Changes in the global impact of COVID-19 on nuclear medicine departments during 2020: an international follow-up survey.

AIM: As a follow-up to the international survey conducted by the International Atomic Energy Agency (IAEA) in April 2020, this survey aims to provide a situational snapshot of the COVID-19 impact on nuclear medicine services worldwide, 1 year later. The survey was designed to determine the impact of the pandemic at two specific time points: June and October 2020, and compare them to the previously collected data. MATERIALS AND METHODS: A web-based questionnaire, in the same format as the April 2020 survey was disseminated to nuclear medicine facilities worldwide. Survey data was collected using a secure software platform hosted by the IAEA; it was made available for 6 weeks, from November 23 to December 31, 2020. RESULTS: From 505 replies received from 96 countries, data was extracted from 355 questionnaires (of which 338 were fully completed). The responses came from centres across varying regions of the world and with heterogeneous income distributions. Regional differences and challenges across the world were identified and analysed. Globally, the volume of nuclear medicine procedures decreased by 73.3% in June 2020 and 56.9% in October 2020. Among the nuclear medicine procedures, oncological PET studies showed less of a decline in utilization compared to conventional nuclear medicine, particularly nuclear cardiology. The negative impact was also significantly less pronounced in high-income countries. A trend towards a gradual return to the pre-COVID-19 situation of the supply chains of radioisotopes, generators, and other essential materials was evident. CONCLUSION: The year 2020 has a significant decrease in nuclear medicine diagnostic and therapeutic procedures as a result of the pandemic-related challenges. In June, the global decline recorded in the survey was greater than in October when the situation began to show improvement. However, the total number of procedures remained below those recorded in April 2020 and fell to less than half of the volumes normally carried out pre-pandemic.

Cardio-Metabolic Health Venezuelan Study (EVESCAM): Design and Implementation.

The EVESCAM (EstudioVenezolano de Salud Cardio-Metabólica) is the first national, population survey in Venezuela, designed to examine the prevalence of diabetes and cardio-metabolic risk factors and its relationship with lifestyle. It is a cross-sectional, cluster sampling study, which recruited 4454 participants aged ≥ 20 years. The data were collected in community health-care centers by trained health professionals and medical students. The data collected from each subject included, after informed consent, structured questionnaires (clinical, demographic, physical activity, nutritional and psychological), anthropometric measurements (weight, height and waist circumference), body fat by bioelectrical impedance, hand grip, blood pressure, electrocardiogram, and biochemical measurements (standard 75 g oral glucose tolerance test, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). The data will be used to estimate the prevalence of overweight, obesity, prediabetes, diabetes, hypertension, dyslipidemias, sarcopenia and metabolic syndrome; and to examine their relationships with lifestyle factors. The risk of coronary heart disease and impaired glucose regulation will be estimated using the Framingham Coronary Heart Disease Risk Score and the Latin America adaptation of the Finnish Diabetes Risk Score (LA-FINDRISC), respectively. These results will guide national cardiovascular and diabetes prevention strategies, and will be available for government agencies to help in the implementation of public health policies.

The diabetes care continuum in Venezuela: Cross-sectional and longitudinal analyses to evaluate engagement and retention in care.

The impact of the humanitarian crisis in Venezuela on care for noncommunicable diseases (NCDs) such as diabetes is unknown. This study aims to document health system performance for diabetes management in Venezuela during the humanitarian crisis. This longitudinal study on NCDs is nationally representative at baseline (2014-2017) and has follow-up (2018-2020) data on 35% of participants. Separate analyses of the baseline population with diabetes (n = 585) and the longitudinal population with diabetes (n = 210) were conducted. Baseline analyses constructed a weighted care continuum: all diabetes; diagnosed; treated; achieved glycaemic control; achieved blood pressure, cholesterol, and glycaemic control; and achieved aforementioned control plus non-smoking. Weighted multinomial regression models controlling for region were used to estimate the association between socio-demographic characteristics and care continuum stage. Longitudinal analyses constructed an unweighted care continuum: all diabetes; diagnosed; treated; and achieved glycaemic control. Unweighted multinomial regression models controlling for region were used to estimate the association between socio-demographic characteristics and changes in care continuum stage. Among 585 participants with diabetes at baseline, 71% were diagnosed, 51% were on treatment, and 32% had achieved glycaemic control. Among 210 participants with diabetes in the longitudinal population, 50 (24%) participants' diabetes management worsened, while 40 (19%) participants improved. Specifically, the proportion of those treated decreased (60% in 2014-2017 to 51% in 2018-2020), while the proportion of participants achieving glycaemic control did not change. Although treatment rates have declined substantially among people with diabetes in Venezuela, management changed less than expected during the crisis.

Impact of the complex humanitarian crisis on the epidemiology of the cardiometabolic risk factors in Venezuela.

BACKGROUND: The complex humanitarian crisis (CHC) in Venezuela is characterized by food insecurity, hyperinflation, insufficient basic services, and the collapse of the healthcare system. The evolution of the epidemiology of cardiometabolic risk factors in this context is unknown. AIM: To compile the last 20 years evidence on the prevalence of cardiometabolic risk factors in adults of Venezuela in the context of the CHC. METHODS: A comprehensive literature review of population-based studies of adults in Venezuela from 2000 to 2020. RESULTS: Seven studies (National EVESCAM 2014-2017, 3 regions VEMSOLS 2006-2010, Maracaibo city 2007-2010, Merida city 2015, Mucuchies city 2009, Barquisimeto city CARMELA 2003-2005, and Zulia state 1999-2001) with samples sizes ranging from 109 to 3414 subjects were included. Over time, apparent decrease was observed in smoking from 21.8% (2003-2005) to 11.7% (2014-2017) and for obesity from 33.3% (2007-2010) to 24.6% (2014-2017). In contrast, there was an apparent increase in diabetes from 6% (2003-2005) to 12.3% (2014-2017), prediabetes 14.6% (2006-2010) to 34.9% (2014-2017), and hypertension 24.7% (2003-2005) to 34.1% (2014-2017). The most prevalent dyslipidemia - a low HDL-cholesterol - remained between 65.3% (1999-2001) and 63.2% (2014-2017). From 2006-2010 to 2014-2017, the high total cholesterol (22.2% vs 19.8%, respectively) and high LDL-cholesterol (23.3% vs 20.5%, respectively) remained similar, but high triglycerides decreased (39.7% vs 22.7%, respectively). Using the same definition across all the studies, metabolic syndrome prevalence increased from 35.6% (2006-2010) to 47.6% (2014-2017). Insufficient physical activity remained steady from 2007-2010 (34.3%) to 2014-2017 (35.2%). CONCLUSION: Changes in the prevalence of cardiometabolic risk factors in Venezuela are heterogeneous and can be affected by various social determinants of health. Though the Venezuelan healthcare system has not successfully adapted, the dynamics and repercussions of the CHC on population-based cardiometabolic care can be instructive for other at-risk populations.

