis de 3,57 ± 2,56 años. La prevalencia de sarcopenia severa y sarcopenia fue de 90,8% y la de pre-sarcopenia de 9% del total de los pacientes; por otro lado, se encontró al 78,1% los pacientes con pérdida de la sensibilidad profunda, mientras que el porcentaje de los pacientes con pérdida de la sensibilidad a la presión y al tacto fue de 54,5%. Se encontró correlación entre los parámetros de sarcopenia y el tiempo de evolución de la insuficiencia renal y la edad. Conclusión: La sarcopenia se presenta, en sus diferentes etapas, en prácticamente todos los pacientes con diabetes mellitus sometidos a hemodiálisis; existe relación con la edad del paciente y el tiempo de hemodiálisis.

Abstract Introduction: Sarcopenia is characterized by loss of strength and muscle mass. Patients with diabetes mellitus who are under hemodialysis treatment show decreased physical activity and changes in their food intake, which also leads to the presence of sarcopenia. On the other hand, peripheral neuropathy and peripheral arterial disease commonly appear as chronic complications of diabetes mellitus. Methods: A cross-sectional, observational study was carried out in diabetes mellitus patients on hemodialysis. For the assessment of sarcopenia, muscle strength, physical performance and muscle mass percentage were measured. Muscle strength was calculated with a dynamometer, while physical performance was evaluated in seconds by means of a walk test with a stopwatch; muscle mass percentage was obtained using a scale with bioelectrical impedance. Sarcopenia was considered severe when there was low muscle strength and percentage in addition to low physical performance. Peripheral neuropathy was assessed by exploring touch and pressure sensibility with the Semmes-Weinstein monofilament test and deep sensibility with a 128 Hz tuning fork. The ankle-brachial index was the measurement taken for the peripheral arterial disease classification. Results: The final analysis was performed with 33 patients, whose time on hemodialysis was 3.57 ± 2.56 years. The prevalence of severe sarcopenia and sarcopenia was 90.8% and that of pre-sarcopenia was 9% of all patients. On the other hand, 78.1% were found to be patients with loss of deep sensibility, while the percentage of patients with loss of sensibility to pressure and touch was 54.5%. A correlation was found between the sarcopenia parameters and the time of evolution of renal failure and age. Conclusion: Sarcopenia occurs, in its different stages, in practically all diabetes mellitus patients undergoing hemodialysis; there is a relationship with the patient's age and hemodialysis time.

Visceral Adiposity Index in Breast Cancer Survivors: A Case-Control Study.

BACKGROUND: Breast cancer (BC) is the first cause of cancer morbidity and mortality in women. This disease has been linked to obesity; however, it is not clear how fat accumulation affects women who survive breast cancer. Although the visceral adiposity index (VAI) is a marker of cardiometabolic risk and adipose tissue dysfunction, it is not clear how it changes in breast cancer survivors. The aim of this investigation was to compare VAI in women with and without breast cancer. METHODS: A case-control cross-sectional study was conducted on women who were BC survivors and women without the history of BC (control group). Body composition was assessed using electrical bioimpedance while VAI by means of waist circumference (WC), body mass index (BMI), triacylglycerols (TG), and high-density lipoprotein cholesterol (HDL-C). RESULTS: 49 women in the BC survivor group and 50 in the control group. WC was wider in the survivor group as regards control (93.65 ± 10.48 vs. 88.52 ± 9.61 cm) (p=0.025); at once, TG and VAI were significantly higher for the survivor group (243.55 ± 199.84 vs. 159.84 ± 75.77) (p=0.007) and (11.03 ± 11.15 vs. 6.41 ± 3.66) (p < 0.005), respectively. Body composition parameters were similar in both groups. CONCLUSIONS: VAI is higher in women who are BC survivors in comparison with controls matched by age and bodyweight.

Risk and lifestyle factors associated to chronic kidney disease. / Factores de riesgo y de estilo de vida asociados a enfermedad renal crónica.

