Human T-lymphotropic virus 1/2 infection among immigrants and refugees in Central Brazil, an emerging vulnerable population.

Introduction: Migratory flows play a significant role in the spread of human T-lymphotropic virus 1/2 (HTLV-1/2). In the last decade, a substantial migration of individuals occurred from Haiti and Venezuela to Brazil. However, data on the prevalence of HTLV-1/2 infection among these international migrants in Brazil are scarce. This study describes the prevalence of this infection among immigrants and refugees in Central Brazil. Methods: A cross-sectional study was conducted with 537 international migrants in the State of Goiás, Central Brazil. Participants were interviewed, and blood samples were collected. Serological screening for anti-HTLV-1/2 was performed using an enzyme-linked immunosorbent assay (ELISA; Murex HTLV-I + II, DiaSorin, Dartford, UK), and seropositive samples were submitted for confirmation by a line immunoassay (INNO-LIA HTLV I/II, Fujirebio, Europe N.V., Belgium). Results: The majority of participants were males (54.4%), between 18 and 50 years old (78%; mean age: 29.1 years), self-declared black (55.1%), reported 1 to 12 years of formal education (70.9%), and were either Venezuelans (47.9%) or Haitians (39.7%). Additionally, 50.1% were immigrants, 49% were refugees, and five were Brazilian children (0.9%) born to Haitian immigrant parents. The overall prevalence of anti-HTLV-1/2 was 0.95% (95% CI: 0.31-2.28), with HTLV-1 at 0.19% and HTLV-2 at 0.76%. All seropositive individuals (n = 5) were refugees from Venezuela, resulting in a rate of 2.26% for anti-HTLV-1/2, HTLV-1 (0.45%) and HTLV-2 (1.81%) among Venezuelan refugees. Of the demographic and behavioral characteristics evaluated, unprotected sexual intercourse and having more than one sexual partner (≥2) in the previous 12 months were associated with HTLV-1/2 seropositivity among Venezuelans. Conclusion: This study revealed, despite the low seroprevalence of HTLV-1/2 among international migrants in Central Brazil, evidence of HTLV-1 and HTLV-2 infections in Venezuelan refugees. In addition, their characteristics highlight that specific social and health programs should be implemented for these emergent and socially vulnerable migrant groups.

"Border closure only increased precariousness": a qualitative analysis of the effects of restrictive measures during the COVID-19 pandemic on Venezuelan's health and human rights in South America.

BACKGROUND: In 2010, a political and social crisis pushed thousands of Venezuelans out of their country; today, seven million Venezuelans live abroad. In addition, during the COVID-19 pandemic, border closure increased and affected specific vulnerable migration flows, such as Venezuelans trying to migrate to Chile through the Northern borders. In this context, there is little evidence of migrants' health status and needs, their access to health services, and other basic needs (e.g., housing) from a human rights perspective. Therefore, we qualitatively explored the effects of border closure due to the COVID-19 pandemic on Venezuelan migrants' health and human rights, focusing on access to healthcare in the Northern Chilean border that adjoins Peru and Bolivia. METHODS: Following a case-study qualitative design, we conducted an ethnography that included participatory observation of relevant sites (e.g., hospitals, main squares, migrant shelters) in Antofagasta, Iquique, and Arica and 30 in-depth interviews with actors in the health sector (n = 7), experts from the non-governmental sector (n = 16), and governmental actors (n = 7) in three large cities close to the Northern border. RESULTS: We found four main dimensions: (i) border and migration processes, (ii) specific groups and intersectionality, (iii) barriers to healthcare services, and (iv) regional and local responses to the crisis during the COVID-19 pandemic. Programs characterized by the presence of healthcare providers in the field were essential to attend to migrants' health needs at borders. CONCLUSIONS: Coordination between actors is crucial to implement regional protocols that respond to current migration phenomena and migrants' health needs. Health policies using a human rights approach are urgently required to respond to migrants' healthcare needs at borders in South America.

Factors associated with not receiving the primary series and booster dose of the COVID-19 vaccine among Venezuelan migrants in Peru: A population-based cross-sectional study.