Cardiometabolic risk factors in Venezuela. The EVESCAM study: a national cross-sectional survey in adults.

BACKGROUND: No previous study in Venezuela and few in the Region of the Americas have reported national cardiometabolic health data. OBJECTIVES: To determine the prevalence and distribution of cardiometabolic risk factors (CMRF) in adults of Venezuela. METHODS: A population-based, cross-sectional, and randomized cluster sampling national study was designed to recruit 4454 adults with 20 years or older from the eight regions of the country from July 2014 to January 2017. Sociodemographic, clinical, physical activity, nutritional, and psychological questionnaires; anthropometrics, blood pressure, and biochemical measurements were obtained. The results were weighted by gender, age, and regions. RESULTS: Data from 3414 participants (77% of recruited), 52.2% female, mean age of 41.2 ± 15.8 years, were analyzed. CMRF adjusted-prevalence were: diabetes (12.3%), prediabetes (34.9%), hypertension (34.1%), obesity (24.6%), overweight (34.4%), abdominal obesity (47.6%), underweight (4.4%), hypercholesterolemia (19.8%), hypertriglyceridemia (22.7%), low HDL-cholesterol (63.2%), high LDL-c (20.5%), daily consumption of fruits (20.9%) and vegetables (30.0%), insufficient physical activity (35.2%), anxiety (14.6%) and depression (3.2%) symptoms, current smoker (11.7%), and high (≥ 20%) 10-year fatal cardiovascular risk (14.0%). CMRF prevalence varied according to gender, age and region of residence. CONCLUSIONS: Cardiometabolic risk factors are highly prevalent in Venezuelan adults. This situation can be affected by the severe socio-economic crisis in the country. The joint action of different stakeholders to implement public health strategies for the prevention and treatment of these risk factors in Venezuela is urgently needed.

Dietary intake and cardiometabolic risk factors among Venezuelan adults: a nationally representative analysis.

BACKGROUND: Increasing trends in global obesity have been attributed to a nutrition transition where healthy foods are replaced by ultra-processed foods. It remains unknown if this nutrition transition has occurred in Venezuela, a country undergoing a socio-political crisis with widespread food shortages. METHODS: We described dietary intake of Venezuelans from a nationally representative study conducted between 2014 and 2017. We conducted a cross-sectional analysis of dietary, sociodemographic, and clinical data from Venezuelans ≥20 years of age (n = 3420). Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Standardized clinical and anthropometric measurements estimated obesity, type 2 diabetes, and hypertension. A Dietary Diversity Score (DDS) was calculated using an amended Minimum Dietary Diversity for Women score where the range was 0 to 8 food groups, with 8 being the most diverse. Analyses accounted for complex survey design by estimating weighted frequencies of dietary intake and DDS across sociodemographic and cardiometabolic risk-based subgroups. RESULTS: The prevalence of obesity was 24.6% (95% CI: 21.6-27.7), type 2 diabetes was 13.3% (11.2-15.7), and hypertension was 30.8% (27.7-34.0). Western foods were consumed infrequently. Most frequently consumed foods included coffee, arepas (a salted corn flour cake), and cheese. Mean DDS was 2.3 food groups (Range: 0-8, Standard Error: 0.07) and this score did not vary among subgroups. Men, younger individuals, and those with higher socioeconomic status were more likely to consume red meat and soft drinks once or more weekly. Women and those with higher socioeconomic status were more likely to consume vegetables and cheese once or more daily. Participants with obesity, type 2 diabetes, and hypertension had lower daily intake of red meat and arepas compared to participants without these risk factors. CONCLUSIONS: Despite high prevalence of cardiometabolic risk factors, adults in Venezuela have not gone through a nutrition transition similar to that observed elsewhere in Latin America. Dietary diversity is low and widely consumed food groups that are considered unhealthy are part of the traditional diet. Future studies are needed in Venezuela using more comprehensive measurements of dietary intake to understand the effect of the socio-political crisis on dietary patterns and cardiometabolic risk factors.

Optimal waist circumference cutoff values to predict cardiometabolic alterations in a Venezuela national representative sample. The EVESCAM study. / Valores óptimos de punto de corte de circunferencia abdominal para predecir alteraciones cardiometabólicas en una muestra representativa nacional de Venezuela. El estudio EVESCAM

