Influence of enlarged waist circumference and hypertriglyceridemia in the severity of acute pancreatitis: A retrospective study / Influencia del aumento de la circunferencia de la cintura y la hipertrigliceridemia en la gravedad de la pancreatitis aguda: un estudio retrospectivo

Introduction: Acute pancreatitis is a frequent inflammatory gastrointestinal disorder with high mortality rates in severe forms. An early evaluation of its severity is key to identify high-risk patients. This study assessed the influence of waist circumference together with hypertriglyceridemia on the severity of acute pancreatitis. Methods: A retrospective study was performed, which included patients admitted with acute pancreatitis from March 2014 to March 2021. Patients were classified into four phenotype groups according to their waist circumference and triglyceride levels: normal waist circumference and normal triglycerides; normal waist circumference and elevated triglycerides; enlarged waist circumference and normal triglycerides; and enlarged waist circumference and triglycerides, namely hypertriglyceridemic waist (HTGW) phenotype. Clinical outcomes were compared among the groups. Results: 407 patients were included. Systemic inflammatory response syndrome (SIRS) and intensive care unit admission were most frequent among patients in the HTGW phenotype group, at 44.9% and 8.2%, respectively. The incidence of local complications was higher in the normal waist circumference with elevated triglycerides group (27%). On multivariable analysis, an enlarged waist circumference was related to an increase of 4% and 2% in the likelihood of developing organ failure and SIRS, respectively. Hypertriglyceridemia was an independent risk factor for both organ failure and local complications. Conclusions: HTGW phenotype was significant related to developing of SIRS. It seems that an enlarged waist circumference has a greater role than hypertriglyceridemia in the development of SIRS. Obesity and hypertriglyceridemia were both independent risk factors for organ failure. Patients with hypertriglyceridemia were more likely to develop local complications. (AU)

Introducción: La pancreatitis aguda es una patología frecuente con altas tasas de mortalidad en sus formas graves. Este estudio evaluó la influencia de la circunferencia de la cintura (CC) junto con la hipertrigliceridemia en la gravedad de la pancreatitis aguda. Métodos: Se realizó un estudio retrospectivo que incluyó pacientes con pancreatitis aguda desde 2014 hasta 2021. Los pacientes se clasificaron en cuatro grupos fenotípicos según su CC y los niveles de triglicéridos: CC normal y triglicéridos normales, CC normal y triglicéridos elevados, CC aumentada y triglicéridos normales, y CC aumentada y triglicéridos elevados, es decir, el fenotipo cintura hipertrigliceridémica (HTGW). Resultados: Se incluyeron 407 pacientes. El síndrome de respuesta inflamatoria sistémica (SIRS) y la admisión a la unidad de cuidados intensivos fueron más frecuentes entre los pacientes con fenotipo HTGW, en 44,9 y 8,2%, respectivamente. La incidencia de complicaciones locales fue mayor en el grupo de CC normal con triglicéridos elevados (27%). En el análisis multivariable, una CC aumentada se relacionó con un aumento de 4 y 2% en la probabilidad de desarrollar fallo orgánico y SIRS, respectivamente. La hipertrigliceridemia fue un factor de riesgo tanto para el fallo orgánico como para las complicaciones locales. Conclusiones: El fenotipo HTGW se relacionó con el desarrollo de SIRS. Parece que una CC aumentada tiene un papel más importante que la hipertrigliceridemia en el desarrollo de SIRS. La obesidad y la hipertrigliceridemia fueron factores de riesgo independientes para el fallo orgánico. Los pacientes con hipertrigliceridemia tenían más probabilidades de desarrollar complicaciones locales. (AU)

Actividad física, adiposidad corporal y presión arterial como parámetros de riesgo para la salud en individuos con discapacidad intelectual / Physical activity, body adiposity and blood pressure as risk parameters for health in individuals with intellectual disability

Introducción: Se han reportado niveles bajos de actividad física (AF) y altos de obesidad en individuos con discapacidad intelectual (DI), asociado a múltiples barreras a las que se enfrentan para acceder a instalaciones deportivas o programas de ejercicio ubicándolas en una situación de vulnerabilidad ymayor riesgo de posible enfermedad cardiovascular (EVC). Objetivo: analizar el nivel de AF, la adiposidad corporal y la presión arterial en individuos con DI que acuden a un centro de capacitación ocupacional. Métodos: Se conformó una muestra de 11 hombres y 7 mujeres con edades comprendidas entre los 18 a los 60 años. Se obtuvieron datos de niveles de AF, así como de me-diciones del índice de masa corporal (IMC), circunferencia dela cintura (CC), índice cintura-talla (ICT) y presión arterial. Resultados: Las mujeres obtuvieron mayores resultadosen los indicadores de adiposidad mientras que los hombresobtuvieron una presión arterial mayor, todas las variables sindiferencias significativas. Seguidamente, las mujeres presen-taron valores considerados de riesgo para la CC, IMC e ICT,en tanto que los hombres en la CC y el ICT. Por último, tantomujeres como varones presentaron niveles de AF bajos. Conclusión: Gran parte de los individuos exhiben altera-ción en los marcadores de adiposidad estudiados, sobre todoa nivel central y más aún en las mujeres, así como uno nivelde AF muy pobre por lo que ambos parámetros podrían contribuir al desarrollo de ECV (AU)

Introduction: Low levels of physical activity (PA) and highlevels of obesity have been reported in individuals with intellectual disabilities (ID), associated with the multiple barriers they face in accessing sports facilities or exercise programs, placing them in a situation of vulnerability and increased riskof possible cardiovascular disease (CVD). Objective: to analyze the leve lof PA, body adiposity, andblood pressure in individuals with ID who attend an occupational training center. Methods: A sample of 11 men and 7 women aged between 18 and 60 years was formed. Data were obtained on PA levels, as well as measurements of body mass index(BMI), waist circumference (WC), waist-to-height ratio (WHR)and blood pressure. Results: Women obtained higher results in adiposity indi-cators while men obtained higher blood pressure, all variables without significant differences. Next, women presented val-ues considered at risk for CC, BMI and BTI, while men pre-sented values considered at risk for CC and BTI. Finally, bothwomen and men had low levels of PA. Conclusion: Most of the individuals showed alterations inthe adiposity markers studied, especially at the central leveland even more so in women, as well as a very poor level ofPA, so that both risk factors could contribute to the development of CVD (AU)

Relación del consumo de calcio con el síndrome metabólico en adultos de la Amazonía Ecuatoriana / Relationship of calcium consumption with metabolic syndrome in adults from the Ecuadorian Amazon