Lifestyle has a determining influence on the progression of a chronic kidney disease (CKD), which starts with some kidney damage, that can remain and progress by the influence of risk factors and accumulate subsequent injury of kidney damage throughout life. It is more common in adults and frequently remains hidden from routine analysis, but if it can be detected early, treatment and healthy lifestyle can be applied, which would allow stopping or lengthening the progress of kidney damage, in order to avoid the need of a renal transplant or dialysis. The objective of this work was to show the possible lifestyles to apply, such as visits to the doctor, not smoking, have intense to moderate physical activity, consume enough vegetables and fruits, avoid diets high in carbohydrates and lipids. To carry out this review, it was obtained literature from databases between 1980 and 2017, freely accessible, using keywords like "chronic kidney disease (CKD)", "lifestyle" and "risk factors", and its equivalents in Spanish.

El estilo de vida tiene una influencia determinante en el avance de la enfermedad renal crónica (ERC), la cual inicia con algún daño renal que puede permanecer y progresar por la acción de factores de riesgo, además de que pueden agregarse lesiones renales a lo largo de la vida. Es más común en personas adultas y frecuentemente permanece oculta a los análisis habituales, pero si logra detectarse de manera temprana puede atenderse con el fin de aplicar estilos de vida saludables que permitan detener o alargar el avance del daño renal, para evitar o retardar la necesidad de diálisis o de trasplante. El objetivo de este trabajo es dar a conocer los posibles estilos de vida que se deben implementar, como las visitas al médico, no fumar, tener actividad de intensa a moderada, consumir suficientes vegetales y frutas, y evitar dietas altas en hidratos de carbono y lípidos. Para llevar a cabo la revisión se obtuvo literatura de bases de datos entre 1980 y 2017, de libre acceso, utilizando las palabras clave en inglés "chronic kidney disease (CKD)", "lifestyle" y "risk factors", y sus equivalentes en español.

Association of Irisin Serum Concentration and Muscle Strength in Normal-Weight and Overweight Young Women.

Background: Irisin is a muscle-contraction-induced myokine. In previous studies, it has been related to exercise type, fitness and physical activity; however, evidence is not consistent. Thus, the aim of this study was to research the association between health-related fitness and irisin in young women. Methods: The study was designed as a prospective cross-sectional one. Young, healthy, nonsmoking women were enlisted. The sample comprised 40 overweight (OW) and 40 normal-weight (NW) individuals. The average age was 18.63 ± 0.63 and 18.78 ± 0.73 years, respectively. Components of health-related fitness, metabolic parameters, serum irisin and body composition were analyzed. Results: Statistically significant differences were found in physical tests between NW and OW groups for one-leg standing, hand grip strength, vertical jump, modified push-up, fitness index and maximal oxygen uptake (VO2MAX). There were no differences in concentrations of serum irisin between the groups. We found a positive correlation between irisin and hand grip strength (r = 0.374, p = 0.023). In a multivariate analysis adjusted by body fat, a significant association between irisin and hand grip strength was observed in OW group (ß = 0.380, p = 0.026); as well, a positive association between irisin and one-leg standing test in NW group (ß = 0.311, p = 0.044) was found. Conclusions: According to our findings, hand grip strength could be linked to irisin concentration in overweight young women.

Prediction of incident hypertension and arterial stiffness using the non-insulin-based metabolic score for insulin resistance (METS-IR) index.

