Relación entre el Finnish Diabetes Risk Score, glucemia en ayunas y hemoglobina A1c / Relationship between the Finnish Diabetes Risk Score, fasting blood glucose and glycohemoglobin A1c

Introducción: el Finnish Diabetes Risk Score (FINDRISC) mostró alta sensibilidad y especificidad para la detección de personas que evolucionarían a diabetes mellitus (DM) en las poblaciones estudiadas, por lo cual se decidió utilizarlo entre quienes concurrieron por diferentes motivos a realizarse análisis de laboratorio en centros de la Asociación de Laboratorios de Alta Complejidad (ALAC), con el objeto de identificar personas con diferentes niveles de riesgo de presentar alteraciones de la glucemia en ayunas (GA) y de la HbA1c. Objetivos: explorar la asociación entre la puntuación del FINDRISC con GA y HbA1c, estableciendo el punto de corte de mayor sensibilidad y especificidad para encontrar una GA ≥100 mg/dL y una HbA1c ≥5,7% (38,8 mmol/mol), en una población que concurrió a centros de la ALAC. Materiales y métodos: se incluyeron 1.175 individuos de 45 laboratorios de la ALAC, procesamiento local de glucemia y centralizado de HbA1c (high performance liquid chromatography, HPLC). Análisis estadístico: chi-cuadrado, Odds Ratio, ANOVA, test de Tukey, regresión logística binomial y curvas ROC. Resultados: los puntajes totales del FINDRISC se asociaron de manera positiva y estadísticamente significativa, tanto con los valores de GA como con los niveles de HbA1c. Entre sus variables, una edad mayor o igual a 45 años, un perímetro abdominal de alto riesgo, un índice de masa corporal mayor o igual a 25 Kg/m., la presencia de antecedentes familiares de DM (padres, hermanos o hijos) y la existencia de antecedentes de medicación antihipertensiva se asociaron de manera significativa con valores de GA iguales o superiores a 100 mg/dL y/o niveles de HbA1c iguales o mayores a 5,7% (38,8 mmol/mol). No se halló asociación significativa con la realización de actividad física (al menos 30 minutos diarios) ni con el registro de ingesta diario de frutas y verduras. Los valores medios de GA y HbA1c en individuos con puntajes totales del FINDRISC menores o iguales a 11 fueron de 89,9 mg/dL y 5,2% (33,0 mmol/mol), respectivamente, elevándose hasta valores medios de 116,1 mg/dL y 6,1% (43,0 mmol/mol) en los individuos con puntajes iguales o superiores a 21, siguiendo una asociación del tipo "dosis/respuesta". Por curvas ROC, un FINDRISC de 13 presenta una sensibilidad del 81,89%, especificidad del 67,60% y 70,55% de diagnósticos correctos de HbA1c ≥5,7% (38,8 mmol/mol), y una sensibilidad del 72,50%, especificidad del 70,62% y 71,20% de diagnósticos correctos para encontrar personas con una GA ≥100 mg/dL. Conclusiones: el puntaje del FINDRISC se relacionó con niveles crecientes de GA y HbA1c, resultando útil para encontrar personas con GA ≥100 mg/dL y HbA1c ≥5,7% (38,8 mmol/mol) en la población estudiada.

Introduction: the Finnish Diabetes Risk Score (FINDRISC) has high sensitivity and specificity for the identification of people at risk of diabetes mellitus (DM) in various populations. Therefore, we aimed to use this index to identify individuals at risk of having alterations in fasting glycemia (FG) and HbA1c among those who underwent laboratory analysis at ALAC, Argentina. Objectives: to explore the relationships of the FINDRISC score with the fasting blood glucose (FG) concentration and glycated hemoglobin (HbA1c) level, and to establish appropriate cut-off scores to predict FG ≥100 mg/dL and HbA1c ≥5.7% (38.8 mmol/mol) in this population. Materials and methods: we recruited 1,175 individuals from 45 ALAC laboratories for whom FG and HbA1c had been measured. We analyzed the data using the chi square test, odds ratios, ANOVA plus Tukey's post-hoc test, binomial logistic regression, and receiver operating characteristic (ROC) curves. Results: total FINDRISC score significantly positively correlated with both FG and HbA1c. Of the constituent variables, age ≥45 years, a large waist circumference, a body mass index ≥25 kg/m., a close family history of DM, and the use of antihypertensive medication were significantly associated with FG ≥100 mg/dL and/or HbA1c ≥5.7% (38.8 mmol/mol). However, no significant association was found with physical activity or the daily consumption of fruit and vegetables. The mean FG and HbA1c for individuals with total FINDRISC scores ≤11 were 89.9 mg/dL and 5.2% (33.0 mmol/mol), respectively, which increased to 116.1 mg/dL and 6.1% (43.0 mmol/mol) for individuals with scores ≥21, with a dose/response-type relationship. ROC analysis showed that a FINDRISC of 13 was associated with a sensitivity of 81.89%, a specificity of 67.60%, and a correct diagnosis rate of 70.55% for HbA1c ≥5.7% (38.8 mmol/mol); and a sensitivity of 72.50%, a specificity of 70.62%, and a correct diagnosis rate of 71.20% for FG ≥100 mg/dL. Conclusions: FINDRISC score increases with increasing FG and HbA1c, and is a useful means of identifying people with FG ≥100 mg/dL and HbA1c ≥5.7% (38.8 mmol/mol).