Introducción. El Síndrome Metabólico (SM) comprende un conjunto de factores de riesgo cardiometabólico representado por obesidad central, dislipidemia, hipertensión arterial y glucosa alterada, se ha evidenciado que el consumo adecuado de calcio representa una disminución del riesgo para este síndrome. Objetivo. Analizar la relación entre el consumo de calcio total, de origen animal y vegetal con el SM y sus indicadores. Materiales y métodos. Estudio transversal de eje correlacional, con una muestra de 100 adultos de la región amazónica ecuatoriana, durante el último trimestre del 2020. La ingesta dietética de calcio se determinó mediante un recordatorio de 24 horas y el SM según los criterios de Adult Treatment Panel-IV (ATP-IV). Resultados. La población estuvo conformada por adultos maduros (40 a 60 años) que evidenciaron una ingesta de calcio deficiente (182,50 mg y 228,60 mg en mujeres y hombres respectivamente). Se evidenció, además, una relación directamente proporcional entre la circunferencia abdominal (r=0,391 ­ p=0,000), presión arterial sistólica (r=0,290 ­ p=0,000) y glucosa en ayuno (r=0,326 ­ p=0,000) con la edad. La ingesta de calcio total se relacionó positivamente con los triglicéridos, (r=0,221 ­ p=0,027). Conclusiones. La ingesta dietética de calcio en ambos sexos no alcanza el requerimiento diario y se relaciona positivamente con los triglicéridos(AU)

Introduction. The Metabolic Syndrome (MS) comprises a set of cardiometabolic risk factors represented by central obesity, dyslipidemia, high blood pressure and altered glucose, it has been shown that adequate calcium intake represents a decreased risk for this syndrome. Objective. To analyze the relationship between the consumption of total calcium, animal and vegetable origin, with MS and its indicators. Materials and methods. Cross-sectional study of correlational axis, with a sample of 100 adults from the Ecuadorian Amazon region, during the last quarter of 2020. Dietary calcium intake was determined through a 24-hour recall and the diagnosis of MS according to the Adult Treatment Panel- IV (ATP-IV) criteria. Results. The population consisted of mature adults (40 to 60 years) who showed a deficient calcium intake in both sexes (182.50 mg and 228.60 mg in women and men respectively). There is also evidence of a directly proportional relationship between abdominal circumference (r=0.391 - p=0.000), systolic blood pressure (r=0.290 - p=0.000) and fasting glucose (r=0.326 - p=0.000) with age. Total calcium intake was positively related to triglycerides (r=0.221 ­ p=0.027). Conclusions. Calcium dietary intake in both sexes does not reach the daily requirement and is positively related to triglycerides(AU)

Relationship between abdominal and neck fat with sleep disorders in obese patients / Relação entre gordura abdominal e do pescoço com distúrbios do sono em pacientes obesas

Abstract Introduction Obesity is one of the main public health problem worldwide and it has a negative short- and long-term relationship with women's health. Assessment of this disorder is essential, as is a body composition assessed by dual-energy X-ray absorptiometry (DXA) with the new region of interest as the neck. Objective To verify the association between abdominal and neck fat with sleep quality in obese women. Methods The sample, obtained from a Biomedical Engineering and Health Program database, was characterized by being obese female aged between 20 and 65 years. The tests performed were anthropometric assessment, sleep quality questionnaire, physical activity level, nutritional assessment, and body composition by dual-energy X-ray absorptiometry (DXA). For statistical analysis, the Shapiro-Wilk test, t test for independent samples, Kendall's Tau, linear and multiple regression and ROC curve were used. Results The sample consisted of 15 individuals with a mean age of 45 ± 11.10 years, neck circumference of 41.50 ± 2.61 and abdominal circumference of 128.20 ± 11.62. We found no correlation between the regions of interest and the sleep quality questionnaire. Regression analysis shows non-significant statistical values for abdominal fat. The statistical test proved that the new region of interest in abdominal fat is closer to better sensitivity and has a greater relationship with sleep quality. Conclusion there was no statistically significant correlation between the regions of interest and the sleep quality questionnaire. However, the abdominal fat region of interest was the point that presented the best association with sleep quality assessed by the Pittsburgh questionnaire.

Resumo Introdução A obesidade é um dos principais problemas de saúde pública em todo o mundo e tem uma relação negativa de curto e longo prazo com a saúde da mulher. A avaliação desse distúrbio é essencial, assim como a composição corporal avaliada por absorciometria de raios X de dupla energia (DXA), com a nova região de interesse como o pescoço. Objetivo Verificar a associação da gordura abdominal e cervical com a qualidade de sono em mulheres obesas. Métodos A amostra, obtida de um banco de dados do Programa de Engenharia Biomédica e Saúde, caracterizou-se por mulheres obesas com idade entre 20 e 65 anos. Os testes realizados foram avaliação antropométrica, questionário de qualidade do sono, nível de atividade física, avaliação nutricional e composição corporal por dual-energy X-ray absorptiometry (DXA). Para análise estatística, foram utilizados o teste de Shapiro-Wilk, teste t para amostras independentes, Tau de Kendall, regressão linear e múltipla, e curva ROC. Resultados A amostra foi composta por 15 indivíduos com idade média de 45 ± 11,10 anos, circunferência do pescoço de 41,50 ± 2,61 e circunferência abdominal de 128,20 ± 11,62. Não encontrou-se correlação entre as regiões de interesse e o questionário de qualidade do sono. A análise de regressão mostrou valores estatísticos não significativos para a gordura abdominal. O teste estatístico comprovou que a nova região de interesse na gordura abdominal está mais próxima de melhor sensibilidade e tem maior relação com a qualidade do sono. Conclusão Não houve correlação estatisticamente significativa entre as regiões de interesse e o questionário de qualidade do sono. A região de gordura abdominal de interesse, no entanto, foi o ponto que apresentou melhor associação com a qualidade do sono avaliada pelo questionário de Pittsburgh.

Baru nuts reduce abdominal adiposity in type 2 diabetic adults: a randomized, placebo-controlled, crossover trial / Amêndoa de baru reduz a adiposidade abdominal de adultos com diabetes Mellitus tipo 2: um estudo randomizado, placebo-controlado, crossover

ABSTRACT Objective: This study aimed to evaluate the effect of baru nuts supplementation on body composition and metabolic profile in adults with type 2 diabetes. Methods: This is a randomized, placebo-controlled, crossover trial with 30 adults with type 2 diabetes. The assay had two periods of 12 weeks each, with a washout period of 12 weeks between treatments. The subjects were randomized and received the two treatments in alternate periods: supplementation of 30g baru nuts or placebo. Anthropometry, body composition, blood pressure, blood sampling, food intake, and physical activity data were analyzed. Results: Baru nut intake reduced waist circumference (p=0.032), compared to placebo group. In the intra-group analysis, baru nut intake reduced total cholesterol (p=0.012) and LDL-c (p=0.017). Conclusion: The daily intake of baru nuts improved abdominal adiposity. Therefore, these nuts should be included in the diet to improve the health status of adults with type 2 diabetes.

