Wakabayashi & Daimon cardiometabolic index as an indicator to assess risk in adults. A systematic review.

OBJECTIVE: To analyze the Wakabayashi & Daimon (2015) equation, as a predictive indicator of cardiometabolic diseases and its comparison with other indices. DESIGN: A systematic review was carried out between January and March 2023, according to the PRISMA statement. DATA SOURCE: Scopus, Web of Science, and PubMed databases were reviewed using "cardiometabolic index" (CMI) as the search term. STUDY SELECTION: The following inclusion criteria were determined: studies in adults with cardiometabolic diseases using the Wakabayashi & Daimon (2015) CMI formula in different populations; studies that validate or compare the equation or that demonstrate the effects of the intervention. DATA EXTRACTION: Of the 11 selected articles, the characteristics of the population, type of study, indicators for the validation of the CMI, the reported statistics and the conclusions that were recorded in a comparative table were obtained. RESULTS AND CONCLUSIONS: Odds ratio, hazard ratio, sensitivity, and specificity were used to assess associations, risk, effectiveness, and validity of the tests, indicating favorable relationships between the factors analyzed and the results obtained. Validation and probabilistic analysis of the CMI were performed against diverse diseases such as obesity [Man >60y=AUC=0.90 (0.75-1.00) (p=0.01), Se=100, Sp=81.8, YI=0.82 and OR 4.66 and Women >60y=AUC=0.95 (0.88-1.00), p=0.001, Se=90.0, Sp=100, YI=0.90 and OR=36.27]; cardiovascular diseases [AUC=0.617, Se=0.675, Sp=0.509; HR=1.48 (1.33, 1.65), p=<0.001], among others. In conclusion CMI is a new utility index that broadly identifies the presence of risk that leads to cardiometabolic diseases in adults.

Relação entre indicadores de risco à saúde e componentes do somatótipo consoante atividade física em crianças

Este estudo analisou a relação entre indicadores de risco à saúde e as componentes do somatótipo consoante os níveis de atividade física em crianças. Trata-se de uma pesquisa epidemiológica de base escolar, composta por 168 crianças (6 a 11 anos) de ambos os sexos. Informações demográficas foram obtidas. Avaliações antropométricas (estatura; massa corporal; pregas de adiposidade subcutânea; perímetros do braço contraído, cintura, quadril e panturrilha), pressão arterial sistólica e diastólica, e atividade física (ativo; inativo) foram mensuradas. O somatótipo, razão cintura-quadril e razão cintura-estatura foram calculados. Análise de comparação, correlação e regressão linear múltipla foram realizadas, considerando intervalo de confiança de 95%. Meninos apresentaram maior número de passos, razão cintura-quadril e cintura-estatura. Crianças ativas eram mais velhas, possuíam maior perímetro de cintura, quadril e pressão arterial sistólica. No grupo fisicamente ativo, o sexo esteve associado diretamente ao perímetro de cintura e razão cintura-estatura, enquanto a idade associou-se com a perímetro de quadril e pressão arterial diastólica. Nas crianças inativas, todas as variáveis preditoras (exceto para a variável sexo em relação ao perímetro de quadril) mostraram-se significativas para o perímetro da cintura e quadril, explicando, conjuntamente, ~83% e 85% da expressão destas variáveis, respectivamente. A relação entre indicadores de risco à saúde e as componentes do somatótipo foi maior em crianças inativas. Independentemente do nível de atividade física, a endomorfia mostrou relação significativa com os componentes de saúde, com maior efeito no grupo inativo, tendo em vista a associação com a composição corporal dos sujeitos.

Este estudio analizó la relación entre indicadores de riesgo para la salud y los componentes del somatótipo según los niveles de actividad física en niños. Se trata de una investigación epidemiológica, compuesta por 168 niños (6 a 11 años) de ambos sexos. Fueron mensuradas: evaluaciones antropométricas (estatura; masa corporal; pliegues de adiposidad subcutánea; perímetros del brazo contraído, cintura, cuadril y pantorrilla), presión arterial sistólica y diastólica, y actividad física (activo/inactivo); el somatótipo, a través del cálculo de: razón cintura-cuadril y razón cintura-estatura. Se realizó el análisis de comparación, correlación y regresión lineal múltiple, considerando intervalo de confianza del 95%. Los niños presentaron mayor número de pasos, razón cintura-cuadril y cintura-estatura. Los niños activos eran mayores, tenían mayor perímetro de cintura, cuadril y presión arterial sistólica. En el grupo físicamente activo, el sexo estuvo asociado directamente al perímetro de cintura y razón cintura-estatura, mientras que la edad se asoció con el perímetro de cuadril y presión arterial diastólica. En los niños inactivos, todas las variables predictoras (excepto para la variable sexo con relación al perímetro de cuadril) se mostraron significativas para el perímetro de la cintura y cuadril, explicando, conjuntamente, ~83% y 85% de la expresión de estas variables, respectivamente. La relación entre indicadores de riesgo para la salud y los componentes del somatotipo fue mayor en niños inactivos. Independientemente del nivel de actividad física, la endomorfia mostró una relación significativa con los componentes de salud, con mayor efecto en el grupo inactivo, con vistas a la asociación con la composición corporal de los sujetos.

This study analysed the relationship between health risk indicators and somatotype components according to physical activity levels in children. This epidemiological and school-based research comprised 168 children of both sexes (56% boys), aged between 6 to 11 years. Demographic information (sex, age) was obtained. Anthropometric information (body height; body mass; contracted arm, waist, hip, and calf circumferences), body composition (subcutaneous adiposity and somatotype), systolic and diastolic blood pressure, and physical activity level (active; inactive) were measured. The waist-hip ratio and waist-to-height ratio were computed. Comparison, correlation, and multiple linear regression analysis were performed, considering 95% of the confidence interval. Boys presented higher values for physical activity, waist-hip, and waist-to-height ratio. Active children were older, had a larger waist and hip circumference, and higher systolic blood pressure. Among the active group, sex was associated with waist circumference and waist-to-height ratio, while age was associated with hip circumference and diastolic blood pressure. Among inactive children, all predictors (except for sex for hip circumference) were significantly associated with waist and hip circumferences, explaining ≅83% and 85% of the expression of these variables, respectively. The relationship between health risk indicators and somatotype components was higher among inactive children. Regardless of the physical activity level, the endomorphic component shows a significant relationship with health components, with a higher effect among the inactive group, considering the body composition association.

[Cardiometabolic effects of intermittent fasting in women]. / Efectos cardiometabólicos del ayuno intermitente en la mujer.

Introduction: Intermittent fasting is a dietary pattern characterized by alternating periods of total or partial fasting and ad libitum food consumption. During prolonged fasting, the body uses the ketone bodies formed from lipolysis of body fat, which also leads to some metabolic modifications with positive effects on health. In this sense, nocturnal intermittent fasting could contribute to properly synchronize the circadian system making the physiological, hormonal, energetic and metabolic processes work correctly and keeping to the individual in homeostasis. Thus, according to the results of different studies, intermittent fasting, in the short-medium term, seems to improve body composition, as well as the values of several cardiometabolic parameters such as insulin and HOMA-IR index, among others. These effects have been observed in both pre- and postmenopausal women (no differences have been found between both states) and are similar to those found in interventions with caloric restriction diets.

Introducción: El ayuno intermitente es un patrón dietético caracterizado por la alternancia de periodos de ayuno, totales o parciales, y de consumo de alimentos ad libitum. Durante el ayuno prolongado, el organismo utiliza los cuerpos cetónicos que se forman a partir de la lipolisis de la grasa del organismo, lo que también da lugar a algunas modificaciones metabólicas con efectos positivos para la salud. En este sentido, el ayuno intermitente nocturno podría contribuir a sincronizar adecuadamente el sistema circadiano, haciendo que los procesos fisiológicos, hormonales, energéticos y metabólicos funcionen correctamente y mantengan al individuo en homeostasis. Así, de acuerdo con los resultados de diferentes estudios, el ayuno intermitente, a corto-medio plazo, parece mejorar la composición corporal, así como los valores de diversos parámetros cardiometabólicos como la insulina y el índice HOMA-IR, entre otros. Estos efectos se han observado tanto en mujeres premenopáusicas como postmenopáusicas, sin hallar diferencias entre ambos estados y son similares a los encontrados con intervenciones con dietas con restricción calórica.