Glucemia en ayunas entre 100 y 109 mg/dL versus prediabetes según hemoglobina glicosilada / Fasting blood glucose between 100 and 109 mg/dL versus prediabetes according to glycosylated hemoglobin

Introducción: algunos estudios han señalado que valores de glucemia en ayunas entre 100 y 109 mg/dL se asocian con frecuencias elevadas de prediabetes cuando el criterio de clasificación son los valores de HbA1c. La Sociedad Argentina de Diabetes (SAD) sostiene a 110 mg/dL como valor a partir del cual se clasifica a un paciente como portador de glucemia en ayunas alterada; la frecuencia de individuos posiblemente clasificados en forma incorrecta, según este criterio, aún no se conoce en la población argentina. Objetivos: establecer la frecuencia con que se presenta prediabetes según HbA1c en una población sin diagnóstico de diabetes mellitus (DM) con glucemias en ayunas entre 100 y 109 mg/dL; correlacionar las dos variables y cuantificar la probabilidad de que esto ocurra respecto de otros con glucemias en ayunas <100 mg/dL. Materiales y métodos: se incluyeron 1.002 muestras de igual número de sujetos desde 45 laboratorios de análisis clínicos de la Asociación de Laboratorios de Alta Complejidad (ALAC), con procesamiento local de glucemia y centralizado de HbA1c por high performance liquid chromatography (HPLC). Análisis estadístico: chi cuadrado, odds ratio, coeficiente de correlación y determinación de Pearson, y correlación serial de Durbin-Watson. Resultados: frecuencia de HbA1c ≥5,7% en la población estudiada con glucemias de ayunas entre 100 y 109 mg/dL=29,7%; test de chi cuadrado: p<0,001; odds ratio de tener HbA1c ≥5,7% entre la población con glucemias en ayunas de 100 a 109 mg/dL vs aquella con valores <100 mg/dL=4,328 (IC 95% 2,922-6,411); r=0,852, r2 = 0,727, Durbin-Watson=1,152. Conclusiones: la prediabetes diagnosticada por HbA1c resultó cuatro veces más frecuente en la población estudiada con glucemias en ayunas entre 100 y 109 mg/dL, que en aquella con valores por debajo de 100 mg/dL.

Introduction: some studies have shown that fasting blood glucose values between 100 and 109 mg/dL are associated with high rates of prediabetes when the classification criteria are HbA1c values. The Argentine Diabetes Society still maintains 110 mg/dL as the value from which a patient is classified as having impaired fasting blood glucose; the frequency of individuals possibly incorrectly classified, according to this criterion, is not yet known in any Argentine population. Objectives: to establish the frequency in a population without a diagnosis of diabetes mellitus with fasting blood glucose levels between 100 and 109 mg/dL in which prediabetes occurs according to HbA1c, to correlate both variables and to quantify the probability that this predicts with respect to others with fasting blood glucose levels <100 mg/dL. Materials and methods: 1.002 samples from the same number of subjects from 45 clinical laboratories belonging to ALAC, with local processing of blood glucose and centralized processing of HbA1c by high performance liquid chromatography (HPLC). Statistical analysis: chi square, odds ratio, Pearson correlation coefficient, coefficient of determination and Durbin-Watson serial correlation. Results: frequency of HbA1c ≥5.7% in the studied population with fasting blood glucose levels between 100 and 109 mg/ dL = 29.7%, chi square test: p<0.001; odds ratio of having HbA1c ≥5.7% between the population with fasting blood glucose levels of 100 to 109 mg/dL vs that one with values <100 mg/dL=4.328 (95% CI 2.922-6.411); r=0.852, r2 =0.727, DurbinWatson=1.152. Conclusions: prediabetes diagnosed by HbA1c was four times more frequent in the studied population with fasting glucose values between 100 and 109 mg/dL than in that one with values below 100 mg/dL.

Cardiometabolic markers among Argentinean normal weight and overweight children with and without central obesity.

