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Serra-Planas E. Referral rate, profile and degree of control of patients with familial hypercholesterolemia: data from a single lipid unit from a Mediterranean area. Lipids Health Dis 2023; 22:62. [PMID: 37170237 PMCID: PMC10176814 DOI: 10.1186/s12944-023-01815-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/10/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The challenging rigorous management of hypercholesterolemia promotes referral to specialized units. This study explored the need, based on referral rate and cardiovascular (CV) risk factor control in patients evaluated for familial hypercholesterolemia (FH), for a lipid unit (LU). METHODS Over a four-year period, 340 referrals to our unit were analyzed to establish the lipid disorder referral rate. Moreover, 118 patients referred for potential FH during the period 2010-2018 (52.4 ± 13.9 years, 47.5% male, Caucasian, 26.3% obese, 33.1% smokers and 51.7% with some glycaemic alteration) were investigated. The Dutch Lipid Clinic Network (DLCN) score, type and dose of lipid-lowering drugs, lipid profile including lipoprotein (a) (Lp(a)) and the presence of plaques with carotid ultrasound (CU) were recorded. RESULTS Lipids represented 6.2% of referrals (38 patient-years) requiring a 2-3 h weekly monographic outpatient consultation. The potential FH sample displayed a DLCN score ≥ 6 in 78% and modifiable CV risk factors in 51%. Only 22% achieved tight disease control despite intensive treatment. The statin-ezetimibe combination treatment group achieved better goals (73.0% vs. 45.5%, P = 0.003), and the rosuvastatin group had a higher proportion of prediabetes (60.9% vs. 39.1%, P = 0.037). Neither CU plaque presence nor Lp(a) > 50 mg/dL was linked with established CV disease patients, but higher Lp(a) concentrations were detected between them (102.5 (26.3-145.8) vs. 25.0 (13.0-52.0) mg/dL, P = 0.012). CONCLUSIONS The referral rate, degree of control, and proportion of modifiable CV risk factors in FH patients demonstrate the need for LU in our area as well as optimize control and treatment.
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Affiliation(s)
- Enric Serra-Planas
- Department of Endocrinology, Internal Medicine Service, Hospital Universitari d'Igualada, Consorci Sanitari de l'Anoia, Avinguda de Catalunya, 11, Igualada, Barcelona, 08700, Spain.
- Unit of lipids and cardiovascular risk, University Hospital of Igualada, Barcelona, Spain.
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Barrios Quinta AM, Morilla Romero de la Osa R, Bueno Ferrán M. Reducing health inequalities among most disadvantaged type 2 diabetes patients: A cross-sectional exploratory pilot study. J Nurs Scholarsh 2022; 54:668-677. [PMID: 35545884 DOI: 10.1111/jnu.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 04/03/2022] [Accepted: 04/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Demographic changes and the increased chronical diseases burden are global challenges that cannot go unnoticed by healthcare systems, which must be organized without losing sight of the increasing influence of social determinants. AIM To evaluate the results of a primary care program implemented to reduce health inequalities associated with social determinants in patients with type 2 diabetes. METHOD An exploratory pilot retrospective cross-sectional study that includes secondary data of 404 nonrandomized patients belonging to socially depressed areas and conventional areas. Descriptive, bivariate, and multivariate analyses were performed. RESULTS The age of the subjects included in the study was 66.80 ± 9.7 years with a proportion of 56.7% men. Proportions of patients from socially depressed areas and adherence to the Nursing Follow-up Program were around 33% and 60%, respectively. The obesity rate was 51%, percentage of patients with HbA1c<7% was 59%. No significant differences were found between patients belonging to socially depressed areas and those who do not, except for greater adherence to nursing follow-up programs. Multivariate models assessed chronical complications as health outcomes (cardiovascular diseases, retinopathy, and nephropathy) as health outcomes showing the influence of previously described risk factors. However, in none of the models did belonging to a socially depressed area or adherence to the Nursing Follow-up Program were predictors. CONCLUSIONS The program has proven to be efficient in equating the health outcomes related with cardiovascular risk of patients from both types of areas. Well-directed health policies could bring primary care systems closer to sustainable development goals through the reduction of health disparities that affect socially vulnerable groups. CLINICAL RELEVANCE To introduce a risk strategy and to adopt a family approach, contemplating the sociocultural and educational differences that diversely affect men and women in their health status has proven to be useful in reducing health disparities due to social determinants in patients with type 2 diabetes.