Ganancia de peso y modificación de la composición corporal después de un trasplante renal / Weight gain and changes in body composition after a kidney transplant

Introducción: Esta constatado un aumento de peso postrasplante renal, entre otros factores, por una reducción de la actividad física en los primeros meses, aumento del apetito y toma de inmunosupresores y corticoides. Objetivo: Conocer la ganancia de peso postrasplante. Determinar relación entre ganancia de peso y comorbilidades. Evaluar la modificación de la composición corporal. Material y Método: Estudio prospectivo, septiembre 2020-abril 2023. Se realizaron mediciones de peso a los 0, 3, 6, 12 meses. Resultados: Se analizaron 92 pacientes, 68,5% varones, edad 58±18,5 años. Peso pretrasplante 72,5 (±5,8), a los 12 meses: 75,10 (±15,7) kg. Se encontraron diferencias entre primero y trasplantes previos (p=0,020). En el análisis de las varianzas de medidas repetidas de peso (p=0,022), las diferencias se mostraron entre el mes 0 y el tercero, el mes 0 y el año y, entre el tercer mes y el año.En la masa muscular (p<0,001), se vieron al comparar el mes 0 con 3º, con 6º y con 12 meses. La masa grasa al comparar 3er mes con 12 meses y la grasa visceral (p=0,032), al comparar 3er mes con 6º y con 12 meses. Conclusión: Tras el trasplante renal se produce un aumento de peso, especialmente a partir del 6º mes, situándose en un 5% al año. La masa muscular aumenta en mayor medida que la masa grasa. Las personas trasplantadas de donante vivo, trasplante previos, con hipertensión y/o enfermedad cardiovascular tienen mayor ganancia de peso. (AU)

Introduction: Weight gain after kidney transplant has been documented, among other factors, due to reduced physical activity in the early months, increased appetite, and the use of immunosuppressants and corticosteroids. Objetives: To understand post-transplant weight gain. Indeed, to determine the relationship between weight gain and comorbidities, as well as, to evaluate changes in body composition. Material and Method: Prospective study, September 2020 to April 2023. Weight measurements were taken at 0, 3, 6, and 12 months. Results: Ninety-two patients were analyzed, 68.5% male, with an average age of 58±18.5 years. Pre-transplant weight was 72.5 (±5.8) kg, and at 12 months, it was 75.10 (±15.7) kg. Differences were found between first-time and repeat transplants (p=0.020). In the analysis of repeated measures of weight (p=0.022), differences were observed between month 0 and the third month, month 0 and one year, and between the third month and one year.In muscle mass (p<0.001), differences were seen when comparing month 0 with the third, sixth, and twelfth months. Fat mass differed when comparing the third month with the twelfth month, and visceral fat (p=0.032) differed when comparing the third month with the sixth and twelfth months. Conclusion: After a kidney transplant, weight gain occurs, especially after the sixth month, reaching 5% per year. Muscle mass increases more than fat mass. People who received kidneys from living donors, those with previous transplants, and those with hypertension and/or cardiovascular disease experience greater weight gain. (AU)

Obesidad central en estudiantes universitarios masculinos de Manabí, Ecuador / Central obesity in male university students from Manabí, Ecuador

Introducción. Los universitarios representan un sector de riesgo por las modificaciones en sus hábitos alimentarios y estilo de vida. Objetivo. Evaluar la presencia de obesidad central en estudiantes masculinos de la Licenciatura Pedagogía de la Actividad Física y el Deporte de la Universidad Laica Eloy Alfaro de Manabí, Ecuador Materiales y métodos. Investigación observacional descriptiva sobre 165 estudiantes. Se les tomaron medidas antropométricas siguiendo el protocolo ISAK, con cálculo del índice de masa corporal, la determinación del riesgo cardiometabólico, por ciento de grasa, índice de conicidad y área de grasa intraabdominal. Resultados Los sujetos en estudio presentaron una edad media de 22,68±4,56 años con valores promedio de talla 1,68±0,08 m y peso 70,17±12,03 kg, la media de la circunferencia abdominal no indicó un estado de riesgo cardiometabólico. El IMC alcanzó un promedio de 24,67±3,48; de acuerdo al %GC los valores de mayor prevalencia se encuentran en la condición óptima con un 58,8% y ligero sobrepeso con un 33,9%. La aplicación de la curva ROC(AUC) al índice de conicidad arrojó un valor de área bajo la curva de 0,537 e intervalo de 45,5% a 61,6%. Discusión. Se presenta sobrepeso y obesidad central como consecuencia de la distribución de la grasa corporal según el modelo andrógino. Los valores obtenidos del IMC y %GC muestran contradicciones, y tendencia a la obesidad de peso normal. El IC no constituye un modelo para una discriminación de sujetos con riesgo cardiometabólico. Conclusiones. Entre los estudiantes se presenta exceso ponderal y obesidad central, y tendencia a la obesidad de peso normal, en ellos índice de conicidad no permite realizar la discriminación de sujetos con riesgo cardiometabólico según obesidad abdominal.(AU)

Introduction: University students represent a risk sectordue to changes in their eating habits and lifestyle. Objective: To evaluate the presence of central obesity instudents of the Pedagogy of Physical Activity and SportsDegree at the Laica Eloy Alfaro University of Manabí, Ecuador. Methods: Descriptive observational research on 211 students. Anthropometric measurements were taken followingthe ISAK protocol, with calculation of body mass index, determination of cardiometabolic risk, percent fat, taper index,and intraabdominal fat area. Results: Women exceed men both in age and in area of intraabdominal fat, but not in weight, height, waist circumference, BMI and conicity index, higher in men, with significant statistical differences. The BMI showed a mean of 25.02± 3.88. The values of prevalence by %GC was in the optimalcondition was 58.3%, while in slightly overweight it was 30%.When relating the classifications of % BG and nutritional status, he explained that the normal weight condition (BMI) is included in the categories of thinness, optimal and slightly overweight of the % BG, while the condition of overweight (BMI)is present in all categories of the %GC. The application of theReceiver Operating Characteristic Curve to the conicity indexrevealed an area under the ROC(AUC) curve value of 0.537(95% CI 0.457 – 0.616). Discussion: Overweight and central obesity occur particularly in men as a consequence of the distribution of body fataccording to the androgynous model compared to the gynoidmodel. The values obtained from the BMI with respect to the%GC show contradictions that indicate a tendency to obesityof normal weight. The area of intraabdominal fat is muchsmaller than the 130 cm2 tomography standard and only represents a risk state. The CI does not constitute a model fordiscriminating subjects with cardiometabolic risk according tothe percentage of the area under the ROC curve...(AU)

Adiposidad y perfil lipídico en mujeres posmenopáusicas venezolanas / Adiposity and lipid profile in venezuelan postmenopausal women / Adiposidade e perfil lipídico em mulheres pós-menopáusicas venezuelanas

Resumen Durante la menopausia se producen cambios metabólicos que favorecen la ganancia de peso y la obesidad abdominal, lo cual facilita el desarrollo de dislipidemias y aumenta el riesgo cardiovascular. El propósito del estudio fue comparar el perfil lipídico y los índices de riesgo cardiometabólico (IRCM) entre mujeres posmenopáusicas del Municipio Naguanagua, Estado Carabobo, Venezuela, clasificadas de acuerdo con su grado de adiposidad. El estudio fue de corte transversal, descriptivo, en el cual participaron 205 mujeres con una mediana de edad de 56 años. Se evaluaron indicadores de adiposidad: índice de masa corporal (IMC), porcentaje de grasa corporal (PGC), circunferencia de cintura (CC), e índice cintura/talla (ICT); así como el perfil lipídico y los IRCM. Se encontraron altos porcentajes de exceso de peso (80%), exceso de grasa corporal (92%), obesidad abdominal (61%) y riesgo metabólico de acuerdo con el ICT (69%). Las mujeres con obesidad mostraron los valores más bajos de cHDL, y aquellas con grasa muy alta, obesidad abdominal y riesgo metabólico de acuerdo con el ICT, los valores más elevados del índice TG/HDL. Se recomiendan otros estudios en este grupo poblacional para comprender mejor la asociación encontrada entre el grado de adiposidad y las alteraciones en el metabolismo de los lípidos con el fin de tomar acciones preventivas en estos trastornos relacionados con el síndrome metabólico.

Abstract During menopause, metabolic changes occur that promote weight gain and abdominal obesity, facilitating the development of dyslipidemias and increasing cardiovascular risk. The purpose of the study was to compare the lipid profile and the cardiometabolic risk indexes (IRCM) among postmenopausal women from the Naguanagua Municipality, Carabobo State, Venezuela, classified according to their degree of adiposity. It was a cross-sectional, descriptive study in which 205 women with a median age of 56 years participated. Adiposity indicators were evaluated: body mass index (BMI), percentage of body fat (PBF), waist circumference (WC), and waist-to-height ratio (WHtR); as well as the lipid profile and the IRCM. High percentages of excess weight (80%), excess body fat (92%), abdominal obesity (61%) and metabolic risk according to the WHtR (69%) were found. Women with obesity showed the lowest values of HDL-C, and those with very high fat, abdominal obesity, and metabolic risk according to the WHtR, the highest values of the TG/HDL index. Other studies are recommended on this population group to better understand the association found between the degree of adiposity and alterations in lipid metabolism to take preventive actions in these disorders related to the metabolic syndrome.