RESUMO: Objetivo: Avaliar o efeito da suplementação com amêndoa de baru sobre a composição corporal e perfil metabólico de adultos com diabetes Mellitus tipo 2. Métodos: Este é um estudo randomizado, placebo-controlado, crossover com 30 adultos com diabetes Mellitus tipo 2. O ensaio clínico foi dividido em dois períodos de 12 semanas cada, com um washout de 12 semanas entre os tratamentos. Os sujeitos foram randomizados e receberam dois tratamentos em períodos alternativos: suplementação com 30 g de amêndoa de baru ou placebo. Foram coletados dados referentes à antropometria, composição corporal, pressão arterial, amostras de sangue, ingestão de alimentos e práticas de atividade física. Resultados: A ingestão de amêndoa de baru reduziu a circunferência da cintura (p=0,032), em comparação com o grupo placebo. Na análise intragrupo, a ingestão de amêndoa de baru também reduziu o colesterol total (p=0,012) e LDL-c (p=0,017). Conclusão: A ingestão diária de amêndoa de baru melhorou a adiposidade abdominal, portanto, deve ser incluída na dieta para a melhora do estado de saúde de adultos com diabetes Mellitus tipo 2.

Anthropometric indicators of adiposity as predictors of systemic arterial hypertension in older people: a cross-sectional analysis / Indicadores antropométricos de adiposidade como preditores de hipertensão arterial sistêmica em pessoas idosas: uma análise transversal

ABSTRACT Objective: To analyze the association of anthropometric indicators of adiposity in older people, according to sex, with hypertension; to compare the scores of these variables between participants with and without hypertension; and to identify among them those with better predictive ability for screening the outcome. Methods: Epidemiological, population-based, cross-sectional study conducted with 210 older people. The anthropometric indicators analyzed were: body mass index, waist circumference, abdominal circumference, body adiposity index, triceps skinfold, waist-to-hip ratio, waist-to-height ratio, and conicity index. Hypertension diagnosis was self-reported. Results: The indicators of adiposity increased the probability of hypertension. Additionally, hypertensive older people of both sexes showed higher scores on adiposity indicators than non-hypertensive subjects (p < 0.05). For men, the most sensitive indicator for the outcome was conicity index (81.82%; cut-off point: 1.30) and the most specific was body mass index (69.77%; cut-off point: 25.05 kg/m2). For women, the most sensitive indicator for the outcome was the body adiposity index (86.08%; cut-off point: 31.03%), and the most specific was the abdominal circumference (82.82%; cut-off point: 98.70 cm). Conclusion: In both sexes, the indicators of adiposity were positively associated with hypertension; hypertensive participants showed higher values in the scores of the indicators. Additionally, the body adiposity index (women) and conicity index (men) demonstrated greater ability to screen for hypertension, while the abdominal circumference and body mass index demonstrated greater ability to screen for non-hypertensive women and men, respectively.

RESUMO Objetivo: Analisar a associação de indicadores antropométricos de adiposidade com a hipertensão, em pessoas idosas, de acordo com o sexo; comparar os escores dessas variáveis entre os participantes com e sem hipertensão; e identificar os indicadores com melhor capacidade preditiva à triagem do desfecho. Métodos: Estudo epidemiológico, populacional, transversal, realizado com 210 pessoas idosas. Os indicadores antropométricos analisados foram: índice de massa corporal, circunferência da cintura, circunferência abdominal, índice de adiposidade corporal, dobra cutânea tricipital, relação cintura/quadril, relação cintura/altura e índice de conicidade. O diagnóstico de hipertensão arterial foi autorreferido. Resultados: Observou-se que os indicadores de adiposidade aumentaram a probabilidade à hipertensão. Além disso, as pessoas idosas hipertensas, de ambos os sexos, apresentaram maiores escores nos indicadores de adiposidade quando comparadas às não hipertensas (p < 0,05). Para os homens, o indicador mais sensível ao desfecho foi o índice de conicidade (81,82%; ponto de corte: 1,30) e o mais específico foi o índice de massa corporal (69,77%; ponto de corte: 25,05 kg/m2). Nas mulheres, o indicador mais sensível ao desfecho foi o índice de adiposidade corporal (86,08%; ponto de corte: 31,03%) e o mais específico foi a circunferência abdominal (82,82%; ponto de corte: 98,70 cm). Conclusão: Em ambos os sexos, os indicadores de adiposidade mostraram-se positivamente associados à hipertensão; os participantes hipertensos apresentaram valores mais elevados nos escores dos indicadores. Ademais, identificou-se para os sexos, feminino e masculino, que os indicadores com melhor capacidade de rastrear a hipertensão, foram, respectivamente, o índice de adiposidade corporal e índice de conicidade. Enquanto a circunferência abdominal e o índice de massa corporal mostraram maior capacidade de rastrear, respectivamente, as mulheres e os homens não hipertensos.

Estado nutricional como preditor de qualidade de vida em pacientes em hemodiálise / Nutritional status as predictor of quality of life in patients undergoing hemodialysis / Estado nutricional como predictor de calidad de vida en pacientes en hemodiálisis

Objetivo: avaliar a associação entre qualidade de vida e estado nutricional de pacientes em hemodiálise, segundo medidas antropométricas e bioquímicas. Métodos: estudo transversal realizado com 1.024 pacientes de 11 centros de hemodiálise de uma região metropolitana da região sudeste do Brasil. Resultados: por meio da regressão linear múltipla, foram identificados os preditores nutricionais de cada domínio da qualidade de vida. Destacamos a albumina sérica, o Índice de Massa Corporal (IMC) e a circunferência da cintura, dentre as medidas associadas tanto a saúde física quanto a mental desta população. Conclusão: a inadequação do estado nutricional está associada a pior qualidade de vida física e mental de indivíduos em hemodiálise. Além do monitoramento do estado nutricional, a avaliação nutricional prediz a qualidade de vida e torna-se uma ferramenta fundamental para um melhor desfecho de saúde, uma vez que a baixa qualidade de vida é um dos principais problemas desta população.

Objective: to evaluate the association between quality of life and nutritional status of hemodialysis patients, according to anthropometric and biochemical measurements. Methods: cross-sectional study conducted with 1,024 patients from 11 hemodialysis centers in a metropolitan region of southeastern Brazil. Results: through multiple linear regression, the nutritional predictors of each domain of quality of life were identified. We highlight serum albumin, Body Mass Index (BMI) and waist circumference, among the measures associated with both physical and mental health in this population. Conclusion: inadequate nutritional status is associated with worse physical and mental quality of life in hemodialysis individuals. In addition to monitoring the nutritional status, nutritional assessment predicts quality of life and becomes a fundamental tool for a better health outcome, since low quality of life is one of the main problems in this population.