BACKGROUND: Waist circumference (WC) value reflects abdominal adiposity, but the amount abdominal fat that is associated to cardiometabolic risk factors varies among ethnicities. Determination of metabolic abnormalities has not undergone a WC adaptation process in Venezuela. AIMS: The aim of the study was (1) to determine the optimal WC cutoff value associated with ≥2 cardiometabolic alterations and (2) incorporating this new WC cutoff, to determine the prevalence of abdominal obesity and cardiometabolic risk factors related in Venezuela. METHODS: The study was national population-based, cross-sectional, and randomized sample, from 2014 to 2017. To assess performance of WC for identifying cardiometabolic alterations, receiver operating characteristics curves, area under the curve (AUC), sensitivity, specificity, and positive likelihood ratios were calculated. RESULTS: Three thousand three hundred eighty-seven adults were evaluated with mean age of 41.2 ± 15.8 years. Using the best tradeoff between sensitivity and specificity, WC cutoffs of 90 cm in men (sensitivity = 72.4% and specificity = 66.1%) and 86 cm in women (sensitivity = 76.2% and specificity = 61.4%) were optimal for aggregation of ≥2 cardiometabolic alterations. AUC was 0.75 in men and 0.73 in women using these new cutoffs. Prevalence of abdominal obesity and metabolic syndrome was 59.6% (95 CI; 57.5-61.7) and 47.6% (95 CI; 45.2-50.0), respectively. Cardiometabolic risk factors were associated with being men, higher age, adiposity, and living in northern or western regions. CONCLUSION: The optimal WC values associated with cardiometabolic alterations were 90 cm in men and 86 cm in women. More than half of the Venezuelan population had abdominal obesity incorporating this new WC cutoff.

Re-Classifying Hypertension in the Venezuelan EVESCAM Database Using 2017 AHA/ACC Criteria: High Prevalence, Poor Control, and Urgent Call for Action.

BACKGROUND: In 2017 the American Heart Association (AHA)/American College of Cardiology (ACC) changed the criteria to define hypertension (HTN). OBJECTIVE: To re-analyze Venezuelan data to update HTN prevalence rates and estimate the number of adults with uncontrolled blood pressure (BP) using AHA/ACC criteria. METHODS: The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3,420 adults from July 2014 to January 2017, with a response rate of 77.3%. The mean of two BP measurements was obtained using a standard oscillometric device protocol. HTN was defined using both 2017 AHA/ACC guideline (BP ≥ 130/80 mmHg) and JNC7 (BP ≥ 140/90 mmHg) criteria. FINDINGS: The crude prevalence of HTN using 2017 AHA/ACC guideline criteria was 60.4%, 13% higher than with the JNC7 criteria. The age-standardized prevalence was 55.4% in men and 49.0% in women (p < 0.001), 17.5% and 12.7% higher, respectively, compared with the JNC7 criteria. In subjects without self-reported HTN, the age-standardized prevalence of HTN was 43.4% in men and 32.3% in women, of whom, 22.9% and 19.2% were between 130-139/80-89 mmHg, respectively. In those with self-reported HTN, the prevalence of uncontrolled BP (≥130/80 mmHg) on antihypertensive medication was 66.8% in men and 65.8% in women. The total estimated number of subjects with HTN in Venezuela increased to 11 million, and only about 1.8 million are controlled. CONCLUSION: Using the new 2017 AHA/ACC guideline, the prevalence of HTN in Venezuela is approximately half of the adult population and associated with relatively poor BP control.

External validation of the Finnish diabetes risk score in Venezuela using a national sample: The EVESCAM.

AIMS: To evaluate the performance of the Latin American Finnish Diabetes Risk Score (LA-FINDRISC) compared with the original O-FINDRISC in general population. To establish the best cut-off to detect unknown type 2 diabetes (uT2D) and prediabetes. METHODS: The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3454 adults from July 2014 to January 2017. Those with self-report of diabetes were excluded; a total of 3061 subjects were analyzed. Waist circumference adapted for Latin America was the difference between the LA-FINDRISC and the O-FINDRISC. The area under the curve (AUC), sensitivity, and specificity were calculated. RESULTS: The prevalence of uT2D and prediabetes were 3.3% and 38.5%. The AUC with the LA-FINDRISC vs. the O-FINDRISC were: for uT2D, 0.722 vs. 0.729 in men (p=0.854) and 0.724 vs. 0.732 in women (p=0.896); for prediabetes (impaired fasting glucose [IFG] + impaired glucose tolerance [IGT], 0.590 vs. 0.587 in men (p=0.887) and 0.621 vs. 0.627 in women (p=0.777); for IFG, 0.582 vs. 0.580 in men (p=0.924) and 0.607 vs. 0.617 in women (p=0.690); for IGT, 0.691 vs. 0.692 in men (p=0.971) and 0.672 vs. 0.671 in women (p=0.974). Using the LA-FINDRISC, the best cut-offs to detect uT2D were 9 in men and 10 in women and to detect IGT was 9 in both genders. CONCLUSION: LA-FINDRISC has similar performance than O-FINDRISC in Venezuelan adults and showed a good performance to detect uT2D and IGT, but not IFG. The best cut-offs to detect glucose alterations were established.

Cardiovascular Health in a National Sample of Venezuelan Subjects Assessed According to the AHA Score: The EVESCAM.

BACKGROUND: Cardiovascular health status of the Venezuelan population has not been evaluated. The American Heart Association recommends the Cardiovascular Health Score (CHS) to assess cardiovascular health. OBJECTIVES: This study sought to determine the prevalence of CHS categories in a nationally representative sample of Venezuelan adults. METHODS: EVESCAM (Venezuelan Study of Cardio-Metabolic Health) was a national population-based, cross-sectional, randomized cluster sampling study performed from July 1, 2014 to January 31, 2017, which assessed 3,454 adults, age ≥20 years, with a response rate of 77.3%. The American Heart Association's CHS evaluates 4 behaviors (smoking, body mass index, physical activity, and diet) and 3 risk factors (total cholesterol, blood pressure, and blood glucose), assigning 1 point to those meting an ideal behavior or factor or 0 points if are not. Subjects were categorized as having ideal (5 to 7 points), intermediate (3 to 4), or poor (<3) cardiovascular health. Weighted prevalence by age, sex, and regions are presented. RESULTS: A total of 2,992 participants completed the data. Mean age and CHS were 41.4 ± 15.8 years and 4.3 ± 1.1 points, respectively. The prevalence of ideal CHS was 37.9% (95% confidence interval: 35.0 to 40.7); two-thirds presented with intermediate to poor CHS. Ideal CHS was most prevalent in women, in the youngest participants, and in those with higher education degree and living in a rural area. The prevalence of 7 components was 0.13%. Subjects evaluated since mid-2016 had a higher prevalence of ideal CHS (≈47%) than those evaluated before it (≈32%) (p < 0.001). CONCLUSIONS: A high prevalence of ideal CHS was observed in Venezuelan adults compared with other reports; however, a large proportion remain with high risk for cardiovascular disease.