Resumo Durante a menopausa ocorrem alterações metabólicas que favorecem o ganho de peso e a obesidade abdominal, facilitando o desenvolvimento de dislipidemias e aumentando o risco cardiovascular. O objetivo do estudo foi comparar o perfil lipídico e os índices de risco cardiometabólico (IRCM) entre mulheres na pós-menopausa do município de Naguanagua, estado de Carabobo, Venezuela, classificadas de acordo com seu grau de adiposidade. O estudo foi transversal, descritivo, do qual participaram 205 mulheres com mediana de idade de 56 anos. Foram avaliados os indicadores de adiposidade: índice de massa corporal (IMC), percentual de gordura corporal (PGC), circunferência da cintura (CC) e índice cintura/estatura (ICE); bem como o perfil lipídico e o IRCM. Foram encontrados altos percentuais de excesso de peso (80%), excesso de gordura corporal (92%), obesidade abdominal (61%) e risco metabólico segundo o ICE (69%). Mulheres com obesidade apresentaram os menores valores de cHDL, e aquelas com muito alto teor de gordura, obesidade abdominal e risco metabólico segundo o ICE, os maiores valores da relação TG/HDL. Outros estudos neste grupo populacional são recomendados para melhor entender a associação encontrada entre o grau de adiposidade e as alterações no metabolismo lipídico, a fim de tomar ações preventivas nesses distúrbios relacionados com a síndrome metabólica.

Efectos cardiometabólicos del ayuno intermitente en la mujer / Cardiometabolic effects of intermittent fasting in women

El ayuno intermitente es un patrón dietético caracterizado por la alternancia de periodos de ayuno, totales o parciales, y de consumo de alimentosad libitum. Durante el ayuno prolongado, el organismo utiliza los cuerpos cetónicos que se forman a partir de la lipolisis de la grasa del organismo, lo que también da lugar a algunas modificaciones metabólicas con efectos positivos para la salud. En este sentido, el ayuno intermitentenocturno podría contribuir a sincronizar adecuadamente el sistema circadiano, haciendo que los procesos fisiológicos, hormonales, energéticosy metabólicos funcionen correctamente y mantengan al individuo en homeostasis. Así, de acuerdo con los resultados de diferentes estudios, elayuno intermitente, a corto-medio plazo, parece mejorar la composición corporal, así como los valores de diversos parámetros cardiometabólicoscomo la insulina y el índice HOMA-IR, entre otros. Estos efectos se han observado tanto en mujeres premenopáusicas como postmenopáusicas,sin hallar diferencias entre ambos estados y son similares a los encontrados con intervenciones con dietas con restricción calórica. (AU)

Intermittent fasting is a dietary pattern characterized by alternating periods of total or partial fasting and ad libitum food consumption. Duringprolonged fasting, the body uses the ketone bodies formed from lipolysis of body fat, which also leads to some metabolic modifications withpositive effects on health. In this sense, nocturnal intermittent fasting could contribute to properly synchronize the circadian system making the physiological, hormonal, energetic and metabolic processes work correctly and keeping to the individual in homeostasis. Thus, according to the results of different studies, intermittent fasting, in the short-medium term, seems to improve body composition, as well as the values of several cardiometabolic parameters such as insulin and HOMA-IR index, among others. These effects have been observed in both pre- and postmenopausal women (no differences have been found between both states) and are similar to those found in interventions with caloric restriction diets. (AU)

Birth conditions nutritional status in childhood associated with cardiometabolic risk factors at 30 years of age: a cohort study / Condições de nascimento, estado nutricional na infância e fatores de risco cardiometabólicos aos 30 anos de idade: um estudo de coorte / Condiciones de nacimiento, estado nutricional en la infancia y factores de riesgo cardiometabólico a los 30 años: un estudio de cohortes

Abstract: This study aimed to assess the association of birth conditions, nutritional status, and childhood growth with cardiometabolic risk factors at 30 years of age. We also evaluated whether body mass index (BMI) at 30 years mediated the association of weight gain in childhood with cardiometabolic risk factors. This is a prospective cohort study that included all live births in 1982 in hospitals in the city of Pelotas, Rio Grande do Sul State, Brazil, whose families lived in the urban area. Mothers were interviewed at birth, and participants were followed at different ages. For our analyses, we used data on weight and height collected at birth, 2 and 4 years and cardiovascular risk factors at 30 years. Multiple linear regressions were performed to obtain adjusted coefficients and G-formula for mediation analysis. Relative weight gain in childhood, despite the age, was positively related to mean arterial pressure, whereas relative weight gain in late childhood was positively associated with carotid intima-media thickness, pulse wave velocity, triglycerides, non-HDL cholesterol, plasma glucose, and C-reactive protein. BMI in adulthood captured the total effect of relative weight gain in the period between 2 and 4 years on carotid intima-media thickness, triglycerides, non-HDL cholesterol, and C-reactive protein. Our findings reinforce the evidence that rapid relative weight gain after 2 years of age may have long-term consequences on the risk of metabolic and cardiovascular disorders.

Resumo: O objetivo deste estudo foi avaliar a associação das condições de nascimento, do estado nutricional e do crescimento infantil com fatores de risco cardiometabólicos aos 30 anos de idade. Também foi verificado se o índice de massa corporal (IMC) aos 30 anos mediava a associação entre o ganho de peso na infância e fatores de risco cardiometabólicos. Trata-se de um estudo de coorte prospectivo que incluiu todos os nascidos vivos em 1982 em hospitais da cidade de Pelotas, Rio Grande do Sul, Brasil, residentes da área urbana. As mães foram entrevistadas no parto e os participantes foram acompanhados em diferentes idades. Para as análises, foram utilizados os dados de peso e altura coletados no nascimento e aos 2 e 4 anos de idade e fatores de risco cardiovascular aos 30 anos. Regressões lineares múltiplas foram realizadas para a obtenção de coeficientes ajustados e G-fórmula para a análise de mediação. O ganho de peso relativo na infância, apesar da idade, está positivamente associado à pressão arterial média, enquanto o ganho de peso relativo tardio na infância está positivamente associado à espessura médio-intimal da artéria carótida, à velocidade da onda de pulso, aos triglicerídeos, ao colesterol não-HDL, à glicose plasmática e à proteína C reativa. O IMC na idade adulta capturou o efeito total do ganho de peso relativo entre 2 e 4 anos sobre a espessura médio-intimal da carótida, os triglicerídeos, o colesterol não-HDL e a proteína C reativa. Estes achados reforçam a evidência de que o rápido ganho de peso relativo após os 2 anos de idade pode ter consequências a longo prazo sobre o risco de distúrbios metabólicos e cardiovasculares.

Resumen: El objetivo de este estudio fue evaluar la asociación de las condiciones de nacimiento, estado nutricional y crecimiento infantil con factores de riesgo cardiometabólico a los 30 años de edad. También se verificó si el índice de masa corporal (IMC) a los 30 años mediaba la asociación entre el aumento de peso infantil y los factores de riesgo cardiometabólicos. Se trata de un estudio de cohorte prospectivo que incluyó todos los nacidos vivos en 1982 en hospitales de la ciudad de Pelotas, estado de Río Grande del Sur, Brasil, residentes del área urbana. Las madres fueron entrevistadas en el momento del parto y los participantes fueron seguidos a diferentes edades. Para los análisis, utilizamos los datos de peso y altura recopilados al nacer y a los 2 y 4 años de edad y los factores de riesgo cardiovascular a los 30 años. Se realizaron regresiones lineales múltiples para obtener coeficientes ajustados y la G-fórmula para el análisis de mediación. El aumento de peso relativo en la infancia, a pesar de la edad, se asocia positivamente con la presión arterial media, mientras que el aumento de peso relativo en la infancia tardía se asocia positivamente con el espesor de la íntima-media de la arteria carotídea, la velocidad de la onda del pulso, los triglicéridos, el colesterol no HDL, la glucosa plasmática y la proteína C reactiva. El IMC en adultos capturó el efecto completo del aumento de peso relativo a los 2 y 4 años sobre el espesor de la íntima-media carotídea, los triglicéridos, el colesterol no HDL y la proteína C reactiva. Estos hallazgos refuerzan la evidencia de que el rápido aumento de peso relativo después de los 2 años puede tener consecuencias a largo plazo sobre el riesgo de trastornos metabólicos y cardiovasculares.