Objetivo: evaluar la asociación entre calidad de vida y estado nutricional de pacientes en hemodiálisis, según medidas antropométricas y bioquímicas. Métodos: estudio transversal realizado con 1.024 pacientes de 11 centros de hemodiálisis de una región metropolitana del sureste de Brasil. Resultados: mediante regresión lineal múltiple, se identificaron los predictores nutricionales de cada dominio de la calidad de vida. Destacamos la albúmina sérica, el índice de masa corporal (IMC) y la circunferencia de la cintura, entre las medidas asociadas a la salud tanto física como mental en esta población. Conclusión: el estado nutricional inadecuado se asocia con una peor calidad de vida física y mental en los individuos en hemodiálisis. Además de monitorear el estado nutricional, la evaluación nutricional predice la calidad de vida y se convierte en una herramienta fundamental para un mejor resultado de salud, ya que la baja calidad de vida es uno de los principales problemas en esta población.

Cardiometabolic risk profile in relation to the practice of healthy habits in a sample of Spanish workers

Insulin resistance is a pathological entity that can lead to alterations in lipid metabolism and can increase cardiovascular risk. Objective. The aim of this study was to assess the influence of different sociodemographic variables such as age, sex and social class and healthy habits such as smoking, physical activity and adherence to the Mediterranean diet on the cardiometabolic profile of Spanish workers. Material and methods. A descriptive, cross-sectional study was carried out in 1457 Spanish workers in an attempt to evaluate the effect of healthy habits (physical exercise determined with the IPAQ questionnaire, Mediterranean diet and tobacco consumption) and sociodemographic variables (age, sex and social class) on the values of different insulin resistance scales. Results. The progressive increase in the level of physical activity and high adherence to the Mediterranean diet achieved an improvement in the mean values and in the prevalence of elevated values in all the insulin resistance scales analyzed in this study. Age over 50 years and belonging to the least favored social classes (social classes II-III) were the variables that increased the risk of presenting insulin resistance. Male sex also increased the risk of presenting insulin resistance. Conclusions. The different healthy habits such as vigorous physical exercise and high adherence to the Mediterranean diet improve the values of the different scales that assess insulin resistance(AU)

La resistencia a la insulina es una entidad patológica que puede provocar alteraciones en el metabolismo de los lípidos y puede aumentar el riesgo cardiovascular. Objetivo. En este trabajo se pretende valorar la influencia de diferentes variables sociodemográficas como la edad, el sexo y la clase social y hábitos saludables como el consumo de tabaco, la actividad física y la adherencia a la dieta mediterránea en el perfil cardiometabólico de trabajadores españoles. Material y métodos. Se realizó un estudio descriptivo y transversal en 1457 trabajadores españoles intentando evaluar el efecto de los hábitos saludables (ejercicio físico determinado con el cuestionario IPAQ, dieta mediterránea y consumo de tabaco) y las variables sociodemográficas (edad, sexo y clase social) sobre los valores de diferentes escalas de resistencia a la insulina. Resultados. El aumento progresivo del nivel de actividad física y la alta adherencia a la dieta mediterránea consiguieron una mejoría en los valores medios y en la prevalencia de los valores elevados en todas las escalas de resistencia a la insulina analizadas en este estudio. La edad por encima de los 50 años y la pertenencia a las clases sociales menos favorecidas (clases sociales II-III) fueron las variables que aumentaron el riesgo de presentar resistencia a la insulina. El sexo masculino también incrementó el riesgo de presentar resistencia a la insulina. Conclusiones. Los diferentes hábitos saludables como el ejercicio físico vigoroso y la alta adherencia a la dieta mediterránea mejoran los valores de las diferentes escalas que valoran resistencia a la insulina(AU)

Adherence to antiretroviral therapy and changes in body composition in people living with HIV and AIDS / Adesão a terapia antirretroviral e alterações da composição corporal em pessoas vivendo com HIV/AIDS

Introduction: The successful treatment of human immunodeficiency virus (HIV) infection depends on adherence to antiretroviral therapy. Since the development of ART, there has been a significant increase in the survival of people living with HIV/AIDS. However, in the same way that it works in a positive way, the antiretroviral therapy has side effects that ultimately influence the rate of adherence to drug treatment. Objective: Evaluate adherence to antiretroviral therapy (ART) and changes in the body composition of adults diagnosed with HIV/AIDSon ART for at least 12 months. Methods: A cross-sectional study was conducted at an outpatient clinic for infectious-parasitic diseases at a teaching hospital that is a reference in the treatment of people living with HIV/ AIDS. Socio-demographic and clinical data were collected from medical records. Weight, height, body mass index (BMI) and abdominal circumference (AC) were recorded. Bioelectrical impedance analysis was performed using the tetrapolar protocol to assess body composition. The "Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral" was used to investigate adherence to ART. Results: Sixty-one patients (27 women and 33 men) participated in the study. Most were more than 40 years of age and were classified as overweight based on BMI. Most patients (86.8%) had been using ART for more than five years and 78.6% were classified as sedentary. Among the patients with an adequate AC, 82.3% were men. Among the 11 patients with low adherence to ART, 90.9% were men. Among the 33 with strict adherence, 69.6% were women. Mean percentage of fat mass was 28.63% among the men, and 40.82% among the women. Conclusion: Strict adherence to ART was seen in more than half of the study population. Women had more side effects from ART, as this group hadgreater adherence to treatment. The findings underscore the relationship between high rates of adherence to ART and changes in body composition, such as increased fat deposition and risk of associated diseases.

Introdução: O sucesso do tratamento da infecção pelo vírus da imunodeficiência humana (HIV) depende da adesão à terapia antirretroviral (TARV). Desde o desenvolvimento da TARV, houve aumento significativo da sobrevida das pessoas que vivem com HIV/Síndrome da Imunodeficiência Adquirida (AIDS). Porém, da mesma forma que atua de modo positivo, a terapia antirretroviral possui efeitos colaterais que acabam influenciando a taxa de adesão terapêutica ao tratamento medicamentoso. Esses efeitos incluem significativas alterações na composição corporal, resistência à insulina e dislipidemias. Objetivo: Avaliar a adesão à terapia antirretroviral e descrever alterações na composição corporal de adultos com diagnóstico de HIV/AIDS que usaram terapia antirretroviral por no mínimo 12 meses. Métodos: Estudo transversal realizado em um ambulatório de doenças infectoparasitárias em Hospital Universitário, referência no tratamento de pessoas que vivem com HIV/AIDS. Verificou-se dados sociodemográficos e clínicos nos prontuários. Foram registrados peso, altura, índice de massa corporal (IMC) e circunferência abdominal (CA). Realizou-se a bioimpedância segundo o protocolo da técnica tetrapolar para avaliação da composição corporal. Para avaliar a adesão terapêutica foi usado o Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral. Resultados: Foram estudados 61 pacientes, 27 mulheres e 34 homens; a maior parte tinha acima de 40 anos e IMC classificado como sobrepeso. A maioria dos pacientes (86,8%) usavam TARV há mais de cinco anos e 78,6% se autodeclararam sedentários. Do total de pacientes que apresentaram circunferência abdominal adequada, 82,3% eram homens. Dos 11 pacientes que se classificaram como baixa adesão à TARV, 90,9% eram homens, e dos 33 que se classificaram como estritamente aderentes, 69,6% eram mulheres. Os homens apresentaram 28,63% de média de porcentual de massa gorda (%MG), enquanto as mulheres apresentaram 40,82%. Conclusão: A adesão estrita à TARV foi vista em mais da metade da população estudada. As mulheres apresentaram mais efeitos colaterais oriundos da TARV, visto que este grupo mostrou uma adesão maior ao tratamento. Isso reforça a relação entre altas taxas de adesão à terapia medicamentosa e alterações na composição corporal, como o aumento da deposição de gordura e riscos de doenças associadas.