BACKGROUND: Ensuring broad COVID-19 vaccination coverage among migrants is a global public health concern. Thus, our study aimed to assess the factors associated with not receiving the primary series and booster dose of the COVID-19 vaccine among Venezuelan migrants in Peru. METHODS: This was a cross-sectional study based on secondary data analysis of the 2022 Venezuelan Population Residing in Peru Survey. Our population included Venezuelan migrants and refugees over 18 years old living in Peru with complete information for the variables of interest. Two outcome variables were assessed: not receiving the primary series and not receiving the booster dose of the COVID-19 vaccine. Crude and adjusted prevalences were calculated with 95% confidence intervals. RESULTS: A total of 7,727 Venezuelan adults were included in our study, of whom 6,511 completed the primary series. The overall COVID-19 vaccination coverage of the primary series was 84.17%, whilst the coverage of the booster dose was 28.06%. Being younger, uninsured, illegally-staying, and having a low educational level were associated with both outcomes. CONCLUSION: Several sociodemographic and migration-related variables were associated with both outcomes. Governmental policies prioritizing vaccination among Venezuelan migrants are needed to ensure broad coverage in this vulnerable group.

A comparison of resource use of insured and uninsured venezuelan migrants: evidence from the hospital setting.

BACKGROUND: There is no characterization of resource use in the hospital setting for immigrants in Colombia, we aimed to describe the resource use by Venezuelan immigrants, comparing those enrolled in the national health insurance system with those with and without the ability to pay. METHODS: Retrospective review in the billing data system of our Hospital from 2011 to 2020. We collected information for 6,837 hospital episodes associated with 1,022 Venezuelan patients, hospital's billing information for all services rendered was extracted. RESULTS: The mean cost per patient event were 4,595 USD for those without the ability to pay, costing 2.37 times more than a legal resident insured. Care in the ICU, inpatient days, surgery, and OB-GYN department consume most resources provided to vulnerable migrants. DISCUSSION: Enrolment in the national health insurance may allow better access to health services by vulnerable Venezuelan migrants and thus reduce resource use for the health system.

Afro-Venezuelans' Perceived Ethnic Discrimination and Its Association with Levels of Depression.

Venezuela is one of the Latin American nations that has traditionally participated in the myth of racial democracy. According to this myth, inasmuch as Venezuela is a racially mixed country, racism is largely absent. That has made virtually invisible the plight of Afro-Venezuelans, who continue to suffer discrimination. In the present study, 402 Afro-Venezuelans were surveyed regarding their perceived discrimination and their levels of depression. Results came out showing that, compared to white Venezuelans, Afro-Venezuelans are more likely to suffer both perceived discrimination and depression. Likewise, it was also found that among Afro-Venezuelans, perceived discrimination has a statistically significant correlation with depression. However, one particular marker of depression (suicidal ideation) does not have correlation with any dimension of perceived discrimination.

Estrategias de acceso a los alimentos implementadas en Venezuela por un grupo de venezolanos que viven en Cuiabá, Brasil / Food access strategies implemented in Venezuela by a group of Venezuelans living in Cuiabá, Brazil

Resumen La crisis sociopolítica de Venezuela ha generado diversos problemas como la inseguridad alimentaria, la escasez de productos básicos y medicinas, el aumento del desempleo y la migración masiva hacia otros países de la región. Este estudio tuvo por objetivo identificar las estrategias de acceso a los alimentos vividas en Venezuela por los inmigrantes venezolanos que residen en Cuiabá, en Mato Grosso, Brasil. Esta investigación se realizó bajo el enfoque cualitativo para indagar cómo fue el impacto respecto al acceso y consumo de alimentos en Venezuela vivido por los inmigrantes venezolanos desde la documentación, descripción y comprensión de las experiencias que ellos enfrentan. Se incluyeron 13 participantes, la técnica de recolección de datos que se utilizó fueron las entrevistas individuales. Entre los principales hallazgos encontrados se evidenció que la mayoría de los entrevistados no se sentía a gusto con la alimentación que tenía en Venezuela, dadas las pocas condiciones de acceso y disponibilidad de alimentos, muchos de estos manifestaron percepciones de hambre y angustia por la falta de alimentos, y estas situaciones llevaron a buscar mejores condiciones de vida. La crisis en Venezuela que produjo la poca disponibilidad y acceso a los alimentos les generó estrategias para poder garantizar una alimentación permanente dentro de los hogares donde muchas veces estas estrategias no son acordes a una alimentación saludable y adecuada.

