Dietary factors related to the increase of cardiovascular risk factors in traditional Tepehuanos communities from Mexico. A 10 year follow-up study.

BACKGROUND AND AIMS: Tepehuanos Indians, a traditional Mexican ethnic group, followed a vegetarian diet exhibiting a low prevalence of obesity and the absence of diabetes. However, from the year 2000 the traditional diet of the Tepehuanos was modified by the introduction of western food. In this study we examine the changes in their customary diet and its impact on the prevalence of cardiovascular risk factors in this group. METHODS AND RESULTS: Individuals from 12 Tepehuanos communities were randomly enrolled during 1995-1996 and 2006-2007. Using a 64-item semiquantitative food frequency questionnaire macronutrient intakes were calculated from values of Mexican food-composition tables. Cardiovascular risk factors such as obesity, hypertension, hyperglycemia and dyslipidemia were determined. The median (25, 75 percentile) of total caloric intake (1476 [1083, 1842]-2100 [1366, 2680]kcal/day, p<0.001) as well as the percentage of energy consumed from saturated fat (3.0 [2.7,4.1]-7.2 [3.9,7.4], p<0.0001) and protein (8.2 [7.8,8.9]-16.8 [16.3,17.1], p<0.0001) increased, whereas the percentage of total calorie intake from carbohydrates (66.4 [61.3,69.5]-61.3 [61,68.8], p<0.0001), polyunsaturated fat (11.2 [10.3,12.1]-4.0 [3.9,4.3], p<0.0001), and the polyunsaturated:saturated fat ratio (3.84-0.53%, p<0.0001) decreased during the period of study. The prevalence of obesity (11.1-21.9%, p=0.04), impaired fasting glucose (5.9-14.9%, p=0.04), diabetes (0.0-0.88%, p=0.48), hypertension (1.7-3.4%, p=0.43), triglycerides (2.6-16.7%, p=0.0006), and low HDL-cholesterol (10.2-71.1%, p<0.0001) increased. CONCLUSIONS: Changes in the customary diet introduced in the Tepehuanos communities are related to the increase of cardiovascular risk factors.

Hypomagnesaemia and risk for metabolic glucose disorders: a 10-year follow-up study.

BACKGROUND: Although several lines of evidence suggest that hypomagnesaemia is a risk factor for developing type 2 diabetes, there are no studies regarding the association between hypomagnesaemia and the risk for developing impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Our objective was to examine the association between serum magnesium levels and the risk for developing IFG, IGT and type 2 diabetes. MATERIALS AND METHODS: A total of 1122 individuals (20-65 years of age) were enrolled between 1996 and 1997, and 817 individuals re-examined about 10 years later. New-onset IFG (5.6-7.0 mmol L(-1) fasting glucose), IGT (7.8-11.1 mmol L(-1) glucose 2-h postload), and type 2 diabetes were determined from the number of subjects who had these conditions at the second examination without evidence that they were present at the first one. The relative risk of new-onset metabolic glucose disorders and diabetes (dependent variables) was computed using Poisson regression model adjusted for age, sex, family history of diabetes, waist circumference and homeostasis model assessment for insulin resistance index. Serum magnesium levels of < 0.74 mmol L(-1) (independent variable) defined the exposed group. RESULTS: At baseline, 420 (51.4%) individuals had hypomagnesaemia. New-onset IFG and IGT was identified in 276 (33.8%) individuals. The relative risk for IFG, IGT and IFG + IGT was 1.11 (95% confidence interval, 0.5-5.1), 1.38 (95% confidence interval, 1.1-6.3) and 1.49 (95% confidence interval, 1.1-4.9), respectively. New-onset diabetes was identified in 78 (9.5%) individuals (relative risk 2.54; 95% confidence interval, 1.1-4.1). CONCLUSIONS: Hypomagnesaemia is independently associated with the development of IGT, IFG + IGT and type 2 diabetes, but not with the development of IFG.

Improved patient/technique survival and peritonitis rates in patients treated with automated peritoneal dialysis when compared to continuous ambulatory peritoneal dialysis in a Mexican PD center.