Diabetes and depression were not associated in Venezuelan adults: The EVESCAM study, a national cross-sectional sample.

BACKGROUND: Evidence suggests that depression is more common in patients with diabetes than in the general population. However, contradictory results expose controversy in this association. OBJECTIVE: To evaluate the relationship between diabetes and depression in a national sample of Venezuelan adults. METHODS: The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3,454 adults from July 2014 to January 2017 (response rate of 77.3%). Diabetes was defined using fasting blood glucose and a 2-hour oral glucose tolerance test. Depressive symptoms were determined using the Hospital Anxiety and Depression Scale. RESULTS: 3255 subjects were assessed. Depressive symptom score was different between genders and among age groups (p<0.001), and similar in those subjects with or without diabetes (p=0.899). Depressive symptoms prevalence was higher in women than in men and increased with age (p<0.05), but was similar in those with and without diabetes (p=0.215). Using a multivariate regression analysis model, the association of depressive symptoms and diabetes remains non-significant after adjusting for age and gender (Odds ratio=0.98; 95% Confidence Intervals 0.95 - 1.02, p=0.504). CONCLUSION: Diabetes and depression were not associated in a large sample of Venezuelan adults.

Impact of the complex humanitarian crisis on the epidemiology of the cardiometabolic risk factors in Venezuela / Impacto de la crisis humanitaria compleja en la epidemiología de los factores de riesgo cardiometabólico en Venezuela

BACKGROUND: The complex humanitarian crisis (CHC) in Venezuela is characterized by food insecurity, hyperinflation, insufficient basic services, and the collapse of the healthcare system. The evolution of the epidemiology of cardiometabolic risk factors in this context is unknown. AIM: To compile the last 20 years evidence on the prevalence of cardiometabolic risk factors in adults of Venezuela in the context of the CHC. METHODS: A comprehensive literature review of population-based studies of adults in Venezuela from 2000 to 2020. RESULTS: Seven studies (National EVESCAM 2014–2017, 3 regions VEMSOLS 2006–2010, Maracaibo city 2007–2010, Merida city 2015, Mucuchies city 2009, Barquisimeto city CARMELA 2003–2005, and Zulia state 1999–2001) with samples sizes ranging from 109 to 3414 subjects were included. Over time, apparent decrease was observed in smoking from 21.8% (2003–2005) to 11.7% (2014–2017) and for obesity from 33.3% (2007–2010) to 24.6% (2014–2017). In contrast, there was an apparent increase in diabetes from 6% (2003–2005) to 12.3% (2014–2017), prediabetes 14.6% (2006–2010) to 34.9% (2014–2017), and hypertension 24.7% (2003–2005) to 34.1% (2014–2017). The most prevalent dyslipidemia – a low HDL-cholesterol – remained between 65.3% (1999–2001) and 63.2% (2014–2017). From 2006–2010 to 2014–2017, the high total cholesterol (22.2% vs 19.8%, respectively) and high LDL-cholesterol (23.3% vs 20.5%, respectively) remained similar, but high triglycerides decreased (39.7% vs 22.7%, respectively). Using the same definition across all the studies, metabolic syndrome prevalence increased from 35.6% (2006–2010) to 47.6% (2014–2017). Insufficient physical activity remained steady from 2007–2010 (34.3%) to 2014–2017 (35.2%).

INTRODUCCIÓN: La crisis humanitaria compleja (CHC) en Venezuela se caracteriza por la inseguridad alimentaria, la hiperinflación, la insuficiencia de servicios básicos y el colapso del sistema de salud. Se desconoce la evolución de la epidemiología de los factores de riesgo cardiometabólico en este contexto. OBJETIVO: Recopilar evidencia de los últimos 20 años sobre la prevalencia de factores de riesgo cardiometabólico en adultos de Venezuela en el contexto del CHC. MÉTODOS: Revisión bibliográfica exhaustiva de estudios poblacionales de adultos en Venezuela desde 2000 hasta 2020. RESULTADOS: Se incluyeron 7 estudios (EVESCAM Nacional 2014-2017, 3 regiones VEMSOLS 2006-2010, ciudad de Maracaibo 2007-2010, ciudad de Mérida 2015, ciudad de Mucuchíes 2009, ciudad de Barquisimeto CARMELA 2003-2005 y estado de Zulia 1999-2001) con tamaños de muestra variables desde 109 hasta 3.414 sujetos. A lo largo del tiempo, hubo una aparente disminución del consumo de tabaco del 21,8% (2003-2005) al 11,7% (2014-2017) y de la obesidad del 33,3% (2007-2010) al 24,6% (2014-2017). Por el contrario, hubo un aparente aumento de la diabetes del 6% (2003-2005) al 12,3% (2014-2017), la prediabetes del 14,6% (2006-2010) al 34,9% (2014-2017) y la hipertensión del 24,7% (2003-2005) al 34,1% (2014-2017). La dislipidemia más prevalente, el colesterol HDL bajo, se mantuvo entre el 65,3% (1999-2001) y el 63,2% (2014-2017). Desde 2006-2010 hasta 2014-207, el colesterol total alto (22,2% versus 19,8%, respectivamente) y el colesterol LDL alto (23,3% versus 20,5%, respectivamente) permanecieron similares, pero los triglicéridos altos disminuyeron (39,7% versus 22,7%, respectivamente). Utilizando la misma definición en todos los estudios, la prevalencia de síndrome metabólico aumentó del 35,6% (2006-2010) al 47,6% (2014-2017). La actividad física insuficiente se mantuvo estable entre 2007-2010 (34,3%) y 2014-2017 (35,2%). [...]