Abstract The socio-political crisis in Venezuela has generated various problems, such as food insecurity, shortages of basic products and medicines, increased unemployment and massive migration to other countries in the region. To identify the strategies for access to food experienced by Venezuelan immigrants residing in Cuiabá-MT, Brazil. This research was conducted under the qualitative approach, this approach allowed us to investigate how was the impact regarding the access and consumption of food in Venezuela lived by Venezuelan immigrants residing in Cuiabá - Brazil, from the documentation, description and understanding of the experiences they face; 13 participants were included, the data collection technique used were individual interviews. Among the main findings was that most of the interviewees did not feel comfortable with the food they had in Venezuela, given the poor conditions of access and availability of food, many of them expressed perceptions of hunger and anguish due to the lack of food and these situations led them to seek better living conditions. The socio-political crisis in Venezuela that produced the lack of availability and access to food, generated strategies to ensure a permanent food supply within households where often these strategies are not in line with a healthy and adequate diet.

HTLV-1 and HTLV-2 Infection Among Warao Indigenous Refugees in the Brazilian Amazon: Challenges for Public Health in Times of Increasing Migration.

INTRODUCTION: Human T-lymphotropic virus (HTLV) infection is endemic in indigenous populations of the Americas. We describe herein the prevalence of HTLV-1 and HTLV-2 infection among Warao indigenous refugees from Venezuela living in Belém, Pará, Brazil. METHODS: In total, 101 individuals of both sexes (43 men and 58 women) between 18 and 77 years of age were investigated. Blood samples were collected and separated into plasma and leukocytes. Serological screening was performed using an enzyme-linked immunosorbent assay (ELISA; Murex HTLV-I+II, DiaSorin, Dartford, UK), and seropositive samples were submitted to proviral DNA extraction followed by real-time polymerase chain reaction (qPCR). A nested PCR of the env region (630 bp) followed by enzymatic digestion with XhoI was performed to identify the molecular subtype of HTLV-2, in addition to sequencing analysis of the 5'LTR-I and 5'-LTR-II regions. RESULTS: Of the 101 individuals analyzed, 3 (3.0%) were seropositive. Molecular analysis of the pol and tax genes confirmed the HTLV-1 infection in a 55-year-old woman and HTLV-2 infection in a man (68 years old) and a woman (23 years old). HTLV-2 strains were defined by enzymatic digestion as belonging to the HTLV-2b subtype. The sequencing of the 5'LTR regions confirmed the presence of subtype 2b and identified HTLV-1 as belonging to subtype 1A (Cosmopolitan) and the Transcontinental subgroup. Among the infected patients, it was possible to conduct medical interviews with two individuals after delivery of the result. One patient with HTLV-2 reported symptoms such as joint pain, foot swelling, frequent headache, dizziness and lower back pain. The HTLV-1-positive woman was diagnosed with a tumor, dementia, urinary incontinence, felt body pain, and had spots on her body. The presence of the HTLV-2b subtype highlights the prevalence of this molecular variant among indigenous South Americans, as well as the presence of HTLV-1 Transcontinental, which has a worldwide distribution. CONCLUSION: These results reveal a high prevalence of HTLV-1/2 infection among Warao immigrants, suggesting migratory flow as a virus spread mechanism among human populations and alert public authorities to the need to create epidemiological surveillance programs, public social and health policies aimed at welcoming immigrants in the Brazilian territory.

Qualidade de vida de migrantes venezuelanos vivendo no Brasil / Quality of life of Venezuelan migrants living in Brazil