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Affiliation(s)
| | - Rubén Morilla Romero de la Osa
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, Seville, Spain.,Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Mercedes Bueno Ferrán
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, Seville, Spain
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3
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Mayoral E, Ravé R, Rodriguez de Vera P, Rojo-Martinez G, Olveira G, Aguilar-Diosdado M, León-Justel A, Martinez-Brocca MA. Temporal trends in hospitalizations due to diabetes complications during COVID-19 pandemic in Andalusia, Spain. BMJ Open Diabetes Res Care 2022; 10:10/2/e002623. [PMID: 35351686 PMCID: PMC8965863 DOI: 10.1136/bmjdrc-2021-002623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/06/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Eduardo Mayoral
- Plan Integral de Diabetes de Andalucía, D.G. de Salud Pública y Ordenación Farmacéutica, Consejería de Salud y Familias, Sevilla, Spain
| | - Reyes Ravé
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Pablo Rodriguez de Vera
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Gemma Rojo-Martinez
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga/Universidad de Málaga, Instituto de Investigación Biomédica de Málaga. CIBERDEM, CIBER de Diabetes y Enfermedades Metabólicas asociadas, Málaga, Spain
| | - Gabriel Olveira
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga/Universidad de Málaga, Instituto de Investigación Biomédica de Málaga. CIBERDEM, CIBER de Diabetes y Enfermedades Metabólicas asociadas, Málaga, Spain
| | | | - Antonio León-Justel
- Servicio de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Maria Asuncion Martinez-Brocca
- Plan Integral de Diabetes de Andalucía, D.G. de Salud Pública y Ordenación Farmacéutica, Consejería de Salud y Familias, Sevilla, Spain
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
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4
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Domínguez-Mayoral A, Sánchez-Gómez J, Guerrero P, Ferrer M, Gutiérrez C, Aguilar M, Fouz-Rosón N, Benítez JM, Pérez-Sánchez S, Gamero-García MÁ, De Torres-Chacón R, Barragán-Prieto A, Algaba P, Ruiz-Bayo L, Montaner J. High prevalence of obstructive sleep apnea syndrome in Spain's Stroke Belt. J Int Med Res 2021; 49:3000605211053090. [PMID: 34719990 PMCID: PMC8562644 DOI: 10.1177/03000605211053090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Spain’s so-called Stroke Belt is an area with high prevalence of vascular disease. We aimed to determine the prevalence of undetected obstructive sleep apnea–hypopnea syndrome (OSAHS) among patients with acute ischemic stroke (AIS) in southern Spain. Methods We conducted a cross-sectional study at the Virgen Macarena University Hospital Stroke Unit during 2018 to 2019. We included patients <72 hours after AIS with a neuroimaging lesion and performed sleep tests. Results Seventy-two patients were included. The median participant age was 72 years. Mean body mass index was 27.07 kg/m2, and 40.28% were daily alcohol drinkers. Hypertension, atrial fibrillation, ischemic cardiomyopathy, and previous stroke were detected in 63.9%, 11.1%, 15.3%, and 17.6% of patients, respectively. Polygraphy was feasible in 91.38% of patients. The prevalence of OSAHS was 84.72% (apnea–hypopnea index ≥5). Patients with moderate and severe OSAHS were more likely to be obese and to have a larger neck circumference and facial palsy. The diagnostic criteria of central sleep apnea syndrome were met in only 1.38% of patients. Conclusions The high prevalence of OSAHS found in the Spanish Stroke Belt justifies further investigation and development of a screening program as a strategy to identify patients with undetected OSAHS.
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Affiliation(s)
- Ana Domínguez-Mayoral
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Jesús Sánchez-Gómez
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Patricia Guerrero
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Marta Ferrer
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Carmen Gutiérrez
- Neurophysiology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - María Aguilar
- Neurophysiology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Natalia Fouz-Rosón
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - José María Benítez
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Soledad Pérez-Sánchez
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Miguel Ángel Gamero-García
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Reyes De Torres-Chacón
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Ana Barragán-Prieto
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Pilar Algaba
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Lidia Ruiz-Bayo
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Joan Montaner
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
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5
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Urrutia I, Martín-Nieto A, Martínez R, Casanovas-Marsal JO, Aguayo A, Del Olmo J, Arana E, Fernandez-Rubio E, Castaño L, Gaztambide S. Incidence of diabetes mellitus and associated risk factors in the adult population of the Basque country, Spain. Sci Rep 2021; 11:3016. [PMID: 33542348 PMCID: PMC7862431 DOI: 10.1038/s41598-021-82548-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/15/2021] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to estimate the incidence of diabetes mellitus in the Basque Country and the risk factors involved in the disease by reassessing an adult population after 7 years of follow-up. In the previous prevalence study, 847 people older than 18 years were randomly selected from all over the Basque Country and were invited to answer a medical questionnaire, followed by a physical examination and an oral glucose tolerance test. In the reassessment, the same variables were collected and the resulting cohort comprised 517 individuals of whom 43 had diabetes at baseline. The cumulative incidence of diabetes was 4.64% in 7 years and the raw incidence rate was 6.56 cases/1000 person-years (95%CI: 4.11-9.93). Among the incident cases, 59% were undiagnosed. The most strongly associated markers by univariate analyses were age > 60 years, dyslipidaemia, prediabetes and insulin resistance. We also found association with hypertension, obesity, family history of diabetes and low education level. Multivariate analysis adjusted for age and sex showed that a set of risk factors assessed together (dyslipidaemia, waist-to-hip-ratio and family history of diabetes) had great predictive value (AUC-ROC = 0.899, 95%CI: 0.846-0.953, p = 0.942), which suggests the need for early intervention before the onset of prediabetes.
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Affiliation(s)
- Inés Urrutia
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country UPV/EHU, Leioa, Bizkaia, Spain
- CIBERDEM (Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders), CIBERER (Spanish Biomedical Research Centre in Rare Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | - Alicia Martín-Nieto
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country UPV/EHU, Leioa, Bizkaia, Spain
- Endocrinology and Nutrition Department, Cruces University Hospital, Osakidetza, Bilbao, Bizkaia, Spain
| | - Rosa Martínez
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country UPV/EHU, Leioa, Bizkaia, Spain
- CIBERDEM (Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders), CIBERER (Spanish Biomedical Research Centre in Rare Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | - J Oriol Casanovas-Marsal
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country UPV/EHU, Leioa, Bizkaia, Spain
| | - Anibal Aguayo
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country UPV/EHU, Leioa, Bizkaia, Spain
- CIBERDEM (Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders), CIBERER (Spanish Biomedical Research Centre in Rare Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Del Olmo
- Clinical Chemistry Laboratory, Cruces University Hospital, Osakidetza, Bilbao, Bizkaia, Spain
| | - Eunate Arana
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country UPV/EHU, Leioa, Bizkaia, Spain
| | - Elsa Fernandez-Rubio
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country UPV/EHU, Leioa, Bizkaia, Spain
- Endocrinology and Nutrition Department, Cruces University Hospital, Osakidetza, Bilbao, Bizkaia, Spain
| | - Luis Castaño
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country UPV/EHU, Leioa, Bizkaia, Spain.
- CIBERDEM (Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders), CIBERER (Spanish Biomedical Research Centre in Rare Diseases), Instituto de Salud Carlos III, Madrid, Spain.
| | - Sonia Gaztambide
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country UPV/EHU, Leioa, Bizkaia, Spain.