Since its introduction in Mexico in 1998, the use of automated peritoneal dialysis (APD) has grown steadily and now 35% of Mexican patients are being treated with it. Peritonitis continues to be the most important infectious cause of drop out in peritoneal dialysis (PD) programs and naturally has an impact on technique survival. The objective of this study was to compare patient and technical survival as well as peritonitis rates in APD vs continuous ambulatory peritoneal dialysis (CAPD) in our hospital PD program. We included all patients who initiated therapy between January 2003 and December 2005. Data at the beginning of therapy, causes of end-stage renal disease, gender, age, dialysis modality, drop out reasons, as well as peritonitis rate and date of presentation of first peritonitis event were collected and analyzed. For Kaplan-Meier survival analysis, patient status (alive, dead, or lost to follow up) at December 2005 was used as the observational end point. Modality differences were analyzed using a Cox regression model. A total of 237 patients were evaluated: 139 on CAPD and 98 on APD. The median age was 62 years on CAPD and 59 years on APD (P<0.031), and the percentage of diabetics was, respectively, 77 and 70% (P=NS). The CAPD drop out causes were death (57%), transfer to HD (29%), and other causes (16%), whereas in APD, 62% were due to death, 24% to transfer to HD, and 14% to other causes. APD/CAPD patient survival for year 1, 2, and 3 was 82/62, 62/49, and 56/42%, respectively. In conclusion, both therapies are considered good renal replacement therapy options in our hospital, but APD is the most attractive one as demonstrated by the positive results presented here.

Histological types of gastric cancer in Mexico.

BACKGROUND: Gastric cancer is the second leading cause of malignant tumours in Mexico. The distribution of the histological types of this tumour has not been estimated from a population-based representative sample. METHODS: The histological types of gastric cancer according to the Lauren classification and selected socio-demographic characteristics for 220 patients from different socioeconomic levels are reported. The study population represents 66% of all new gastric cancer cases during 1989-1990 reported to the Mexico City Cancer Registry. The patients attended four public hospitals, seven social security hospitals and four private hospitals in Mexico City. A second histological diagnosis was performed by one pathologist. RESULTS: No specific histological type of gastric cancer predominated since the estimated distribution for intestinal gastric cancer was 44.5%, for diffuse gastric cancer 43.2% (and the remaining 12.3% corresponded to indeterminate tumours). The distribution of intestinal and diffuse gastric cancer did not vary significantly according to socioeconomic level or medical care unit and it showed a clear relationship with gender, the intestinal type of gastric cancer being more common among males. CONCLUSIONS: Mexico may not have been affected by the gastric cancer epidemic at the beginning of the twentieth century but the available information and the results of this study are only useful to demonstrate that, currently, no histological type of gastric cancer (according to Lauren's classification) predominates significantly in this country.

Trends of lung cancer mortality in Mexico.

Lung cancer (LC) is one of the most important public health problems in the world; 1,035,000 annual deaths are estimated each year and more than 80% of these are attributed to tobacco. The trend of lung cancer mortality in Mexico City from 1979 - 1993 was determined, as was the rate ratio of lung cancer mortality in 31 states in Mexico, taking Mexico City as a reference by means of a Poisson model. A strong linear regression model was used to evaluate the rate, where the dependent variable was LC mortality rate and the independent variable the year observed. In 15 years, 73,807 deaths from LC were reported, with an increase in mortality from 5.01 - 7.25 per 100,000 inhabitants. Mortality increases significantly after 60 years of age (B not equal to 0), p<.05) in men and in women. Mortality from LC was 70% in men, and more than 60% of deaths were reported after 65 years of age. Mortality risk is higher in the northern states of the country (e.g., Sonora, RR=2.40) than in the southern region (e.g., Oaxaca RR=0.40). In Mexico, almost 10,000 deaths by LC are estimated for the year 2010. Therefore, changes in lifestyle should be encouraged in order to decrease the smoking habit. The governmental tax on cigarettes should be increased, smoking restricted in squares and public spaces, and the risks should be announced on cigarette packages, among other measures. With respect to other emergent risk factors, the sources of industrial pollution and toxic emissions should be regulated.