Función de las vitaminas D, E y K en condiciones especiales: salud y enfermedad / Function of vitamins D, E and K in Special Conditions: Health and Disease

Resumen: Antecedentes: se cuenta con recomendaciones de energía y nutrientes para población sana; sin embargo, a nutrientes como las vitaminas D, E, K se les atribuyen funciones importantes en diferentes situaciones de salud. Objetivo: explorar la efectividad de dosis dietarias y de suplementos de las vitaminas D, E y K en condiciones especiales de salud y enfermedad. Materiales y métodos: se realizó una búsqueda de documentos en las bases de datos PubMed, Scopus, ScienceDirect, Lilacs, SciELO, Ebsco y en textos especializados utilizando palabras clave: "vitamin D", "vitamin E", "vitamin K", "health", "disease", "nutritional recommendations". Resultados: hay un importante número de estudios y revisiones sistemáticas que contribuyen a la evidencia y la discusión en cuanto a efecto, dosis y tiempo, los cuales arrojaron tanto desenlaces positivos como nulos. Conclusión: los efectos de la vitamina D dietaria en la salud ósea están bien documentados, y sus suplementos acompañados de calcio están indicados en grupos poblacionales con riesgo de osteoporosis, pero no en otras condiciones clínicas. No hay suficiente evidencia sobre los beneficios de la vitamina E en el manejo o prevención de enfermedad hepática, cardiovascular o cáncer. La vitamina K podría ser importante en la salud ósea, sobre otras condiciones clínicas.

Abstract: Background: There are energy and nutrient recommendations for a healthy population; however, important functions in different health situations are attributed to nutrients such as vitamins D, E, K, E and K. Objective: To explore the effectiveness of dietary doses and supplements of vitamins D, E and K in special conditions of health and disease. Materials and Methods: A document search was carried out in the PubMed, Scopus, Sciencedirect, Lilacs, Scielo and Ebsco databases, and in specialized texts using keywords: "vitamin D", "vitamin E", "vitamin K", "Health", "disease", "nutritional recommendations". Results: There is a significant number of studies and systematic reviews that contribute to the evidence and discussion regarding effect, dose and time, which yielded both positive and null outcomes. Conclusion: The effects of dietary vitamin D in bone health are well documented and its supplementation accompanied by calcium is indicated in population groups at risk for osteoporosis, but not in other clinical conditions. There is insufficient evidence on the benefits of vitamin E in the management or prevention of liver disease, cardiovascular disease, or cancer. Vitamin K could be important in bone health, over other clinical conditions.

Optimal waist circumference cutoff values to predict cardiometabolic alterations in a Venezuela national representative sample. The EVESCAM study / Valores óptimos de punto de corte de circunferencia abdominal para predecir alteraciones cardiometabólicas en una muestra representativa nacional de Venezuela. El estudio EVESCAM

Abstract Objective: Waist circumference (WC) value reflects abdominal adiposity, but the amount abdominal fat that is associated to cardiometabolic risk factors varies among ethnicities. Determination of metabolic abnormalities has not undergone a WC adaptation process in Venezuela. The aim of the study was (1) to determine the optimal WC cutoff value associated with ≥2 cardiometabolic alterations and (2) incorporating this new WC cutoff, to determine the prevalence of abdominal obesity and cardiometabolic risk factors related in Venezuela. Methods: The study was national population-based, cross-sectional, and randomized sample, from 2014 to 2017. To assess performance of WC for identifying cardiometabolic alterations, receiver operating characteristics curves, area under the curve (AUC), sensitivity, specificity, and positive likelihood ratios were calculated. Results: Three thousand three hundred eighty-seven adults were evaluated with mean age of 41.2 ± 15.8 years. Using the best tradeoff between sensitivity and specificity, WC cutoffs of 90 cm in men (sensitivity = 72.4% and specificity = 66.1%) and 86 cm in women (sensitivity = 76.2% and specificity = 61.4%) were optimal for aggregation of ≥2 cardiometabolic alterations. AUC was 0.75 in men and 0.73 in women using these new cutoffs. Prevalence of abdominal obesity and metabolic syndrome was 59.6% (95 CI; 57.5-61.7) and 47.6% (95 CI; 45.2-50.0), respectively. Cardiometabolic risk factors were associated with being men, higher age, adiposity, and living in northern or western regions. Conclusion: The optimal WC values associated with cardiometabolic alterations were 90 cm in men and 86 cm in women. More than half of the Venezuelan population had abdominal obesity incorporating this new WC cutoff.

Resumen Objetivo: El valor de la circunferencia abdominal (CA) refleja la adiposidad abdominal, pero la cantidad de grasa abdominal asociada a factores de riesgo cardiometabólicos varía según la etnia. La determinación de anomalías metabólicas no se ha adaptado a la CA en Venezuela. 1) Detrerminar el valor de corte óptimo de CA asociados a ≥ 2 alteraciones cardiometabólicas. 2) Incorporando este nuevo límite de CA, determinar la prevalencia de obesidad abdominal y factores de riesgo cardiometabólicos relacionados en Venezuela. Métodos: Fue un estudio poblacional, transversal, de muestreo aleatorio de 2014 a 2017. Para evaluar el valor de CA para identificar alteraciones cardiometabólicas, se realizaron curvas características operativa del receptor y se calculó área bajo la curva (ABC), sensibilidad, especificidad y razón de similitud. Resultados: se evaluaron 3387 adultos con una edad promedio de 41.2 ± 15.8 años. Utilizando la mejor relación entre sensibilidad y especificidad, se determinó que los valores de corte de 90 cm en hombres (sensibilidad = 72.4% y especificidad = 66.1%) y 86 cm en mujeres (sensibilidad = 76.2% y especificidad = 61.4%) fueron óptimos para la agregación de ≥ 2 alteraciones cardiometabólicas. El ABC fue de 0,75 en hombres y de 0,73 en mujeres usando estos nuevos puntos de corte. La prevalencia de obesidad abdominal y síndrome metabólico fue 59.6% (95IC; 57.5 - 61.7) y 47.6% (95CI; 45.2 - 50.0), respectivamente. La presencia de factores de riesgo cardiometabólicos se asoció con ser hombre, mayor edad, adiposidad y vivir en regiones del norte o del oeste. Conclusión: Los valores óptimos de CA asociados con alteraciones cardiometabólicas fueron 90 cm en hombres y 86 cm en mujeres. Más de la mitad de la población venezolana tenía obesidad abdominal al incorporar este nuevo corte de CA.