- CIBERDEM (Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders), CIBERER (Spanish Biomedical Research Centre in Rare Diseases), Instituto de Salud Carlos III, Madrid, Spain.
- Endocrinology and Nutrition Department, Cruces University Hospital, Osakidetza, Bilbao, Bizkaia, Spain.
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Rodriguez-Acuña R, Mayoral E, Aguilar-Diosdado M, Rave R, Oyarzabal B, Lama C, Carriazo A, Martinez-Brocca MA. Andalusian program for early detection of diabetic retinopathy: implementation and 15-year follow-up of a population-based screening program in Andalusia, Southern Spain. BMJ Open Diabetes Res Care 2020; 8:8/1/e001622. [PMID: 33020135 PMCID: PMC7536837 DOI: 10.1136/bmjdrc-2020-001622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Diabetic retinopathy (DR) is a preventable cause of vision loss and blindness worldwide. We aim at analyzing the impact of a population-based screening program of DR using retinal photography with remote reading in terms of population coverage, diagnosis of asymptomatic DR and impact on visual disability, in the region of Andalusia, Spain, in the period 2005-2019. RESEARCH DESIGN AND METHODS Descriptive study. Sociodemographic and clinical features included in the Andalusian program for early detection of diabetic retinopathy (APDR) were analyzed. Population coverage, annual incidence of DR, and DR severity gradation were analyzed. Estimated data on prevalence and incidence of legal blindness due to DR were included. RESULTS 407 762 patients with at least one successful DR examination during the study period were included. Most of the performed retinographies (784 584, 84.3%) were 'non-pathological.' Asymptomatic DR was detected in 52 748 (5.9%) retinographies, most of them (94.2%) being classified as 'mild to moderate non-proliferative DR.' DR was detected in 44 815 patients, while sight-threatening DR (STDR) in 6256 patients; cumulative incidence of DR was 11.0% and STDR was 1.5%, as DR and STDR was detected in 44 815 and 6256 patients, respectively. Annual incidence risk per patient recruitment year progressively decreased from 22.0% by January 2005 to 3.2% by June 2019. CONCLUSIONS Implementation of a long-term population-based screening program for early detection of DR is technically feasible and clinically viable. Thus, after 15 years of existence, the program has enabled the screening of the vast majority of the target population allowing the optimization of healthcare resources and the identification of asymptomatic DR.
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Affiliation(s)
| | - Eduardo Mayoral
- Comprehensive Healthcare Plan for Diabetes, Regional Ministry of Health and Families of Andalusia, Government of Andalusia, Seville, Spain
| | - Manuel Aguilar-Diosdado
- Endocrinology and Nutrition, Hospital Puerta del Mar, Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cadiz, Spain
| | - Reyes Rave
- Endocrinology and Nutrition, Virgen Macarena University Hospital, Seville, Spain
| | | | - Carmen Lama
- Regional Ministry of Health and Families of Andalusia, Government of Andalusia, Seville, Spain
| | - Ana Carriazo
- Regional Ministry of Health and Families of Andalusia, Government of Andalusia, Seville, Spain
| | - Maria Asuncion Martinez-Brocca
- Comprehensive Healthcare Plan for Diabetes, Regional Ministry of Health and Families of Andalusia, Government of Andalusia, Seville, Spain
- Endocrinology and Nutrition, Virgen Macarena University Hospital, Seville, Spain
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Menéndez Torre EL, Ares Blanco J, Conde Barreiro S, Rojo Martínez G, Delgado Alvarez E. Prevalence of diabetes mellitus in Spain in 2016 according to the Primary Care Clinical Database (BDCAP). ENDOCRINOLOGIA, DIABETES Y NUTRICION 2020; 68:109-115. [PMID: 32988801 DOI: 10.1016/j.endinu.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 12/25/2022]
Abstract
The prevalence of type 2 diabetes mellitus is increasing worldwide, including in Spain, and this disease has become a major challenge for health care. In Spain, the computerization of medical records in primary care, in the Primary Care Clinical Database (BDCAP), has made possible the diagnoses of diabetes in a representative sample of the nation as a whole. This article analyzes the prevalence of diabetes recorded in this database and compares the data of the different autonomous communities. The prevalence of diabetes in Spain is 6.66% of the total population assigned to primary care in the National Health System, is higher in men than in women (7.27% vs. 6.06%), and increases with age up to 80 years. There are significant differences in the adjusted prevalence of diabetes between autonomous communities, with lower prevalence rates in North and Central Spain and higher rates in the South and East, as well as the islands. The lowest prevalence is seen in Castile and Leon (4.51%), and the highest in the Canary Islands (9.72%).
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Affiliation(s)
- Edelmiro Luis Menéndez Torre
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España.
| | - Jessica Ares Blanco
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España
| | | | - Gemma Rojo Martínez
- Servicio de Endocrinología y Nutrición, Hospital Regional de Málaga, IBIMA, Málaga, España
| | - Elías Delgado Alvarez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España
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8
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Toms R, Mayne DJ, Feng X, Bonney A. Geographic variation in cardiometabolic risk factor prevalence explained by area-level disadvantage in the Illawarra-Shoalhaven region of the NSW, Australia. Sci Rep 2020; 10:12770. [PMID: 32728133 PMCID: PMC7391748 DOI: 10.1038/s41598-020-69552-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
Cardiometabolic risk factors (CMRFs) demonstrate significant geographic variation in their distribution. The study aims to quantify the general contextual effect of the areas on CMRFs; and the geographic variation explained by area-level socioeconomic disadvantage. A cross sectional design and multilevel logistic regression methods were adopted. Data included objectively measured routine pathology test data between years 2012 and 2017 on: fasting blood sugar level; glycated haemoglobin; total cholesterol; high density lipoprotein; urinary albumin creatinine ratio; estimated glomerular filtration rate; and body mass index. The 2011 Australian census based Index of Relative Socioeconomic Disadvantage (IRSD) were the area-level study variables, analysed at its smallest geographic unit of reporting. A total of 1,132,029 CMRF test results from 256,525 individuals were analysed. After adjusting for individual-level covariates, all CMRFs significantly associated with IRSD and the probability of higher risk CMRFs increases with greater area-level disadvantage. Though the specific contribution of IRSD in the geographic variation of CMRF ranged between 57.8 and 14.71%, the general contextual effect of areas were found minimal (ICCs 0.6-3.4%). The results support universal interventions proportional to the need and disadvantage level of populations for the prevention and control of CMRFs, rather than any area specific interventions as the contextual effects were found minimal in the study region.