Comportamento Sedentário, Hábitos Alimentares e Risco Cardiometabólico em Crianças e Adolescentes Fisicamente Ativos / Sedentary Behavior, Dietary Habits, and Cardiometabolic Risk in Physically Active Children and Adolescents

Resumo Fundamento O comportamento sedentário tem sido associado a diversos fatores de risco cardiometabólicos durante a infância. No entanto, pouco se sabe sobre o impacto do comportamento sedentário na saúde e nos hábitos alimentares de crianças e adolescentes fisicamente ativos. Objetivo Avaliar a associação entre comportamento sedentário e fatores de risco cardiometabólicos e hábitos alimentares em crianças e adolescentes fisicamente ativos. Métodos Esse estudo transversal avaliou 516 crianças e adolescentes (10 a 18 anos; ambos os sexos) fisicamente ativos integrados no projeto social "Estação Conhecimento-Vale". O comportamento sedentário foi determinado de maneira indireta (questionário), utilizando como ponto de corte o tempo sentado ≥ 3 h/dia. Foram estatisticamente significantes as análises com p-valor < 0,05. Resultados O comportamento sedentário não foi associado ao excesso de peso (odds ratio = 0,72 [intervalo de confiança (IC) de 95%: 0,325-1,389]), hipertrigliceridemia ( odds ratio = 0,63 [IC95%: 0,306-1,297]), HDL colesterol baixo ( odds ratio = 0,57 [IC95%: 0,323-1,019]) e HDL não colesterol alto ( odds ratio = 0,63 [IC95%: 0,283-1,389]). Contudo, crianças e adolescentes que adotavam comportamento sedentário apresentaram maior chance de consumir regularmente alimentos em frente à televisão ( odds ratio =1,96 [IC95%: 1,114-3,456]) e de consumir pelo menos um alimento ultraprocessado por dia ( odds ratio =2,42 [IC95%: 1,381-4,241]). Além disso, apresentaram menor chance de consumir frutas regularmente (OR=0,52 [IC95%: 0,278-0,967]). Conclusão Não houve associação entre comportamento sedentário e fatores de risco cardiometabólicos em crianças e adolescentes fisicamente ativos. Contudo, o comportamento sedentário foi associado a hábitos alimentares inadequados. Dessa forma, podemos sugerir que a prática regular de atividade física pode atenuar os efeitos deletérios do comportamento sedentário nos parâmetros cardiometabólicos de crianças e adolescentes.

Abstract Background Sedentary behavior has been associated with several cardiometabolic risk factors during childhood. However, little is known about the impact of sedentary behavior on the health and eating habits of physically active children and adolescents. Objective To evaluate the association between sedentary behavior and cardiometabolic risk factors and eating habits in physically active children and adolescents. Methods This cross-sectional study was conducted, including 516 physically active children and adolescents (10 to 18 years old; both sexes) enrolled in the social project "Estação Conhecimento-Vale" were evaluated. Biochemical and lifestyle variables (questionnaire) were collected. Sedentary behavior was determined indirectly (questionnaire), by using sitting time ≥ 3 hours per day as a cutoff point. A p-value < 0.05 was considered statistically significant for all tests. Results Sedentary behavior was not associated with overweight/obesity (odds ratio = 0.72 [95% confidence interval (CI): 0.325-1.389]), hypertriglyceridemia (odds ratio = 0.63 [95% CI: 0.306-1.297]), low HDL cholesterol (odds ratio = 0.57 [95% CI: 0.323-1.019]), or high non-HDL cholesterol (odds ratio = 0.63 [95% CI: 0.283-1.389]). However, children and adolescents with sedentary behavior were more likely to regularly consume food in front of the television (odds ratio = 1.96 [95% CI: 1.114-3.456]) and to consume at least one ultra-processed food per day (odds ratio = 2.42 [95% CI: 1.381-4.241]). In addition, they were less likely to consume fruit regularly (odds ratio = 0.52 [95% CI: 0.278-0.967]). Conclusion There was no association between sedentary behavior and cardiometabolic risk factors in physically active children and adolescents. However, sedentary behavior was associated with inadequate eating habits. Thus, we may suggest that the regular engagement in physical activity may attenuate the deleterious effects of sedentary behavior on the cardiometabolic parameters of children and adolescents.

Restricción del crecimiento intrauterino y enfermedades no transmisibles durante las edades pediátricas

Introducción: En la aparición de las enfermedades crónicas durante las edades pediátricas y la adolescencia, la restricción del crecimiento intrauterino se considera un factor clave. Objetivo: Determinar la relación entre la restricción del crecimiento intrauterino y las enfermedades no trasmisibles durante las edades pediátricas. Métodos: Se realizó una revisión narrativa con búsqueda bibliográfica en Pubmed, SciELO, LILACS y Google académico en los últimos cinco años sobre el tema que se trata. Se examinaron artículos originales, de revisión y capítulos de libros. Se utilizaron las palabras clave: retardo del crecimiento fetal, factores de riesgo cardiometabólicoy atención integrada a las enfermedades prevalentes de la infancia. Se descartaron aquellos artículos no pertinentes o que tuvieran deficiencias metodológicas notables. Análisis y síntesis de la información: Se expusieron las definiciones de "pequeño para la edad gestacional" y "restricción del crecimiento intrauterino", se mostró la clasificación más actualizada, se mencionaron las enfermedades que aparecen en la infancia en estos recién nacidos de riesgo y se señalaron sus mecanismos. Conclusiones: El antecedente de restricción del crecimiento intrauterino se relaciona con alteraciones del crecimiento pondoestatural, del neurodesarrollo; el síndrome metabólico; las afecciones cardiovasculares; las enfermedades endocrinas, hepáticas, respiratorias, del sistema inmunológico y renales, los trastornos auditivos y de la visión. Estas afecciones se presentan en etapas tempranas de la vida como la infancia y la adolescencia.

Introduction: In the occurrence of chronic diseases during pediatric ages and adolescence, intrauterine growth restriction is considered a key factor. Objective: To determine the relationship between intrauterine growth restriction and noncommunicable diseases during pediatric ages. Methods: A narrative review was performed with a literature search in Pubmed, SciELO, LILACS and Google Scholar in the last five years on the topic under discussion. Original articles, review articles and book chapters were examined. The keywords used were: fetal growth retardation, cardiometabolic risk factors, integrated care for prevalent childhood diseases. Articles that were not relevant or had notable methodological deficiencies were discarded. Analysis and synthesis of the information: The definitions of "small for gestational age" and "intrauterine growth restriction" were exposed, the most updated classification was shown, the diseases that appear during infancy in these at-risk newborns were mentioned and their mechanisms were pointed out. Conclusions: The history of intrauterine growth restriction is related to alterations of pondoestatural growth, neurodevelopment, metabolic syndrome, cardiovascular conditions, endocrine, hepatic, respiratory, immune system, renal, hearing and vision disorders. These conditions surface in early stages of life such as infancy and adolescence.

Pediatric kidney transplant and cardiometabolic risk: a cohort study / Transplante renal pediátrico e risco cardiometabólico: um estudo de coorte

Abstract Introduction: Patients with chronic kidney disease (CKD) are known to have increased cardiovascular risk but there are few data on the risk of pediatric kidney transplant recipients. We aimed to assess the impact of pre- and post-transplant overweight on allograft function and to characterize the evolution of several cardiovascular risk variables over time and their impact. Methods: A retrospective analysis of the records of 23 children/adolescents followed at a tertiary center after kidney transplant was conducted. Data on anthropometry and cardiometabolic variables were analyzed before transplant, six and 12 months after the transplant, and at the last follow-up visit. The impact of the variables on allograft function (glomerular filtration rate (GFR)) was estimated by creatinine-based revised Schwartz formula (Cr-eGFR) and was evaluated using nonparametric tests. Results: The 23 patients included in the study had a median age of 6.3 (4.4-10.1) years. Both systolic and diastolic BP z-score values significantly decreased between BMI groups [1.2 (-0.2 - 2.3) vs. 0.3 (-0.4 - 0.6), p=0.027 and 0.8 (-0.4 - 1.3) vs. 0.1 (-0.6 - 0.7), p=0.028, pre-transplant and at the final evaluation, respectively]. During follow-up, GFR values decreased (Cr-GFR: 68.9 (57.7-76.8) vs. 58.6 (48.9-72.9), p=0.033 at 6-months and at the end, respectively). Significant negative correlations between triglycerides and cystatin C-based eGFR (ρ=-0.47, p=0.028) and Cr-Cys-eGFR (ρ=-0.45, p=0.043) at the end of the study were found. Conclusion: Our study showed a high number of overweight children undergoing kidney transplant. A negative correlation between triglycerides and GFR was found, which highlights the importance of managing nutritional status and regular blood lipids evaluation after kidney transplant.