Transcultural diabetes nutrition algorithm (tDNA): Venezuelan application.

Medical nutrition therapy (MNT) is a necessary component of comprehensive type 2 diabetes (T2D) management, but optimal outcomes require culturally-sensitive implementation. Accordingly, international experts created an evidence-based transcultural diabetes nutrition algorithm (tDNA) to improve understanding of MNT and to foster portability of current guidelines to various dysglycemic populations worldwide. This report details the development of tDNA-Venezuelan via analysis of region-specific cardiovascular disease (CVD) risk factors, lifestyles, anthropometrics, and resultant tDNA algorithmic modifications. Specific recommendations include: screening for prediabetes (for biochemical monitoring and lifestyle counseling); detecting obesity using Latin American cutoffs for waist circumference and Venezuelan cutoffs for BMI; prescribing MNT to people with prediabetes, T2D, or high CVD risk; specifying control goals in prediabetes and T2D; and describing regional differences in prevalence of CVD risk and lifestyle. Venezuelan deliberations involved evaluating typical food-based eating patterns, correcting improper dietary habits through adaptation of the Mediterranean diet with local foods, developing local recommendations for physical activity, avoiding stigmatizing obesity as a cosmetic problem, avoiding misuse of insulin and metformin, circumscribing bariatric surgery to appropriate indications, and using integrated health service networks to implement tDNA. Finally, further research, national surveys, and validation protocols focusing on CVD risk reduction in Venezuelan populations are necessary.

Educación médica en América Latina: Venezuela / Medical education in Latin America: Venezuela

Los estudios médicos en Venezuela comienzan en 1763, siendo la Universidad Central de Venezuela (UCV) sede de la primera facultad de medicina. En la actualidad en el país existen 9 escuelas de medicina en 8 universidades nacionales públicas; 6 autónomas, con currículos disímiles. Se otorga el título de médico cirujano, y todas ellas tienen como meta formar un médico acorde con los requerimientos de los sistemas de salud: el médico general. En 2005 se inicia en el país la enseñanza de medicina fuera de las escuelas universitarias formales, con el Programa Nacional de Formación de Medicina integral comunitaria, producto del acuerdo Sandino entre Venezuela y Cuba. El título a otorgar sería el de médico integral comunitario (MIC), con sus consecuencias para el sistema sanitario y para la salud de la población. El número de cursos de especialización, así como las maestrías, se ha incrementado, de manera que para el año 2012 había 171 cursos de posgrado funcionando cabalmente en la Facultad de Medicina de la Universidad Central de Venezuela, y en la actualidad existen 351 cursos de especialización, maestría y doctorado en las escuelas de medicina de las universidades venezolanas. El ingreso a los posgrados se hace a través de pruebas de admisión organizadas por las comisiones de estudios de posgrados de las respectivas facultades de medicina. El cursante recibe durante los años de formación una beca salario de parte de la institución sede del posgrado. Finalizada la residencia de posgrado y luego de la defensa de un trabajo especial de grado, el título universitario es conferido por la universidad correspondiente. En los últimos años una grave situación ha aparecido en lo atinente a los cursos de especialización: una marcada disminución de la demanda anual por dichos cursos, fenómeno que ha afectado a la mayoría de ellos, con sus evidentes repercusiones en el número de residentes de posgrado en los hospitales. Las investigaciones señalan entre los factores que están produciendo este problema los siguientes: el evidente fenómeno de migración médica que está ocurriendo en Venezuela, la escasa remuneración, la continua descalificación gubernamental hacia el gremio médico nacional y la preferencia dada a médicos extranjeros, la inseguridad personal, la actitud positiva de otras naciones ante la posibilidad de contar con médicos venezolanos bien formados, la sobrecarga asistencial y el deterioro de la infraestructura de nuestros centros de salud. Se elabora una propuesta para la transformación de la educación médica en Venezuela, dirigida a construir una metodología amigable y transferible para el diseño de currículos por competencia profesional, con el objetivo de orientar el proceso de transformación curricular de los estudios médicos en grado y posgrado en el país. Existen muchas barreras, pero hemos asumido el reto y aprovecharemos los recursos que permitan mejorar nuestras prácticas pedagógicas