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Affiliation(s)
- Renin Toms
- School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia.
| | - Darren J Mayne
- School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
- Public Health Unit, Illawarra Shoalhaven Local Health District, Warrawong, NSW, 2502, Australia
- School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Bonney
- School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
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9
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Martín-Peláez S, Fito M, Castaner O. Mediterranean Diet Effects on Type 2 Diabetes Prevention, Disease Progression, and Related Mechanisms. A Review. Nutrients 2020; 12:nu12082236. [PMID: 32726990 PMCID: PMC7468821 DOI: 10.3390/nu12082236] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
The search for a quality diet has grown over the past decade. Diet is considered one of the pillars for the prevention and progression of several diseases, among them: diabetes. Type 2 diabetes (T2D) is an epidemic of western countries that increases the vulnerability of other diseases, such as cardiovascular and cancer. T2D is associated with lifestyle and diet. The traditional Mediterranean diet has proven its benefits over several cardiovascular risk factors, and specifically on diabetes. This review compiles recent published evidence on the effects of the Mediterranean diet on the incidence and progression of type 2 diabetes (T2D) and its relation with several other cardiovascular healthy diets. We will also focus on how the Mediterranean diet could play a role in T2D-related mechanisms, such as anti-inflammatory or antioxidant compounds, glucagon-like peptide agonist compounds, and changes in gut microbiota. Each component of the Mediterranean diet could be involved in processes related to diabetes homeostasis, many of them sharing common physio-pathological pathways. The importance of this diet within the set of habits of a healthy lifestyle must be emphasized.
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Affiliation(s)
- Sandra Martín-Peláez
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18071 Granada, Spain
| | - Montse Fito
- Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute [IMIM], 08003 Barcelona, Spain;
- Consorcio CIBER, M.P. Fisiopatologia de la Obesidad y Nutrición [CIBERObn], Instituto de Salud Carlos III [ISCIII], 28029 Madrid, Spain
| | - Olga Castaner
- Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute [IMIM], 08003 Barcelona, Spain;
- Consorcio CIBER, M.P. Fisiopatologia de la Obesidad y Nutrición [CIBERObn], Instituto de Salud Carlos III [ISCIII], 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-933-160-720; Fax: +34-933-160-796
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Toms R, Feng X, Mayne DJ, Bonney A. Role of Area-Level Access to Primary Care on the Geographic Variation of Cardiometabolic Risk Factor Distribution: A Multilevel Analysis of the Adult Residents in the Illawarra-Shoalhaven Region of NSW, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4297. [PMID: 32560149 PMCID: PMC7344656 DOI: 10.3390/ijerph17124297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Access to primary care is important for the identification, control and management of cardiometabolic risk factors (CMRFs). This study investigated whether differences in geographic access to primary care explained area-level variation in CMRFs. METHODS Multilevel logistic regression models were used to derive the association between area-level access to primary care and seven discrete CMRFs after adjusting for individual and area-level co-variates. Two-step floating catchment area method was used to calculate the geographic access to primary care for the small areas within the study region. RESULTS Geographic access to primary care was inversely associated with low high density lipoprotein (OR 0.94, CI 0.91-0.96) and obesity (OR 0.91, CI 0.88-0.93), after adjusting for age, sex and area-level disadvantage. The intra-cluster correlation coefficient (ICCs) of all the fully adjusted models ranged between 0.4-1.8%, indicating low general contextual effects of the areas on CMRF distribution. The area-level variation in CMRFs explained by primary care access was ≤10.5%. CONCLUSION The findings of the study support proportionate universal interventions for the prevention and control of CMRFs, rather than any area specific interventions based on their primary care access, as the contextual influence of areas on all the analysed CMRFs were found to be minimal. The findings also call for future research that includes other aspects of primary care access, such as road-network access, financial affordability and individual-level acceptance of the services in order to gain an overall picture of the area-level contributing role of primary care on CMRFs in the study region.
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Affiliation(s)
- Renin Toms
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia; (D.J.M.); (A.B.)
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong NSW 2500, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2033, Australia
| | - Darren J Mayne
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia; (D.J.M.); (A.B.)
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
- Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong NSW 2502, Australia
- School of Public Health, The University of Sydney, Sydney NSW 2006, Australia
| | - Andrew Bonney
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia; (D.J.M.); (A.B.)
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
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Ramón-Arbués E, Martínez-Abadía B, Granada-López JM, Echániz-Serrano E, Huércanos-Esparza I, Antón-Solanas I. Association between adherence to the Mediterranean diet and the prevalence of cardiovascular risk factors. Rev Lat Am Enfermagem 2020; 28:e3295. [PMID: 32520245 PMCID: PMC7282722 DOI: 10.1590/1518-8345.3904.3295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 03/12/2020] [Indexed: 12/15/2022] Open
Abstract
Objective: to determine the prevalence of cardiovascular risk factors in a cohort of
workers and to quantify its association with compliance with the
Mediterranean diet follow-up. Method: a cross-sectional descriptive study was carried out on a cohort of 23,729
workers. Clinical data from annual medical examinations and the
Mediterranean Diet Adherence Screener were used to assess adherence to the
Mediterranean diet. Results: 51.3% of the participants showed good adherence to the Mediterranean diet.