BACKGROUND: The association between central obesity and cardiometabolic complications justifies exploring its association in normal-weight and overweight/obese (OW/OB) schoolchildren. OBJECTIVE: To describe cardiometabolic markers in four groups according to BMI/WC categories: (i) normal weight with central OB; (ii) normal weight without central OB; (iii) OW/OB with central OB and (iv) OW/OB without central OB, in a sample of Argentinean schoolchildren. METHODS: A cross-sectional study of 1264 Argentinean schoolchildren (624 F), aged 9.5 ± 2.2 years was performed between November 2013 and 2015. Children's anthropometric measures, blood pressure (BP), glucose, lipids, and insulin were measured. Children were divided into four groups: (i) normal weight with central OB; (ii) normal weight without central OB; (iii) OW/OB with central OB and (iv) OW/OB without central OB. RESULTS: The prevalence of normal-weight children without central OB was 64.3% (796), normal weight with central OB 5% (66), OW/OB without central OB 11% (137), and OW/OB with central OB 21% (265). Normal weight with central OB had significantly higher triglycerides than normal-weight children without central OB (86 vs 70 mg/dL, respectively) and OW/OB children without central OB (81 vs 77 mg/dL). Multiple linear regression analyses showed that age, systolic BP, HDL-C, triglycerides, and maternal WC were significantly associated with children's WC; R2 = 0.50 as well as children's BMI; R2 = 0.37. CONCLUSION: This study found that children with central OB might be at future higher cardiometabolic risk than those without central OB independently of the presence of OW/OB. However, future longitudinal studies should be performed to confirm these findings.

Comparison between two newborn screening strategies for cystic fibrosis in Argentina: IRT/IRT versus IRT/PAP.

BACKGROUND: The benefits of early cystic fibrosis (CF) detection using newborn screening (NBS) has led to widespread use in NBS programs. Since 2002, a two-stage immunoreactive trypsinogen (IRT/IRT) screening strategy has been used as a CFNBS method in all public maternity units in the City of Buenos Aires, Argentina. However, novel screening strategies may be more efficient. The aim of this study is to prospectively compare two CFNBS strategies: IRT/IRT and IRT/PAP (pancreatitis-associated protein). METHODS: A two-year prospective study was performed. IRT was measured in dried blood samples collected 48-72 h after birth. When an IRT value was abnormal, PAP was determined, and a second visit was scheduled to obtain another sample for IRT before 25 days of life. Newborns with a positive CFNBS were referred for a confirmatory sweat test. RESULTS: There were 69,827 births in the City of Buenos Aires during the period studied; 918 (1.31%) had an abnormal IRT. A total of 207 children (22.5%) failed to return for the second IRT, but only two PAP (0.2%) were not performed. IRT/IRT was more likely to lead to a referral for sweat testing than IRT/PAP (odds ratio 2.3 [95% confidence interval 1.8-2.9], p < .001). Sensitivity and specificity were: 80% and 100% and 86.5% and 82.6% for IRT/IRT and IRT/PAP strategies, respectively. CONCLUSION: The IRT/PAP strategy is more sensitive than IRT/IRT and has similar specificity; it avoids a second visit and unnecessary sweat testing, and it reduces loss to follow-up in our population.

Asociación del peso al nacer con adiposidad en niños escolares de distintas regiones de argentina / Association of birth weight with adiposity in school children from different regions of argentina

Introducción: diversos estudios han sugerido que el bajo y alto peso al nacer (PN) se asocian a obesidad (OB) y sobrepeso (SP) durante la infancia y la edad adulta. Objetivos: determinar la asociación entre PN y OB en escolares de 9 años de tres regiones de Argentina. Materiales y métodos: las medidas antropométricas y la presión arterial (PA) se tomaron en 1.131 escolares (505 masculinos) de 8,8±2,1 años de edad promedio, en tres regiones de Argentina durante el año 2019. Se interrogó, además, acerca del peso al nacer y el estilo de vida. Resultados: el 21,1% (239) de los niños presentaba SP (IMC>85 <95 percentilo según CDC) y el 21,8% (246) OB (IMC>95 percentilo). La prevalencia de PN bajo (<2.500 g) fue de fue de 6,2% (n=70) y de PN alto (>4.000 g) de 7,3% (n=82). El puntaje z-IMC de los niños de 9 años aumentaba significativamente con el aumento del PN: PN bajo (z-IMC=0,33), normal (z-IMC=0,72) y alto (z-IMC=1,12). En modelos de regresión logística múltiple se observó que el PN bajo se asoció inversamente a la OB (OR, 0.41 [IC del 95%: 0,19-0,92]), mientras que el PN alto se asoció directamente con la OB ajustado por edad y sexo (OR, 2.48 [95% IC 1,53-4,02]). Conclusiones: nuestros datos indican que el alto PN, pero no el bajo PN, se asocia con OB en niños en edad escolar de 9 años, mientras que el bajo PN está inversamente asociado con OB.

