Epidemiología de los desórdenes venosos crónicos y factores asociados en amerindios nativos embera-chamí, Antioquia / Epidemiology of chronic venous disorders and associated factors in embera-chami native amerindians, Antioquia / Epidemiologia das doenças venosas crônicas e fatores associados em ameríndios nativos embera-chamí, Antioquia

Resumen Objetivo: Analizar la prevalencia de los desórdenes venosos crónicos (dvc) en los embera-chamí de Cristianía (Karmata Rua), en el suroeste de Antioquia, y conocer sus posibles factores asociados (fa). Metodología: Estudio de corte de una muestra aleatoria de 488 sujetos. El diagnóstico se realizó mediante ecoduplex venoso. Se recolectó información sobre fa sociodemográficos, comportamentales y antropométricos. Los fa más relevantes se seleccionaron por regresión logística binaria múltiple. Resultados: La prevalencia de várices fue del 27,5 % y la de insuficiencia venosa crónica (ivc) del 0,8 %. Hubo compromiso de segmentos anatómicos superficiales en el 34,8 % de los individuos. La edad fue el fa más importante, con Odds Ratio (or) entre 3,33 y 6,30 según el tipo de dvc (excepto C1). El sexo femenino, la paridad, la grasa en el muslo y pierna y la talla alta se asociaron a telangiectasias. La edad, la grasa abdominal y la forma de la pierna fueron fa de várices. A las venas superficiales, en ambos sexos, se asociaron la edad y la grasa abdominal y, en mujeres, también los antecedentes familiares de várices. A las profundas y perforantes se asociaron la edad y la depleción de grasa periférica. Conclusiones: El patrón de baja prevalencia de los dvc en embera-chamí puede ser consecuencia de los estilos de vida relacionados con la actividad física diaria y las diferencias genéticas compartidas con amerindios. En los programas de atención en salud diferencial deberían considerarse los desórdenes profundos y perforantes respecto a mestizos.

Abstract Objective: To analyze the prevalence of chronic venous disorders (CVD) in the embera-chamí from Cristianía (Karmata Rua), in the southwest of Antioquia, and to study possible associated factors (AF). Methodology: A cross sectional study of a random sample of 488 subjects. The diagnosis was performed through Doppler ultrasonography. Information about sociodemographic, behavioral and anthropometric AFs was collected. The most relevant AFs were selected through multiple binary logistic regression. Results: The prevalence of varicose veins was 27.5% and that of chronic venous insufficiency (cvi) was 0.8%. Superficial anatomical segments were compromised in 34.8% of individuals. Age was the most important AF, with an Odds Ratio (OR) between 3.33 and 6.30 according to the type of cvd. Being a female, parity, fat in the thigh/leg and large size were associated with telangiectasias. Age, abdominal fat and leg shape were AF of varicose veins. Superficial veins in both sexes were associated with age and abdominal fat and in women, also with a family background of varicose veins. Deep and perforator veins were associated with age and peripheral fat depletion. Conclusions: The low prevalence pattern of CVDs in embera-chamí may be a consequence of lifestyles involving daily physical activity and genetic differences shared with Amerindians. Deep and perforating disorders should be considered in differential health care programs in relation to mestizos.

Resumo Objetivo: Analisar a prevalência de doenças venosas crônicas (dvc) na Embera-Chami Christiania (KarmataRua), no sudoeste do estado de Antioquia, e conhecer seus fatores associados (AF). Metodologia: Um estudo de coorte de uma amostra aleatória de 488 indivíduos. O diagnóstico foi feito por ecoduplex venoso. Informações sobre FA sócio demográficas, comportamentais e antropométricas foram coletadas. Os FAs mais relevantes foram selecionados para múltipla regressão logística binária. Resultados: A prevalência de varizes foi de 27,5% e a de insuficiência venosa crônica (ivc) foi de 0,8%. Houve comprometimento dos segmentos anatômicos superficiais em 34,8% dos indivíduos. A idade foi a FA mais importante, com Odds Ratio (OR) entre 3,33 e 6,30 de acordo com o tipo de dvc. Sexo feminino, paridade, gordura na coxa e perna e altura foram associados a telangiectasias. Idade, gordura abdominal e formato de perna foram FA de varizes. Nas veias superficiais, em ambos os sexos, idade e gordura abdominal estavam associadas e, nas mulheres, também a história familiar de varizes. Às profundas e perfurantes foram associadas a idade e depleção de gordura periférica. Conclusões: O padrão de baixa prevalência de DVC em embera-chamí pode ser uma consequência de estilos de vida relacionados à atividade física diária e diferenças genéticas compartilhadas com ameríndios. Em programas diferenciais de atenção à saúde, distúrbios profundos e perfurantes devem ser considerados em relação aos mestiços.