The multivariate analysis showed an inverse and significant association
between the follow-up of the Mediterranean diet and the prevalence of
abdominal obesity (Odds Ratio = 0.64, 95% CI 0.56; 0.73), dyslipidemia (Odds
Ratio = 0.55, 95% CI 0.42; 0.73), and metabolic syndrome (Odds Ratio = 0.76,
95% CI 0.67; 0.86). Conclusions: our results suggest that the Mediterranean diet is potentially effective in
promoting cardiovascular health. Implementing the interventions promoting
the Mediterranean diet in the working population seems justified.
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Affiliation(s)
- Enrique Ramón-Arbués
- Universidad San Jorge, Facultad de Ciencias de la Salud, Zaragoza, Esp, Espanha.,Grupo de Investigación Tranfercult (Exp. H27-20D), Zaragoza, Esp, Spain
| | | | - José Manuel Granada-López
- Universidad de Zaragoza, Facultad de Ciencias de la Salud, Zaragoza, Esp, Espanha.,Grupo de Investigación Tranfercult (Exp. H27-20D), Zaragoza, Esp, Spain
| | - Emmanuel Echániz-Serrano
- Universidad de Zaragoza, Facultad de Ciencias de la Salud, Zaragoza, Esp, Espanha.,Grupo de Investigación Tranfercult (Exp. H27-20D), Zaragoza, Esp, Spain
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Romera I, Díaz S, Sicras-Mainar A, López-Simarro F, Dilla T, Artime E, Reviriego J. Clinical Inertia in Poorly Controlled Type 2 Diabetes Mellitus Patients with Obesity: An Observational Retrospective Study. Diabetes Ther 2020; 11:437-451. [PMID: 31884573 PMCID: PMC6995792 DOI: 10.1007/s13300-019-00745-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION To evaluate clinical inertia in patients with type 2 diabetes mellitus (T2DM), obesity and poor glycaemic control in routine clinical practice. METHODS This was a retrospective, observational study based on the analysis of medical records from the BIG-PAC® database. Subjects who required medical care in 2013 with the following characteristics were enrolled in the study: age ≥ 30 years, diagnosis of T2DM, glycosylated haemoglobin (HbA1c) ≥ 8%, obesity (body mass index [BMI] ≥ 30 kg/m2) and treatment with ≥ 2 oral antidiabetic drugs (OADs). Inertia was evaluated by time (days) to the first intensification during the period while HbA1c levels were ≥ 8% and percentage of patients whose treatment was not intensified at 6 months, 1, 2 and 3 years and the end of follow-up. The minimum length of follow-up was 4 years. Descriptive analyses and Kaplan-Meier survival curves were performed. RESULTS A total of 13,824 patients with T2DM receiving ≥ 2 OADs were identified; of these 2709 (19.6%) had HbA1c ≥ 8% and BMI ≥ 30 kg/m2, thus fulfilling the inclusion criteria. Of these 2709 patients, the mean age was 65.5 (standard deviation [SD] 12.0) years; 54.9% were male, mean HbA1c level was 9.2% (SD 1.3%); mean BMI was 32.1 (SD 0.9) kg/m2; and mean time from diagnosis was 8.2 (SD 3.0) years. HbA1c remained ≥ 8% for a median of 440 (95% confidence interval [CI] 421-459) days. The median time to first intensification was 456 (95% CI 429-483) days. No intensification had occurred in 77.8, 59.5, 41.5, 28.1 and 22.4% of patients at 6 months, 1, 2, 3 years and the end of follow-up, respectively. CONCLUSIONS The patients with T2DM analysed in this study had a mean HbA1c of 9.2% at baseline, and this remained at ≥ 8% for > 1 year. The time to the first treatment intensification was longer than that recommended by guidelines. Treatment was not intensified in a large percentage of patients, with almost 60% of patients not receiving intensification at 1 year of follow-up.
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Affiliation(s)
- Irene Romera
- Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain.
| | - Silvia Díaz
- Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain
| | | | | | - Tatiana Dilla
- Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain
| | - Esther Artime
- Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain
| | - Jesús Reviriego
- Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain
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Castillejos MC, Martín-Pérez C, García-Ruiz A, Mayoral-Cleries F, Moreno-Küstner B. Recording of cardiovascular risk factors by general practitioners in patients with schizophrenia. Ann Gen Psychiatry 2020; 19:34. [PMID: 32467716 PMCID: PMC7236925 DOI: 10.1186/s12991-020-00284-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 05/10/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients with schizophrenia and related disorders (SRD) are more predisposed to having cardiovascular risk factors (CVRFs) compared to the general population due to a combination of lifestyle factors and exposure to antipsychotic medications. We aimed to analyse the documentation practices of CVRFs by general practitioners (GPs) and its associations with patient variables in a sample of persons with SRD. METHODS An observational, cross-sectional study was conducted in 13 primary care centres (PCCs) in Malaga (Spain). The population comprised all patients with SRD who were in contact with a GP residing in the study area. The number of CVRFs (type 2 diabetes mellitus, hypertension, hypercholesterolaemia, obesity and smoking) recorded by GPs were analysed by considering patients' demographic and clinical variables and use of primary care services. We performed descriptive, bivariate and multivariate regression analyses. RESULTS A total of 494 patients were included; CVRFs were not recorded in 59.7% of the patients. One CVRF was recorded in 42.1% of patients and two or more CVRFs were recorded in 16.1% of patients. Older age, living in an urban area and a higher number of visits to the GP were associated with a higher number of CVRFs recorded. CONCLUSION The main finding in this study is that both patients' demographic variables as well as use of primary care services were found to be related to the documentation of CVRFs in patients with SRD by GPs.