A crise econômica, social e sanitária que vem acometendo a Venezuela tem ocasionado a maior migração forçada da história da América Latina. O Brasil tem sido um dos países de acolhimento dos venezuelanos. O objetivo deste estudo foi descrever e analisar o perfil sociodemográfico, migratório e a qualidade de vida de migrantes venezuelanos vivendo no Brasil. Trata-se de um estudo transversal com coleta de dados primários. A população elegível consistiu de indivíduos com 18 anos ou mais, de nacionalidade venezuelana e vivendo no Brasil, recrutados via curso de português promovido pela Cáritas Arquidiocesana do Rio de Janeiro em parceria com a Universidade do Estado do Rio de Janeiro, além de contatos com docentes vinculados às Cátedras Sérgio Vieira de Mello sediadas em outras universidades brasileiras, e por meio de divulgação em mídias sociais. Um questionário on-line para autopreenchimento foi composto por três blocos: perfil sociodemográfico; trajetória e situação migratória; e qualidade de vida (instrumento abreviado de avaliação da qualidade de vida, o WHOQOL-BREF). Foram estimadas as frequências absolutas e relativas das características sociodemográficas e de migração. Foram calculados as pontuações médias, os desvios padrão para o item extradomínio da qualidade de vida geral, quatro domínios da qualidade de vida e suas respectivas facetas, todos na escala 0 a 100. Quanto maiores tais pontuações médias, maior o indicativo de melhor qualidade de vida. Foram conduzidas regressões lineares múltiplas da qualidade de vida e seus domínios em relação às variáveis sociodemográficas e migratórias. A população de estudo incluiu 318 participantes, porém 312 responderam pelo menos 80% dos itens do WHOQOL-BREF. Entre esses 312, foram encontrados 65,7% do sexo feminino, idade média de 37,1 anos, 38,1% com autorização de residência por prazo determinado, 37,5% e 27,2% moravam, respectivamente, nas regiões Norte e Sudeste. O item da qualidade de vida geral apresentou uma pontuação média de 44,7 (DP=21,8). O domínio físico teve a melhor avaliação média, com 66,2 pontos (DP=17,8); já o meio ambiente a pior média, com 51,1 pontos (DP=14,6). A menor qualidade de vida geral foi associada a não ter apresentado renda ou ter recebido menos de R$1.501 (ß=-17,3), morar sozinho (ß=-13,3), viver há menos de um mês no estado de residência (ß=-13,2) e ter vivenciado algum episódio de discriminação (ß=-6,8). A menor percepção dos domínios pelos venezuelanos esteve associada a ser do sexo feminino, ter sofrido discriminação, viver há menos de um mês no estado de residência e não morar em estados da região Sul e Sudeste do país. A autopercepção da qualidade de vida no Brasil não foi boa, o que permite supor que a integração social e a garantia dos direitos humanos dos migrantes e refugiados venezuelanos não estejam sendo satisfatórias.

The economic, social and health crisis that has been affecting Venezuela has caused the largest forced migration in the history of Latin America. Brazil has been one of Venezuelans host countries. This study aimed to describe and analyze the sociodemographic, migratory profile and the quality of life of Venezuelan migrants living in Brazil. This is a cross-sectional study with primary data collection. Venezuelans over 18 years of age living in Brazil were eligible, recruited through a Portuguese course promoted by Caritas Archdiocesan of Rio de Janeiro in partnership with the Rio de Janeiro State University, in addition to contacts with professors linked to the Cathedra Sérgio Vieira de Mello based in other Brazilian universities, and through dissemination in social media. An online questionnaire for self-completion was composed of three blocks: sociodemographic profile; migratory trajectory and situation; and quality of life (abbreviated instrument for assessing quality of life, the WHOQOL-BREF). Absolute and relative frequencies of sociodemographic and migration characteristics were estimated. Mean scores, standard deviations for the item (extra domain) of general quality of life, 4 domains of quality of life, and their respective facets were calculated, all on a scale from 0 to 100. The higher such mean scores, greater the indicative of better quality of life. Multiple linear regressions of quality of life and its domains were carried out in relation to sociodemographic and migratory variables. The study population included 318 participants, but 312 answered at least 80% of the WHOQOL-BREF items. Among these 312, were found 65.7% female, mean age of 37.1 years, 38.1% with a fixed-term residence permit, 37.5% and 27.2% lived, respectively, in the North and Southeast regions. The general quality of life item had an average score of 44.7 (SD=21.8). The physical domain had the best average rating with 66.2 points (SD=17.8), while the environment had the worst average with 51.1 points (SD=14.6). The lowest general quality of life was associated with having no income or having received less than R$1,501 (ß=-17.3), living alone (ß=-13.3), living for less than a month in the state of residence (ß=-13.2) and having experienced some episode of discrimination (ß=-6.8). The lower perception of domains by Venezuelans was associated with being female, having suffered discrimination, living for less than a month in the state of residence and not living in states in the South and Southeast regions of the country. The self-perception of quality of life in Brazil was not well evaluated, which allows to assume that social integration and the guarantee of the human rights of Venezuelan migrants and refugees are unsatisfactory.

Immigration, perceived discrimination and mental health: evidence from Venezuelan population living in Peru.