Insulin resistance and ß-cell function in Colombian mestizo and Embera-Chamí populations and their relation with adiposity degree.

BACKGROUND AND OBJECTIVE: Insulin resistance (IR) is a condition favored by metabolic and endocrine changes experienced by adipose tissue in the context of obesity. The prevalence and the presentation of both IR and obesity vary among the populations, and may be affected by ancestral genetic composition among other factors. The aim of this study was to compare the presence of IR and obesity in Amerindians of the Embera-Chamí ethnicity and Colombian mestizo population. PATIENTS AND METHODS: A sample of 630 individuals, 471 mestizos and 159 Amerindians of the Embera-Chamí ethnicity, from the general population of Colombia were studied. For each participant, anthropometric and biochemical measurements, as well as blood pressure and the Homeostatic Model Assessment (HOMA) of IR and ß-cell function (%B) were recorded. These values were compared between the two populations. RESULTS: While prevalence of central obesity was similar in both populations (48.7% and 42.6% in the mestizo and Embera groups respectively; p=0.148), body mass index (BMI) values suggested a higher prevalence of overweight in the Embera than in mestizo population (43.4% Embera, 31.8% mestizo; p=0.027). Despite the similarities in the prevalence of HOMA-IR and HOMA-%B status between both populations, the Embera population had a significantly greater pancreatic ß-cell function, higher insulin levels, and better glucose control, across BMI and central obesity categories, than the mestizo population. CONCLUSION: There are differences in aspects related to energy metabolism between the samples of the mestizo and Amerindian populations analyzed.

Insulin resistance and Beta-cell function in Colombian mestizo and Embera-Chamí populations and their relation with adiposity degree

Background and objective: Insulin resistance (IR) is a condition favored by metabolic and endocrine changes experienced by adipose tissue in the context of obesity. The prevalence and the presentation of both IR and obesity vary among the populations, and may be affected by ancestral genetic composition among other factors. The aim of this study was to compare the presence of IR and obesity in Amerindians of the Embera-Chamí ethnicity and Colombian mestizo population. Patients and methods: A sample of 630 individuals, 471 mestizos and 159 Amerindians of the Embera-Chamí ethnicity, from the general population of Colombia were studied. For each participant, anthropometric and biochemical measurements, as well as blood pressure and the Homeostatic Model Assessment (HOMA) of IR and β-cell function (%B) were recorded. These values were compared between the two populations. Results: While prevalence of central obesity was similar in both populations (48.7% and 42.6% in the mestizo and Embera groups respectively; p=0.148), body mass index (BMI) values suggested a higher prevalence of overweight in the Embera than in mestizo population (43.4% Embera, 31.8% mestizo; p=0.027). Despite the similarities in the prevalence of HOMA-IR and HOMA-%B status between both populations, the Embera population had a significantly greater pancreatic β-cell function, higher insulin levels, and better glucose control, across BMI and central obesity categories, than the mestizo population. Conclusion: There are differences in aspects related to energy metabolism between the samples of the mestizo and Amerindian populations analyzed (AU)

Antecedentes y objetivo: La resistencia a la insulina (RI) es una condición favorecida por las alteraciones metabólicas y endocrinológicas experimentadas por el tejido adiposo en el contexto de obesidad. Tanto la prevalencia como la presentación de RI y obesidad varían entre las poblaciones y puede ser afectada, entre otros factores, por la composición genética ancestral. El objetivo de este estudio fue comparar la presentación tanto de RI como de obesidad entre amerindios de la etnia embera-chamí y población mestiza colombiana. Pacientes y métodos: Se estudió una muestra de 630 individuos de la población general mestiza colombiana (471 individuos) y de amerindios de la etnia embera-chamí (159 individuos). Para todos los participantes se registraron tanto medidas antropométricas, bioquímicas así como de presión arterial y el índice homeostatic model assessment (HOMA) para la RI y función de la célula β, valores que fueron comparados entre las poblaciones. Resultados: Mientras que ambas poblaciones mostraron una prevalencia de obesidad central similar (48,7% en mestizos, 42,6% en embera; p=0,148), los embera presentaron mayor exceso de peso de acuerdo al índice de masa corporal que los mestizos (43,4% en embera, 31,8% en mestizos; p=0,027). A pesar de las similitudes en la prevalencia de HOMA2-RI y HOMA2- %B entre ambas poblaciones, los embera presentan una función significativamente mayor de las células β del páncreas, niveles de insulina comparativamente mayores y un mejor control glucémico que los mestizos. Conclusión: Existen diferencias en aspectos del metabolismo energético entre las muestras de población mestiza y amerindia analizadas (AU)