Introduction: several studies have suggested that low and high birth weight are associated with obesity (OB) and overweight (OW) during childhood and adulthood. Objectives: to determine the association between birth weight and OB in 9-year-old schoolchildren from three areas of Argentina. Materials and methods: anthropometric measurements and blood pressure (BP) were taken in 1.131 schoolchildren (505 males) of an average age of 8.8±2.1 years in three areas of Argentina during 2019. Mothers were asked about their children's birth weight and lifestyle. Results: 21.1% (239) of the children had OW (BMI>85 <95 percentile according to the CDC) and 21.8% (246) OB (BMI>95 percentile). The prevalence of low birth weight (<2.500 g) was 6.2% (n=70) and of high birth weight (>4.000 g) was 7.3% (n=82). The 9-year-old z-BMI score increased significantly with increasing birth weight: low birth weight (z-BMI=0.33), normal (z-BMI=0.72) and high (z-BMI=1.12). In multiple logistic regression models, it was found that low birth weight was inversely associated with OB (OR, 0.41 [95% CI: 0.19-0.92]), while high birth weight was directly associated with OB adjusted for age and sex (OR, 2.48 [95% CI 1.53-4.02]). Conclusions: our data indicate that high birth weight, but not low birth weight, is associated with OB in 9-year-old schoolchildren, while low birth weight is inversely associated with OB

Non-high-density lipoprotein cholesterol curves in Argentinean indigenous children living at high altitude and US children.

OBJECTIVE: To describe the non-high-density lipoprotein cholesterol (non-HDL-C) as mean and percentiles by age and sex in Argentinean indigenous schoolchildren living at 3750 m, contrasting these estimates with those reported in the 2011-2012 National Center for Health Statistics reference population (NHANES). METHODS: Non-HDL-C was calculated as total cholesterol-HDL-C. Analyses incorporated sampling weights for age and sex to obtain unbiased estimates. Sex- and age-specific smoothed percentile curves were performed with Cole's LMS method. RESULTS: A total of 236 (49% males) children from San Antonio de los Cobres (SAC) were evaluated twice and compared with 1409 NHANES children. Non-HDL-C values were 4 mg/dL higher in SAC than in NHANES (109 vs 105 mg/dL, respectively). Trends in non-HDL-C 50th percentile in females differed between ages 6 to 7 and 8 years; in SAC non-HDL-C decreased from 111 to 104 mg/dL, NHANES levels remained stable from103 to 104 mg/dL. Among children aged 9 to10 years, non-HDL-C increased from 114 mg/dL to 117 mg/dL in SAC, but decreased from 113 to 107 mg/dL in NHANES. Between ages 12 and 13 years, non-HDL-C increased from 108 to 120 mg/dL in SAC, and remained steady from105 to 106 mg/dL in NHANES. The 50th percentile of non-HDL-C in males showed similar trends except for ages 6 to 7 to age 8 when non-HDL-C remained stable from 106 to 107 mg/dL in SAC, and increased from 98 mg/dL to 104 mg/dL in NHANES. CONCLUSIONS: Non-HDL-C levels in children vary with age, sex, ethnicity, and altitude. Different patterns in non-HDL-C were observed for girls in SAC compared with NHANES. However, more stable patterns were observed in boys in both groups.

Regulation of Serum Sphingolipids in Andean Children Born and Living at High Altitude (3775 m).

Recent studies on Andean children indicate a prevalence of dyslipidemia and hypertension compared to dwellers at lower altitudes, suggesting that despite similar food intake and daily activities, they undergo different metabolic adaptations. In the present study, the sphingolipid pattern was investigated in serum of 7 underweight (UW), 30 normal weight (NW), 13 overweight (OW), and 9 obese (O) Andean children by liquid chromatography-mass spectrometry (LC-MS). Results indicate that levels of Ceramides (Cers) and sphingomyelins (SMs) correlate positively with biochemical parameters (except for Cers and Vitamin D, which correlate negatively), whereas sphingosine-1-phosphate (S1P) correlates negatively. Correlation results and LC-MS data identify the axis high density lipoprotein-cholesterol (HDL-C), Cers, and S1P as related to hypoxia adaptation. Specifically UW children are characterized by increased levels of S1P compared to O and lower levels of Cers compared to NW children. Furthermore, O children show lower levels of S1P and similar levels of Cers and SMs as NW. In conclusion, our results indicate that S1P is the primary target of hypoxia adaptation in Andean children, and its levels are associated with hypoxia tolerance. Furthermore, S1P can act as marker of increased risk of metabolic syndrome and cardiac dysfunction in young Andeans living at altitude.

Vitamin D Levels and Cardiometabolic Markers in Indigenous Argentinean Children Living at Different Altitudes.