BACKGROUND: The association between international migration and mental health is conditioned to several factors, and discrimination may play a significant role. Currently, Peru is one of the principal Venezuelan migrant-receiving countries in Latin America. There are around one million Venezuelan refugees and migrants in the country. This study evaluates the association between self-perceived discrimination and mental health problems in Venezuelan population living in Peru. METHOD: We analyzed data from the Venezuelan Population Residing in Peru Survey 2018, a nationally representative urban sample aimed at collecting information on several dimensions of Venezuelan population wellbeing. We applied logistic regression models to assess the association between self-perceived discrimination and mental health problems. Moreover, we applied the propensity score matching method as a robustness check of our results. RESULTS: Of 9487 Venezuelans surveyed, 6806 included complete information. From this sample, 6.3% reported mental health problems related to fear, anger, anxiety, or stress. Logistic regression models showed that Venezuelans who perceived being discriminated against had 2.4 higher odds of presenting mental health problems than their non-discriminated counterparts. Moreover, propensity score matching models showed that Venezuelans who perceived being discriminated against increased by 3.5 percentage points their probability of presenting mental health problems compared to their non-discriminated counterparts. CONCLUSIONS: There is evidence that self-perceived discrimination is associated with mental health deterioration in Venezuelan migrants living in Peru. Our findings are relevant in the current geopolitical context and could be useful in the decision making processes in international health.

Role of depressive symptoms in the health-related quality of life of Venezuelan patients with rheumatoid arthritis. Results from a tertiary care center.

INTRODUCTION/OBJECTIVE: To examine the effect of depressive symptoms on health-related quality of life (HR-QoL) in Venezuelan patients with rheumatoid arthritis (RA). METHODS: HR-QoL was assessed in a cross-sectional, single-center study of 212 consecutive Venezuelan patients with RA (1987 American College of Rheumatology criteria) using the Medical Outcomes Study Short Form (SF-36), which includes a Physical Composite Scale (PCS) and a Mental Composite Scale (MCS); depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Covariates included socio-demographics, comorbidities, disease characteristics, body mass index, and disability. Unadjusted and multivariable linear regression analysis were used to determine the effect of depressive symptoms on HR-QoL. RESULTS: Mean age was 50.2 years and 89.6% were female. Twenty-five percent of patients had depressive symptoms. In the multivariable regression analysis, the presence of depressive symptoms changed the mental SF-36 scores by - 4.81 (p = 0.0052) and the physical SF-36 scores by - 3.33 (p = 0.0527). Other factors significantly associated with scores on the PCS of the SF-36 were functional class, disability and job loss due to RA. CONCLUSIONS: The presence of depressive symptoms negatively affected the HR-QoL in our patients, with a predominant effect on the MCS of the SF-36. The PCS of the SF-36 was mainly affected by those symptoms related to the functional impairment and inflammatory activity of the disease. The routine assessment and early treatment of depressive symptoms, targeting mental and mood manifestations, may improve the HR-QoL and thus contribute to healthier outcomes in Venezuelan RA patients.

Vigilância epidemiológica e sua relação com os processos migratórios: observações do caso dos Venezuelanos em Roraima / Epidemiological surveillance and its relation with migratory processes: observations of the Venezuelan case in Roraima / La vigilancia epidemiológica y su relación con los procesos migratorios: observaciones del caso venezolano en Roraima

A partir do enfoque etnográfico sobre as redes sociais articuladas em torno da questão do migrante em Roraima, o artigo reflete sobre como os processos migratórios e a vigilância epidemiológica, interagem entre si. O foco é o intenso fluxo migratório de venezuelanos rumo ao Brasil, iniciado em meados de 2014, pelo estado fronteiriço, Roraima, descrevendo alguns aspectos do período mais crítico da migração, que se deu em meados de 2017, culminando com a reinserção do vírus do sarampo no Estado e a sua disseminação para o Brasil, em um curto espaço de tempo. As observações deste artigo refletem uma fragilidade no serviço de vigilância epidemiológica, no que tange o sistema vacinal e ainda a necessidade de se construir um novo olhar às populações que migram em busca de melhores condições de vida, sem estigmatizá-los como responsáveis por novas "tragédias sociais".

Based on the ethnographic approach on social networks articulated around the issue of migrants in Roraima, the article reflects on how migration processes and epidemiological surveillance interact with each other. The focus is the intense migratory flow of Venezuelans towards Brazil, begun in mid 2014, by the border state, Roraima, describing some aspects of the most critical period of migration, which occurred in mid 2017, culminating in the reinsertion of the measles in the State and its dissemination to Brazil, in a short time. The observations of this article reflect a fragility in the epidemiological surveillance service, regarding the vaccination system and the need to build a new look to the populations that migrate in search of better living conditions without stigmatizing them as responsible for new " social tragedies ".