Resumo Introdução: Sabe-se que pacientes com doença renal crônica (DRC) têm maior risco cardiovascular, mas há poucos dados sobre risco de receptores de transplante renal pediátrico. Visamos avaliar o impacto do sobrepeso pré/pós-transplante na função do aloenxerto e caracterizar a evolução de diversas variáveis de risco cardiovascular com o tempo e seus impactos. Métodos: Realizou-se análise retrospectiva dos registros de 23 crianças/adolescentes acompanhados em um centro terciário após transplante renal. Foram analisados dados sobre antropometria e variáveis cardiometabólicas antes do transplante, seis e 12 meses após transplante, e na última consulta de acompanhamento. O impacto das variáveis na função do aloenxerto (taxa de filtração glomerular (TFG)) foi estimado pela fórmula de Schwartz revisada e baseada na creatinina (TFGe-Cr), e avaliado usando testes não paramétricos. Resultados: Os 23 pacientes incluídos no estudo tinham idade média de 6,3 (4,4-10,1) anos. Valores do escore Z das pressões arteriaissistólica e diastólica diminuíram significativamente entre grupos de índice de massa corporal [1,2 (-0,2 - 2,3) vs. 0,3 (-0,4 - 0,6), p=0,027 e 0,8 (-0,4 - 1,3) vs. 0,1 (-0,6 - 0,7), p=0,028, pré-transplante e na avaliação final, respectivamente]. Durante acompanhamento, valores da TFG diminuíram [TFG-Cr: 68,9 (57,7-76,8) vs. 58,6 (48,9-72,9), p=0,033 aos 6 meses e ao final, respectivamente]. Encontramos correlações negativas significativas entre triglicerídeos, TFGe baseada na cistatina C (ρ=-0,47, p=0,028) e TFGe-Cr-Cis (ρ=-0,45, p=0,043) ao final do estudo. Conclusão: Nosso estudo mostrou alto número de crianças com sobrepeso submetidas a transplante renal. Verificou-se correlação negativa entre triglicerídeos e TFG, destacando a importância de controlar o estado nutricional e da avaliação regular dos lipídios sanguíneos após transplante renal.

Efeito da dieta hipocalórica na pressão arterial e demais cofatores da síndrome metabólica / Effect of hypocaloric diet on blood pressure and other cofactors of metabolic syndrome

Introdução: a hipertensão arterial sistêmica (HAS) está associada a fatores de risco metabólicos e pode ser definida como uma doença crônica multifatorial, com valores persistentes de pressão arterial sistólica (PAS) e (ou) pressão arterial diastólica (PAD) maiores ou iguais a 140 mmHg x 90 mmHg, respectivamente. A HAS é um dos fatores que compõem a síndrome metabólica (SM) juntamente com a hiperglicemia, dislipidemia e (ou) obesidade central. Modificações no estilo de vida, como a alimentação e perda de peso, demonstraram melhorar os parâmetros cardiometabólicos nos pacientes com HAS e SM. Objetivo: verificar o efeito de uma dieta hipocalórica na antropometria, na pressão arterial e em outros cofatores da síndrome metabólica. Metodologia: trata-se de um ensaio clínico não randomizado, retrospectivo, com dados secundários, em que o mesmo grupo foi de "intervenção" e "comparador", e cujos dados foram coletados antes (baseline) e após a intervenção. A pesquisa foi realizada com 84 pacientes, adultos, com síndrome metabólica, de ambos os sexos. Os pacientes seguiram dieta com restrição calórica de 200 a 500kcal/dia, com cálculo energético em torno de 20kcal/kg de peso, valor energético total não inferior a 1200kcal, durante um período de dois meses. Foi utilizada estatística descritiva e o teste t pareado ou Wilcoxon-Sign-Rank intragrupo para analisar as variações ao longo do tempo (p < 0,05). Resultado:houve uma redução na antropometria (índice de massa corporal, circunferência da cintura, circunferência do braço e circunferência do quadril), PAS e PAD, glicemia de jejum e triglicerídeos com p< 0,05 dos pacientes após a intervenção, mas não houve melhora no HDL (p > 0,05). Conclusão: a dieta hipocalórica reduziu as medidas antropométricas, a pressão arterial e os demais cofatores da SM nos pacientes avaliados após o acompanhamento de dois meses.

Introduction: systemic arterial hypertension (SAH) is associated with metabolic risk factors and can be defined as a multifactorial chronic disease, with persistent values of systolic blood pressure (SBP) and (or) diastolic blood pressure (DBP) greater than or equal to 140 mmHg x 90 mmHg, respectively. SAH is one of the factors that make up the metabolic syndrome (MS) along with hyperglycemia, dyslipidemia and (or) central obesity. Lifestyle modifications, such as diet and weight loss, have been shown to improve cardiometabolic parameters in patients with SAH and MS. Objective: to verify the effect of a hypocaloric diet on anthropometry, blood pressure and other cofactors of the metabolic syndrome. Methodology: this is a non-randomized, retrospective clinical trial, with secondary data, in which the same group was "intervention" and "comparator", and whose data were collected before (baseline) and after the intervention. Research was carried out with 84 patients, adults, with metabolic syndrome, of both sexes. Patients followed a calorie-restricted diet of 200 to 500kcal/day, with energy calculation around 20kcal/kg of weight, total energy value not less than 1200kcal, during a period of two months. Descriptive statistics and the paired t test or intragroup Wilcoxon-Sign-Rank were used to analyze variations over time (p < 0.05). Result: there was a reduction in anthropometry (body mass index, waist circumference, arm circumference and hip circumference), SBP and DBP, fasting glucose and triglycerides with p<0.05 of patients after the intervention, but there was no improvement in HDL (p > 0.05). Conclusion: the hypocaloric diet reduced anthropometric measurements, blood pressure and other MS cofactors in the patients evaluated after a two-month follow-up.

Asociación del índice triglicérido-glucosa con colesterol-no-HDL aumentado como indicador de riesgo cardiometabólico en estudios poblacionales / Association of the triglyceride-glucose index with increased non-HDL-cholesterol as an indicator of cardiometabolic risk in population studies / Associação do índice triglicerídeo-glicose com colesterol-não-HDL aumentado como indicador de risco cardiometabólico em estudos populacionais / Reconocimiento a la trayectoria del Prof. Dr. Juan Miguel Castagnino†

Resumen Se propone la asociación de dos indicadores para la detección de personas con riesgo cardiometabólico (RCM) en estudios poblacionales: triglicéridoglucosa (TyG) >8,75 y colesterol-no-HDL (C-no-HDL) ≥160 mg/dL, que se denominará indicador de RCM. La enfermedad cardiovascular aterosclerótica (ECVA) y la diabetes tipo 2 (DT2) son muy frecuentes. TyG aumentado es un estimador de insulinorresistencia y síndrome metabólico (SM) y está relacionado con la detección precoz de riesgo para DT2. C-no-HDL ≥160 mg/ dL ha sido recomendado informarlo en los estudios de laboratorio vinculados con el riesgo para ECVA, sus aumentos están relacionados con todas las lipoproteínas aterogénicas y es de mucho interés en hipertrigliceridemias y SM, por la presencia de lipoproteínas remanentes. En un estudio poblacional sobre 540 personas del sur argentino se halló un aumento significativo de RCM luego de los 20 años y luego de los 40 años de edad un tercio de la población lo tenía presente. El RCM se halló asociado con el índice de masa corporal (IMC), luego de ajustar para edad y género. Después de los 30 años, el RCM estaba presente en un tercio de las personas con IMC ≥27 kg/m2. En otro estudio realizado en personas con riesgo para DT2 con RCM presente, 65,8% tenían HOMA-IR (homeostasis model assessment-insulin-resistance) >2,1 y 61,8% SM. Se concluye que la asociación de TyG >8,75 y C-no-HDL ≥160 mg/dL (RCM) podría ser de interés para la detección de grupos poblacionales con alto riesgo cardiometabólico, en la prevención de ECVA y DT2.