Estilos de vida y estado nutricional en el personal militar sanitario durante la COVID-19 / Lifestyles and nutritional status in military health personnel during COVID-19

Introducción: El personal militar sanitario posee características laborales y factores propios de la vida militar, que los predisponen a alterar sus estilos de vida, más aún con las medidas restrictivas que se establecen por la emergencia sanitaria de la COVID-19. Objetivo: Determinar la asociación entre los estilos de vida y el estado nutricional del personal militar sanitario. Métodos: El estudio fue transversal, la muestra estuvo conformada por 104 profesionales sanitarios militares que laboran en el Hospital Militar Central. Se aplicó el Cuestionario de Estilos de Vida de Arrivillaga, Salazar y Gómez; se pesó y talló a los sujetos, para obtener el índice de masa corporal, también se obtuvo la medida del perímetro abdominal, que indicó el riesgo cardiometabólico, se realizó el análisis descriptivo, bivariado (prueba de ji cuadrado) y multivariado para obtener razones de prevalencia. Resultados: Se evidenció asociación entre estilo de vida poco saludable con el índice de masa corporal (razón de prevalencia = 15,467; IC 95 por ciento: 2,228 - 107,357: p < 0,001) de igual manera cuando fue ajustado para las variables edad, sexo, profesión y grado militar (razón de prevalencia ajustado =18,515; IC 95 por ciento: 2,98 - 114,913: p < 0,001). Conclusiones: Se concluye que existe asociación entre el estilo de vida y el estado nutricional, determinado por el IMC y el PA en el personal militar sanitario estudiado(AU)

Introduction: Military health personnel have work characteristics and factors inherent to military life that predispose them to alter their lifestyles, even more so with the restrictive measures that were established by the health emergency of COVID-19. Objective: To determine the association between lifestyles and nutritional status of military health personnel. Methods: The study was cross-sectional, the sample consisted of 104 military health professionals who work in the Central Military Hospital. The Lifestyle Questionnaire of Arrivillaga, Salazar and Gómez was applied; subjects were weighed and carved to obtain the body mass index, the measurement of the abdominal perimeter was also obtained, which indicated the cardiometabolic risk, the descriptive, bivariate analysis (chi-square test) and multivariate analysis was performed to obtain prevalence ratio values. Results: The association between "unhealthy" lifestyle with the Body Mass Index (prevalence ratio = 15,467; 95 percent CI: 2,228-107,357: p < 0,001) was evidenced in the same way when it was adjusted for the variables age, sex, profession and military rank (adjusted prevalence ratio = 18,515; 95 percentCI: 2,98-114,913: p < 0,001). Conclusions: There is an association between lifestyle and nutritional status determined by body mass index and abdominal circumference in military health personnel(AU)

Relación entre la actividad física vigorosa y la composición corporal en adultos mayores / Relationship between vigorous physical activity and body composition in older adults

OBJETIVO: el objetivo del presente estudio fue analizar las relaciones entre la actividad física vigorosa y la composición corporal en personas mayores que asistían a centros de atención primaria. MATERIAL Y MÉTODOS: este estudio se caracteriza por ser un estudio epidemiológico descriptivo y transversal de 654 adultos mayores (288 hombres y 366 mujeres), la mayoría de ellos de 60 a 69 años (59 %), que asistían a centros de atención primaria en la ciudad de Maringá, Brasil. Los participantes fueron evaluados con el Cuestionario Internacional de Actividad Física (IPAQ), mediciones antropométricas y un cuestionario sociodemográfico para caracterizar la muestra. RESULTADOS: los ancianos que practican actividad física en los centros de atención primaria con intensidad vigorosa presentan mediciones más bajas de circunferencia abdominal, cintura, cadera, cuádriceps y pantorrilla en comparación con las personas mayores que practican actividad física de baja a moderada intensidad. CONCLUSIONES: la práctica de actividad física vigorosa está relacionada con bajos perímetros corporales (abdominal, cadera, cintura, pantorrilla) en las personas adultas mayores atendidas en centros de atención primaria

OBJECTIVE: the objective of the present study was to analyze the relationship between vigorous physical activity and body composition in older people who attend primary care centers. MATERIAL AND METHODS: this study is characterized by being a descriptive, cross-sectional epidemiological study in 654 older adults (288 men and 366 women), most of them between 60 and 69 years of age (59 %), attending primary care centers in the city of Maringá, Brazil. The participants were evaluated using the International Physical Activity Questionnaire (IPAQ), anthropometric measurements, and a sociodemographic questionnaire to characterize the sample. RESULTS: older adults who practice physical activities in primary care centers with vigorous intensity are associated with lower abdominal circumference, waist, hip, quadriceps, and calf measurements when compared to older people with low or moderate levels of physical activity. CONCLUSIONS: the practice of vigorous physical activity is related to low body perimeters (abdominal, hip, waist, calf) in older adults who attend primary care centers

Nutritional knowledge, anthropometric profile, total cholesterol and motivations in vegetarians and non-vegetarians