Basado en el enfoque etnográfico en las redes sociales articulado en torno al tema de los migrantes en Roraima, el articulo reflexiona sobre cómo los procesos de migración y la vigilancia epidemiológica interactúan entre sí. El foco es el intenso flujo migratorio de los venezolanos hacia Brasil, a partir de mediados de 2014, por el estado fronterizo, Roraima, que describe algunos aspectos del período más crítico de la migración, que se produjo a mediados de 2017, que culminó en la reinserción del sarampión. En el Estado y su difusión a Brasil, en poco tiempo. Las observaciones de este articulo reflejan la fragilidad en el servicio de vigilancia epidemiológica, con respecto al sistema de vacunación y la necesidad de construir una nueva mirada a las poblaciones que migran en busca de mejores condiciones de vida sin estigmatizarlas como responsables de las nuevas "tragedias sociales".

Association of free fatty acids with the insulin-resistant state but not with central obesity in individuals from Venezuela

Individuals with insulin resistance (IR) usually have upper body obesity phenotype, often accompanied by an increase in plasma free fatty acids (FFA). Since the Venezuelan population has a high frequency of IR and central obesity, the purpose of this work was to determine FFA levels in 47 Venezuelan individuals, men and women, 24-58 years old, and analyze their relationship with central obesity and parameters of carbohydrate and lipid metabolism. Basal concentrations of TG, total cholesterol, LDL-C, and HDL-C were measured, and FFA, glucose and insulin, at basal state and at different times after a glucose load. Eighteen individuals presented insulin resistance (HOMA-IR >2.7) and 29 were non-insulin resistant (non-IR). Insulin resistant individuals (IR) had higher waist circumference, BMI and basal concentrations of FFA than the non-IR. No differences were observed in skin folds and other basal lipids studied. The increased FFA seemed to be related to the IR associated to BMI and not to central obesity, since the difference between IR and non-IR disappeared when they were matched for waist circumference. After a glucose load, FFA decreased in both groups, but remained significantly elevated in IR subjects. This effect disappeared after matching for BMI or waist circumference, inferring that it was independent of anthropometrics. FFA were positively associated with HOMA-IR, glucose and TG levels; however, there was no association with BMI or waist circumference. These findings, and the lack of elements to support the presence of hepatic IR, common to increased visceral lipolysis, might suggest that the IR present in the obese individuals studied, might be due to an increase in subcutaneous fat.

Los individuos con insulino-resistencia (IR) usualmente presentan obesidad central, fenotipo comúnmente acompañado de incremento de ácidos grasos libres (AGL). Como los individuos venezolanos presentan una alta frecuencia de IR y obesidad central, el objetivo de este trabajo fue analizar, en un grupo de ellos, la relación entre AGL y obesidad central y parámetros relacionados con el metabolismo de carbohidratos y lípidos. En 47 venezolanos, hombres y mujeres, entre 24 y 58 años, se determinaron las concentraciones basales de TG, Colesterol total, LDL-C, HDL-C y AGL, glucemia e insulina a nivel basal y a diferentes tiempos después de una sobrecarga glucosada. Dieciocho individuos resultaron IR (HOMA-IR > 2,7) y 29 no IR. Los IR presentaron mayor circunferencia de cintura (CC), índice de masa corporal (IMC) y concentraciones basales de AGL. No hubo diferencias en los pliegues cutáneos ni en los otros lípidos. Los valores elevados de AGL parecieron relacionarse con la IR asociada al IMC y no a la obesidad central puesto que una vez apareados por CC, la diferencia en los valores de AGL entre IR y no-IR desapareció. Después de la sobrecarga glucosada los AGL disminuyeron en ambos grupos, pero permanecieron significativamente elevados en los IR. Esta diferencia desapareció al aparear por IMC o CC. Los AGL estuvieron significativamente asociados a HOMA-IR, glucemia y TG, sin embargo no se encontró asociación con IMC o CC. Estos hallazgos, más la falta de elementos que apoyen la presencia de IR hepática, común en un incremento de la lipólisis visceral, sugieren que la IR presente en estos individuos obesos pueda ser debida a incremento de la grasa subcutánea.