Prevalencia de factores de riesgo cardiovascular en indígenas embera-chamí de Cristianía (Jardín), Antioquia / Prevalence of cardiovascular risk factors in the embera-chami indigenous population of Cristianía (Jardín) Antioquia, Colombia / Prevalência de fatores de risco cardiovascular em indígenas embera-chamí de Cristianía (Jardim), Antioquia

Estudiamos la prevalencia de los factores de riesgo cardiovascular en 488 individuos mayores de 14 años, en el resguardo indígena Karmata Rúa de Cristianía. Se encontraron las siguientes frecuencias: hipertensión arterial (HTA) 18,1%; antecedente personal de diabetes mellitus 3,3%; glucemia mayor de 126 mg/dL 0,7%; hábito de fumar 15%; sobrepeso 40,2%; obesidad 8,0%; hipercolesterolemia 21,4%; hipertrigliceridemia 33,3% y dislipidemia 56,2%. El índice de masa corporal y los valores de colesterol total, glucemia, perímetro de la cintura, índice cintura/ cadera y presión arterial sistólica y diastólica presentaron correlación positiva y significativa con la edad. El grado de escolaridad mostró correlación negativa con el perímetro de la cintura, el índice cintura/cadera, la glucemia y la presión arterial. Al comparar con poblaciones indígenas y no indígenas de Colombia y de otros países, se encontró una prevalencia entre tres y cuatro veces menor de diabetes mellitus; en la población estudiada hay menos HTA aunque existe tendencia al sobrepeso. No se encontraron diferencias significativas en otros factores de riesgo; todos ellos fueron más frecuentes en mujeres, en personas de escolaridad baja y en individuos mayores. Los factores que contribuyen a estas diferencias son genéticos (homogeneidad étnica) y ambientales, como la mayor actividad física de los hombres, la dieta y la estructura demográfica.

Prevalence of cardiovascular risk factors was studied in 488 individuals over the age of 14 years in the Karmata Rua indigenous population of Cristianía, Colombia. The following rates were found: arterial hypertension 18.1%, family history of diabetes mellitus 3.3%, serum glucose over 126 mg/dL 0.7%, smoking habit 15%, overweight 40.2%, obesity 8.0%, hypercholesterolemia 21.4%, hypertriglyceridemia 33.3% and dyslipidemia 56.2%. Values of body mass index, total cholesterol, glucose, waist circumference, waist/hip index, systolic and diastolic blood pressure showed a positive and significant correlation with age. Higher level of education showed negative correlation with waist circumference, the waist/hip index, blood sugar and blood pressure. In comparison with other indigenous and non-indigenous communities of Colombia and other countries, prevalence of diabetes mellitus was between three and four times lower in the studied population; prevalence or high blood pressure was also lower despite a tendency to overweight. For other risk factors no significant differences were found, but they were more common in women, in people with low level of schooling and in elder individuals. Probably this difference is caused by genetic and environmental factors, such as increased physical activity in men, diet, and population structure.

Estudamos a prevalência dos fatores de risco cardiovascular em 488 indivíduos maiores de 14 anos, no resguardo indígena Karmata Rúa de Cristianía. Encontraram- se as seguintes frequências: hipertensão arterial (HTA) 18,1%; antecedente pessoal de diabete mellitus 3,3%; glicemia maior de 126 mg/DL 0,7%; hábito de fumar 15%; sobrepeso 40,2%; obesidade 8,0%; hipercolesterolemia 21,4%; hipertrigliceridemia 33,3% e dislipidemia 56,2%. O índice de massa corporal e os valores de colesterol total, glicemia, perímetro da cintura, índice cintura/quadril e pressão arterial sistólica e diastólica apresentaram correlação positiva e significativa com a idade. O grau de escolaridade mostrou correlação negativa com o perímetro da cintura, o índice cintura/quadril, a glicemia e a pressão arterial. Ao comparar com populações indígenas e não indígenas da Colômbia e de outros países, encontrou-se uma prevalência entre três e quatro vezes menor de diabetes mellitus; na população estudada há menos HTA ainda que existe tendência ao sobrepeso. Não se encontraram diferenças significativas em outros FR; todos eles foram mais frequentes em mulheres, em pessoas de escolaridade baixa e em indivíduos maiores. Os fatores que contribuem a estas diferenças são genéticos (homogeneidade étnica) e ambientais, como a maior atividade física dos homens, a dieta e a estrutura demográfica.