Mortality from cervical carcinoma in Mexico: impact of screening, 1980-1990.

OBJECTIVE: To determine the temporal mortality trends of uterine cervical cancer in Mexico for the period 1980-1990. STUDY DESIGN: In Mexico, data from death certificates are collected in a national repository at the National Institute of Statistics, Geography and Informatics. These data were analyzed to obtain mortality trends, and regional variations were obtained for the same period using a Poisson regression model. RESULTS: The official mortality figure for cervical cancer for the study period was 37,982 cases. Subregistration due to misclassification was evident, particularly in the first five years of the study period; however, poor quality of information was proportionally distributed across the different age groups. A standardized analysis by quinquennia showed a steady mortality trend during the last 10 years, with slightly upward significant trends within some age groups (beta=0, P<.05). High regional variations in cervical cancer mortality risks were found using a Poisson regression model. Twenty-four states in Mexico showed an increased mortality risk when compared with Mexico City; seven states showed a steady or downward trend. CONCLUSION: The results show the ineffectiveness of the cancer screening program, underscoring the need to ensure access to and the quality of the cervical cancer screening program in order to decrease mortality rates.

[Effects of the application of the years of productive life lost index (investment-production-consumer model) on the sequence of causes of death in Mexico]. / Efectos de la aplicación del indicador de años de vida productivos perdidos (modelo inversion producción consumo) en el ordenamiento de las causas de muerte en México, 1990.

In the search for methods to support the decision making process and to maximize the benefit resulting from the health priorities, this paper discusses the investment-production-consumption model (IPC). This method attempts to quantify the socio-economic impact of mortality. This type of evaluation takes into account age at death and the potential for future productivity and thus assesses the generation of losses or gains to society, depending on the stage of life in which death occurs. The impact of different causes of death estimated by this method is illustrated from the cause of Mexico. These results are compared with the relative importance attributed by the use of mortality rates and years of potential life lost. The ordering by rates shows heart diseases, accidents and tumors as first causes of deaths. On the other hand, the indicator of years of potential life lost shows causes of death at younger ages to occupy the first place. The YPLLipc, however, gives greater importance to infections, accidents and homicides.

[Helicobacter pylori infection and gastric cancer in Mexico. A challenge for prevention and population control]. / Infección por Helicobacter pylori y cáncer gástrico en México. Un reto para la prevención y el control poblacional.

The International Agency for Research on Cancer (IARC) of the WHO has recognized a cause-effect relationship between Helicobacter pylori (Hp) infection and gastric cancer of such magnitude that the presence of this infection increases the risk of gastric cancer approximately four times. Gastric cancer is currently the second cause of mortality due to malignant neoplasms in Mexico City. This article explores the association between Hp infection and gastric cancer incidence through an epidemiological study including 109 gastric cancer patients and 177 hospital controls in Mexico City. The study estimates that, in the population studied, Hp infection was present in 87.2% of the cases, compared with 82.5% of the controls. The odds ratio of having gastric cancer if infected with Hp was 1.44 IC95% 0.7-2.8. In addition, it was calculated that with eradication of Hp infection in the general population, gastric cancer incidence would decrease by at least 26.6%. An improvement of the actual sanitary conditions along with the development of an effective vaccine for Hp infection and the existence of increasingly effective treatments to eradicate the bacteria are the necessary next step for populational prevention and control of gastric cancer.

[Consumption of foods prepared with corn, wheat and rice and its relationship to gastric cancer incidence in Mexico]. / El consumo de alimentos preparados con maíz, trigo y arroz, y su relación con la incidencia de cáncer gástrico en México.