Hypertension is associated with insulin resistance (IR), metabolic syndrome (MS), and arterial stiffness. Non-insulin-based IR indexes were developed as tools for metabolic screening. Here, we aimed to evaluate the novel non-insulin-based Metabolic Score for IR (METS-IR) index for the prediction of incident hypertension and arterial stiffness evaluated using pulse wave velocity (PWV) analysis, compared with other non-insulin-based IR indexes. We evaluated two populations, a cross-sectional evaluation of high-risk individuals (n = 305) with a wide range of metabolic comorbidities and dyslipidemia in whom PWV measurement was performed and a 3-year prospective cohort of normotensive individuals (N = 6850). We observed a positive correlation between METS-IR and PWV in the cross-sectional cohort, which was higher compared with other non-insulin-based fasting IR indexes; furthermore, PWV values >75th percentile were associated with the upper tercile of METS-IR values. In the prospective cohort, we observed an increased risk for incident hypertension for the upper METS-IR tercile (METS-IR ≥ 46.42; HR: 1.81, 95% CI: 1.41-2.34), adjusted for known cardiovascular risk factors, and observed that METS-IR had greater increases in the predictive capacity for hypertension along with SBP and the Framingham Hypertension Risk Prediction Model compared with other non-insulin-based IR indexes. Therefore, METS-IR is a novel non-insulin-based IR index which correlates with arterial stiffness and is a predictor of incident hypertension, complementary to previously validated risk prediction models.

Development and validation of a predictive model for incident type 2 diabetes in middle-aged Mexican adults: the metabolic syndrome cohort.

BACKGROUND: Type 2 diabetes mellitus (T2D) is a leading cause of morbidity and mortality in Mexico. Here, we aimed to report incidence rates (IR) of type 2 diabetes in middle-aged apparently-healthy Mexican adults, identify risk factors associated to ID and develop a predictive model for ID in a high-risk population. METHODS: Prospective 3-year observational cohort, comprised of apparently-healthy adults from urban settings of central Mexico in whom demographic, anthropometric and biochemical data was collected. We evaluated risk factors for ID using Cox proportional hazard regression and developed predictive models for ID. RESULTS: We included 7636 participants of whom 6144 completed follow-up. We observed 331 ID cases (IR: 21.9 per 1000 person-years, 95%CI 21.37-22.47). Risk factors for ID included family history of diabetes, age, abdominal obesity, waist-height ratio, impaired fasting glucose (IFG), HOMA2-IR and metabolic syndrome. Early-onset ID was also high (IR 14.77 per 1000 person-years, 95%CI 14.21-15.35), and risk factors included HOMA-IR and IFG. Our ID predictive model included age, hypertriglyceridemia, IFG, hypertension and abdominal obesity as predictors (Dxy = 0.487, c-statistic = 0.741) and had higher predictive accuracy compared to FINDRISC and Cambridge risk scores. CONCLUSIONS: ID in apparently healthy middle-aged Mexican adults is currently at an alarming rate. The constructed models can be implemented to predict diabetes risk and represent the largest prospective effort for the study metabolic diseases in Latin-American population.

Irisin a Novel Metabolic Biomarker: Present Knowledge and Future Directions.

The rising prevalence of chronic diseases such as type 2 diabetes and cardiovascular diseases owing to fat mass excess has been described. In recent years, muscle function/dysfunction has become relevant in metabolic homeostasis. Irisin was described as an exercise-induced myokine. It is the product of type I membrane protein cleavage encoded by the fibronectin type III domain containing 5 (FNDC5) gene. The main beneficial function attributable to irisin is the change of subcutaneous and visceral adipose tissue into brown adipose tissue, with a consequential increase in thermogenesis. Irisin has also been described as a hormone that may have a key role in glucose homeostasis. The way the association of type 2 diabetes with obesity occurs is not fully understood. In recent years, the possible pathways through which irisin could interact with other organs such as the brain or bone have been described. The present paper intends to review the new findings and possible new directions in irisin research.

A low dose lipid infusion is sufficient to induce insulin resistance and a pro-inflammatory response in human subjects.