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Affiliation(s)
- Mª Carmen Castillejos
- 1Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology Andalusian Group of Psychosocial Research (GAP), University of Malaga, Campus Teatinos, 29071 Malaga, Spain
| | - Carlos Martín-Pérez
- 2North East Granada Sanitary District, Clinical Management Unit at Marquesado, Andalusian Health Service, Carretera los Pozos, 18518 Alquife, Granada Spain
| | - Antonio García-Ruiz
- 3Department of Health Economics and the Rational Drug Use of Medicines. Faculty of Medicine, University of Malaga, Campus Teatinos, 29071 Malaga, Spain
| | - Fermín Mayoral-Cleries
- 4Clinical Management Unit of Mental Health of the Regional Hospital of Malaga. Andalusian Health Service, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital, 29009 Malaga, Spain
| | - Berta Moreno-Küstner
- 5Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology. Andalusian Group of Psychosocial Research (GAP). Biomedical Research Institute of Malaga (IBIMA), University of Malaga, Campus Teatinos, 29071 Malaga, Spain
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14
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Toms R, Mayne DJ, Feng X, Bonney A. Geographic variation in cardiometabolic risk distribution: A cross-sectional study of 256,525 adult residents in the Illawarra-Shoalhaven region of the NSW, Australia. PLoS One 2019; 14:e0223179. [PMID: 31574124 PMCID: PMC6772048 DOI: 10.1371/journal.pone.0223179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Metabolic risk factors for cardiovascular disease (CVD) warrant significant public health concern globally. This study aims to utilise the regional database of a major laboratory network to describe the geographic distribution pattern of eight different cardiometabolic risk factors (CMRFs), which in turn can potentially generate hypotheses for future research into locality specific preventive approaches. METHOD A cross-sectional design utilising de-identified laboratory data on eight CMRFs including fasting blood sugar level (FBSL); glycated haemoglobin (HbA1c); total cholesterol (TC); high density lipoprotein (HDL); albumin creatinine ratio (ACR); estimated glomerular filtration rate (eGFR); body mass index (BMI); and diabetes mellitus (DM) status was used to undertake descriptive and spatial analyses. CMRF test results were dichotomised into 'higher risk' and 'lower risk' values based on existing risk definitions. Australian Census Statistical Area Level 1 (SA1) were used as the geographic units of analysis, and an Empirical Bayes (EB) approach was used to smooth rates at SA1 level. Choropleth maps demonstrating the distribution of CMRFs rates at SA1 level were produced. Spatial clustering of CMRFs was assessed using Global Moran's I test and Local Indicators of Spatial Autocorrelation (LISA). RESULTS A total of 1,132,016 test data derived from 256,525 individuals revealed significant geographic variation in the distribution of 'higher risk' CMRF findings. The populated eastern seaboard of the study region demonstrated the highest rates of CMRFs. Global Moran's I values were significant and positive at SA1 level for all CMRFs. The highest spatial autocorrelation strength was found among obesity rates (0.328), and the lowest for albuminuria (0.028). LISA tests identified significant High-High (HH) and Low-Low (LL) spatial clusters of CMRFs, with LL predominantly in the less populated northern, central and southern regions of the study area. CONCLUSION The study describes a range of CMRFs with different distributions in the study region. The results allow generation of hypotheses to test in future research concerning location specific population health approaches.
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Affiliation(s)
- Renin Toms
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Darren J. Mayne
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- Public Health Unit, Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Andrew Bonney
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
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15
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Antihyperlipidemic and Antioxidant Effects of Averrhoa Carambola Extract in High-Fat Diet-Fed Rats. Biomedicines 2019; 7:biomedicines7030072. [PMID: 31527433 PMCID: PMC6784245 DOI: 10.3390/biomedicines7030072] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 09/12/2019] [Accepted: 09/14/2019] [Indexed: 01/24/2023] Open
Abstract
The present study explored the antihyperlipidemic potential of a standardized methanolic extract of Averrhoa carambola (A. carambola) leaf (MEACL) in high-fat diet (HFD)-fed rats. The standardized MEACL was orally administered at different doses (250, 500, and 1000 mg/kg) to HFD-induced hyperlipidemic rats for five weeks. Serum lipid profile, body weight changes, body mass index (BMI), daily food intake, relative organ weight, and histology of the liver were evaluated. In addition, the effect of MEACL on HMG-CoA reductase and pancreatic lipase activities as well as hepatic and fecal lipids was demonstrated. MEACL supplementation reduced serum lipids in HFD-fed rats in a dose-dependent manner. Histopathological scores revealed that 1000 mg/kg MEACL restored the damage to liver tissue in hyperlipidemic rats. MEACL decreased the body mass index (BMI), atherogenic index, and hepatic cholesterol and triglycerides and increased fecal cholesterol and bile acids in HFD-fed rats. Also, MEACL ameliorated lipid peroxidation and improved antioxidant defenses in the liver of HFD-fed rats. Furthermore, HMG-CoA reductase and lipase were suppressed by MEACL. In conclusion, this study shows the potential effect of MEACL to ameliorate hyperlipidemia and oxidative stress in HFD-fed rats. It prevented hepatic lipid accumulation and exerted an inhibitory effect on HMG-CoA reductase and lipase.
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16
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Lago-Sampedro A, García-Escobar E, Rubio-Martín E, Pascual-Aguirre N, Valdés S, Soriguer F, Goday A, Calle-Pascual A, Castell C, Menéndez E, Delgado E, Bordiú E, Castaño L, Franch-Nadal J, Girbés J, Chaves FJ, Gaztambide S, Rojo-Martínez G, Olveira G. Dairy Product Consumption and Metabolic Diseases in the Di@bet.es Study. Nutrients 2019; 11:nu11020262. [PMID: 30682848 PMCID: PMC6412325 DOI: 10.3390/nu11020262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 02/07/2023] Open
Abstract
To date it is not clear what the role of dairy products is in metabolic diseases like diabetes, obesity, and hypertension. Therefore, the aim of this study is to test the association between dairy product consumption and those pathologies. A cross-sectional study was conducted with 5081 adults included in the di@bet.es study, from 100 health centers around Spain. Food frequency questionnaires were carried out concerning consumption habits, which included dairy product consumption. Logistic regression models were used for the association analyses between the variables controlling confounding variables. Women had a higher consumption of milk, cheese, or yogurt than men (p < 0.0001), but men consumed more sugar dairy products (p < 0.001). People who live in the North of Spain consume more dairy products than those who live in the East. Dairy product consumption was inversely associated with the presence of hypertension regardless of age, sex, geographical region, and body mass index (BMI) (Odds Ratio (OR) 0.743; p = 0.022). The presence of obesity was inversely associated with dairy consumption regardless of age, sex, and geographical region (OR 0.61; p < 0.001). Milk consumption was not associated with diabetes. Our results show that consuming dairy products is associated with a better metabolic profile in the Spanish population.