Abstract The association of two indicators was proposed for the detection of people with cardiometabolic risk (CMR) in population studies: triglyceride-glucose (TyG) >8.75 and non-HDL-cholesterol (Non-HDL-C) ≥160 mg/dL, which will be called CMR indicator. Atherosclerotic cardiovascular disease (ACVD) and type 2 diabetes (T2D) are very common. Increased TyG is an estimator of insulin resistance and metabolic syndrome (MS) and is related to the early detection of risk for T2D. Non-HDL-C≥160 mg/dL has been recommended to be reported in laboratory studies related to the risk for CVA and its increases are related to all atherogenic lipoproteins and it is of great interest in hypertriglyceridemia and MS, due to the presence of lipoproteins remnants. In a population study of 540 people from Southern Argentina, a significant increase in CMR was found after 20 years of age, and after 40 years of age; a third of the population had it. CMR was found to be associated with body mass index (BMI), after adjusting for age and gender. After age 30 years, CMR was present in a third of the people with a BMI ≥27 kg/m2. In another study conducted in people at risk for T2D with CMR present, 65.8% had HOMA-IR (homeostasis model assessment-insulin-resistance) >2.1 and 61.8% MS. It is concluded that the association of TyG <8.75 and non-HDL-C ≥160 mg/dL (CMR) could be of interest for the detection of population groups with high cardiometabolic risk, in the prevention of ACVD and T2D.

Resumo A associação de dois índices é proposta para a detecção de pessoas com risco cardiometabólico (RCM) em estudos populacionais: triglicerídeo-glicose (TyG) >8,75 e colesterol-não-HDL (C-não-HDL) ≥160 mg/ dL, que será denominado indicador de RCM. A doença cardiovascular aterosclerótica (DCVA) e o diabetes tipo 2 (DT2) são muito comuns. TyG aumentado é um estimador de resistência à insulina e síndrome metabólica (SM) e está relacionado com a detecção precoce de risco para DT2. C-não-HDL ≥160 mg/dL tem sido recomendado para relatá-lo em estudos laboratoriais vinculados com o risco de DCVA e seus aumentos estão relacionados com todas as lipoproteínas aterogênicas e é de grande interesse na hipertrigliceridemia e SM devido à presença de restos de lipoproteínas. Em um estudo populacional de 540 pessoas do sul da Argentina, foi encontrado um aumento significativo de RCM após os 20 anos de idade e, depois dos 40 anos, um terço da população o apresentava. A RCM foi associada ao índice de massa corporal (IMC), após ajustar para idade e gênero. Após os 30 anos, a RCM estava presente em um terço das pessoas com IMC ≥27 kg/m2. Em outro estudo realizado em pessoas com risco para DT2 com RCM presente, 65,8% tinham HOMA-IR (homeostasis model assessment-insulin-resistance) >2,1 e 61,8% SM. Conclui-se que a associação de TyG >8,75 e C-não-HDL ≥160 mg/dL (RCM) poderia ser de interesse para a detecção de grupos populacionais com alto risco cardiometabolico, na prevenção de DCVA e DT2.

Riesgo cardiometabólico en pacientes con hipertensión arterial esencial no complicada

Introducción: La evaluación del riesgo cardiometabólico en pacientes con hipertensión arterial esencial es vital y constituye un reto diagnóstico. Objetivo: Evaluar el comportamiento del riesgo cardiometabólico en pacientes con hipertensión arterial esencial no complicada. Métodos: Se realizó una investigación descriptiva y transversal en 100 pacientes hipertensos sin lesión en órgano diana a los que se les realizó historia clínica, glucemia, hemoglobina glicosilada, lipidograma y ácido úrico. Se correlacionaron con el índice de masa corporal, el tiempo de evolución de la hipertensión arterial y el riesgo cardiovascular global. Resultados: De los pacientes, el 56 % fueron hombres, el 31 % fumadores, con sobrepeso y obesidad el 83 %, el 86 % eran sedentarios, 71 % no llevaban dieta saludable y 53 % tenían más de 5 años de hipertensos. En los obesos se encuentra una relación significativa con la circunferencia abdominal (110,9 ± 8,9, p=0,000), los triglicéridos (1,8 ± 0,9, p=0,000) y al ácido úrico (374 ± 100,7, p=0,001). La edad (62,9 ± 7,8, p=0,000), la presión arterial sistólica (151,6 ± 15,6, p=0,021), la disminución del HDL (0,9 ± 0,3, p=0,000) y el ácido úrico (349, 3 ± 115,3, p=0,015) se relacionaron significativamente con el riesgo cardiovascular alto. Conclusiones: Los resultados demostraron el valor de parámetros clínicos como la edad, la circunferencia abdominal, el índice de masa corporal y la presión arterial sistólica, así como de parámetros metabólicos como los triglicéridos, el HDL y el ácido úrico en la evaluación del riesgo cardiometabólico y su relación con el riesgo cardiovascular en pacientes hipertensos.

Introduction: Cardiometabolic risk assessment in patients with essential arterial hypertension is vital and a diagnostic challenge. Objective: To evaluate the behavior of cardiometabolic risk in patients with uncomplicated essential hypertension. Methods: A descriptive, cross-sectional study was carried out in 100 hypertensive patients without target organ damage who underwent clinical history, glycemia, glycosylated hemoglobin, lipidogram and uric acid. They were correlated with body mass index, time of evolution of arterial hypertension and global cardiovascular risk. Results: Of the patients, 56% were men, 31% were smokers, 83% were overweight and obese, 86% were sedentary, 71% did not have a healthy diet and 53% had been hypertensive for more than 5 years. In the obese, a significant relationship was found with abdominal circumference (110.9 ± 8.9, p=0.000), triglycerides (1.8 ± 0.9, p=0.000) and uric acid (374 ± 100.7, p=0.001). Age (62.9 ± 7.8, p=0.000), systolic blood pressure (151.6±15.6, p=0.021), lower HDL (0.9±0.3, p=0.000) and uric acid (349, 3 ± 115.3, p=0.015) were significantly related to high cardiovascular risk. Conclusions: The results demonstrated the value of clinical parameters such as age, abdominal circumference, body mass index and systolic blood pressure, as well as metabolic parameters such as triglycerides, HDL and uric acid in the evaluation of cardiometabolic risk and its relationship with cardiovascular risk in hypertensive patients.

Effect of dietary chia supplementation on glucose metabolism and adipose tissue function markers in non-alcoholic fatty liver disease subjects / Efecto de la suplementación de la dieta con chía sobre el metabolismo de la glucosa y marcadores de función del tejido adiposo en sujetos con hígado graso no alcohólico

Background: adipose tissue dysfunction is a key factor for diabetes and non-alcoholic fatty liver disease (NAFLD) development. Chia (Salvia hispanica) is an abundant source of omega-3 fatty acids, antioxidants, and fiber which could improve adipose tissue functionality. Aim: to analyze the effect of an isocaloric chia-supplemented diet on glucose metabolism, adipose tissue inflammation, and endothelial function markers in patients with NAFLD and early stages of diabetes. Methods: in 32 patients with previous NAFLD diagnosis, without known diabetes, the effect of a diet supplemented with ground chia (25 g/day/8 weeks) was evaluated. Visceral (VAF) and liver fat, plasma lipids, fatty acids, and cytokine profiles, oral glucose tolerance test (OGTT), insulinogenic index (IGI30), insulin disposition index (DIO), and endothelial progenitor cells (EPC) were analyzed. Before and after eight weeks of diet supplementation. Results: chia supplementation promoted increases in plasma alpha-linolenic acid (75 %) and fiber consumption (55 %), and a higher number of EPC (+126 %). Basal OGTT showed that nine patients had normal OGTT, 17 pre-diabetes, and six newly diagnosed diabetes. In patients with diabetes, chia favored a healthier adipose tissue (VAF -7 %, NAFLD -100 %, adiponectin +47 %, resistin -30 %, IL-6 -44 %, IL-1β -22 %) and upturn glucose metabolism through the improvement of beta-cell function (IGI30 +50 %, DIO +66 %). (AU)

Antecedentes: la disfunción del tejido adiposo es un factor clave para el desarrollo de diabetes e hígado graso no alcohólico (HGNA). La chía (Salvia hispanica) es una fuente abundante de ácidos grasos omega-3, antioxidantes y fibra, que podrían mejorar la funcionalidad del tejido adiposo. Objetivo: analizar el efecto de una dieta isocalórica suplementada con chía sobre el metabolismo de glucosa y los marcadores de inflamación del tejido adiposo y de función endotelial en pacientes con HGNA y etapas tempranas de diabetes. Métodos: en 32 pacientes con diagnóstico previo de HGNA, pero sin diabetes conocida, se evaluó el efecto de una dieta suplementada con chía molida (25 g/día) sobre la grasa visceral (GAV) y hepática, el perfil de lípidos, los ácidos grasos y las citoquinas en plasma, la prueba de tolerancia oral a la glucosa (OGTT), el índice insulinogénico (IGI30), el índice de disposición de insulina (DIO) y las células progenitoras endoteliales (EPC), antes y después de ocho semanas de suplementación. Resultados: la suplementación con chía promovió aumentos en el consumo de ácido alfa-linolénico en plasma (75 %) y fibra de alta viscosidad (55 %) y un mayor número de EPC (+126 %). La OGTT basal mostró que nueve pacientes tenían curva normal, 17 tenían prediabetes y seis, diabetes de recién diagnóstico. En los pacientes con diabetes, la chía favoreció un tejido adiposo más sano (GAV -7 %, NAFLD -100 %, adiponectina +47 %, resistina -30 %, IL-6 -44 %, IL-1β -22 %) y un aumento del metabolismo de la glucosa a través de la mejora de la función de las células beta (IGI30 +50 %, DIO +66 %). (AU)

Effect of dietary chia supplementation on glucose metabolism and adipose tissue function markers in non-alcoholic fatty liver disease subjects.