To assess the consumption of food prepared with corn, wheat or rice, in relation to the risk of developing gastric cancer (GC). We analyzed information about cereal consumption using data from a study of diet and GC for which 220 histologically confirmed incident GC cases and 752 population-based controls, were recruited. All subjects were interviewed using a food frequency questionnaire in which the consumption of 11 foods prepared with corn, wheat or rice, 54 additional food items and 4 alcoholic beverages was assessed. Adjusting by age, gender and total caloric intake, the results did not show an increased risk for gastric cancer incidence in regard to the consumption of foods prepared with corn (O.R. q4 vs. q1 = 0.97 C.I. 95% 0.58-1.63), wheat (O.R. q4 vs. q1 = 1.07 C.I. 95% 0.62-1.84) or rice (O.R. q4 vs. q1 = 1.36 C.I. 95% 0.96-1.90). These results remained similar after stratifying by histological type of GC (i.e. intestinal vs. diffuse). Our results do not lend support to the hypothesis that the consumption of foods prepared with corn, wheat or rice increase the risk of being diagnosed with gastric cancer.

An analysis of spatial and socio-economic determinants of tuberculosis in Hermosillo, Mexico, 2000-2006.

SETTING: The city of Hermosillo, in Northwest Mexico, has a higher incidence of tuberculosis (TB) than the national average. However, the intra-urban TB distribution, which could limit the effectiveness of preventive strategies and control, is unknown. METHODS: Using geographic information systems (GIS) and spatial analysis, we characterized the geographical distribution of TB by basic geostatistical area (BGA), and compared it with a social deprivation index. Univariate and bivariate techniques were used to detect risk areas. RESULTS: Globally, TB in the city of Hermosillo is not spatially auto-correlated, but local clusters with high incidence and mortality rates were identified in the northwest, central-east and southwest sections of the city. BGAs with high social deprivation had an excess risk of TB. DISCUSSION: GIS and spatial analysis are useful tools to detect high TB risk areas in the city of Hermosillo. Such areas may be vulnerable due to low socio-economic status. The study of small geographical areas in urban settings similar to Hermosillo could indicate the best course of action to be taken for TB prevention and control.

Time-trends and causes of infant, neonatal and postneonatal mortality in Mexico, 1980-1990.

OBJECTIVE: This article analyzes the time-trends and causes of infant, neonatal, and postneonatal mortality in Mexico during the 1980's. MATERIAL AND METHODS: Data on infant deaths came from yearly tabulations (1980 to 1990) published by the Mexican government. Time-trends of mortality rates were determined by simple linear regression models. The parallelism test was performed for evaluating similarities in trends in neonatal and postneonatal mortality rates by causes. RESULTS: During the 1980's, infant mortality rates in Mexico declined from 40.4 to 31.1/1000 (beta = -0.791). Postneonatal mortality rates showed a strong decrease (beta = -0.892), while neonatal mortality rates were almost stationary (beta = 0.089). Significant rate decreases were observed for intestinal infections, Pneumonia and influenza and All other causes while Certain perinatal problems, Congenital defects and Nutritional deficiencies increased. No changes were observed in Acute respiratory infections. The neonatal proportional mortality showed an incremental trend accounting for 37.6% in 1980 and ascending to 48.8% in 1990 of the mortality in the first year of life. CONCLUSIONS: This analysis indicates that the reduction in infant mortality in Mexico during the 1980's was due to declining postneonatal mortality while neonatal mortality rates remain almost unchanged.

PIP: This report describes the time-trends and causes of infant, neonatal, and postneonatal mortality in Mexico during 1980-90. Data were obtained from annual data collected by the General Direction of Statistics and Information of the Secretary of Health. The infant mortality rate (IMR) declined during the 1980s due to declines in the postneonatal mortality rate (PMR). The neonatal mortality rate (NMR) remained stable at around 15.2/1000. IMR declined from 40.4/1000 to 31.1/1000. PMR declined from 25.6/1000 to 16.2/1000. Both changes in PMR and IMR were statistically significant. Rates of mortality due to intestinal infections, pneumonia, and influenza declined. Perinatal problems and congenital defects increased. Significant increases occurred for nutritional deficiencies in IMR and PMR. Acute respiratory infections remained about the same. State variation in infant mortality shows that some states have double the IMR. Further analysis is needed to determine the trends in state-specific IMR and PMR. Decreases in pneumonia and influenza are accounted for by increased levels of sanitation, improved literacy of women, promotion of oral rehydration therapy, massive immunization campaigns against measles, and greater access to health care services. The trends are considered reliable based on the assumption that births are underregistered.