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Affiliation(s)
- Ana Lago-Sampedro
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain.
- UGC Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain.
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- UGC Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, 29010 Málaga, Spain.
| | - Eva García-Escobar
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain.
- UGC Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain.
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Elehazara Rubio-Martín
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain.
- UGC Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain.
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Nuria Pascual-Aguirre
- UGCI de Prevención, Promoción y Vigilancia de la Salud, Complejo Hospitalario Universitario Granada, 18016 Granada, Spain.
| | - Sergio Valdés
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain.
- UGC Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain.
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Federico Soriguer
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain.
- UGC Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain.
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Albert Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain.
| | - Alfonso Calle-Pascual
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Department of Endocrinology and Nutrition, Hospital Universitario S. Carlos de Madrid, 28040 Madrid, Spain.
| | - Conxa Castell
- Public Health Division, Department of Health, Autonomous Government of Catalonia, 08023 Barcelona, Spain.
| | - Edelmiro Menéndez
- Department of Endocrinology and Nutrition, Hospital Central de Asturias, 33011 Oviedo, Spain.
| | - Elías Delgado
- Department of Endocrinology and Nutrition, Hospital Central de Asturias, 33011 Oviedo, Spain.
| | - Elena Bordiú
- Laboratorio de Endocrinología, Hospital Universitario San Carlos de Madrid, 28040 Madrid, Spain.
| | - Luis Castaño
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Diabetes Research Group, Hospital Universitario de Cruces, UPV-EHU, 48903 Baracaldo, Spain.
| | - Josep Franch-Nadal
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- EAP Raval Sud, Institut Català de la Salut, Red GEDAPS, Primary Care, Unitat de Suport a la Recerca (IDIAP e Fundació Jordi Gol), 08001 Barcelona, Spain.
| | - Juan Girbés
- Diabetes Unit, Hospital Arnau de Vilanova, 46015 Valencia, Spain.
| | - Felipe Javier Chaves
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Genotyping and Genetic Diagnosis Unit, Fundación de Investigación del Hospital Clínico de Valencia-INCLIVA, 46010 Valencia, Spain.
| | - Sonia Gaztambide
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Diabetes Research Group, Hospital Universitario de Cruces, UPV-EHU, 48903 Baracaldo, Spain.
| | - Gemma Rojo-Martínez
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain.
- UGC Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain.
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Gabriel Olveira
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain.
- UGC Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain.
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- UGC Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, 29010 Málaga, Spain.
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Geographic and area-level socioeconomic variation in cardiometabolic risk factor distribution: a systematic review of the literature. Int J Health Geogr 2019; 18:1. [PMID: 30621786 PMCID: PMC6323718 DOI: 10.1186/s12942-018-0165-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/31/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION A growing number of publications report variation in the distribution of cardiometabolic risk factors (CMRFs) at different geographic scales. A review of these variations may help inform policy and health service organisation. AIM To review studies reporting variation in the geographic distribution of CMRFs and its association with various proxy measures of area-level socioeconomic disadvantage (ASED) among the adult ( ≥ 18 years) population across the world. METHODS A systematic search for published articles was conducted in four databases (MEDLINE (Ovid), PubMed, Scopus and Web of Science) considering the interdisciplinary nature of the review question. Population-based cross-sectional and cohort studies on geographic variations of one or more biological proxies of CMRFs with/without an analysed contextual association with ASED were included. Two independent reviewers screened the studies and PRISMA guidelines were followed in the study selection and reporting. RESULT A total of 265 studies were retrieved and screened, resulting in 24 eligible studies. The review revealed reports of variation in the distribution of CMRFs, at varying geographic scales, in multiple countries. In addition, consistent associations between ASED and higher prevalence of CMRFs were demonstrated. The reports were mainly from industrialised nations and small area geographic units were frequently used. CONCLUSION Geographic variation in cardiometabolic risk exists across multiple spatial scales and is positively associated with ASED. This association is independent of individual-level factors and provides an imperative for area-based approaches to informing policy and health service organisation. The study protocol is registered in International prospective register of systematic reviews (Register No: CRD42018115294) PROSPERO 2018.
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de Luis DA, Aller R, Izaola O, Primo D, Romero E. rs10767664 Gene Variant in Brain-Derived Neurotrophic Factor Is Associated with Diabetes Mellitus Type 2 in Caucasian Females with Obesity. ANNALS OF NUTRITION AND METABOLISM 2017; 70:286-292. [PMID: 28595187 DOI: 10.1159/000474956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/31/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of brain-derived neurotrophic factor (BDNF) variants on diabetes prevalence, basal adipokine levels, body weight, and cardiovascular risk factors remains unclear in obese patients. OBJECTIVE This study is aimed at analyzing the effects of rs10767664 BDNF gene polymorphism on diabetes mellitus prevalence, body weight, cardiovascular risk factors, and serum adipokine levels in obese female patients. DESIGN A total of 507 obese women were enrolled in a prospective way. Biochemical evaluation and anthropometric measures were recorded. RESULTS The frequency of diabetes mellitus in the group of patients with non-T allele was 20.1 and 28.3% in T-allele carriers. Logistic regression showed a risk of diabetes mellitus of 1.33 (95% CI 1.17-2.08) in subjects with T allele adjusted by age and body mass index (BMI). T-allele carriers with diabetes mellitus have a higher weight, BMI, waist circumference, blood pressure, glucose, homeostasis model assessment insulin resistance (HOMA-IR), insulin, and C-reactive protein (CRP) levels than non-T-allele carriers. CONCLUSION rs10767664 polymorphism of BDNF gene is associated with prevalence of diabetes mellitus in obese female patients. T-allele carriers with diabetes mellitus have a higher weight, fat mass, blood pressure, level of insulin, glucose, HOMA-IR, and CRP than non-T-allele carriers.