BACKGROUND: Research often reports on the anthropometric and biochemical profile of vegetarians and non-vegetarians, yet few have compared nutritional knowledge in both populations. This cross-sectional study compared nutritional knowledge, anthropometric profile and total cholesterol in vegetarians and non-vegetarians. In addition, the motivations for choosing a vegetarian diet were analyzed. METHODS: A registry card and a questionnaire were administered to evaluate sociodemographic, anthropometric, total cholesterol, nutritional knowledge and motivation data of the vegetarians. Data were analyzed using Chi-square and t-student tests, considering a significance level of 5%. RESULTS: No significant difference was found in the level of nutritional knowledge of the two groups. In addition, a sufficient score was not observed in either group (>80 %). Vegetarians had significantly lower average weight, body mass index (BMI) and waist circumference (WC) compared to non-vegetarians (59.948 ± 8,923 kg vs. 64.362 ± 12.272 kg, p = 0.017), (23.22 ± 3.026 kg/m2 vs. 25.152 ± 3,373 kg/m2, p < 0.01) and (78.435 ± 10.883 cm vs. 86.207 ± 13.662 cm, p < 0.01), respectively. Total cholesterol concentration was significantly lower in vegetarians (166.307 ± 26.139 mg/dL vs. 189.138 ± 38.451 mg/dL, p < 0.01). The "health benefits" were the main motivations to opt for vegetarianism (32.3%). CONCLUSIONS: Vegetarians presented a better anthropometric profile and lower levels of total cholesterol. However, there were no differences regarding knowledge levels. The highest proportion of vegetarian's report choosing the vegetarian lifestyle for health reasons

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Prevalencia de acantosis nigricans y factores asociados con el síndrome metabólico en Nobsa (Boyacá, Colombia) / Prevalence of Acanthosis Nigricans and Associated Factors to Metabolic Syndrome in Nobsa (Boyacá, Colombia) / Prevalência de acantose nigricans e fatores associados com a síndrome metabólica em Nobsa (Boyacá, Colômbia)

Introducción: El síndrome metabólico es un conjunto de anormalidades fisiológicas que manifiestan resistencia a la insulina, de la que se derivan complicaciones micro y macrovasculares de alto costo en salud. Objetivo: Estimar la prevalencia de la acantosis nigricans y los factores sociodemográficos asociados en una pobla-ción con síndrome metabólico del municipio de Nobsa (Boyacá, Colombia) en el periodo agosto de 2017-agosto de 2018. Método: Estudio transversal analítico en una muestra de 82 pacientes del programa de crónicos del municipio de Nobsa. Se recolectó información sobre la presencia o ausencia de acantosis nigricans en la exploración física, junto con medidas antropométricas, fototipo de piel y presión arterial; así como concentración sérica de glucosa en ayuno, creatinina y perfil lipídico. Los datos se analizaron mediante la prueba de chi cuadrado. Resultados: En una muestra de 82 pacientes con edad media de 62 años, de los cuales el 91 % fueron mujeres, se encontró una prevalencia de acantosis nigricans del 41,5 % con asociación estadísticamente significativa para niveles elevados de glucosa (p = 0,008) y un odds ratio de 3,75 (IC95 %: 1,3-10,2). Para las demás variables en estudio no se evidenció asociación con significancia estadística. Conclusiones: la acantosis nigricans es un signo clínico indicador de resistencia a la insulina y de niveles alterados de glucemia

Introduction: The metabolic syndrome is a set of physiological abnormalities that manifest insulin resistance, from which high cost micro- and macrovascular complications in health derive. Objective: To estimate the prevalence of acanthosis nigricans and the sociodemographic factors asso-ciated with the population with metabolic syndrome in the municipality of Nobsa (Boyacá, Colombia), from August 2017 to August 2018. Method: Analytical cross-sectional study in a sample of 82 patients from the Nobsa municipality chronic program. Information was collected on the presence or absence of acanthosis nigricans in the physical examination together with anthropometric measurements, skin phototype and blood pres-sure, as well as serum concentration of fasting glucose, creatinine, and lipid profile. The data were analyzed using the Chi square test. Results: In a sample of 82 patients with a mean age of 62 years, of which 91% were women, a pre-valence of acanthosis nigricans of 41.5% was found with a statistically significant association for high glucose levels (p = 0.008) and an Odds Ratio of 3.75 (95% CI: 1.3-10.2). For the other variables under study, no association with statistical significance was evidenced. Conclusions: Acanthosis nigricans is a clinical sign of insulin resistance and altered blood glucose levels

Introdução: A síndrome metabólica é um conjunto de anomalias fisiológicas que manifestam resis-tência à insulina, da qual derivam complicações micro e macro vasculares de alto custo em saúde. Objetivo: Estimar a prevalecia de acantose nigricans e os fatores sociodemográficos associados, a uma população com síndrome metabólica no município de Nobsa (Boyacá, Colômbia) no período de Agosto de 2017 ­ Agosto de 2018. Método: Estudo analítico transversal com uma amostra de 82 pacientes do Programa de crónicos no município de Nobsa. Foram recolhidas informações sobre a presença ou ausência de acantose nigri-cans no exame físico, juntamente com medições antropométricas, fotótipo de pele e pressão sanguí-nea; bem como a concentração sérica da glicose em jejum, creatinina e perfil lipídico. Os dados foram analisados utilizando o teste do qui-quadrado. Resultados: Uma amostra de 82 pacientes com idade meia de 62 anos, 91 % dos quais eram mulhe-res, foi identificada uma prevalência de acantose nigricans de 41,5 % com associação estatisticamente significativa para níveis elevadas de glicose (p = 0,008) e um odds ratio de 3,75 (IC95 %: 1,3-10,2). Para as outras variáveis em estudo, não foi evidenciada associação estatisticamente significativa. Conclusões: A acantose nigricans é um sinal clinico indicador de resistência à insulina e níveis eleva-dos de glicose no sangue

Fatores associados a medidas biométricas fetais pequenas para idade gestacional no Estudo MINA-Brasil / Factors associated with small-for-gestational-age fetal biometric measurements in the MINA-Brazil Study

Introdução - As elevadas taxas de mortalidade neonatal e a prevalência de bebês nascidos pequenos para idade gestacional (PIG) ainda apresentadas por regiões de baixa e média renda indicam a necessidade de investigação sobre fatores que influenciam o crescimento fetal. Medidas biométricas fetais