The objective of this study was to assess the association between vitamin D and cardiometabolic markers in 2 indigenous communities from similar ethnic backgrounds, but living at different altitudes. A cross-sectional study compared 152 (72 females) indigenous schoolchildren from San Antonio de los Cobres (SAC), 3750 m above sea level, with 175 (86 females) from Chicoana (CH), 1400 m above sea level, mean age 9 years. Anthropometry, blood pressure, lipids, glucose, insulin, and vitamin D were assessed in spring season. The prevalence of children's overweight/obesity was significantly lower in SAC, 9.2% (13), than in CH, 41.5% (71). There was a significantly higher prevalence of vitamin D deficiency (<20 ng/mL) in SAC (n = 103, 67.7%) than in CH (n = 62, 36.3%). SAC showed an inverse correlation between vitamin D and insulinemia (r = -0.17, P < .05), whereas CH showed an inverse correlation between vitamin D and systolic blood pressure (r = -0.19, P < .05), z-BMI (body mass index; r = -0.25, P < .01), triglycerides (r = -0.15, P < .05), glucose (r = -0.35, P < .05), and insulinemia (r = -0.24, P < .01). Multiple linear regression analysis showed that vitamin D (ß = -.47; R 2 = .21) was significantly associated with SAC location, adjusted for confounding variables. Vitamin D levels were significantly and directly associated with altitude and inversely with metabolic markers, suggesting that populations living at high altitudes are at higher risk for future cardiovascular diseases.

Blood pressure levels among Indigenous children living at different altitudes.

The objective was to compare blood pressure (BP) levels in 2 groups of Indigenous Argentine school children from similar ethnic backgrounds but living at different altitudes. One hundred and fifty-two (46.3%) children (age, 4-14 years) from San Antonio de los Cobres (SAC), at 3750 m above sea level, and 176 children (53.7%) from Chicoana (CH), at 1400 m above sea level, participated in this cross-sectional study. Data for children's anthropometry, BP, glucose, lipids, vitamin D, and insulin, as well as mothers' height and weight were assessed. Hypertension was defined as BP ≥ 95th percentile. The prevalence of overweight/obesity among children was significantly lower in SAC (n = 17, 11.2%) than in CH (n = 74, 42%) (body mass index (BMI) > 85th percentile per US Centers for Disease Control and Prevention norms). However, the prevalence of hypertension was significantly higher among children in SAC (n = 15, 9.9%) than among those in CH (n = 2, 1.1%). Children were divided into 4 groups by mean arterial BP quartiles for comparison by ANOVA. As mean arterial BP increased, age, BMI, glucose, triglycerides, triglycerides/high-density lipoprotein cholesterol, and insulin levels increased significantly. Multiple linear regression analyses showed that children's mean arterial BP was significantly associated with altitude adjusted for confounding variables (R2 = 0.42). Furthermore, when mean arterial BP was replaced by systolic BP (R2 = 0.51) or diastolic BP (R2 = 0.33), similar results were obtained. Our results suggest that Indigenous children who live permanently at high altitude have higher levels of BP, adjusted for confounding variables. Routine BP measurements conducted in the SAC community could be essential for the prevention of cardiovascular disease.

Prevalence of hypertension in argentinean indigenous children living at high altitudes versus US children.

BACKGROUND: Exposure to hypoxia at high altitude is increasingly being recognized as a risk factor for hypertension. OBJECTIVE: To compare the prevalence of hypertension in Indigenous Argentinean children living at high altitude with that reported in the 2011-2012 National Health and Nutrition Examination Survey (NHANES) of US children. METHODS: A cross-sectional study of 811 (400 females) Argentinean Indigenous school children (8-14 years) from San Antonio de los Cobres (SAC) was performed between 2011-2014. SAC is located in the Andean foothills 3,750 m above sea level. 98% of its population is Indigenous. Anthropometric, BP, and biochemical data were obtained from SAC and compared with those of 1279 (625 females) US children. Pre-hypertension and hypertension were defined by BP≥90th to <95th percentile or ≥95th percentile, respectively. RESULTS: The prevalence of obesity was significantly lower in SAC (22; 2.7%) than in the US (310; 24.3%). However, the prevalence of hypertension was significantly higher in SAC (129; 15.9%) than in US children (35; 2.9%). Multiple logistic regression analyses showed that SAC children had four times the odds of having pre-hypertension compared with US children (OR 4.47; 95% CI 3.29-6.08), and eight times the odds of presenting hypertension (OR 8.36; 95% CI 5.36-13.05), adjusted for age, gender, and BMI. CONCLUSIONS: This study shows a higher prevalence of hypertension in Indigenous Argentinean children living at high altitude compared with US children. Various factors such as high hemoglobin levels, lifestyle behavior, and genetics may have an influence on BP in high altitude Indigenous SAC children. ABBREVIATIONS: BP: Blood pressure; SAC: San Antonio de los Cobres; CDC: Centers for Disease Control and Prevention; NHANES: National Health and Nutrition Examination Survey.