The medical studies in Venezuela begin in 1763, being the Central University of Venezuela (UCV), seat of the first faculty of medicine. At present in the country there are 9 Schools of Medicine in 8 National public universities; 6 autonomous with dissimilar curricula. It is awarded as a Medical Surgeon, and all of them have the goal of forming a doctor according to the requirements of the health systems: the General Practitioner. In 2005, the teaching of medicine outside formal university schools began with the National Training Program Comprehensive Community Medicine, product of the Sandino agreement between Venezuela and Cuba. The title to be awarded would be The Integral Community Medicine (MIC), with its consequences for the health system and for the health of the population. The number of Specialization Courses as well as the Masters have increased, so that by 2012, there were 171 Postgraduate Courses fully functioning in the Faculty of Medicine of the UCV and in total there are 351 Specialization Courses, Masters and Doctorates In the Medical Schools of the Venezuelan Universities. Admission to postgraduate courses is done through admission tests organized by the Postgraduate Studies Commissions of the respective Faculties of Medicine. The student receives during the years of training a salary scholarship from the host institution of the postgraduate course. Once the postgraduate residence is finished and after the defense of a Special Degree Work (TEG), the university degree is conferred by the corresponding university. In recent years, a serious situation has arisen, as regards the Specialization Courses, such as the marked decrease in the annual demand for these courses, a phenomenon that has affected most of them, with their evident repercussions on the number of postgraduate residents in hospitals. Research indicates among the factors that are causing this problem are: the evident phenomenon of medical migration that is occurring in Venezuela, low remuneration, continued governmental disqualification towards the national medical profession and preference given to foreign doctors, personal insecurity, the positive attitude of other nations to the possibility of well-trained Venezuelan physicians, the burden of care, and the deterioration of the infrastructure of our health centers. A proposal is made for the transformation of medical education in Venezuela; to construct a friendly and transferable methodology for the design of Curricula by Professional Competence with the objective of orienting the process of curricular transformation of the medical studies in degree and postgraduate in the country. There are many barriers but we have taken up the challenge and will take advantage of the resources to improve our pedagogical practices

Estudio venezolano de salud cardio-metabólica (EVESCAM): resultados generales presentados en el XVII congreso venezolano de medicina interna 2017 / Venezuelan study of cardio-metabolic health (EVESCAM): General results presented at the XVII Congress Venezuelan Internal medicine 2017

Ningún estudio ha evaluado la prevalencia nacional de factores de riesgo cardiometabólico en Venezuela. Objetivo: El EVESCAM (Estudio Venezolano de Salud Cardio-Metabólica) fue diseñado para evaluar la prevalencia de los factores de riesgo cardiometabólico en sujetos con ≥ 20 años de las 8 regiones del país. Métodos: Estudio transversal, fueron reclutados un total de 4,454 participantes entre julio de 2014 y febrero de 2017, usando un muestreo multi-etápico estratificado por conglomerados. Fueron evaluados 3,445 (tasa de respuesta 77,3%), con una pérdida de datos de sólo 0,7%, para una muestra final de 3,420 participantes. Los datos fueron recolectados en los hogares y en centros de campo de la comunidad por personal entrenado. Luego de firmar el consentimiento informado, se aplicaron cuestionarios (clínicos, demográficos, actividad física, nutricionales y psicológicos), medidas antropométricas (peso, altura y circunferencia abdominal), grasa corporal por bioimpedancia, fuerza de aprehensión de la mano, presión arterial, electrocardiograma y mediciones bioquímicas (Prueba de tolerancia a la glucosa oral y perfil lipídico(AU)

Resúmenes de los trabajos de la pirámide de investigadores del EVESCAM presentados en el XXIV Congreso Venezolano de Medicina Interna / Abstracts of the works of the Pyramid of Researchers of EVESCAM presented at the XXIV Venezuelan Congress of Internal Medicine

Para el año 2015 la Organización Mundial de la Salud (OMS) estimó que el 3,6% de la población mundial padecía ansiedad y 4,4% depresión, similar a lo estimado para Venezuela por la misma organización, 4,4 y 4,2%, respectivamente. En el 2011 en una población rural de los Andes, Estado Mérida, Venezuela, se reportó una prevalencia de 12% de síntomas de ansiedad y 9% de depresión, mientras que en la Región Capital fue del 19,1 y 6,7% para el año 2016, respectivamente. Se desconoce la prevalencia de síntomas de ansiedad y depresión en la población urbana de la región Guayana de Venezuela. Objetivo: Determinar la prevalencia de síntomas de ansiedad y depresión en la población urbana de la Región Guayana de Venezuela que participaron en el estudio EVESCAM. Métodos: Durante 2015 a 2017, se evaluaron 399 sujetos de 20 o más años de edad en la Región Guayana, seleccionados por un muestreo aleatorio poliestratificado por conglomerados en 6 comunidades urbanas: Aceiticos I (n=72); Aceiticos II (n=81); Vista Hermosa (n=77); Sector Perú (n=59); El Rincón (n=57); Pinto Salinas (n=53). Los síntomas se determinaron usando la escala hospitalaria de ansiedad y depresión, un cuestionario de auto reporte con 14 ítems (7 para la depresión y 7 para la ansiedad), con cada ítem completado en una escala Likert de 0 a 3 puntos, que categoriza a los sujetos como normales (<8 puntos), con síntomas leves (8-10 puntos), o síntomas moderados/severos (≥ 11 puntos)(AU)

Prevalencia de prediabetes y diabetes mellitus en la región de Zulia, Venezuela: resultados preliminares del estudio EVESCAM / Prevalence of prediabetes and diabetes mellitus in the Zulia region, Venezuela: preliminary results of the EVESCAM study

Determinar la prevalencia de prediabetes y de Diabetes Mellitus (DM) en el estado Zulia, Venezuela. Métodos: se realizó un estudio poblacional, aleatorio, descriptivo utilizando los datos del Estudio Venezolano de la Salud Cardiometabólica (EVESCAM) de la región zuliana incluyendo 525 sujetos adultos de ambos géneros. Se aplicó una encuesta sobre factores de riesgo, antecedentes de DM, se registró peso, talla, índice de masa corporal (IMC) kg/m2, circunferencia de cintura en cm (CC) y presión arterial. Se les tomó muestra de sangre para determinación de glucemia, perfil lipídico y prueba de tolerancia a la glucosa (PTG). Los resultados presentados en tablas y figuras utilizando promedios y desviación estándar, procesados con programa estadístico SSPS, la prevalencia fue calculada y ajustada por edad y sexo, fijando un valor alfa menor de 0,05 (P<0,05) como significativo. Resultados: En total 404 sujetos completaron la evaluación: 126 (31,1%) hombres y 278 (68,8 %) mujeres, con edad promedio de 49,6 ± 15,8 años, Glucemia basal: 108,5 ± 28,9 y PTG a las 2 horas 120,6 ± 37,2 mg/dl. La prevalencia de diabetes ajustada por edad y sexo resultó de 16,0%; 19,9% en hombres y 12,1% en mujeres (P = 0,029) y para Prediabetes 58,5%; 65,8% en hombres y 51,3% en mujeres (P= 0,005). Conclusiones: La población zuliana presentó elevada prevalencia de prediabetes y diabetes mellitus. Urge la necesidad de intervención a través de programas de prevención que detengan su avance(AU)