Introduction Elevated rates of neonatal mortality and small-for-gestational-age (SGA) babies in low- and middle-income regions indicate the need to investigate factors associated with fetal growth. Fetal biometric measurements below the 10th percentile for gestational age (GA) reflect failure in achieving growth potential and provide opportunities for prenatal interventions. Objective To investigate factors associated with fetal biometric measurements below the 10th percentile assessed at early third trimester among pregnant women in the MINA-Brazil study. Methods This was a prospective analysis of pregnant women living in the urban area of Cruzeiro do Sul (AC), followed up since the antenatal period. Screening of participants took place from February 2015 to January 2016. A sociodemographic and health history interview was carried out along with two clinical assessments, scheduled between the second and third trimesters of pregnancy, to collect data on lifestyle factors and complications during pregnancy, anthropometric evaluation, blood collection, and ultrasound scan assessing fetal biometric measurements of head circumference (HC), abdominal circumference (AC) and femoral length (FL). Poisson regression models with hierarchical selection of variables were fitted for factors associated with occurrence of fetal measurements below the 10th percentile at early third trimester. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were estimated. Results Among 426 participants (mean age 25 years (SD 6.4) and gestational age 27.8 weeks (SD 1.7)), 11.3%, 8.9% e 9.4% had fetuses with HC, AC, FL below the 10th percentile at early third trimester. Fetal biometric measurements below the 10th percentile were negatively associated with higher maternal education level, which denoted over 50% of protection (HC: PR 0.47, 95%CI 0.28; 0.81; AC: PR 0.48, 95%CI 0.26; 0.87; and FL: PR 0.48, 95%CI 0.27; 0.86). Adjusted for maternal education level, nulliparity (PR 1.94, 95%CI 1.10; 3.43), higher pre-gestational body mass index (BMI) (PR 1.06, 95%CI 1.01; 1.11), and pre-gestational alcohol consumption (PR 1.80, 95%CI 0.98; 3.30) were associated with HC measurements below the 10th percentile. Maternal height (p for trend 0.039) and pre-gestational alcohol consumption (PR 2.55, 95%CI 1.31; 4.96) were also associated with AC measurements below the 10th percentile. Association between higher average screen time per day during antenatal follow-up and FL measurements below the 10th percentile were observed as well (p for trend 0.031). Higher maternal education level, which may provide better material and non-material conditions, seems to protect fetal growth from failure to reach potential fetal size for GA. Positive associations observed with obstetric and antenatal conditions may be mediated by biological factors or gestational dysfunctions to incur in fetal measurements below the 10th percentile. Conclusion The occurrence of fetal biometric measurements below the 10th percentile for GA and their associated factors corroborate pre-pregnancy and antenatal care improvements anchored in equity policies, and for new strategies prior to birth that optimize the window of opportunity in the first thousand days of life.

Prevalência de sobrepeso e obesidade em idosas frequentadoras da Universidade Aberta da Terceira Idade ­ UATI / Prevalence of overweight and obesity in elderly people attending the Open University of the Elderly ­ UATI

Introdução: este artigo trata-se da prevalência de sobrepeso e obesidade em idosas frequentadoras da Universidade Aberta da Terceira Idade. Objetivo: avaliar as prevalências de sobrepeso e de obesidade associadas a fatores socioeconômicos e presença de comorbidades, em uma amostra de idosas não institucionalizadas de Salvador-BA, Brasil. Metodologia: um estudo transversal com uma amostra de 72 idosas com mais de 60 anos frequentadoras da Universidade Aberta da Terceira Idade (UATI) vinculada a Universidade Estadual da Bahia (UNEB). Foram aplicados questionários as participantes sobre aspectos pessoais, sócio-demográficos e presença de comorbidades. Resultados: os dados antropométricos avaliados foram o Índice de Massa Corporal (IMC) e da Circunferência da Cintura (CC). Associações entre as variáveis categóricas foram testadas utilizando o teste qui-quadrado com um nível de significância 5%. Observou-se que prevalência de sobrepeso e obesidade de acordo com o IMC foi de 34,48% e 24,14%, respectivamente e 86,54% dos idosos apresentaram um substancial aumento da circunferência abdominal. Verificou-se que 13,46% dos indivíduos eram diabéticos, 63,46% hipertensos. Conclusão: neste estudo não houve associação com significância estatística entre excesso de peso e renda ou presença de comorbidades (Diabete Melito e Hipertensão).

Introduction: the aim of this study was to evaluate the prevalence of overweight and obesity associated with socioeconomic factors and the presence of comorbidities, in a sample of non-institutionalized elderly women from Salvador-BA, Brazil. Metodology: crosssectional study was carried out with a sample of 72 elderly women over 60 years of age attending the Open University of the Third Age (UATI) linked to the State University of Bahia (UNEB). Questionnaires were applied to participants on personal, socio-demographic and presence of comorbidities. Results: the anthropometric data evaluated were the body mass index (BMI) and waist circumference (WC). Associations between categorical variables were tested using the chi-square test with a 5% significance level. It was observed that the prevalence of overweight and obesity according to the BMI was high (34.48% and 24.14%, respectively) and 86.54% of the elderly showed a substantial increase in waist circumference. It was found that 13.46% of the individuals were diabetic, 63.46% were hypertensive. Conclusion: It was observed that BMI was not significantly associated (p <0.05) with income or the presence of comorbidities (Diabetes Mellitus and Hypertension).

Fatores de risco cardiovascular em idosos de uma comunidade quilombola / Cardiovascular risk factors in the older adults of a quilombola community / Factores de riesgo cardiovascular en ancianos de una comunidad quilombola

Objetivo:descrever a frequência dos fatores de risco cardiovascular em idosos de uma comunidade quilombola. Método: estudo transversal desenvolvido com idosos quilombolas cadastrados na Estratégia Saúde da Família. A coleta foi realizada com uma amostra de 62 idosos, utilizando-se o teste do qui-quadrado para análise dos dados. Resultados: as frequências dos fatores de risco foram: 67,7% de hipertensão arterial, 54,8% de adiposidade abdominal, 22,6% de glicemia capilar elevada, 19,4% de excesso de peso, 3,2% de sedentarismo e 3,2% de tabagismo, com diferença estatística apenas para adiposidade abdominal em idosas de cor branca (p<0,05). Conclusão: o estudo identificou elevada frequência de fatores de risco cardiovasculares nos idosos quilombolas atendidos na atenção primária à saúde, com destaque para hipertensão arterial, adiposidade abdominal e glicemia capilar elevada. Os resultados apontam a necessidade de melhoria de acesso da comunidade quilombola aos serviços de saúde.

Objective: to describe the frequency of cardiovascular risk factors in the older adults of a quilombola community. Method: in this cross-sectional study of 62 older adults of a quilombo registered with Brazil's Family Health Strategy, the data collected were analyzed using the Chi-square test. Results: risk factor frequencies were: 67.7% for arterial hypertension; 54.8%, abdominal adiposity; 22.6%, high capillary blood glucose; 19.4%, overweight; 3.2%, sedentary lifestyle; and 3.2%, smoking. Statistical difference was observed only for abdominal adiposity in older, white women (p<0.05). Conclusion: this study identified a high frequency of cardiovascular risk factors in quilombola older adults treated in primary health care, particularly arterial hypertension, abdominal adiposity, and high capillary blood glucose. These results indicate the need to improve quilombola communities' access to health services.