[Does clinical depression increase the risk of death from non-violent causes?]. / Aumenta la depresión clínica el riesgo de muerte por causas no violentas?

Studies of the effect of depression on life expectancy have found controversial results. In the past, an excess mortality was attributed to conditions seen at psychiatric institutions. More recently, in addition to an excess mortality due to violent causes of death, some studies also found excess mortality due to non-violent and all-cause mortality. Hospital studies that evaluated this relationship are generally flawed and lack of control for potential confounders. Underlying physical illnesses could explain the excess mortality reported. On the other hand, community-based studies have studied small number of depressed subjects, and have used diverse measurements of depression which hamper comparability. This paper critically reviews recent published studies and discusses possible mechanisms for this association.

[Mortality due to homicide in children. Mexico, 1979-1990]. / Mortalidad por homicidio en niños. México, 1979-1990.

A study of homicides in children under five years old was conducted in order to define the mortality panorama by this cause during 1979-1990 in Mexico. Trends of homicide mortality were analyzed, as well as the main causes by age and sex. Rate ratio (RR) by cause and sex were analyzed too. The variables were age, sex, year and external cause of intentional injuries which were analyzed according to the International Classification of Diseases, 9th Revision E960-E969. The total number of deaths due to homicide were 2,939. Each day one children under five years of age died in Mexico due to homicide. The trend of homicide is b = 0.126. Thirty per cent of deaths occurred in children under one year old. Boys were most affected than girls in the causes by age: strangulation < 1 year old RR 21, confidence interval (CI) 15-30; fire arm in two years old children RR 3.1 CI 2.0-5.7; drowning in three years old children RR 2.6 CI 1.7-4.8 and assault by other and unspecified means. Further research in the area and prevention should involve the use of a multidisciplinary approach in considering the multiple causes and solutions to this problem.

Ozone, suspended particulates, and daily mortality in Mexico City.

To investigate acute, irreversible effects of exposure to ozone and other air pollutants, the authors examined daily death counts in relation to air pollution levels in Mexico City during 1990-1992. When considered singly in Poisson regression models accounting for periodic effects, the rate ratio for total mortality associated with a 100-ppb increment in 1-hour maximum ozone concentration was 1.024 (95% confidence interval (CI) 1.011-1.039). Measures of average ozone concentration were somewhat more strongly related to mortality. The rate ratio was 1.024 (95% CI 0.984-1.062) per 100 ppb for sulfur dioxide and 1.050 (95% CI 1.030-1.067) per 100 micrograms/m3 for total suspended particulates. However, when all three pollutants were considered simultaneously, only total suspended particulates remained associated with mortality, indicating excess mortality of 6% per 100 micrograms/m3 (rate ratio = 1.058, 95% CI 1.033-1.083), consistent with observations in other cities in the United States and Europe. The authors found no independent effect of ozone, but it is difficult to attribute observed effects to a single pollutant in light of the complexity and variability of the mixture to which people are exposed. Nevertheless, particulate matter may be a useful indicator of the risk associated with ambient air pollution.

[Mortality ranking in the norwest of Mexico according to the years of productive life lost index]. / Reordenación de la mortalidad en el noroeste de México, según el índice de años de vida productivos perdidos.