Type 2 diabetes markers in indigenous Argentinean children living at different altitudes.

BACKGROUND: Exposure to hypoxia at high altitude is increasingly being recognized as a risk factor for metabolic diseases. OBJECTIVE: To determine the association between Type 2 diabetes (T2D) risk factors and altitude in two groups of Argentinean indigenous schoolchildren who live permanently at different altitudes. METHODS: This cross-sectional study compared 142 schoolchildren from San Antonio de los Cobres (SAC), 3750 m above sea level, with 171 from Chicoana (CH), 1400 m. Data for children's anthropometry, blood pressure and lipids, as well as mothers' height and weight were assessed. RESULTS: There was not a significant difference in age between SAC (9.0 + 2y) and CH (9.4 + 2y) children. However, mean children's weight (29 vs. 38 kg), height (130 vs. 138 cm), BMI (17 vs. 19 kg/m2), and HDL-C (46 vs. 48 mg/dL) were significantly lower in SAC than in CH, respectively. In contrast, systolic blood pressure (87 vs. 70 mmHg), cholesterol (157 vs. 148 mg/dL), and triglycerides (104 vs. 88 mg/dL) were significantly higher in SAC than in CH, respectively. There was not a significant difference in age (33.2 + 7y vs. 34.4 + 8y) and BMI (26.2 + 4y vs. 28 + 5y) between SAC and CH mothers. Multiple linear regression analyses showed that children's blood pressure (R2 = 0.38), triglycerides (R2 = 0.21), and HDL-C (R2 = 0.16) were significantly associated with altitude, adjusted for confounding variables. CONCLUSION: This study shows that indigenous Argentinean children living at 3750 meters have higher T2D risk compared with those living at 1400 meters above sea level.

Descenso del 10% del peso corporal en pacientes con síndrome metabólico: impacto sobre variables cardiometabólicas y función autonómica cardíaca / Impact of 10% of body weight lost on cardiometabolic variables and autonomic neuropathy in patientes with metabolic syndrome

El síndrome metabólico (SM) es una de las entidades que más atención ha recibido en la literatura médica en los últimos años. Hace referencia a un conjunto de factores de riesgo específicos para enfermedad cardiovascular, cuya fisiopatología se relaciona con el estado de insulinorresistencia. El término SM se ha posicionado en la literatura médica y ha sido definido e institucionalizado,permitiendo al equipo de salud utilizar las distintas herramientas disponibles para manejarlo en su conjunto o en sus componentes por separado. Dentro de la diabetes mellitus (DM), la neuropatía autonómica cardiovascular (NACV) es el tipo de afectación neuropática autonómica más estudiada y la de mayor implicancia clínica. Habitualmente es asintomática y su diagnóstico requiere pruebas sensibles y específicas. El análisis de estas alteraciones puede evidenciarse a través de la batería de los test descritos por Ewing hace más de 30 años. Tomando estos conceptos en consideración, se llevó a cabo el presente estudio cuyo principal objetivo fue determinar el impacto del descenso del 10% del peso corporal inicial sobre variables cardiometabólicas y sobre la actividad electrofisiológica cardíaca en pacientes con SM

Association between blood pressure and magnesium and uric acid levels in indigenous Argentinean children at high altitude.

OBJECTIVE: To determine the association between nontraditional risk factors such as magnesium and uric acid with blood pressure (BP) in Indigenous children. METHODS: A total of 263 school-aged indigenous children living at high altitude were enrolled in a cross-sectional study in November 2011. Prehypertension (preHTN) and hypertension (HTN) were defined by systolic and/or diastolic BP ≥ 90th to <95th percentile or ≥95th percentile respectively, according to age, sex, and height. RESULTS: The prevalence of preHTN and HTN was 13.7 and 8.3%, respectively. Low magnesium levels were identified in 21.7% (57/263): 28.1% (16/57) of the children with low magnesium levels had preHTN versus 9.7% (20/206) with normal magnesium values. Furthermore, 21.8% (12/57) of the children with low magnesium levels had HTN versus 4.5% (20/206) with normal magnesium values. There was a significant association between mean arterial pressure and magnesium (r = -026), uric acid (r = 0.20), phosphorus (r = -0.17), z-BMI (r = 0.22), potassium (r = -0.10), HOMA-IR (r = 0.17), calcium (r = -0.10), and sodium (r = -0.13). Multiple linear regression analysis showed that mean arterial pressure was associated significantly and directly with BMI, age, gender, and uric acid; and inversely with magnesium, adjusted for sodium, calcium, phosphorus, potassium, and HOMA-IR (R2 = 0.43). Furthermore, multiple logistic regression analyses showed that magnesium (OR = 0.015) and uric acid (OR = 2.95) were significantly associated with preHTN. Similar results were obtained when preHTN was replaced by HTN. CONCLUSION: Our results indicate that HTN was associated inversely with magnesium and positively with uric acid in indigenous school children.