Objetivo: describir la frecuencia de factores de riesgo cardiovascular en los adultos mayores de una comunidad quilombola. Método: en este estudio transversal de 62 adultos mayores de un quilombo inscrito en la Estrategia de Salud de la Familia de Brasil, los datos recolectados se analizaron mediante la prueba de Chi-cuadrado. Resultados: las frecuencias de los factores de riesgo fueron: 67,7% para la hipertensión arterial; 54,8%, adiposidad abdominal; 22,6%, glucemia capilar elevada; 19,4%, sobrepeso; 3,2%, sedentarismo; y 3,2%, tabaquismo. Se observó diferencia estadística solo para la adiposidad abdominal en mujeres blancas mayores (p<0,05). Conclusión: este estudio identificó una alta frecuencia de factores de riesgo cardiovascular en adultos mayores quilombolas tratados en atención primaria de salud, particularmente hipertensión arterial, adiposidad abdominal y glucemia capilar alta. Estos resultados indican la necesidad de mejorar el acceso de las comunidades quilombolas a los servicios de salud.

Riesgo de desarrollar diabetes tipo 2 según LA FINDRISC y enfermedad arterial periférica / Risk of developing type 2 diabetes according to LA FINDRISC and peripheral arterial disease

La diabetes mellitus tipo 2 (DM2) representa un problema de salud pública, debido a su alta incidencia y prevalencia en el mundo. Un método para evaluar el riesgo de desarrollar DM2 es la escala Latin American Finnish Diabetes Risk Score (LA FINDRISC). La DM2 es un factor de riesgo de enfermedad arterial periférica (EAP) la cual puede ser diagnosticada mediante el índice tobillo-brazo (ITB). Objetivo: evaluar la presencia y severidad de enfermedad arterial periférica mediante ITB y relacionarlo con el riesgo de desarrollar DM2 según LA FINDRISC. Métodos: estudio descriptivo, correlacional, de corte transversal. Se evaluaron 134 personas y se les midió glicemia capilar para descartar diabetes. Posteriormente, se realizó el LA FINDRISC y el ITB. Resultados: El puntaje LA FINDRISC y la glicemia alteradas en ayunas aumentaron proporcionalmente (R2=0,5). Esta relación no se observó entre LA FINDRISC y el ITB arrojado por la población general. Sin embargo, al seleccionar los pacientes con vasos no comprimibles aparece una correlación positiva (R2=0,36) entre los dos instrumentos diagnósticos. Conclusión: LA FINDRISC y el ITB son instrumentos de diagnósticos no invasivo, sencillos y válidos para detectar riesgo de desarrollar DM2, y detectar presencia y severidad de enfermedad arterial periférica, respectivamente(AU)

Type 2 diabetes mellitus (DM2) represents a public health problem, due to its high incidence and prevalence in the world. One method to assess the risk of developing DM2 is the Latin American Finnish Diabetes Risk Score (LA FINDRISC) scale. DM2 is a risk factor for peripheral arterial disease (PAD) which can be diagnosed using the ankle-brachial index (ABI). Objective: to evaluate the presence and severity of peripheral arterial disease using ABI and to relate it to the risk of developing DM2 according to LA FINDRISC. Methods: descriptive, correlational, cross-sectional study. 134 people were evaluated, and capillary glycemia was measured to rule out diabetes. Subsequently, the LA FINDRISC and the ITB were held. Results: The LA FINDRISC score and impaired fasting blood glucose increased proportionally (R2 = 0.5). This relationship was not observed between LA FINDRISC and the ITB showed by the general population. However, when selecting patients with non-compressible vessels, a positive correlation (R2 = 0.36) appears between the two diagnostic instruments. Conclusion: FINDRISC and ITB are simple and valid non-invasive diagnostic instruments to detect the risk of developing DM2, and detect the presence and severity of peripheral arterial disease, respectively(AU)

Comparative analysis of screening models for undiagnosed diabetes in Mexico / Análisis comparativo de modelos de cribado de la diabetes no diagnosticada en México

BACKGROUND: It is estimated that 37% of Mexican adults have undiagnosed diabetes, and are therefore at high risk of developing the severe and devastating complications associated to it. In recent years, a variety of screening tools based on the characteristics of the adult Mexican population have been proposed in order to reduce the negative effects of the disease. OBJECTIVES: To assess the performance of screening models to diagnose diabetes in the Mexican adult population and to propose a screening model based on HbA1c measurements. MATERIALS AND METHODS: Data from the 2016 Halfway National Health and Nutrition Survey (NHNS) were used to assess the screening models and to develop and validate the proposed 2016 NHNS model, built using a multivariate logistic regression model. Explanatory variables included in the 2016 NHNS 2016 model were selected through a stepwise backward procedure, using sensitivity and specificity as performance indicators. RESULTS: Of the screening models assessed, only the model based on the 2006 NHNS survey showed a performance consistent with previous reports. The proposed 2016 NHNS model included age, waist circumference, and systolic blood pressure as explanatory variables and showed a sensitivity of 0.72 and a specificity of 0.80 in the validation data set. CONCLUSIONS: Age, waist circumference, and systolic blood pressure are variables of special importance for early detection of undiagnosed diabetes in Mexican adults. Based on the consistent performance of the 2006 NHNS model in different data sets, its use as a screening tool for adults with undiagnosed diabetes in Mexico is recommended

ANTECEDENTES: Se estima que el 37% de adultos mexicanos que padecen diabetes no han sido diagnosticados, teniendo un alto riesgo de desarrollar las graves y devastadores complicaciones asociadas. En los últimos años, con el objetivo de reducir los efectos negativos de la enfermedad, se han propuesto herramientas de detección basadas en las características de la población adulta mexicana. OBJETIVOS: Evaluar el funcionamiento de los modelos de detección de diabetes no diagnosticada en la población adulta mexicana y proponer un modelo de detección basado en mediciones de HbA1c. MATERIAL Y MÉTODOS: Se utilizaron datos de la Encuesta Nacional de Salud y Nutrición (NHNS) de Medio Camino 2016 para evaluar los modelos de detección y para desarrollar y validar el modelo NHNS 2016, construido usando un modelo de regresión logística multivariada. Las variables incluidas en el modelo NHNS 2016 se seleccionaron mediante un procedimiento de pasos hacia atrás, utilizando la sensibilidad y la especificidad como indicadores de funcionamiento. RESULTADOS: De los modelos de detección evaluados, únicamente el modelo basado en la encuesta NHNS 2006 mostró un funcionamiento consistente con lo reportado anteriormente. Las variables seleccionadas para el modelo propuesto (NHNS 2016) fueron edad, circunferencia de cintura y presión sistólica como variables explicativas, mostrando una sensibilidad de 0,72 y una especificidad de 0,80 en el conjunto de datos de validación. CONCLUSIONES: Edad, circunferencia de cintura y presión sistólica son variables de relevancia especial para la detección temprana de diabetes no diagnosticada en adultos mexicanos. Dada la consistencia en el funcionamiento mostrado por el modelo NHNS 2006 en diferentes conjuntos de datos, se recomienda su uso como herramienta de detección de adultos con diabetes no diagnosticada en México