OBJECTIVE: To determine the order of death causes in the Northwestern states of Mexico using the years of potential life lost (YPLL) index. MATERIAL AND METHODS: The 1995 INEGI mortality data base for the states of Baja California, Baja California Sur, Sinaloa and Sonora was used to estimate the YPLL index. The method by Bustamante et al. was followed to calculate the cause of death, with ponderation of the potential investment, production and consumption of each individual, according to the age of death. RESULTS: A ranking of cause of death resulted from the application of the YPLL index. At present, in the four states, the group with the greatest potential loss is that between 5 and 14 years of age, and the rate is higher in Baja California than in Sonora. The group of "Perinatal problems as a cause of death" ranked first in three states and in the fourth, Sinaloa, the group of "Homicide and lesions caused intentionally by another person" ranked first. CONCLUSIONS: This work highlights the importance of the YLPP with economic loss ponderation index to discriminate death causes among states in a region with apparently homogeneous mortality.

[Epidemiologic monitoring system for the diabetic patient; use of computerized technology in the quality of medical care]. / Sistema de vigilancia epidemiológica para el paciente diabético; el uso de tecnología computacional en la calidad de la atención médica.

OBJECTIVE: To describe an instrument for epidemiologic surveillance of diabetes mellitus and evaluating the quality of care in primary health care. MATERIAL AND METHODS: The study was conducted from January 1, 1998, to June 30, 1999, at the Epidemiology and Health Services Research Unit of the Mexican Institute for Social Security (IMSS), in Hermosillo, Sonora. A single data collection form was designed, which contains items included in the diabetes care clinic of the Unit of Family Medicine of the Mexican Institute of Social Security. RESULTS: We developed and implemented a software program to enter data from the paper format and to generate individual and group reports on attendance to scheduled medical visits, medical history, evolution of signs and symptoms, laboratory tests, and medication. CONCLUSIONS: Electronic data systems allow the availability of reliable and continuing information for surveillance of the comprehensive care of the diabetic patient.

[The prevalence of risk factors for coronary disease in workers of the Hospital General de México]. / Prevalencia de factores de riesgo de enfermedad coronaria en trabajadores del Hospital General de México.

OBJECTIVE: To evaluate the prevalence of risk factors of coronary heart disease in the personnel of the General Hospital in Mexico City. MATERIAL AND METHODS: We studied 2,228 workers, 1,531 female (68.7%) and 697 male (31.2%) whose ages ranged from 16 to 65 years old in the period of 1993 to 1995. They were divided in work areas: Intendancy 477 (21.4%), Administrative, 697 (31.2%), Physicians, 495 (22.2%) and Nurses, 559 (25.0%). We collected clinical histories, anthropometric measures, and laboratory determinations of glucose, total cholesterol, LDL, HDL and triglicerydes. RESULTS: We found that 367 (14.9%) had total cholesterol above 240 mg/dl, with high values in females of the administrative area (17.1%) and males in the nursing department (26%), which was the highest tendency. Trigliceryde levels above 200 mg/dl were found in 208 males (24.6%) and 263 females (16.2%), with high prevalence in the nursing and administrative departments, in males (39.1 and 34.1% respectively). Obesity was present in 236 females (14.5%) and 97 males (11.5%). High blood pressure in 549 individuals (22.2%), 297 females (18.3%) and 252 males (29.8%) without significance regarding to work area. Smoking habits were positive in 32% of the total with highest prevalence in males from 30 to 45 years and in females from 30 to 50 years. We found an incidence of 6.24% of diabetes in all the subjects studied, 2.27% ignored the diagnosis at the moment they were studied. CONCLUSIONS: In this study we confirmed the high prevalence of risk factors of coronary heart disease in personnel of the General Hospital in Mexico City. In most cases, these risk factors that can be modified and, therefore, prevented.

[Malnutrition as a multiple cause of death]. / El análisis de la desnutrición como causa múltiple de muerte.

With the purpose of describing the role of malnutrition at death time, an analysis of multiple causes of death in children under five years-old was performed on deaths which occurred during April and May 1985 in Mexico City. A proportional mortality analysis was done taking in consideration all the causes listed on the death certificate, not only the underlying causes. The number of deaths associated to malnutrition was greater by multiple cause than by underlying cause (OR = 7.9, 95% CI 5.0-12.7, p = 0.00000). The importance of considering multiple causes of death, mainly when there are frequent diseases which are some times recorded as underlying cause of death, is also discussed.