OBJECTIVE: The root cause behind the low-grade inflammatory state seen in insulin resistant (obesity and type 2 diabetes) states is unclear. Insulin resistant subjects have elevations in plasma free fatty acids (FFA), which are ligands for the pro-inflammatory toll-like receptor (TLR)4 pathway. We tested the hypothesis that an experimental elevation in plasma FFA (within physiological levels) in lean individuals would upregulate TLR4 and activate downstream pathways (e.g., MAPK) in circulating monocytes. RESEARCH DESIGN AND METHODS: Twelve lean, normal glucose-tolerant subjects received a low dose (30 ml/h) 48 h lipid or saline infusion on two different occasions. Monocyte TLR4 protein level, MAPK phosphorylation, and expression of genes in the TLR pathway were determined before and after each infusion. RESULTS: The lipid infusion significantly increased monocyte TLR4 protein and phosphorylation of JNK and p38 MAPK. Lipid-mediated increases in TLR4 and p38 phosphorylation directly correlated with reduced peripheral insulin sensitivity (M value). Lipid increased levels of multiple genes linked to inflammation, including several TLRs, CD180, MAP3K7, and CXCL10. Monocytes exposed in vivo to lipid infusion exhibited enhanced in vitro basal and LPS-stimulated IL-1ß secretion. CONCLUSIONS: In lean subjects, a small increase in plasma FFA (as seen in insulin resistant subjects) is sufficient to upregulate TLR4 and stimulate inflammatory pathways (MAPK) in monocytes. Moreover, lipids prime monocytes to endotoxin. We provide proof-of-concept data in humans indicating that the low-grade inflammatory state characteristic of obesity and type 2 diabetes could be caused (at least partially) by pro-inflammatory monocytes activated by excess lipids present in these individuals.

[Effect of exercise on the serum concentrations of leptin and adiponectin in adolescents with risk factors of developing diabetes]. / Efecto del ejercicio en la concentración sérica de leptina y adiponectina en adolescentes con factores de riesgo de DM.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is an increasing health issue. Physical activity (PA) in early stages is a preventive measure in the development of degenerative diseases. It has been documented the association between exercise and leptin and adiponectin concentrations. The objective was to evaluate the effect of a physical activity program (PAP) on serum leptin and adiponectin in teenagers with risk factors for developing T2DM. METHODS: Experimental-longitudinal study. Teenagers (men and women), with T2DM risk factors, aged 14 to 16 years, participated in a PAP for three months, five days a week, 45 minutes each day. Before and after the program, all anthropometric variables, incluiding leptin and adiponectin, were evaluated. RESULTS: 22 adolescents participated in the PAP and they were compared with 22 adolescents from the control group (who did not participate in the PAP). There was a reduction in the serum concentration of leptin in the intervention group (baseline 23 ± 13; after the PAP 14 ± 8, p > 0.0001), compared with the control group (baseline 18 ± 13, three months follow-up 20 ± 14, p < 0.520). Also, the adiponectin concentration increased (baseline 10 ± 3, after the PAP 13 ± 4.0, p > 0.014), compared with the control group (baseline 11 ± 3, 13 ± 4.0 after the PAP p > 0.032). CONCLUSIONS: This study support the efficacy of an aerobic exercise intervention on metabolic markers of adolescents with risk factors for developing diabetes.

INTRODUCCIÓN: la diabetes mellitus tipo 2 (DM2) es un problema de salud cada vez más preocupante. El ejercicio en etapas tempranas es una medida preventiva en el desarrollo de enfermedades crónico-degenerativas. Se ha postulado la asociación entre el ejercicio con las concentraciones de leptina y adiponectina. El objetivo fue evaluar el efecto de un programa de actividad física (AF) sobre la concentración sérica de leptina y adiponectina en adolescentes con factores de riesgo para el desarrollo de DM2. Métodos: estudio de tipo experimental-longitudinal. Participaron en un programa de AF durante tres meses adolescentes de 14 a 16 años, con factores de riesgo para el desarrollo de diabetes, cinco días a la semana, durante 45 minutos. Antes y después del programa, se evaluó la respuesta de leptina y adiponectina. RESULTADOS: participaron 22 adolescentes en el programa y se compararon con 22 adolescentes del grupo control. Las cifras de leptina disminuyeron en el grupo de intervención: basal 23 ± 13, después del programa 14 ± 8, p < 0.001; grupo control: basal 18 ± 13, seguimiento a tres meses 20 ± 14, p < 0.520. Asimismo, incrementaron las cifras de adiponectina: basal 10 ± 3, después del programa 13 ± 4.0, p < 0.014; grupo control: basal 11 ± 3, post ejercicio 13 ± 4.0, p < 0.032. CONCLUSIONES: nuestros resultados apoyan la eficacia de una intervención con ejercicio aeróbico sobre las características en un grupo minoritario de adolescentes con factores de riesgo para desarrollar diabetes.