Introduction: Background: adipose tissue dysfunction is a key factor for diabetes and non-alcoholic fatty liver disease (NAFLD) development. Chia (Salvia hispanica) is an abundant source of omega-3 fatty acids, antioxidants, and fiber which could improve adipose tissue functionality. Aim: to analyze the effect of an isocaloric chia-supplemented diet on glucose metabolism, adipose tissue inflammation, and endothelial function markers in patients with NAFLD and early stages of diabetes. Methods: in 32 patients with previous NAFLD diagnosis, without known diabetes, the effect of a diet supplemented with ground chia (25 g/day/8 weeks) was evaluated. Visceral (VAF) and liver fat, plasma lipids, fatty acids, and cytokine profiles, oral glucose tolerance test (OGTT), insulinogenic index (IGI30), insulin disposition index (DIO), and endothelial progenitor cells (EPC) were analyzed. Before and after eight weeks of diet supplementation. Results: chia supplementation promoted increases in plasma alpha-linolenic acid (75 %) and fiber consumption (55 %), and a higher number of EPC (+126 %). Basal OGTT showed that nine patients had normal OGTT, 17 pre-diabetes, and six newly diagnosed diabetes. In patients with diabetes, chia favored a healthier adipose tissue (VAF -7 %, NAFLD -100 %, adiponectin +47 %, resistin -30 %, IL-6 -44 %, IL-1ß -22 %) and upturn glucose metabolism through the improvement of beta-cell function (IGI30 +50 %, DIO +66 %). Conclusions: dietary supplementation with 25 g/day of ground chia may promote a healthier adipose tissue and improve pancreatic ß-cell and endothelial function. Among patients with early metabolic abnormalities, phytochemical properties of chia may retard diabetes progression and advanced stages of liver damage.

Introducción: Antecedentes: la disfunción del tejido adiposo es un factor clave para el desarrollo de diabetes e hígado graso no alcohólico (HGNA). La chía (Salvia hispanica) es una fuente abundante de ácidos grasos omega-3, antioxidantes y fibra, que podrían mejorar la funcionalidad del tejido adiposo. Objetivo: analizar el efecto de una dieta isocalórica suplementada con chía sobre el metabolismo de glucosa y los marcadores de inflamación del tejido adiposo y de función endotelial en pacientes con HGNA y etapas tempranas de diabetes. Métodos: en 32 pacientes con diagnóstico previo de HGNA, pero sin diabetes conocida, se evaluó el efecto de una dieta suplementada con chía molida (25 g/día) sobre la grasa visceral (GAV) y hepática, el perfil de lípidos, los ácidos grasos y las citoquinas en plasma, la prueba de tolerancia oral a la glucosa (OGTT), el índice insulinogénico (IGI30), el índice de disposición de insulina (DIO) y las células progenitoras endoteliales (EPC), antes y después de ocho semanas de suplementación. Resultados: la suplementación con chía promovió aumentos en el consumo de ácido alfa-linolénico en plasma (75 %) y fibra de alta viscosidad (55 %) y un mayor número de EPC (+126 %). La OGTT basal mostró que nueve pacientes tenían curva normal, 17 tenían prediabetes y seis, diabetes de recién diagnóstico. En los pacientes con diabetes, la chía favoreció un tejido adiposo más sano (GAV -7 %, NAFLD -100 %, adiponectina +47 %, resistina -30 %, IL-6 -44 %, IL-1ß -22 %) y un aumento del metabolismo de la glucosa a través de la mejora de la función de las células beta (IGI30 +50 %, DIO +66 %). Conclusiones: la suplementación de la dieta con 25 g/día de chía molida puede promover un tejido adiposo más saludable y mejorar la función endotelial y de las células ß pancreáticas. Entre los pacientes con anomalías metabólicas tempranas, las propiedades fitoquímicas de la chía pueden retrasar la progresión de la diabetes y el desarrollo de etapas avanzadas de daño hepático.

Relación inversa entre la altitud y el riesgo cardiometabólico en la población peruana: resultados de una encuesta de base poblacional e importancia de la relación cintura-talla como indicador de riesgo cardiometabólico

Presentación: En el presente artículo exponemos nuestra valoración crítica de un estudio observacional publicado en la revista International Journal of Environmental Research and Public Health el año 2022. Conclusiones del estudio: Se identificó una asociación inversa entre vivir a mayor altura y el nivel de riesgo cardiometabólico en la población adulta peruana. Sin embargo, la prevalencia de riesgo cardiometabólico en las diferentes categorías altitudinales evaluadas se mantiene por encima del 82% (80.9 - 84.6), lo que representa una gran proporción de la población en riesgo en cada altitud. Comentario crítico: El estudio es relevante por el uso de la relación cintura-talla, considerado como un indicador antropométrico con gran precisión para estimar el riesgo cardiometabólico, ser un estudio de bajo riesgo de sesgo y tener representatividad nacional. Por otro lado, es importante porque la relación cintura-talla es económica y fácil de usar, además de ser superior al IMC, ideal para aplicarlo en Perú. Además la conclusión general del estudio es válida, sin embargo, la falta de evaluación de la temporalidad por la misma característica del estudio (tipo transversal) y el sesgo residual que tiene al no evaluar algunas variables, hace necesario que se realicen estudios longitudinales para poder apoyar los resultados del estudio.La presente revisión crítica encuentra validez interna de los resultados del estudio, pero al momento no serían aplicables para generalizarse en toda la población por el sesgo residual.

Presentation: This article presents our critical appraisal of an observational study published in the International Journal of Environmental Research and Public Health in 2022. Conclusions of the Study: An inverse association was identified between living at higher altitudes and the level of cardiometabolic risk in the Peruvian adult population. However, the prevalence of cardiometabolic risk in the different altitude categories evaluated remains above 82% (80.9 - 84.6), which represents a large proportion of the population at risk at every altitude. Critical comment: The study is relevant because of the use of the waist-height ratio, considered an anthropometric indicator with greater precision for estimating cardiometabolic risk, being a study with a low risk of bias, and having national representativity. In addition, it is important because the waist-height ratio is inexpensive and easy to use. It is also superior to BMI and ideal for application in Peru. In addition, the general conclusion of the study is valid; however, the lack of evaluation of temporality due to the same characteristic of the study (cross-sectional study) and the residual bias that it has by not evaluating some variables, makes it necessary to carry out a longitudinal study to be able to support the results of the study. The present critical review finds internal validity in the results of the study, but at the moment they would not be applicable to generalize to the entire population due to the residual bias.

Obesidad y estratificación del riesgo cardiometabólico en escolares de Santa Clara / Obesity and Cardiometabolic Risk Stratification in Schoolchildren from Santa Clara

RESUMEN Fundamento las enfermedades no transmisibles han estado entre las primeras causas de morbi-mortalidad en el mundo y en Cuba desde hace más de 20 años. Entre ellas se destacan: la obesidad, la hipertensión arterial y la diabetes mellitus. Estas patologías aparecen desde la infancia y su prevención debe comenzar desde edades tempranas. Objetivo: determinar la obesidad, estratificar el riesgo cardiometabólico y promover estilos de vida saludable en escolares de Santa Clara. Métodos se realizó una investigación epidemiológica, descriptiva con diseño transversal a 959 escolares entre 8 y 12 años de Santa Clara y entre los años 2012 al 2020. Se desarrollaron programas computacionales, que permitieron estudiar la obesidad y calcular los índices de masa corporal, de cintura-cadera y de cintura-talla. Se incluyeron variables como: edad, sexo, color de la piel, peso, talla, circunferencia de la cintura, circunferencia de la cadera, tensión arterial, antecedentes patológicos personales y familiares, complementarios de laboratorio clínico, electrocardiogramas y ecocardiogramas. Se emplearon tablas de contingencia con doble entrada, para registrar la frecuencia de aparición de los valores de dos variables simultáneamente. Se aplicaron pruebas no paramétricas, como el Chi Cuadrado para independencia de factores y prueba de hipótesis de diferencia de proporción para grupos independientes. Resultados se detectaron un 17,94 % de escolares con sobrepeso y 15,95 % con obesidad. Fueron obesos moderados 4,48 % y 9,18 % severos. Aumentaron las medias de colesterol, triglicéridos y ácido úrico con el grado de obesidad. Se desarrollaron estimaciones de riesgo cardiometabólico en formatos Androide y WEB. Conclusiones existen altos porcentajes de obesos y sobrepesos. El índice cintura-cadera fue el mejor predictor de riesgo cardiometabólico en la investigación realizada en Santa Clara. Se requiere una mayor intervención clínica y educativa, que garantice la adopción de estilos de vida más saludable.