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Affiliation(s)
- Daniel Antonio de Luis
- Center of Investigation of Endocrinology and Nutrition, Medicine School and Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
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Pérez-Losada FL, Jané-Salas E, Sabater-Recolons MM, Estrugo-Devesa A, Segura-Egea JJ, López-López J. Correlation between periodontal disease management and metabolic control of type 2 diabetes mellitus. A systematic literature review. Med Oral Patol Oral Cir Bucal 2016; 21:e440-6. [PMID: 26827070 PMCID: PMC4920457 DOI: 10.4317/medoral.21048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/11/2015] [Indexed: 12/23/2022] Open
Abstract
Background Diabetes and periodontal disease share common features in terms of inflammatory responses. Current scientific evidence suggests that treatment of periodontal disease might contribute to glycemic control. The objective of the study is a review of the last three years. Material and Methods A literature search was performed in the MEDLINE (PubMed), Cochrane, and Scopus databases, for articles published between 01-01-2013 and 30-06-2015, applying the key terms “periodontal disease” AND “diabetes mellitus”. The review analyzed clinical trials of humans published in English and Spanish. Results Thirteen clinical trials were reviewed, representing a total of 1,912 patients. Three of them had samples of <40 patients, making a total of 108 patients and the remaining ten samples had >40 patients, representing a total of 1,804. Only one article achieved a Jadad score of five. Seven articles (998 patients, 52.3% total), presented a statistically significant decrease in HbA1c (p<
0.05) as a result of periodontal treatment. In the six remaining articles (representing 914 patients, 47.8% of the total), the decrease in HbA1c was not significant. Patient follow-up varied between 3 to 12 months. In three articles, the follow-up was of 3, 4, and 9 months, in two 6 and 12 months. Conclusions The majority of clinical trials showed that radicular curettage and smoothing, whether associated with antibiotics or not, can improve periodontal conditions in patients with diabetes mellitus. However, few studies suggest that this periodontal treatment improves metabolic control. However, there is no clear evidence of a relation between periodontal treatment and improved glycemic control in patients with type 2 diabetes mellitus. Key words:Diabetes, periodontal disease, HbA1c, metabolic control.
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Affiliation(s)
- F-L Pérez-Losada
- Department of Odontostomatology, School of Dentistry, Pabellón de Gobierno, Bellvitge University Campus, C/Feixa LLarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain,
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Barranco RJ, Gomez-Peralta F, Abreu C, Delgado M, Palomares R, Romero F, Morales C, de la Cal MA, Garcia-Almeida JM, Pasquel F, Umpierrez GE. Incidence and care-related costs of severe hypoglycaemia requiring emergency treatment in Andalusia (Spain): the PAUEPAD project. Diabet Med 2015; 32:1520-6. [PMID: 26118472 PMCID: PMC4755037 DOI: 10.1111/dme.12843] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 12/31/2022]
Abstract
AIMS Hypoglycaemia is a serious medical emergency. The need for emergency medical service care and the costs of hypoglycaemic emergencies are not completely known. METHODS This was a retrospective observational study using Public Company for Health Emergencies (EPES) data for hypoglycaemia in 2012. The EPES provides emergency medical services to the entire population of Andalusia, Spain (8.5 million people). Data on event type, onsite treatments, emergency room visits or hospitalization were collected. Medical costs were estimated using the public rates for healthcare services. RESULTS From a total of 1 137 738 emergency calls that requested medical assistance, 8683 had a primary diagnosis of hypoglycaemia (10.34 per 10 000 person-years). The incidence of severe hypoglycaemic episodes requiring emergency treatment in the estimated population with diabetes was 80 episodes per 10 000 person-years. A total of 7479 episodes (86%) required an emergency team to visit the patient's residence. The majority of cases (64%) were addressed in the residence, although 1784 (21%) cases were transferred to hospital. A total of 5564 events (65%) involved patients aged > 65 years. Overall mortality was 0.32% (28 cases). The total annual cost of attending a hypoglycaemic episode was €6 093 507, leading to an estimated mean direct cost per episode of €702 ± 565. Episodes that required hospital treatment accounted for 49% of the total costs. CONCLUSIONS Hypoglycaemia is a common medical emergency that is associated with high emergency medical service utilization, resulting in a significant economic impact on the health system.
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Affiliation(s)
- R J Barranco
- Public Company for Health Emergencies of Andalucıa (EPES), Sevilla, Spain
- Department Health Sciences, University of Jaen, Segovia, Spain
| | - F Gomez-Peralta
- Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia, Spain
| | - C Abreu
- Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia, Spain
| | - M Delgado
- Division of Preventive Medicine and Public Health, Department Health Sciences, University of Jaen, Jaen, Spain
- Center for Biomedical Research in Epidemiology and Public Health (CIBERESP), ISCIII, Ministry of Health, Madrid, Spain
| | - R Palomares
- Endocrinology and Nutrition Unit, Reina Sofia Hospital, Cordoba, Spain
| | - F Romero
- Public Company for Health Emergencies of Andalucıa (EPES), Sevilla, Spain
| | - C Morales
- Endocrinology and Nutrition Unit, Virgen Macarena Hospital, Sevilla, Spain
| | - M A de la Cal
- Public Company for Health Emergencies of Andalucıa (EPES), Sevilla, Spain
| | - J M Garcia-Almeida
- Endocrinology and Clinical Nutrition Unit, Virgen de la Victoria Hospital, Malaga, Spain
| | - F Pasquel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - G E Umpierrez
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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