La calidad de vida en mayores con insuficiencia renal crónica estadio V / Quality of life in elderly with chronic kidney disease stage V

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Dietary patterns associated with body mass index (BMI) and lifestyle in Mexican adolescents.

BACKGROUND: The objetive in this study is to determine the relationship between dietary patterns, BMI, type 2 diabetes mellitus family history (T2DMFH) and some lifestyle variables such as smoking and skipping breakfast in a Mexican adolescent population. METHODS: Cross-sectional, observational, analytical study.Subjetcts: 14-16 years old male and female adolescents (n 373). A previously validated food frequency questionnaire (FFQ) was used and dietary patterns were derived using principal component analysis (PCA). Scores for dietary patterns were categorized by tertiles. RESULTS: Three major dietary patterns that explained 47 % of variance were found: westernized, high in protein/fat and prudent pattern. Subjects at the highest tertile of prudent pattern had lower BMI. And was also associated with less T2DMFH and less smoking habit when compared with the lowest tertile. We found a positive correlation between BMI and high scores for westernized and high in protein/fat pattern CONCLUSIONS: Dietary patterns of adolescents are a public health concern because there is a direct association between inadequate diet at this early age and obesity.

Thyroid function is associated with insulin resistance markers in healthy adolescents with risk factors to develop diabetes.

INTRODUCTION: The prevalence of obesity and Type 2 diabetes mellitus (T2DM) among children and adolescents is rising. Thyroid function has been associated with insulin resistance. There is scarce information about how thyroid function could be related with cardiovascular risk or glucose homeostasis in adolescent. AIM: To analyze how thyroid function is associated with insulin resistance and another cardiovascular risk factors in healthy adolescents with risk factors to develop diabetes. METHODS: A prospective cross-sectional analysis was carried out on euthyroid, adolescents. considered at high risk to develop Type 2 diabetes. Fasting blood samples were obtained. Thyroid function test and another cardiometabolic parameters were assessed. A 75 grams oral glucose tolerance test was performed to calculate insulin resistance. RESULTS: One hundred adolescents were evaluated. The mean age was 15.9 ± 0.8 years, There is a negative correlation between Fasting insulin, post glucose load insulin and HOMA IR. There were no correlation with Matsuda index. We could not found any correlation with TSH values. CONCLUSIONS: We found a correlation between fasting insulin, HOMA IR and serum thyroid hormones, we did not find any relation with serum TSH. In euthyroid adolescents with risk factors to develop diabetes.

Correlación entre la resistencia a la insulina y T3 en adolescentes con factores de riesgo para el desarrollo de diabetes / Correlation between insulin resistance and T3 in adolescents with risk factors for developing diabetes

Objetivo. Establecer la correlación entre las concentraciones séricas de triyodotironina y la resistencia a la insulina a través del índice HOMA en un grupo de hombres adolescentes con factores de riesgo para el desarrollo de diabetes. Materiales y métodos: estudio descriptivo de corte transversal. Participaron adolescentes con algún factor de riesgo para diabetes. Se determinó la presencia de síndrome metabólico empleando los criterios de ATPIII modificada por Cook. Se determinaron T3, T4, TSH e insulina basal. Se calculó el índice HOMA para resistencia a la insulina. Resultados. Se estudiaron 36 hombres con una edad promedio de 15.97±0.9 años. En la población total existió correlación positiva entre T3 y HOMA-IR (r=0.380 p=0.022), cuando se analizó en el grupo de SM la correlación se incrementó entre T3 y HOMA-IR (r=0.647 p=0.031). Determinando que existe correlación positiva entre los índices de resistencia a la insulina y las concentraciones de hormona tiroidea.