ABSTRACT Background: noncommunicable diseases have been among the leading causes of morbidity and mortality in the world and in Cuba for more than 20 years. These include: obesity, high blood pressure and diabetes mellitus. These pathologies appear from childhood and their prevention must begin from an early age. Objectives: to determine obesity, stratify cardiometabolic risk and promote healthy lifestyles in schoolchildren from Santa Clara. Methods: an epidemiological, descriptive investigation with a cross-sectional design was carried out on 959 schoolchildren between 8 and 12 years of age in Santa Clara and between 2012 and 2020. Computer programs were developed, which allowed studying obesity and calculating body mass indexes, waist -hip and waist-height. Variables were included such as: age, sex, skin color, weight, height, waist circumference, hip circumference, blood pressure, personal and family pathological history, clinical laboratory tests, electrocardiograms and echocardiograms. Double-entry contingency tables were used to record the frequency of appearance of the values ​​of two variables simultaneously. Non-parametric tests were applied, such as Chi Square for factor independence and proportion difference hypothesis test for independent groups. Results: 17.94 % of schoolchildren were overweight and 15.95 % obese. 4.48 % were moderately obese and 9.18 % were severely obese. The means of cholesterol, triglycerides and uric acid increased with the degree of obesity. Cardiometabolic risk estimates were developed in Android and WEB formats. Conclusions: there are high percentages of obese and overweight. The waist-hip ratio was the best predictor of cardiometabolic risk in the study conducted in Santa Clara. Greater clinical and educational intervention is required, which guarantees the adoption of healthier lifestyles.

Comparative analysis of anthropometric indicators for diagnosing obesity and predicting cardiometabolic risk in Mexican adolescents / Análisis comparativo de indicadores antropométricos para el diagnóstico de obesidad y predicción del riesgo cardiometabólico en adolescentes mexicanos

Introduction: obesity is a cardiometabolic risk (CMR) factor in adolescents. It represents a public health problem that requires simple diagnostic strategies based on the determination of anthropometric indicators (AIs) such as body mass index (BMI), waist circumference (WC), conicity index (CONI), waist-to-height ratio (WHtR), and body fat percentage (BFP). The purpose of the current contribution was to analyze the utility of the aforementioned AIs for evaluating obesity as a CMR factor in Mexican adolescents. Materials and methods: the design of the study is descriptive and cross-sectional. Nutritional status was established by using various AIs and as a CMR factor under the criteria of WHtR. Participating in the present investigation were 2,000 adolescents from 15 to 17 years of age, of which 1,079 (53.9 %) were female and 921 (46.1 %) were male. All were high school students in Tuxtla Gutiérrez, Chiapas, Mexico. Results and conclusion: the prevalence of obesity was influenced by gender. With the WHtR and BFP, male students exhibited a greater prevalence of obesity, while with the BMI and CONI, the percentage of obesity was similar between the two genders. BMI was significantly correlated with BFP, WC and WHtR, and was one of the AIs with the greatest area under the curve, showing a good capacity to predict cardiometabolic risk. BMI is a simple and adequate tool for diagnosing obesity and predicting CMR in adolescents (AU)

Introducción: la obesidad es un factor de riesgo cardiometabolico (RCM) en los adolescentes y representa un problema de salud pública que requiere estrategias diagnosticas sencillas, basadas en la determinación de indicadores antropométricos (IA) como el índice de masa corporal (IMC), la circunferencia de la cintura (CC), el índice de conicidad (ICONI), el índice de cintura-talla (ICT) y el porcentaje de grasa corporal (PGC). El propósito del presente estudio fue analizar la utilidad de diversos IA (IMC, CC, ICONI, ICT y PGC) para evaluar la obesidad como factor de RCM en adolescentes mexicanos. Materiales y métodos: el diseño del estudio fue descriptivo y transversal. Se analizó el estado nutricional mediante varios IA y el factor de RCM bajo los criterios del ICT. Este estudio fue conducido en 2000 adolescentes de entre 15 y 17 años, de los cuales 1079 (53,9 %) eran mujeres y 921 (46,1 %) varones, todos ellos estudiantes de nivel medio superior de Tuxtla Gutiérrez, Chiapas, México. Resultados y conclusión: la prevalencia de la obesidad estuvo influenciada por el género: los varones presentaron una mayor prevalencia de obesidad con ICT y PGC, mientras que con IMC e ICONI, el porcentaje de obesidad fue similar entre ambos géneros. El IMC se correlacionó significativamente con el PGC, la CC y el ICT, y fue uno de los IA con mayor área bajo la curva, mostrando una buena capacidad para predecir el RCM. El IMC representa una herramienta sencilla y adecuada para el diagnóstico de obesidad y predecir el RCM en adolescentes (AU)

Changes in body composition and cardiometabolic risk factors in relation to the reduction in body mass index in adolescents with obesity / Cambios en la composición corporal y factores de riesgo cardiometabólico en relación con la reducción del índice de masa corporal en adolescentes con obesidad

Introduction: there are controversial data in relation to the reduction in body mass index standard deviation score (BMI-SDS) needed to improve adiposity in the pediatric population with obesity. The aim of this work was to determine the minimum variation in BMI-SDS required to improve the values of adiposity markers and cardiometabolic risk factors in growing adolescents with obesity. Methods: a longitudinal study consisting of clinical evaluation (waist circumference, waist-to-height ratio, fat mass index, and blood pressure) and blood testing (insulin resistance and lipid profile) was conducted in 350 adolescents with obesity (152 boys and 198 girls) aged 10.2-14.3 years who went through a combined intervention (12 months). Results: a decrease in SDS-BMI ≤ 0.5 was not associated with any significant improvement in the clinical features and blood testing recorded. A decrease in BMI-SDS > 0.5, and especially if > 1.0, was linked to a significant improvement in adiposity markers. A decrease in BMI-SDS > 0.5 was associated with a significant improvement in insulin resistance, and a decrease in BMI-SDS > 1.0 was associated with a significant decrease in the percentage of patients who showed high values of systolic blood pressure, HOMA-IR, and lipid profile Conclusions: improvement in body composition, insulin resistance, and lipid profile can be observed with reductions in BMI-SDS ≥ 0.5 in obese adolescents, while extended benefits are obtained by losing at least 1.0 BMI-SDS (AU)

Introducción: los datos en relación con la reducción del índice de masa corporal (IMC-SDS) necesario para mejorar la adiposidad en la población pediátrica con obesidad son controvertidos. El objetivo de este trabajo es determinar la variación mínima del IMC-SDS necesaria para mejorar los valores de los marcadores de adiposidad y los factores de riesgo cardiometabólico en adolescentes obesos. Métodos: estudio longitudinal clínico (perímetro de cintura, índice cintura-estatura e índice de masa grasa y presión arterial) y analítico (HOMA-R y perfil lipídico) realizado en 350 adolescentes con obesidad (152 niños y 198 niñas) de entre 10,2 y 14,3 años de edad que completaron una intervención combinada (12 meses). Resultados: una disminución en el índice de masa corporal (SDS-BMI) ≤ 0,5 no se asoció con ninguna mejora significativa de las características clínicas y analíticas registradas. Una disminución del IMC-SDS > 0,5, y especialmente si > 1,0, se relacionó con una mejora significativa de los marcadores clínicos de adiposidad. Una disminución del IMC-SDS > 0,5 se asoció con una mejora significativa de la resistencia a la insulina y una disminución del BMI-SDS > 1,0 se asoció con una disminución significativa del porcentaje de pacientes que mostraban valores altos de presión arterial sistólica, HOMA-IR y perfil lipídico Conclusiones: con una reducción del IMC-SDS ≥ 0,5 se observa una mejoría tanto en la composición corporal como en los factores de riesgo cardiovascular en los adolescentes obesos; no obstante, estos beneficios son mayores si la reducción del IMC-SDS es superior a 1.0 (AU)