Comparison Between HDL-C Levels in Argentine Indigenous Children Living at High Altitudes and U.S. Children.

BACKGROUND: Studies have shown low levels of high-density lipoprotein cholesterol (HDL-C) in indigenous children versus urban children from Argentina. We hypothesized that indigenous children living at high altitudes might have lower HDL-C levels compared with U.S. children, probably due to ambient hypoxia, lifestyle conditions, or ethnicity. This study was designed (1) to compare HDL-C levels in Argentinean indigenous children with those reported in the 2011-2012 National Health and Nutrition Examination Survey (NHANES) for U.S. children and (2) to determine the association between HDL-C and adiposity in both groups. SUBJECTS AND METHODS: A cross-sectional study of 1,232 (631 females) Argentinean indigenous schoolchildren (4-14 years old) from San Antonio de los Cobres (SAC) was performed between November 2011 and November 2014. Anthropometric measures were performed in the whole group and compared with those of 2,151 U.S. children (1,034 females). However, HDL-C concentrations were measured in 905 SAC children and compared with those of 1,451 U.S. children. Analyses were done incorporating sampling weights for age in both samples to obtain unbiased estimates. In the case of NHANES the weights provided by each individual in the 2011-2012 NHANES demographic file were used, whereas in the SAC sample the weights were obtained using the census data provided by the 2010 National Statistics and Censuses Institute of Argentina. RESULTS: The prevalence of overweight/obesity was significantly lower in SAC (135/1,232; 11%) than in the United States (759/2,151; 35%). However, the prevalence of low levels of HDL-C was significantly higher in SAC (298/905; 33%) than in the United States (142/1,451; 10%). The prevalence of low levels of HDL-C increased significantly in both groups as body mass index categories increased. Multiple logistic regression analysis showed that SAC children had nine and a half times the odds of having low levels of HDL-C compared with U.S. children, adjusted for confounding variables (odds ratio = 9.55; 95% confidence interval, 7.18-12.71). CONCLUSIONS: This study shows a high prevalence of low levels of HDL-C in indigenous Argentinean children 4-14 years of age living at high altitudes compared with U.S. children.

Healthier Lipid Profiles with Vitamin D Supplementation in a Pilot Study in Argentinean Children of Two Ethnicities.

OBJECTIVE: to explore changes in lipid levels in two groups of children of different ethnicities who were able to access vitamin D supplementation versus those who were not. METHODS: A prospective one-year study evaluated 87 San Antonio de los Cobres (SAC) Indigenous and 36 Buenos Aires (BA) urban schoolchildren aged 9.7 + 2.1 years between October 2013 and October 2014. SAC children included 70 (80.5%) treated with 100,000 IU/year of vitamin D and 17 (19.5%) untreated; and BA children included 25 (69,5%) treated and 11(30.5%) untreated. BMI, lipids, and 25-hydroxyvitamin D (25(OH)D) concentrations were measured at baseline and after one year. RESULTS: There was a significantly lower prevalence of overweight/obesity in SAC (n = 7; 8%) versus BA (n = 7; 36.4%) children. There was a significant association between changes in (25(OH)D) and changes in HDL-C levels in SAC (r0.44;p < 0.01) and in BA (r0.34;p < 0.05). Multiple linear regression analyses showed that changes in (25(OH)D ) were significantly associated with changes in HDL-C in SAC (Beta = 0.55, p = 0.02; R20.11) and BA children (Beta = 0.42, p = 0.04; R2 0.21) adjusted for age, gender, and BMI. Furthermore, multiple logistic regression analysis showed that children in the treated group had a likelihood six times greater of having HDL-C >40 mg/dL than the untreated group, adjusted for age, gender, and BMI (OR 6.3: CI 2.0 - 19.8; p < 0.01). CONCLUSION: These results suggest that children who had received vitamin D supplementation had significantly higher vitamin D status and HDL-C, as compared with non-supplemented children in both communities.

Waist Circumference Percentiles in Indigenous Argentinean School Children Living at High Altitudes.