Objetive. Establish the correlation between serum triiodothyronine concentrations and insulin resistance by HOMA index in a group of adolescent men with risk factors for developing diabetes. Material and Methods. It´s a descriptive cross-sectional study. Participating adolescents with some risk factor for diabetes. The presence of metabolic syndrome using the modified ATPIII criteria determined by Cook. T3, T4, TSH and basal insulin were determined. HOMA index was calculated for insulin resistance. Results. 36 men with an average age of 15.97 ± 0.9 years were studied. There was positive correlation between T3 and total population HOMA-IR (r = 0.380 p = 0.022), when analyzed in the group of SM correlation increased between T3 and HOMA-IR (r = 0.647 p = 0.031). Metabolic syndrome in adolescents with a positive correlation between indices of insulin resistance and thyroid hormone concentrations.

Osteoporotic fracture risk evaluation. Options when central densitometry is not available.

BACKGROUND: Osteoporosis-related fractures represent a major health problem. Although spine and hip bone densitometry is the gold standard to assess bone density, this test is not always accesible. The purpose of this study was to describe two options to assess the risk of fracture due to osteoporosis in post-menopausal women assigned to a primary care unit where bone densitometry is not available. METHODS: A cross-sectional study was conducted in 332 post-menopausal women without diagnosis or treatment for osteoporosis, attending regularly to a primary care unit. A heel bone peripheral densitometry, physical exam and medical history were performed. The assessment of fracture risk was carried out using the FRAX™ method. RESULTS: Mean age was 60 ± 8.7 years and body mass index was 28.68 ± 4.24. According to the heel bone peripheral densitometry, 19 (5.7 %) women had osteoporosis (T-score less than or equal to -2.5), 171 (51.8 %) had osteopenia (T-score between -2.5 and less than or equal to -1) and 141 (42.5 %) had normal bone mineral density. According to the FRAX method, 13 (3.9 %) had an increased risk of osteoporotic fracture in a 10-year period and 40 (12 %) of hip fracture. CONCLUSIONS: There was low concordance in the 10-year risk for major osteoporotic fracture and hip fracture assessed with both the FRAX™ and the peripheral bone densitometry methods.

INTRODUCCIÓN: las fracturas relacionadas con la osteoporosis son un problema de salud. Aunque la densitometría ósea de columna y cadera es el estándar para evaluar la densidad ósea, no siempre es accesible. El objetivo de este estudio fue describir dos alternativas a la densitometría ósea para evaluar el riesgo de fractura por osteoporosis en mujeres posmenopáusicas. MÉTODOS: estudio transversal de 332 mujeres posmenopáusicas sin diagnóstico o tratamiento de osteoporosis, que asistían regularmente a una unidad de primer nivel. Se realizó densitometría periférica de talón, examen físico e historia médica. La evaluación del riesgo de fractura se llevó a cabo mediante FRAXTM. RESULTADOS: la edad media fue de 60 ± 8.7 años y el índice de masa corporal de 28.68 ± 4.24. Según la densitometría periférica de talón, mujeres 19 (5.7 %) tenían osteoporosis (T-score menor de ­2.5), 171 (51.8 %) osteopenia (T-score entre ­2.5 y menos de ­1) y 141 (42.5 %) densidad mineral ósea normal. Según el método FRAX, 13 (3.9 %) tenían riesgo aumentado de fractura osteoporótica en un periodo de 10 años y 40 (12 %) de fractura de cadera. CONCLUSIONES: la prevalencia de riesgo para osteoporosis es diferente de acuerdo con el método que se utilice para medirlo. La concordancia entre los dos métodos fue baja.