To determine the prevalence of prediabetes and Diabetes Mellitus (DM) in the State of Zulia, Venezuela. Methods: A clinical, randomized, descriptive study was conducted using data from the Venezuelan Cardio-Metabolic Health Study (EVESCAM) of the Zulian region, including 525 adults of both genders. A risk factors questionnaire, history of DM, weight, height, body mass index (BMI) kg/m2, waist circumference in cm (CC), and blood pressure were measured. Blood samples were taken to determine of Glycaemia, lipid profile, and glucose tolerance test (GTT). Results were presented in tables and figures using averages and standard deviation, analyzed with the software SSPS statistical program, prevalence was calculated and adjusted by age and sex, alpha value lower than 0.05 (P <0.05) was considered significant. Results: A total of 404 subjects completed the evaluation: 126 (31.1%) men and 278 (68.8%) women, with a mean age of 49.6 ± 15.8 years; baseline glycaemia were 108.5 ± 28,9 and GTT 120.6 ± 37.2 mg/dl. The age-standardized diabetes prevalence was 16.0%; 19.9% in men and 12.1% in women (P = 0.029); and the age-standarized prevalence of prediabetes was 58.5%; 65.8 in men and 51.3 in women (P =0.005). Conclusions: Zulia´s population presented a high prevalence of prediabetes and diabetes mellitus. To implement an intervention program to halt it´s progress is of urgent need(AU)

Prevalencia de dislipidemias en la región capital: resultados preliminares del estudio EVESCAM / Prevalence of dyslipidemias in the capital region: preliminary results of the EVESCAM study

Las dislipidemias son un factor de riesgo para enfermedades cardiovasculares. Se desconoce la prevalencia actual de dislipidemias en la región Capital de Venezuela. Objetivo: Determinar la prevalencia de dislipidemias en adultos de la región capital evaluados en el estudio EVESCAM. Métodos: Estudio poblacional, observacional, transversal de muestreo aleatorio poliestratificado por conglomerados. Se evaluaron 7 comunidades de la Región Capital desde julio de 2015 hasta enero de 2016: El Retiro; Miranda Casco Central y Bello Campo; Los Teques: La Cima; Guatire: Centro y Castillejo y rural: Guatire: La Candelaria. Participaron 416 sujetos desde los 20 años de edad. Los puntos de corte para definir las dislipidemias fueron hipoalfalipoproteinemia: colesterol HDL < 40 mg/dL; hipertrigliceridemia: triglicéridos (TG) ≥ 150 mg/dL; hipercolesterolemia: colesterol total ≥ 200 mg/dL; colesterol LDL elevado: colesterol LDL ≥ de 130 mg/dL; dislipidemia aterogénica: TG ≥ 150 mg/dL más colesterol HDL bajo (mujeres: < 40 mg/dl y hombres: < 50 mg/dl). Las frecuencias se expresaron en porcentajes y se aplicó el estadístico Chi cuadrado, un valor de p < 0,05 fue considerado como estadísticamente significativo. Resultados: La dislipidemia con mayor prevalencia fue la hipoalfalipoproteinemia (67.1%) seguida de la LDLc elevada (20%), hipercolesterolemia (17,1%), hipertrigliceridemia (12,0%) y por último dislipidemia aterogenica (9,4%). La hipoalfalipoproteinemia, fue mayor en hombres que en mujeres (81,6% y 60,8%; respectivamente, p < 0,001) presentándose con mayor prevalencia en el grupo etario de 20 a 40 años al contrario del resto de las dislipidemias. Conclusión: La hipoalfalipoproteinemia persiste como la dislipidemia más prevalente de la región(AU)

Dyslipidemias are a risk factor for cardiovascular diseases. The current prevalence of dyslipidemias in the Capital Region of Venezuela is unknown. Objective: To determine the prevalence of dyslipidemias in adults from the capital region of Venezuela evaluated in the EVESCAM study. Methods: apopulation based, observational, cross-sectional, and cluster sampling study was desing. Seven communities from the Capital Region were evaluated from July 2015 to January 2016: El Retiro; Miranda- Chacao: Casco Central y Bello Campo; Los Teques: La Cima; Guatire: Centro y Castillejo y Rural: Guatire: Candelaria. 416 subjects were included. Dyslipidemias was define as hypoalphalipoproteinemia: HDL cholesterol <40 mg/ dL; hypertriglyceridemia: triglycerides ≥ 150 mg/dL; hypercholesterolemia: total cholesterol ≥ 200 mg/dL; High LDL cholesterol: ≥ 130 mg/dL; therogenic dyslipidemia: triglycerides ≥ 150 mg / dL and low HDL cholesterol (women: <40 mg / dl and men: <50 mg / dl). The frequencies were expressed as percentages and Chi-square test was applied to assess differences. The level of statistical significance accepted was a p-value < 0.05. Results: The most prevalent dyslipidemia was hypoalphalipoproteinemia (67.1%) followed by elevated LDLc (20%), hypercholesterolemia (17.1%), hypertriglyceridemia (12.0%), and atherogenic dyslipidemia (9.4%). Hypoalphalipoproteinemia was higher in men than women (81.6% and 60.8%, respectively, p <0.001), with a higher prevalence at the age group of 20 to 40 years, unlike the rest of dyslipidemias. Conclusion: The hypoalphalipoproteinemia persists as the most prevalent dyslipidemia in the region(AU)