BACKGROUND: Central obesity is associated with increased risk of type 2 diabetes. OBJECTIVES: The study objectives were to develop waist circumference (WC) percentiles, to determine if WC is associated with metabolic risk, and to compare our WC percentiles with those reported in the 2007-2010 National Health and Nutrition Examination Survey (NHANES). METHODS: A cross-sectional study of 1232 children (606 boys ) 5-14 years was performed from 2011 to 2014 in indigenous Koya children from northwestern Argentina. Anthropometric characteristics, glucose, lipids, and insulin levels were measured. Sex-specific reference percentiles were computed using the Lambda-Mu-Sigma (LMS) method. We obtained 2007-2010 NHANES data for comparison with our results. RESULTS: Compared with the NHANES 90th percentile, WC values for children in this study were lower by an average of 11.05 cm for girls and 12.66 cm for boys. The prevalence of low high-density lipoprotein cholesterol (HDL-C) was 11.8% in children with WC ≤50th percentile, 10.3% in children with WC >50th-70th percentile, 17.5% in children with WC >70th-90th percentile, and 21.3% in children with WC >90th percentile. The prevalence of high triglycerides (TG) was 19.5% in children with WC ≤50th percentile, 19.9% in children with WC >50th-70th percentile, 28.8% in children with WC >70th-90th percentile, and 39.7% in children with WC >90th percentile. Multiple logistic regression analyses showed that high TG values (>150 mg/dL) were significantly associated with WC [odds ratio (OR)] 1.05; 95% confidence interval (CI) 1.03-1.08; and low HDL-C values (<35 mg/dL) were significantly associated with WC (OR 1.04; 95% CI 1.01-1.06), adjusted for age and gender. CONCLUSION: We present for the first time WC reference data for indigenous Koya children ages 5-14 years. There was a significant association between WC and dyslipidemia in this community. Compared with the NHANES WC percentiles, our WC values were lower. These differences possibly reflect ethnicity or the lower prevalence of obesity.

Improvement of Apolipoprotein B in Argentine Indigenous School Children after Vitamin D Supplementation.

OBJECTIVE: To determine whether vitamin D supplementation improves non-traditional cardiovascular risk factors such as Apo B levels among indigenous children. METHODS: A prospective two-year study evaluated a treated cohort of 190 children (104 males) aged 9.4+ 2.2 years. Children were divided into group A (n=104; 54.7%) and group B (n=86; 45.3%). Both groups received vitamin D supplementation with 100,000 u/year; group B was treated in 2013 and group A in 2014. All subjects were evaluated at the end of each treatment and anthropometric measures, lipids and vitamin D levels between the two groups were compared. RESULTS: Changes in vitamin D levels were significantly higher in Group A, which was supplied in 2014, than in group B, which was not supplied in 2014 (6.8 vs 0.96 ng/dL; respectively). Levels of LDL-C and Apo B were improved in group A versus B: LDL-C (-5.7 vs 6.9 mg/dL respectively) and Apo B (-0.9 vs 11. mg/dL respectively). Several multiple regression linear analyses showed that changes in vitamin D were significantly associated with lower LDL-C levels (Beta- 0.41, p<0.01; R2 0.07); and with lower Apo B levels (Beta-0.37, p<0.01; R2 0.17). CONCLUSION: Vitamin D supplementation among indigenous children could improve Apo B levels.

Status of Dyslipidemia in Vitamin D Supplemented Argentinean Indigenous Children Versus A Non-supplemented Mixed Population Group.

BACKGROUND: Epidemiological studies have suggested an inverse association between circulating levels of vitamin D and cardiovascular disease risk biomarkers, including an atherogenic lipid profile. OBJECTIVE: To compare the prevalence and the distribution of lipid levels among vitamin D supplemented Argentinean indigenous San Antonio de los Cobres (SAC) children with a nonsupplemented Buenos Aires (BA) mixed population group. METHODS: A group of indigenous children from SAC with hypovitaminosis D supplemented with vitamin D; and a nonsupplemented group from a BA mixed population were compared via a cross sectional study. Anthropometric measures, glucose, lipids, vitamin D, and insulin were measured. RESULTS: The mean ages were 10.3 + 2.3 in SAC and 8.7 ± 1.8 years in BA children. There was a lower prevalence of overweight 7.9%(15/192) vs 17.8% (23/129); and of obesity 1.6% (3/192) vs 30.2% (39/129) in SAC vs. BA respectively. Approximately half of the SAC children versus 30% from BA had optimal vitamin D levels (≥30ng/mL). There was a significantly higher prevalence of high triglycerides (TG) (27.6%vs 4.6%) and low HDL-C (21.3% vs 5.4%) in SAC vs BA children, respectively. In separate linear regression models, we found that despite effective vitamin D repletion, SAC children had higher TG and TG/HDL-C values, whereas HDL-C levels were lower than those of BA children adjusted for age, gender, BMI, and insulin levels. CONCLUSION: Indigenous Argentinean children have a higher risk for dyslipidemia in comparison with BA children, even after vitamin D treatment, suggesting that dyslipidemia could be related to diet or ethnic backgrounds.